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LECOM-Bradenton

Clinical Examination CLE-1004


Semester III
Academic Year 2014-2015
Course Syllabus
Course Co-Directors
Kim Schoeffel, D.O.
Office: 387
Office Hours: By appointment
Email: kschoeffel@lecom.edu
Richard Heibel, M.D.
Office: 376
Office Hours: By appointment
Email: rheibel@lecom.edu
Standardized Patient Coordinator
Cinda Roberts
Office Patient Encounter Area
Office Hours: By appointment
Email croberts@lecom.edu
Course Faculty
James Beresford, M.D.
Mark Best, M.D.
Larry Bunnell, D.O.
Paul Danahy, M.D.
Robert Glinski, D.O.
Kim Fabre, D.M.D.
Warner Farr, M.D.
Anthony Ferretti, D.O.
Robert George, D.O.

Robert Glinski, D.O.


Stephen Harlin, M.D.
Eng Huu, D.O.
Ali Moradi, M.D.
Edward Papish, D.O.
Teresa Pettersen, M.D.
I.J. Pober, M.D.
Thomas Quinn, D.O.
Michael Sampson, D.O.

Additional adjunct faculty and preceptors may be utilized during the course as
needed. They will evaluate students during skills sessions and practical
examinations.

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Description: This course is a continuation of Clinical Examination OMS1. The
student will continue to practice their patient interview techniques and
demonstrate a proper physical examination. The course will define the structure
and components of a medical history and how to record it. Competency in
interpersonal skills is enhanced by the introduction and development of
empathetic listening, recognizing non-verbal cues, and cultural awareness.
The student will review the medical history and physical examination skills
pertinent to the organ system under study. Common pathologic conditions within
the organ system are in the required textbook and may be discussed in the
presentations.
Credit Hours: per Student Handbook
Goals: Students are to develop competence in obtaining and recording a
medical history and performing a physical examination of the organ systems
covered during this and the previous academic year.
Learning Objectives: Upon successful completion of this course, the student
will be able to:
a. Demonstrate the ability to perform a focused medical history and physical
examination on a standardized patient (SP) within given time constraints
b. Demonstrate a professional demeanor while performing a focused medical
history and physical examination on a SP
c. Demonstrate the ability to use common medical equipment
d. Correctly identify anatomical landmarks that are significant in a physical
examination
e. Correctly identify and explain the significance of abnormal physical findings
f. Record the history and physical findings in a standard SOAP format
Rationale: An adequate history and physical examination is fundamental to the
clinical diagnosis and treatment of medical conditions. To that end, this course
will teach the student how to perform a medical history and thorough physical
examination and accurately record the findings.
Overview: Clinical Examination is organized as a systems-based course as
follows:
Semester I (Fall) Cardiac, EKG Tracings, Abdomen, Female Genitalia, Male
Genitalia, Anus, Rectum, and Prostate

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Methodology: All students will meet as a group for scheduled lectures. At other
times the students will meet in small groups with a faculty member and/or upper
class member, and a SP to participate in skill sessions and workshops. In skill
sessions, the student will be instructed in techniques of obtaining a relevant
history and performing a focused physical examination. Workshops by the
student will focus on obtaining and recording a history from a SP relevant to the
organ system being studied and performing a focused physical examination of
that system/region. Encounter write-ups will be evaluated by the clinical faculty
for progression and completeness.
Scheduled Meetings: Lectures will be given at times indicated in a separate
semester schedule. Skill sessions and focused exam workshops will be
scheduled throughout the semesters. These schedules will be on the Master
Schedule and in a separate posting on the LECOM Portal.
Required Textbook:
Seidel, Henry M., Mosbys Guide to Physical Examination, Seventh Edition 2011,
Mosby St. Louis. ISBN#978-0-323-05570-3
Garcia, Thomas B., 12-Lead ECG, The Art of Interpretation, Second Edition
2014, Jones and Bartlett, Sudbury, MA, ISBN # 978-0-7637-7351-9
The faculty expects that assigned readings will be completed prior to class
meetings.
Recommended Materials:
Tierney, Lawrence M. & Henderson, Mark C. (Ed.), The Patient History:
Evidence-Based Approach, 2005, McGraw-Hill New York. ISBN # 0-07-140260
Eight copies will be available in the library.
Satcher, David, Multicultural Medicine and Health Disparities, 2006, McGraw-Hill
New York ISBN #0-07-143680 Four copies will are available in the library.
Seidel: Mosbys Physical Examination Video Series, Version 2
http://medicine.ucsd.edu/clinicalmed/introduction.htlm
http://library.med.utah.edu/kw/ecg/

