Learning Objectives for

Case 1: 45-year-old woman wellness visit

  1. Describe the principles of screening and the characteristics of a good screening test.
  2. Identify risk factors for breast and cervical cancer based on family history, age, gender, and exposures.
  3. Perform a thorough breast exam.
  4. Discuss the current recommendations for mammography.
  5. Discuss the current recommendations for Papanicolaou testing and the different types of testing available.
  6. Identify risk factors for osteoporosis and appropriate preventative measures.
  7. List recommended immunizations for adults.
  8. Describe symptoms of menopause.
  9. Identify age-appropriate cancer screening for adult women.

Case 2: 55-year-old man wellness visit

  1. Define the characteristics of a good screening test.
  2. Describe the recommendation for cancer screening for common cancers for an adult male patient (e.g., lung, colorectal, and prostate).
  3. Describe the significance of nutrition and obesity in health promotion and disease prevention. 
  4. Propose an exercise program for a sedentary patient.
  5. Formulate timely vaccinations based on age, medical conditions, lifestyle, and environment.
  6. Perform smoking cessation counseling for patients who smoke.
  7. Describe principles that guide behavior change counseling.

Case 3: 65-year-old woman with insomnia

  1. Describe the common causes of insomnia in the elderly.
  2. Describe the common therapeutic options for major depressive disorder and their side effects. 
  3. Perform history, physical, and tests to rule out medical causes of depressive symptoms.
  4. Describe the diagnostic criteria for major depressive disorder.
  5. Recognize the importance of inquiring about the use of complementary and alternative therapies. 
  6. Describe the risk factors for elder abuse.
  7. Appreciate the effects of depression on the patient's family.

Case 4: 19-year-old woman with sports injury

  1. Develop a differential diagnosis for ankle pain.
  2. Perform a focused history and physical appropriate for ankle pain.
  3. Describe the signs and symptoms of life/limb-threatening injuries.
  4. Describe the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for strains/sprains. 
  5. Apply evidence-based medicine indications for radiologic evaluation of ankle injury. 
  6. Develop a treatment plan for ankle pain, including RICE (Rest, Ice, Compression, Elevation).
  7. Provide counseling to the patient regarding injury prevention.
  8. Explain the role of the family medicine physician in treating ankle injuries.
  9. Diagnose and manage a young woman presenting with dysuria.

Case 5: 30-year-old woman with palpitations

  1. Develop a differential diagnosis of palpitations.
  2. Describe the common presentations of hyperthyroidism.
  3. List the common physical findings in hyperthyroidism: lid lag, tremor, and hyperreflexia.
  4. Identify the common causes of hyperthyroidism.
  5. Outline the initial evaluation of a patient with suspected hyperthyroidism.
  6. Discuss the usual course of a patient with Graves disease after radioactive iodine treatment.
  7. Discuss the treatment of hypothyroidism after radioactive iodine treatment.

Case 6: 57-year-old woman diabetes care visit

  1. Incorporate appropriate psychosocial, cultural, health literacy, and family data into the management plan of a patient with Type 2 diabetes.
  2. Apply evidence-based standards of care to the diagnosis, monitoring, and management of a patient with Type 2 diabetes mellitus.
  3. Describe the barriers to coordination of diabetes care and systemwide improvements that could improve coordination of diabetes care.
  4. Describe the importance of an inter-professional team approach to the care of patients with diabetes.
  5. Describe the utility of the electronic medical record in the care of your practice population and in the reporting of quality measures.
  6. Educate a patient about Type 2 diabetes with attention to and respect for the patient's own disease model.

Case 7: 53-year-old man with leg swelling

  1. Discuss the differential diagnosis of unilateral leg swelling.
  2. Differentiate between deep venous thrombosis, leg ulcer, and peripheral arterial disease.
  3. Describe the impact of obesity on health. 4.
  4. Describe the implications of deep venous thrombosis, its diagnosis, and management.
  5. Discuss the value of a team-based approach to chronic disease management.

