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SYLLABUS

KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE

DEPARTMENT OF GENERAL

MEDICINE

2014 -2015

CLASS: SECOND YEAR (CLI 200)

COURSE COORDINATOR:

ABE OSBOURNE, DPM, MBA

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“Every job is a self portrait of the person who did it. Autograph your work with excellence.” -Unknown ______________________________________________________________________ WHAT IS A STANDARDIZED PATIENT? Standardized patients are individuals who are highly trained to portray a particular patient history, physical findings and emotional mood during an interview with a podiatric medical student. This unique educational style was developed by Dr. Howard Barrows some fifty years ago. Within the past twenty years however, this teaching technique has gained increasing popularity in many medical schools and other professional schools around the world. The standardized patient (SP) is now commonly used in medical and nursing education to allow students to practice their clinical and conversational skills before they encounter actual patients in clinic. During the encounter the podiatric medical student performs an interview and either a focused physical or complete physical of the patient. The SP is responsible for evaluating the podiatric medical students proficiency in both the interview and the physical examination. The SPs often use a check list to provide students immediate feedback after a patient encounter. The SPs can be used to help early learners acquire skills of history taking and physical examination. It is also perfectly suited to allow students to practice more advanced or difficult patient encounters such as delivering “bad news.” If done properly the SP should be able to fool even a seasonal practitioner. The standardized patient is much more than just a role player. A role player is someone who without much warning or no warning is given a situation to act out. There would likely be no consistency from one presentation to the next. The standardized patient’s presentation is much more controllable and reproducible. The standardized patient allows the podiatric medical student to improve their clinical and conversational skills prior to seeing an actual patient in clinic. The standardization of the clinical presentations allows an instructor to draw comparisons of one student’s clinical skill with another student.

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I. COURSE RATIONALE:

The standardized patient’s course offers second year students the opportunity to interview SPs and receive feedback on their patient interviewing and history recording skills which will prepare them to function competently in a doctor/patient encounter once they enter the Cleveland Foot and Ankle Clinic (CFAC) in their third year. Some students find interviewing patients come naturally, while for others it is more of a learned skill. The standardized patients used are actors who have been coached to simulate a actual patients so accurately that the simulation could possibly fool even a skilled clinician. The students will also practice performing a lower extremity examination. This also a valuable skill they will utilize at CFAC initially then at outside facilities while on the clerkships. Students will also utilize the EMR system to write their patient notes. This will provide them with earlier exposure to the EMR utilized at CFAC. The skills obtained by students in the rotation will also aid them in preparing to take the CSPE examination, the first of which will be offered in August 2014.

II. COURSE GOALS: Students in the standardized patient rotation will be able to develop:

Patient interviewing skills used in obtaining a medical history. Written communication skills used in recording the patient’s history. Improved verbal skills from performing patient presentation. Overall, much improved confidence in the patient interaction. Gaining familiarity with an electronic medical records system Opportunity to practice lower extremity examination skills

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III. COURSE INFORMATION: Course Coordinator: Abe Osbourne, DPM, MBA aosbour1@kent.edu Office Hours: Fridays 1:30pm – 4:30pm Course Instructor: Abe Osbourne, DPM,MBA Leslee Ruszkowski, DPM

1. Class will meet on Tuesday and Thursday from July – November 2014 and

Tuesday, Thursday, and Friday starting in January 2015 2. Please consult the schedule for your section’s assigned time. 3. Attendance is MANDATORY 4. Class will meet in the Simulated Patient Conference Room

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IV. INSTRUCTIONAL STRATEGY:

1. Students will meet twice a week for a total of four weeks or eight contact

sessions. The students will meet on Tuesdays and Thursdays. On the Tuesday of each week the student will meet in the Simulated Patient area. The student will conduct a history and lower extremity physical of the Standardized Patient (SP). The first two weeks there will not be a time restriction on the patient encounter but every attempt should be made to conduct the history taking and the focused examination in a timely manner. The third week the maximum time allowed for the encounter is 40 minutes and the fourth week the maximum time allowed will be 30minutes.