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Required Equipment:
Blood pressure cuff
Stethoscope
Penlight
Reflex hammer
Rosenbaum eye chart (Near Vision)
Tuning forks (128 Hz and 512 Hz)
Otoscope/ophthalmoscope
Ruler or tape measure (cm)
Watch with a means to measure seconds
Policies:
Attendance - LECOM-Bradenton has a mandatory attendance policy.
Students who are absent may be referred to the Student Promotion and
Graduation Committee per the LECOM-Bradenton Student Handbook.
Class Participation - Clinical medicine is by necessity interactive. Therefore,
students must participate in all skill sessions. The student must come to the skill
sessions prepared to perform the examination and discuss the findings and their
significance.
Attire and Medical Equipment - Students are expected to maintain a
professional appearance (clean white coat with nametag) for each skills session/
SP encounter. You are permitted to be in clothing required for OMM on days
when you have OMM lab. You should avoid extremes in fashion and personal
appearance. You are required to bring any relevant medical equipment with you
to the skills sessions, focused workshops, SCF, VTHP, and OSCE.
Scheduling
a. Attendance at scheduled appointments is mandatory. The course director will
approve an excused absence only under extreme circumstances, with
documentation from the Office of Student Affairs. It is the students responsibility
to inform the course directors of an absence by email so that a make-up session
may be arranged.
b. Learning issues for each specific skill session consist of demonstration of the
skills listed on the physical examination check-list. These lists will be distributed
to the students in advance of every scheduled skill session.

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c. The Patient Encounter Suite will be scheduled by Ms. Cinda Roberts.
d. Changes: Due to the challenge of scheduling a large number of individual
students, requests for time changes will not be honored except for emergency
situations. All schedule changes must be requested a minimum of one
workday in advance via email to Cinda Roberts at croberts@lecom.edu.
e. When a scheduled appointment has been rescheduled due to an unexcused
absence, a monetary fee based on the required staffing will be assessed.
*Please note that the course schedule may have to be altered due to
unforeseen circumstances. If that becomes necessary, students will be
notified at the earliest opportunity.

Skills Sessions
A skills session is a hands-on approach. Students will be organized in small
groups to practice relevant skills of each organ system. Each group will have a
clinical preceptor to reinforce previously demonstrated techniques and observe
student skills. Students are encouraged to help and coach each other during the
sessions as a means of preparing for work in physician team settings. The
clinical preceptor may question students regarding pathophysiology and
abnormal findings relevant to the organ system covered during the skill session.
Please Note: The skill sessions will start with a 5 question fill-in-the-blank quiz
on that skill area. The skill sessions instruct students in the correct method of
performing physical examinations, but it is the students responsibility to practice
techniques outside of class time to attain proficiency and increase their speed of
examination.

Focused Exam Workshop (FEW)


This exercise most closely resembles the skills necessary for success on a board
examination. Each student will be given doorway information which includes
the patient demographics, vital signs and chief complaint. You will have 15
minutes to perform the history and physical. You will interview the SP with
careful attention to the chief complaint and history of present illness. The
remainder of the patient history will be tailored to the presenting complaint, i.e.
problem focused. The student will follow with a problem focused physical
examination. Following the physical examination, the student will complete an
encounter note in 13 minutes. This is a timed exercise. The SP will assess the
students interpersonal skills and physical examination technique at the end of
the workshop. The faculty will assess the students patient encounter note with
verbal or written feedback.