Case 8: 54-year-old man with elevated blood pressure

  1. Describe nationally accepted guidelines for screening for and diagnosing hypertension. 
  2. Define elements of the history for a patient with hypertension that may help identify lifestyle and other cardiovascular risk factors.
  3. Assess illnesses that commonly co-exist with hypertension and may affect prognosis and treatment. 
  4. Define elements of the physical examination for a patient with hypertension, including proper techniques in blood pressure measurement.
  5. Propose recommended testing for a patient with newly diagnosed hypertension.
  6. Formulate management plans for the longitudinal care of patients with hypertension.
  7. Propose first line medications for a patient with uncontrolled hypertension.
  8. Describe elements of lifestyle modification (including health education and behavioral change strategies) that can benefit patients with hypertension.
  9. Describe the importance of providing socio-culturally sensitive and responsive education, counseling, and care to patients and their families.

Case 9: 50-year-old woman with palpitations

  1. Identify risk factors for coronary heart disease.
  2. Elicit a clear history characterizing chest pain and palpitations. 
  3. Formulate a differential diagnosis for palpitations based on an organ system approach. 
  4. Conduct a directed physical to search for findings to support or exclude differential diagnoses of atypical chest pain. 
  5. Formulate target goals for cholesterol and lipoproteins.
  6. Describe the predictive role of exercise stress testing for coronary heart disease in men and women.

Case 10: 45-year-old man with low back pain

  1. Discuss the differential diagnosis for low back pain. 
  2. Develop physical exam skills in evaluating low back pain.
  3. Develop the skills in diagnosis and treatment of low back pain.
  4. Recognize red flags for possible serious causes of low back pain.
  5. List the indications for imaging studies for low back pain.
  6. Propose appropriate treatment for back pain. 
  7. Discuss the management of refractory back pain with consultation and surgical intervention.

Case 11: 74-year-old woman with knee pain

  1. Elicit a thorough history for the chief concern of knee pain.
  2. Discuss the components of a thorough knee exam.
  3. Formulate differential diagnoses for acute and chronic knee pain in an adult.
  4. Develop an appropriate treatment plan for osteoarthritis, including medications and non-pharmacologic interventions.
  5. Recognize when imaging and referral to specialists are appropriate for knee pain.
  6. Describe the different classes of medications useful for the treatment of chronic pain, and recognize their common side effects.
  7. Discuss the USPSTF recommendations for appropriate screenings and immunizations in older adults.

Case 12: 16-year-old female with vaginal bleeding and UCG

  1. Describe the essential features of a preconception consultation, including how to incorporate this content into any visit. 
  2. Discuss chlamydia screening.
  3. Demonstrate the use of the HEEADSS adolescent-interviewing technique.
  4. Recognize pregnancy: intrauterine, ectopic, and miscarriage.
  5. Discuss options during an unplanned pregnancy.
  6. Select initial prenatal labs. 
  7. Counsel a pregnant patient for healthy behavior, folic acid supplementation, and immunizations.
  8. Outline normal progression of symptoms and physical exam findings during pregnancy.
  9. Demonstrate the management of a miscarriage, including the medical and social follow-up.

Case 13: 40-year-old man with a persistent cough

  1. Formulate differential diagnoses for chronic cough and wheezing.
  2. Discuss important features of the history and physical examination that support the diagnosis of asthma.
  3. Describe how to determine the severity of a patient's asthma.
  4. List the common comorbid conditions of asthma.
  5. Propose an appropriate treatment plan, including an asthma action plan, for a patient with asthma. 
  6. Describe how to educate patients on the use of a peak flow meter, inhaler, and spacer device.

Case 14: 35-year-old woman with missed period

  1. Establish diagnosis and timing of pregnancy, including week of gestation and estimated delivery date.
  2. Describe the common symptoms of pregnancy, from diagnosis through the post-partum period.
  3. Describe appropriate responses to common problems that arise during pregnancy, including: nausea, back pain, mood changes, and fatigue.
  4. Propose appropriate preventive measures and follow-up during pregnancy, including: diet, exercise, immunizations, and diagnostic testing.
  5. Propose appropriate screening tests during and after pregnancy, including: genetic, infectious, blood, hypertension, diabetes, domestic violence, and depression screening.
  6. Define types of hypertension in pregnancy and common complications of hypertension in pregnancy.
  7. Define gestational diabetes and common complications of gestational diabetes. 
  8. Propose appropriate history, exam, and diagnostic work-up for vaginal discharge in pregnancy.
  9. Discuss common etiologies of vaginal bleeding, including: placenta previa and placental abruption.
  10. Identify appropriate contraceptive options and preventive care in the post-partum period.
  11. Discuss family-centered, longitudinal perinatal care.