2. The entire interview will be recorded. The SPs will fill a check list that illustrates

key points of the history taking process and the physical examination. The students will utilize the computers outside the treatment rooms or in the computer center to write the patient notes.

3. All the students in the rotation will meet at 1 pm in the Simulated Patient Conference Room on the second floor, the first Tuesday of the rotation. At the first meeting, they will be assigned meeting times for the remainder of the rotation.

4. Students will return on Thursday to review their recorded interview. Their

performance can then be evaluated by themselves, a fellow classmate and/or the instructor. Their write-ups will be returned with written feedback. Utilizing the information obtained in their interview, students may be given a short verbal presentation of their patient case to the other members of their group.

5. With the help of the instructor the students may be asked to develop learning issues based on the patient feedback they receive. Students may then be expected to furnish typed copies of the reports for the instructor and their classmates.

6.During the rotation extra time is set aside to discuss what will be expected of students when they submit charts in the clinic setting. They will then review actual patient notes which are lacking relevant information in order to further assess their awareness of appropriate charting.

7. Some time is set aside to discuss malpractice cases. The purpose of which is to highlight the importance of patient-doctor interaction and patient charting.

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V. LEARNING RESOURCES:

Required Readings: Gabel LL, Haines DJ, Papp KK. The Aging Foot: An Interdisciplinary Perspective. Copyright 2004 The Ohio State University Department of Family Medicine. - Specific chapters will be assigned the first day of the rotation The students will be referred to Mediasite to review relevant material There may be handouts provided during the rotation that all students in the rotation will be required to read.

Suggested Readings: 1. Platt, F., Gordon, G.: Field Guide to the Difficult Patient Interview. Lippincott

Williams & Wikins, 1999. Baltimore, Maryland 2. Kettenbach, G.: Writing SOAP Notes: With Patient/Client Management Formats,

3rd Edition. Philadelphia: F.A. Davis Company, 2004 3. Springhouse: Charting Made Incredibly Easy! Malvern, Pa.: Springhouse

Corporation, 1998 4. Cohen-Cole, S: The Medical Interview: The Three-Function Approach. Mosby

Year Book, 1991

5. Kettenbach, G.: Writing Patient/Client Notes. Ensuring Accuracy in Documentation 4th Edition. Philadelphia, F. A. Davis Company, 2009

Additional Resources: http://webcampus.drexelmed.edu/doccom/user - Building a Relationship - Communicating with Geriatric Patients - Tobacco Intervention - The Clinical Assessment of Substance Use Disorders

http://videos.med.wisc.edu/videoInfo.php?videoid=3156 - You! Your First Patient

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VI. STUDENT EVALUATION:

Grading Scale: Pass/Fail (Based on attendance, interview skills, examination and charting) Appropriate clinical attire to be worn on patient interview days Remainder of policies are in line with those published in the Student Handbook

A passing grade requires:

A) Attendance at all class sessions, except for illness and/or absences pre-approved by the coordinator.

1. Students who have an unexpected absence or who are going to be late are

expected to leave a message for the coordinator at (216) 916-7464 (aosbour1@kent.edu) or Mrs. Barbara Strong at (216) 916-7482.

2. If a student cannot be present for the FIRST DAY OF ROTATION, They are

responsible for trading with a student in a later rotation. The coordinator MUST be notified of this change prior to the start of rotation.

3. If a student misses a patient interview, they may be required to make up an

ENTIRE WEEK at a later date.

B) An understanding of the basic interviewing skills as demonstrated in the videotapes and “patient” comments.

C) An understanding of the basic charting principles as demonstrated class lectures

and elaborated on in the rotation discussion.

D) Developing a comfortable level with oral presentations of a patient history.

E) Reviewing and correcting patient notes with missing information. F) Turning in learning issue reports at the assigned times.