State College of Florida Collaborative Session


This is a joint endeavor of LECOM and the State College of Florida to improve
communication skills of healthcare professionals. Communications skills are
known to suffer in unfamiliar, stressful situations. The goal is to identify areas to
enhance communication skills.
SKILLS: You will be given a scenario involving nursing staff, a patient with
changing or critical findings, and family members. You are expected to navigate
through the challenges of a stressful situation.
TIMING: You will have time to discuss the patient with the nurse, evaluate the
simulated patient and interact with family members while answering questions
and dealing with imminent issues.
ATTIRE AND EQUIPMENT: Per Clinical Examination policy on attire and
medical equipment.
TIME: Attendance is mandatory. Arrival times will be posted with your
assignment. Be on time.
LOCATION: A map to the location, State College of Florida Simulation Center,
will be available prior to the scheduled collaborative session.
FEEDBACK: Immediately following the session there will be a review and
discussion.

Recorded Detailed History and Physical


This detailed history and physical requires you to obtain a relevant history and
perform specific skills on a SP and record your findings. You either completely
examine two skills associated with the Chief Complaint or one skill area
completely and two additional skill areas to not less than 50% of those skills.
SKILLS: You will be provided with the checklists ahead of your scheduled OSCE.
Each physical examination skill must be performed correctly for you to receive
full credit. When you are examining an area it is helpful if you state what you are
doing so the examiner can properly record that you have completed the task.
(You may also do an OMM assessment. If that is the case, you will receive the
necessary information regarding the OMM skills prior to the examination.)
TIMING: You will have 25 minutes in the exam room. If you obtain the history
and complete the examination prior to the end of the time, please return to the
hall. If you do not complete the examination within the time allotted, you are to

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stop immediately and return to the hall. Following the patient encounter, you will
type your findings, print, and submit.
ATTIRE and EQUIPMENT: per Clinical Examination policy on attire and
equipment.
TIME: Arrival times will be posted with your assignment. Being late may be
considered an unexcused absence.
PLACE: LECOM Patient Encounter Area. Please gather and wait in the outside
hallway area across from the OMM labs until someone comes to get you.
PRACTICE: If you would like additional practice time in one of the clinical skills
exam rooms please contact Cinda Roberts croberts@lecom.edu or 782-5985.
The faculty is available by appointment for additional help.

Objective Structured Clinical Examination (OSCE)


This timed exam requires you to perform specific skills on a SP. Each exam
room has a SP and a faculty member. That faculty members only task is to
observe you performing the skills set. The faculty will not give you feedback on
your performance at that time. You will perform four different skills checklists.
SKILLS: You will have been provided with the skills set checklists ahead of your
scheduled OSCE. Each skill should be performed correctly for you to receive
credit. When you are examining an area it is helpful if you state what you are
doing so the examiner can properly record that you have completed the task.
TIMING: You will have 5 minutes for each skill set. If you complete the
examination prior to the end of the time you may return to the hallway. If you do
not complete the examination within the time allotted, you are to stop
immediately when time expires and return to the hallway.
ATTIRE and EQUIPMENT: per Clinical Examination policy on attire and
equipment.
TIME: Arrival times will be posted with your assignment. Being late may be
considered an unexcused absence.
PLACE: LECOM Patient Encounter Area. Please gather and wait in the outside
hallway area across from the OMM labs until someone comes to get you.
PRACTICE: If you would like to set up additional practice time in one of the
clinical skills exam rooms please contact Cinda Roberts croberts@lecom.edu or
782-5985. The faculty is available by appointment for additional help.

Student Evaluation
Your final grade for the course will be based on written examinations, fill-in
the blank quizzes with the skills sessions, and subjective review by our
standardized patients and clinicians.
The weighting of this semester is 55% from the written examinations and quizzes
and 45% from your Patient Encounter Suite/State College of Florida activities.
The Patient Encounter Suite activities are broken down as 4% for quizzes, 10%
for OSCE, 6% for SCF, 12% for VTHP, and 13% for FEWs.
The second examination may be cumulative, containing less than 10% from
previous material.
A final score of 69.5% will be rounded up to 70%. (79.5% to 80%, 89.5% to 90%)
Clinical Examinations requires mastery of examination skills. Using the format for
COMLEX-PE, your FEW/OSCE will be evaluated for; global skills, examination
skills, OMM, and SOAP format documentation. These will be assigned points
based on subjective criteria; Competent, Marginal, Poor.
If you believe that your examiner has not evaluated you in a fair manner, you
must register your complaint with the course coordinators within 7 days of the
date that your grades are available. Any student failure will be addressed
according to the procedures outlined in the LECOM-Bradenton Academic
Catalog and Student Handbook.
Professionalism is a core competency that is monitored by attendance and the
improvement of interpersonal skills. Documented tardiness will result in the
loss of 0.5 percentage point per occurrence and unexcused absences will
result in a loss of 1 percentage point per occurrence from the final semester
grade.
Medical knowledge is a core competency that requires medical equipment to
increase skill and proficiency. Documented failure to obtain and maintain
required medical equipment will result in a loss of 3 percentage points from
the final semester grade.