Case 15: 42-year-old man with right upper quadrant pain

  1. Take an adequate history on a patient with right upper quadrant abdominal pain. 
  2. Perform a diagnostic abdominal exam on a patient with right upper quadrant abdominal pain. 
  3. Formulate a differential diagnosis on a patient with right upper quadrant abdominal pain. 
  4. Obtain and interpret laboratory and radiologic tests as they relate to right upper quadrant abdominal pain. 
  5. Describe screening for alcohol abuse.
  6. Manage a patient with biliary tract disease. 
  7. Counsel a patient with alcohol abuse.

Case 16: 68-year-old man with skin lesion

  1. Describe skin lesions with accuracy.
  2. Define terms that describe the morphology, shape, and pattern of skin lesions.
  3. Formulate the treatment principles of topical corticosteroid and local and systemic antifungal agents. 
  4. Apply the ABCDE criteria for the evaluation of hyperpigmented lesions as possible melanoma.
  5. Describe common biopsy procedures including shave biopsy, punch biopsy, incisional and excisional biopsies. 
  6. Discuss the treatment modalities for squamous cell carcinoma.
  7. Describe the importance and methods of prevention of skin cancers. 8
  8. Develop initial workup and management of benign prostatic hyperplasia.

Case 17: 55-year-old post-menopausal woman with vaginal bleeding

  1. Define menopause and discuss common symptoms and treatment options.
  2. Develop a differential for postmenopausal bleeding.
  3. Counsel a patient regarding the differential, work-up, and follow-up plan for postmenopausal bleeding.
  4. Discuss risk factors for osteoporosis and the recommended screening for osteoporosis.
  5. Counsel patients regarding osteoporosis prevention/treatment.
  6. Discuss the recommended cancer screening for a 50-plus-year-old female.
  7. Describe the risks/benefits of hormone therapy in the postmenopausal female.

Case 18: 24-year-old woman with headaches

  1. Identify the typical presenting signs and symptoms of common as well as serious causes of headache (tension, cluster, brain tumor, intracranial hemorrhage, medication use).
  2. Obtain an appropriately focused history on a patient who presents with headache.
  3. Perform a reliable focused neurologic exam on a patient who presents with headache. 
  4. dentify appropriate indications for ordering imaging tests on a patient who presents with headache. 
  5. Counsel a patient who presents with headache on the appropriate prevention and treatment of the headache.
  6. Discuss the importance of continuity of care when treating a patient who presents with chronic headache.
  7. Demonstrate the use of point-of-care technology when uncertainty regarding diagnosis, appropriate evaluation, and/or treatment of a patient arises during the course of an office visit.

Case 19: 39-year-old man with epigastric pain

  1. Establish a differential diagnosis for a male patient who presents with epigastric abdominal pain.
  2. Outline key features of the history and physical examination that support the diagnosis of peptic ulcer disease.
  3. Describe the differences in diagnostic workup and treatment for peptic ulcer disease due to Helicobacter pylori (H. pylori) versus gastroesophageal reflux disease (GERD).
  4. Outline the differences between ulcer and non-ulcer (functional) dyspepsia.
  5. Determine evidence-based treatment strategies for H. pylori gastritis.
  6. Discuss appropriateness of follow-up and testing for eradication in patients with H. pylori gastritis.
  7. Provide an overview of potential risks and adverse events associated with non-judicious use of proton pump inhibitors (PPIs).

Case 20: 28-year-old woman with abdominal pain

  1. Conduct a culturally sensitive, empathic history.
  2. Appreciate the ways in which victims of violence may manifest symptoms and be alert to clues a patient may give that he/she has been a victim of intimate partner violence.
  3. Discuss ways to assist the patient in developing a safety plan. 
  4. Discuss reporting requirements for domestic violence.
  5. Appreciate a survivor?s perspective in an abusive relationship and the barriers to his/her seeking help.
  6. Apply knowledge of the differential diagnosis of abdominal and pelvic pain in evaluating the patient.