VII. COURSE SCHEDULE:

Will be discussed the first meeting of the rotation

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VIII. TOPIC OR ACTIVITY OBJECTIVES: At the conclusion of the standardized patient rotation, students will be able to:

Obtain an accurate history of a standardized patient in a logical order as evaluated by the SP and course facilitator.

Demonstrate an understanding of the basic principles of accurate history writing as evaluated by the course facilitator.

Use both patient interviewing and chart writing to generate learning issues which will increase the student’s knowledge of interpersonal skills and legal issues involved in patient records.

Utilize the EMR used at CFAC to document the essential points of the patient history and physical

Conducting the appropriate lower extremity exam that corresponds to SP complaint

IX. SUGGESTIONS FOR INTERVIEWING/DRESS CODE:

1. Knock on the door to treatment room, enter room, identify yourself, put patient at ease.

2. Obtain chief complaint(s), set agenda. Keep it simple! 3. Encourage the patient to start talking about his/her problems using open-ended

questions about a specific symptom ie, “Please tell me more about your foot pain.”

4. Establish a personal focus as appropriate, i.e., “It must be hard getting up every morning feeling as tired as you do…”

5. Prioritize: focus on the most urgent symptoms. 6. Summarize the patient’s problems. 7. Focus with closed-ended questions. 8. Pursue other symptoms as time permits.

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Dress Code: Does your attire pass the “reach-up, bend over, squat test”? Low-rise pants without adequate length tucked-in shirts, tank tops, mini-skirts Necklines need to be conservative; no cleavage should be revealed Clothing should not be tight or in any way revealing or suggestive (no bare

midriffs, etc.) Shear tops are not appropriate Street clothes should not be appropriate to a professional appearance. (Think

“business casual”.) Shorts, leggings & stretch pants are generally not appropriate Denim jeans of any color are not permitted All clothing must be clean, ironed, and well mended Shoes need to be comfortable and functional. Opened-toed sandals are not

acceptable Socks or hose should be worn Jewelry, especially rings should be kept to a minimum. Avoid dangling earrings,

necklaces, or bracelets that could get caught in equipment when you are working. Visible body piercing should be limited to no more than 2 piercing per ear. Nose

rings, lip, tongue, eyebrow piercings, etc. should not be worn in clinic. Tattoos should be covered. Personal hygiene is also very important. Fingernails should be short, clean, and preferably, without polish. Artificial nails

should not be worn. Hair, sideburns, mustaches and/or beards should be clean and well trimmed. Long hair should be pulled back. Extreme or unusual hair coloring is not appropriate. Because any odor can be noxious to individuals who are ill, perfume and cologne

should be kept to a minimum. Avoid chewing gum while in clinic.

X. SAS STATEMENT: SAS (Student Accessibility Services ) STATEMENT University Policy (3342-3-18) requires that students with disabilities be provided reasonable accommodations to ensure their equal access to course content. If you have a documented disability and require accommodations, please contact the instructor at the beginning of the semester to make arrangements for necessary classroom adjustments. Please note, you must first verify your eligibility for these through the Student Accessibility Services (contact 330-672-3391 or visit www.kent.edu/sas for more information on registration procedures).

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XI. PLAGIARISM AND CHEATING:

Plagiarism and Cheating

Plagiarism is using the intellectual property of others without attributing it to them. According to university policy, plagiarism and cheating are serious offenses. Students guilty of cheating on exams or other assignments may face disciplinary action up to and including expulsion from the university. Referring to notes, books, or unauthorized Internet sites; looking at another student’s paper or computer screen; or talking during an exam will be construed as evidence of cheating. University Policy on Plagiarism and Cheating link: http://dept.kent.edu/policyregister/register/Chapter%203/Chapter%203%20Section%20342-3-07.htm

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“Think wrongly, if you please, but in all cases think for yourself.” - Doris Lessing

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