Core Competencies
II. Medical Knowledge
By the conclusion of Clinical Examination Semester III, students will demonstrate
the ability to:

Perform a focused medical history and physical examination using


common medical equipment
Record the history and physical findings in a standard medical format
Identify correctly and explain the significance of abnormal physical
findings
Develop an assessment and plan about the causes and courses of
patients illnesses.

These will be evaluated via written tests, feedback during skills sessions, SP
feedback following a FEW, and the OSCE.
III. Patient Care (Problem Solving and Clinical Skills)
By the conclusion of Clinical Examination Semester III, students will demonstrate
the ability to:

Perform a history and a physical examination that is appropriate for age,


sex, and clinical problem and setting
Develop assessments and management plans that are compassionate,
appropriate, and effective for the treatment of health problems and the
promotion of health.
Write progress notes in an appropriate manner.

These will be evaluated via feedback during skills sessions, SP feedback


following a FEW, and the OSCE.
IV. Interpersonal and Communication Skills
By the conclusion of Clinical Examination Semester III, students will demonstrate
the ability to:

Establish rapport with patients by showing genuine concern for patients'


anxieties or concerns through tone of voice, style of speaking, expressions
and gestures
Collect data with an appropriate mixture of open and closed questions

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Use language and behaviors that are sensitive to and accepting of


differences in patients age, gender, ethnicity, religion, and sexual
orientation.
Conclude interviews with proper timing and respect
Communicate assessments and management plans that are
compassionate, appropriate, and effective.
Collaborate with patients, their families and health professionals
incorporating cultural, ethnic, gender, racial, and religious sensitivity

These will be evaluated via feedback during skills sessions, SP feedback


following a FEW, and the OSCE.
V. Professionalism
By the conclusion of Clinical Examination Semester III, students will demonstrate
the ability to:

Maintain a professional manner as reflected in attendance, dress and


demeanor
Be courteous to patients, staff and colleagues
Display respect, empathy, responsiveness, and concern regardless of the
patient's problems, personal characteristics, sexual orientation, cultural or
ethnic background
Maintain professional boundaries with SPs (physical, sexual, financial, and
emotional)
Be truthful about medical data
Display respect for privacy of patient information

These will be evaluated via feedback during skills sessions, SP feedback


following a FEW, and the OSCE.

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Schedule
Block 1

Cardiac Skills
Heart (Chapter 14)
12-Lead ECG, The Art of Interpretation (to include the Basic and
Intermediate Levels, but not the Advanced level sections)
Learning Objectives:
1. Describe anatomy and physiology of the organ system
2. Identify anatomical landmarks that are significant in a physical
examination of the organ system
3. Identify normal age variations found on examination of the organ
system
4. Identify and explain the significance of abnormal physical findings
5. Recognize findings that deviate from expected findings
6. Relate symptoms or clinical findings to common pathologic conditions of
the organ system
7. Demonstrate the ability to use common medical equipment
8. Demonstrate examination techniques for the organ system

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Block 2

Abdomen Skills
Abdomen (Chapter 17)
Female Genitalia
Female Genitalia (Chapter 18)
Breasts and Axillae
Breast and Axillae (Chapter 16)
Male Genitalia
Male Genitalia (Chapter 19)
Anus, Rectum, and Prostate
Anus, Rectum, and Prostate (Chapter 20)
Learning Objectives:
1. Describe anatomy and physiology of the organ system
2. Identify anatomical landmarks that are significant in a physical
examination of the organ system
3. Identify normal age variations found on examination of the organ
system
4. Identify and explain the significance of abnormal physical findings
5. Recognize findings that deviate from expected findings
6. Relate symptoms or clinical findings to common pathologic conditions of
the organ system
7. Demonstrate the ability to use common medical equipment
8. Demonstrate examination techniques for the organ system