Case 21: 12-year-old female with fever

  1. Take a thorough history and perform an appropriate physical exam in the setting of an acute respiratory illness.
  2. Outline appropriate diagnostic studies, if necessary, to determine cause of illness and severity of illness, and have the knowledge to treat acute respiratory infection.
  3. Counsel a pediatric patient and his/her family regarding appropriate treatment of obesity including diet and exercise.
  4. Discuss the changing pattern of obesity and name three complications of obesity.
  5. Identify common positive findings on physical exam for pneumonia, influenza and acute respiratory infection.
  6. Calculate a body mass index, and determine the diagnosis of obesity in children and adults.

Case 22: 70-year-old male with new-onset unilateral weakness

  1. Assess signs and symptoms of transient ischemic attack (TIA) and stroke.
  2. Interpret laboratory data related to patients with new onset neurological symptoms, particularly numbness or weakness in an extremity with or without accompanying speech difficulty.
  3. Interpret target goals for cholesterol and lipoproteins using the best available guidelines (e.g., National Cholesterol Education Program Adult Treatment Panel [NCEP ATP] III guidelines).
  4. Describe the appropriate therapy for acute stroke and primary and secondary prevention of stroke.
  5. Discuss the evidence for the role of lifestyle changes in prevention of stroke.
  6. Describe the importance of effective communication between physicians, students, patients, and families in the management of atherosclerotic cardiovascular disease.
  7. Demonstrate the ability to care for patients with coronary artery disease from diverse patient backgrounds and at different points in their illness.
  8. Discuss depression with a patient appropriately.
  9. Perform at least two commonly used tests to determine the functional ability of an elderly patient, e.g., the "Timed Up and Go" (TUG) test, and the Mini?Mental State Examination (MMSE).

Case 23: 5-year-old female with sore throat

  1. Examine a patient with pharyngitis, including appropriate history and physical examination, use of clinical prediction rules and appropriate antibiotic use.
  2. Describe the suppurative and non-suppurative complications of Group A beta-hemolytic streptococcal pharyngitis (strep throat).
  3. Describe the health maintenance visit for a 5-year-old.
  4. Use CDC/ACIP chart in order to determine what immunizations are required based on age of the patient.
  5. Describe contraindications to immunizations.
  6. Describe how to diagnose Attention Deficit Hyperactivity Disorder (ADHD).
  7. Describe the recommendations for screening of anemia in children.
  8. Demonstrate how to calculate BMI in a child and be able to identify a child at risk for obesity.

Case 24: 4-week-old female with fussiness

  1. Formulate the fundamental components of an appropriate newborn and infant history.
  2. Formulate the differential for fussiness in a young infant and the pathophysiology of colic in infants. 
  3. Describe proper physical exam techniques for a newborn and learn the basics of growth charting.
  4. Appreciate normal newborn and young infant behavioral norms, deviations from them, and signs and symptoms of concern in evaluating a young infant.
  5. Demonstrate the fundamentals of screening and assessment of postpartum blues and postpartum depression.
  6. Develop fundamental precepts of family systems thinking and practice supportive counseling skills which will empower parents to develop autonomy and mastery as parents.

Case 25: 38-year-old man with shoulder pain

  1. Elicit the patient?s chief complaint/concern - "shoulder pain" - in an open-ended fashion.
  2. Elicit the patient?s related story/narrative/HPI about their "shoulder pain" in a fashion that is appropriately detailed and inclusive of appreciating the functional impact of the patient?s concern.
  3. Conduct a physical examination pertaining to the patient's chief complaint of shoulder pain that includes and is guided by the information gained in the clinical interview.
  4. Communicate to the physician preceptor the pertinent interview and examination findings and a related differential diagnosis pertaining to the patient's chief complaint of shoulder pain in the presence of the patient using patient-centered language.
  5. Incorporate an assessment and treatment plan pertaining to the patient's chief complaint of shoulder pain that is subject to physician preceptor review and patient partnership providing an opportunity for ongoing learning and application.

CCase 26: 55-year-old man with fatigue

  1. Develop a differential diagnosis for a patient presenting with fatigue.
  2. Apply a cost-effective strategy when selecting a laboratory evaluation of a patient with fatigue.
  3. Formulate the U.S. Preventive Services Task Force guidelines regarding screening for common cancers among adult men and women.
  4. Describe principles of clinical epidemiology relevant to screening and screening guidelines. 
  5. Apply a patient-centered approach to counsel patients on recommended preventive services. 
  6. Develop an evaluation and management plan for an adult male with iron deficiency anemia.
  7. Formulate a compassionate approach to delivering bad news to a patient.
  8. Recognize the primary care physician?s role in maintaining a longitudinal therapeutic relationship with a patient during the process of consultation and referral.

CaCase 27: 17-year-old male with groin pain

  1. Elicit focused history of patients presenting with scrotal pain.
  2. Demonstrate the ability to perform proficient testicular examination and to elicit signs specific to identify or exclude testicular torsion.
  3. Develop a differential diagnosis for adolescent male presenting with scrotal pain.
  4. Identify appropriate laboratory and radiological studies as it relates to the differential diagnosis of scrotal pain.
  5. Outline the algorithmic approach to testicular pain.
  6. Discuss management of testicular torsion.
  7. Recognize sexually transmitted infections as a cause of testicular pain among adolescent males.
  8. Discuss the importance of counseling to prevent sexually transmitted infections.
  9. Discuss epidemiology and USPSTF recommendations for screening for common testicular cancers.

CCase 28: 58-year-old man with shortness of breath

  1. Formulate a differential diagnosis for a patient who presents with shortness of breath and cough.
  2. Discuss key features of the history and physical exam that support the diagnosis of chronic obstructive pulmonary disease (COPD).
  3. Describe the differences between asthma and chronic obstructive pulmonary disease (COPD). 
  4. Describe an organized and effective approach to smoking cessation counseling.
  5. Interpret pulmonary function test (PFT) results.
  6. Use a validated symptom score to grade the severity of a patient's chronic obstructive pulmonary disease (COPD).
  7. Propose a treatment plan for a patient with chronic obstructive pulmonary disease (COPD) based on symptom severity.
  8. Educate a patient on the use of an inhaler.

Case 29: 72-year-old man with dementia

  1. Differentiate among the presentations of delirium, dementia, and depression in an older adult patient. 
  2. Interpret at least one standardized instrument (e.g., MiniCog or Folstein Mini-Mental State Examination (MMSE)) to screen for cognitive loss in an older adult patient for whom there are concerns regarding memory or function.
  3. Describe baseline functional abilities (instrumental activities of daily living, activities of daily living) in an older adult patient with altered mental status.
  4. Formulate the differential diagnosis for acute change in mental status for a patient with dementia.
  5. Recognize management options, including pharmacological, non-pharmacological, complementary therapies, and caregiver support for an older adult patient with dementia.
  6. Recognize caregiver stress and its impact on the care of a patient with dementia. 
  7. Describe therapeutic interventions to prevent or treat delirium in the hospital setting.
  8. Describe the role of social service, healthcare agencies, hospice, and other community organizations to provide care and assistance to older adult patients with dementia and their families.

CCase 30: 27-year-old woman labor and delivery

  1. Define active labor.
  2. Describe the group prenatal care and its advantages.
  3. Interpret fetal monitoring strips using the National Institute of Child Health and Human Development (NICHD) guidelines.
  4. Describe the evaluation and diagnosis of preeclampsia, and the health disparities related to preeclampsia. 
  5. Describe the role of the family physician in the management of prenatal care, labor, delivery, postpartum and newborn care.
  6. Demonstrate effective counseling of patients and families regarding breastfeeding and newborn anticipatory guidance related to breastfeeding.

CCase 31: 66-year-old woman with shortness of breath

  1. Define nationally accepted guidelines for assessing the risk of developing coronary artery disease and apply that risk assessment to an individual patient.
  2. Discuss important elements of the history of present illness and past medical history in a patient with a high risk of coronary artery disease who presents with symptoms and signs consistent with new onset congestive heart failure.
  3. Determine psycho-social events/stressors that have had an impact on the patient's recent behaviors, affecting the management of health problems.
  4. Identify the important elements of the physical exam in a patient with suspected coronary artery disease/congestive heart failure. Explain the significance of positive findings.
  5. Formulate a differential diagnosis for the most likely precipitating causes of congestive heart failure.
  6. Develop a diagnostic testing strategy for a patient with likely new onset congestive heart failure and interpret the test results.
  7. Develop a patient-centered strategy for counseling a patient about lifestyle changes and management goals to reduce the risk of coronary artery disease.
  8. Identify the benefits of self-reflection about personal reactions to patients.

CaCase 32: 33-year-old woman with painful periods

  1. Describe the risk factors for dysmenorrhea.
  2. Describe normal and abnormal physical examination findings on a pelvic exam.
  3. Discuss an appropriate differential diagnosis for a patient with dysmenorrhea.
  4. Describe the treatment of dysmenorrhea.
  5. Define menorrhagia.
  6. Discuss the evaluation of a patient with possible premenstrual syndrome (PMS).
  7. List the treatment options for a patient with premenstrual syndrome.
  8. Describe the use and insertion for the progestin only intrauterine device (IUD) in a patient with dysmenorrhea.

CaCase 33: 28-year-old female with dizziness

  1. Identify common causes of upper respiratory infections in adults.
  2. Discuss appropriate use of antibiotics in the treatment of upper respiratory infections.
  3. Counsel patients regarding appropriate therapeutic measures for upper respiratory infections.
  4.  Employ effective and empathic strategies for communicating with patients and families.
  5. Identify the common causes and treatment options for vertigo, presyncope and disequilibrium. 
  6. Describe history and physical characteristics that correlate with different causes of dizziness. 
  7. Discuss specific exam maneuvers and the significance of physical exam findings for the diagnosis vertigo.
  8. Identify signs and symptoms of dizziness that may indicate serious disease.
  9. Identify indications for use of neuroimaging in evaluation of dizziness.
  10. Formulate cause-specific treatment for common causes of vertigo.

Case 34: Newborn male infant evaluation and care

  1. List elements of the maternal prenatal history that are relevant to the care of the newborn. 
  2. Discuss the potential effect on the fetus of maternal use of tobacco, alcohol, marijuana, and other drugs. 
  3. Discuss the epidemiology and approach to prevention of neonatal Group B Streptococcal sepsis.
  4. Summarize clinical findings in the infant that are associated with intrauterine (TORCH) infections.
  5. Outline steps in neonatal resuscitation.
  6. Describe the components of the APGAR score and explain its significance. 
  7. Describe and perform components of a complete physical examination of a newborn infant, including primitive reflexes and red reflex.
  8. Discuss the use of the Ballard Gestational Age Assessment Tool in the evaluation of the newborn infant. 
  9. Define the terms small for gestational age (SGA) and intrauterine growth restriction (IUGR). Differentiate symmetric and asymmetric IUGR.
  10. Outline a differential diagnosis for an infant noted to be small for gestational age.
  11. List potential complications in infants who are born small for gestational age.
  12. List medications and immunizations routinely given in the immediate newborn period and explain the rationale for their use.
  13. Summarize elements of routine discharge teaching for parents of newborns.
  14. Discuss the potential role of social work in facilitating the transition from newborn nursery to home.

CaCase 35: Infant female well-child visits (2, 6, and 9 months)

  1. Recognize appropriate growth patterns in infants up to 9 months of age using standard growth charts.
  2. Summarize nutritional requirements for appropriate growth for infants at ages 2, 6, and 9 months, including caloric requirements, differences between formula and breast milk, and how and when to add solid foods to the diet.
  3. Explain the difference between developmental surveillance and developmental screening.
  4. List normal developmental milestones at 2, 4 and 6 months.
  5. Discuss the importance of prevention and anticipatory guidance during the well visits, including behavior, development, safety and immunizations.
  6. Develop a differential diagnosis for an asymptomatic abdominal mass in an infant; formulate a plan for evaluation.

CCase 36: 3-year-old male well-child visit

  1. Discuss the importance of identifying parent concerns in order to set priorities for a well child visit.
  2. Describe the components of a preschool health supervision visit, including common concerns, key elements of health promotion, recommended screening, and immunizations.
  3. Demonstrate ability to measure and assess growth including height/length, weight, and body mass index using standard growth charts.
  4. List normal developmental milestones at 3, 4 and 5 years of age.
  5. Identify eczema and discuss principles of management.
  6. Describe key elements of the physical exam for a well-child visit in early childhood, including tests to identify strabismus.
  7. Discuss strategies for modifying the elements of the well-child visit to match the child's level of comfort and cooperation.
  8. List common causes of injury in early childhood.
  9. Discuss age-appropriate anticipatory guidance about safety in preschoolers, including recommendations for addressing firearms in the home.
  10. Summarize risk factors and screening for TB, lead poisoning, anemia.
  11. List potential causes of anemia in a preschool aged child.
  12. Describe an initial approach to the management of suspected iron deficiency anemia.
  13. List common dietary issues in early childhood. 
  14. Discuss strategies for counseling parents on making dietary changes in preschoolers.

CCase 37: 8-year-old male well-child check (Pediatrics Case 4)

  1. Discuss conditions that may contribute to a child's failure in school.
  2. Summarize the signs, symptoms, and management of ADHD.
  3. Demonstrate ability to measure and assess growth including height/length, weight, and body mass index using standard growth charts.
  4. Discuss the epidemiology, risk factors, management, and complications of childhood obesity. 
  5. Discuss diagnosis, causes and management of hypertension in children.

CaCase 38: 6-year-old female with chronic cough (Pediatrics Case 13)

  1. Perform an age-appropriate history and physical examination for a child with chronic cough.
  2. Generate an age appropriate differential diagnosis for a child with chronic cough.
  3. Describe the epidemiology, pathophysiology, clinical findings, and management of important causes of chronic cough.
  4. Describe physical exam maneuvers included in a complete pulmonary examination and discuss the significance of abnormal findings.
  5. Summarize the epidemiology, risk factors, and diagnosis of tuberculosis in children.
  6. Summarize current guidelines for the diagnosis, classification of severity, and management of asthma.
  7. Discuss clinical findings and management of allergic rhinitis.
  8. Discuss the association between environmental allergies and asthma.

CasCase 39: 60-year-old woman with chest pain

  1. Compare the typical qualities and characteristics of chest pain associated with angina pectoris, atypical angina, and non-cardiac chest pain.
  2. Obtain an appropriately complete medical history that differentiates among the common etiologies of chest pain and evaluates for risk factors for coronary artery disease.
  3. Calculate and interpret a patient's 10 year risk for atherosclerotic cardiovascular disease using a Pooled Cohort Equation. 
  4. List the criteria for metabolic syndrome.
  5. Propose appropriate laboratory and diagnostic studies based on patient demographics and the most likely etiologies of chest pain.
  6. Discuss primary and secondary prevention of ischemic heart disease through the reduction of cardiovascular risk factors (e.g. controlling hypertension and dyslipidemia, diabetes management, avoiding tobacco, and aspirin prophylaxis).
  7. Propose appropriate anti-anginal medications when indicated and communicate potential adverse reactions.

CCase 40: 45-year-old man who is overweight (Internal Medicine Case 16)

  1. Discuss health implications of obesity.
  2. Assess risk factors for obesity-related changes.
  3. Describe possible physical findings of hypercholesterolemia.
  4. List etiologies of primary and secondary dyslipidemias.
  5. Describe screening recommendations for dyslipidemias in adults.
  6. Outline basic management of common dyslipidemias, including therapeutic lifestyle changes.
  7. Calculate daily caloric requirement to maintain weight and daily caloric requirement for weight loss.

b. Communication Skills

  1.  Write a coherent history and physical, or SOAP note. 
  2. Clearly present a patient?s history and physical exam.
  3. Effectively talk to patients and their families, especially in difficult situations, i.e. end of life issues.
  4. Motivate and instruct patients in health promotion and disease prevention. 
  5. Demonstrate an understanding of how family, culture, and religious beliefs can influence healthcare decisions and outcomes. 
  6. Respectfully and effectively communicate issues of patient care with non-physician healthcare workers, including clergy.
  7. Explain to patients and families, findings from clinical investigations, including plans for follow up, possible courses of therapy with indications, risks, and benefits, and alternatives.
  8. Collaborate with fellow students, healthcare professionals, patients and families. Including strategies for teaching in small groups, especially giving feedback.

c. Professionalism

  1. Demonstrate an effective physician-patient relationship to provide quality health care and understand the therapeutic role these relationships confer. 
  2. Understand the major obligations of physicians to their patients and show skill and service to people who come for care for a variety of reasons.
  3. Demonstrate advocacy for patients over personal interests.
  4. Display behaviors that foster patient trust in the physician, by appropriate dress, grooming, punctuality, honesty, respect for patient confidentiality, and other norms of behavior in professional relationships with patients.
  5. Converse appropriately and behave with personal integrity in all course and clerkship activities and in interactions with peers, faculty, residents, and non-physician staff and identify these interactions as analogs of future professional relationships thereby maintaining the same high standards expected in patient care.
  6. Work collaboratively as members of a healthcare team in a variety of settings.
  7. Demonstrate commitment to and examples of service to patients in need.
  8. Recognize and accept their own limitations in knowledge and clinical skills and commit to continuously improve their knowledge and ability.

d. Patient Care

  1. Perform, record, present and interpret a complete screening physical exam. 2.
  2. Effectively observe, communicate, and interact with patients, families, and other healthcare workers to obtain histories, deal with difficult situations, and insure proper record keeping. 3.
  3. Integrate data from the history, physical, and laboratory to construct a problem list, develop a prioritized differential diagnosis along with therapeutic, diagnostic, and patient education plans for each problem identified. 4.
  4. Make clinical decisions and solve problems using deductive reasoning based on data obtained about the patient, principles of clinical epidemiology, and evidence-based medicine. 5.
  5. Construct appropriate management strategies (diagnostic, therapeutic and behavioral) for common conditions, both acute and chronic 6.
  6. Develop care plans for patients with chronic conditions not amenable to immediate cure, including: rehabilitative services, care of chronically disable persons and patient facing the end of life. 7.
  7. Interpret the results of the most frequent commonly used clinical laboratory tests. 8.
  8. Perform relevant routine clinical exams and procedures including: a.
    1. Breast Examination
    2. Testicular Examination
    3. Pelvic examination and PAP smear
    4. Skin exam
  9. Exhibit an understanding of how to perform database retrievals, retrieve patient-specific information, select and use information technology, and employ electronic communications for the direct care of patients.

e. Practice Based And Lifelong Learning

  1. Demonstrate knowledge of specific topics related to students' patients and use the medical literature to gather relevant information for patient care.
  2. Use information technology to access and manage clinical information and perform on-line searches to support ongoing self-directed learning. 
  3. Search, evaluate, and critically review scientific evidence appropriate to the care of individual patients or as an approach to a clinical problem.
  4. Demonstrate an understanding of the variations in physician behavior for common conditions, the importance of developing evidence-based practice methodology to lessen variations, the role of practice pathways to manage common problems, and the need to individualize recommendations for the patient.
  5. Formulate questions regarding outcomes seen in patient care and consider simple methods of quality improvement including improved patient satisfaction, decreased complication rates, improved clinical outcomes, and improved access to healthcare for patients from underserved groups. 
  6. Demonstrate a commitment to identifying errors in medicine, reasons for errors, and develop basic strategies to reduce medical errors.
  7. Demonstrate a plan for professional growth.

f. Social And Community Context Of Healthcare

  1. Demonstrate an understanding that some individuals in our society are at risk for inadequate healthcare, including the poor, uninsured, underinsured, children, unborn, single parents, elderly, racial minorities, immigrants, refugees, physically disabled, mentally disabled, chemically dependent, and those with incurable diseases. 2.
  2. Demonstrate an understanding of the impact of economic and health insurance issues on patient care. 3.
  3. Under supervision, develop diagnostic and treatment strategies that are cost-effective, sensitive to limited resources, and do not compromise quality of care. 4.
  4. Appropriately recommend use of consultants and referrals. 5.
  5. Demonstrate knowledge of non-biological determinants of poor health including child abuse, domestic violence, and the economic, psychological, social, and cultural factors that contribute to their development and continuation. 6.
  6. Demonstrate an understanding of economic, psychological, social, and cultural factors that impact patient health.