medportal CDB | Grid: Activities in ugme tagged End of Life

Activities in ugme tagged End of Life

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Activities

Tagged with:

Palliative Care [E02.760.666] (MeSH)
Palliative Care [N02.421.585.666] (MeSH)
Death Certificates [L01.280.900.350] (MeSH)
Palliative care (Discipline)
The Dying Patient (MCC Presentations)
Sudden Infant Death Syndrome (SIDS) (MCC Presentations)
Head Trauma / Brain Death / Transplant Donations (MCC Presentations)
Cause of Death [E05.318.308.985.550.250] (MeSH)
Terminal Care [E02.760.905] (MeSH)
Death [C23.550.260] (MeSH)
Brain Death [C10.228.140.151] (MeSH)
Long-Term Care [N02.421.585.476] (MeSH)

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Displaying 29 records

Activities	Linked Objectives	Curriculum Block	MCC Presentations
Active Large Group Session: Decolonization of Anatomy Part 1, Medical Foundation 1, Introduction to Medicine, Week 1 Bias in anatomy.	Activity Objectives Compare and contrast different views and perspectives about anatomy and physiology principles for medical learners. Explore how personal experiences and cultural practices can impact the relevance of anatomy as a physician and a patient. Enhance awareness of the historical impact of colonization on anatomy principles and identify methods to address these concepts as a medical student. General Objectives Demonstrate specific actions that build an inclusive and respectful learning environment. Discuss the historical and contemporary events and the systemic factors influencing current practices and issues regarding Indigenous Health and anti-Indigenous racism, all of which impact current and future practitioners, individuals, and communities.	Part 1 Medical Foundation 1 Introduction to Medicine Week 1
Active Large Group Session: Palliative Care: A Good Death Part 2, Medical Foundation 2, Hematology, Week 4		Part 2 Medical Foundation 2 Hematology Week 4	The Dying Patient
Tutorial: Charlotte Bouchard MF2 Hematology Part 2, Medical Foundation 2, Hematology, Week 4 Charlotte Bouchard is a 31 year old female who has presented to the ER with new onset shortness of breath. She is previously healthy with no history of medical problems and is not on any medications. She tells you her chest pain and shortness of breath started roughly six weeks prior and have gotten worse to the point she can barely take a few steps without having to stop. She’s also lost about 15 lbs in this time and has noted night sweats such that she has had to change her pajamas during the night. On exam, her pulse is 105, BP 115/87, SpO2 97% on R/A, Temp 37.2. She is not visibly distressed. Respiratory exam reveals decreased air entry on the left and you are able to palpate lymph nodes along her bilateral cervical chains and supraclavicular regions. You also appreciate enlarged lymph nodes in her bilateral axillae and inguinal regions. Her spleen is palpable 5 cm below the costal margin. Chest x-ray performed in the ER reveals a left-sided pleural effusion and is suspicious for a mediastinal mass. You order a follow up CT and this confirms a 15.3 cm mediastinal mass as well as diffuse hilar and axillary adenopathy.	General Objectives Describe the differentiation and development of white blood cells. Describe the classification of the types of white blood cells. Describe the roles of neutrophils, monocytes, and lymphocytes. Describe the pathophysiology that leads to white cell malignancies. Recognize the most common types of white cell malignancies. Global Objectives Upon completion of this problem, students will be able to describe the role of the lymphocyte in the immune system, develop an introductory approach to the manifestations, diagnosis, and complications of lymphoma, and will be able to describe a palliative approach to care.	Part 2 Medical Foundation 2 Hematology Week 4	Abdominal masses and pelvic masses Lymphadenopathy Mediastinal Mass
Small Group Session: Neuro Team based learning session #1 Part 4, Medical Foundation 4, Neuroscience, Week 1 Neuroanatomic Localization, Spinal Cord Pathology, Concussion	Activity Objectives Develop an approach to localize the cause of neurologic weakness. Appreciate the role of cortical, brainstem, and spinal cord neuroanatomy in clinical localization. Appreciate the importance of left/right lateralization and UMN vs. LMN findings in localization. Describe spinal cord anatomy. Describe the clinical presentation seen with different patterns of spinal cord lesions (e.g., complete transection, hemicord lesion, etc.). List the clinical signs and symptons that suggest spinal cord involvement. Relay how to clear a c-spine. Discuss the Return to Play guidelines. Be aware of red flags when evaluating traumatic head injury. Understand the pathophysiology of concussion and its heterogenous presentation as it pertains to cortical function.	Part 4 Medical Foundation 4 Neuroscience Week 1	Weakness (not caused by Cerebrovascular Accident) Head Trauma / Brain Death / Transplant Donations Spinal Trauma
Large Group Session: Neuroimaging Part 4, Medical Foundation 4, Neuroscience, Week 2	Activity Objectives Develop a basic approach to interpreting head CT in the emergent and “on-call” setting. Identify major emergent findings on head CT. Understand appropriate imaging workup for various common clinical presentations: head trauma, headache, stroke, seizure, altered mental status, low back pain.	Part 4 Medical Foundation 4 Neuroscience Week 2	Cerebrovascular Accident and Transient Ischemic Attack (Stroke) Seizures / Epilepsy Major/Mild Neurocognitive Disorders (Dementia) Head Trauma / Brain Death / Transplant Donations
PC Session: Ethical Issues in End-of-Life Care Part 4, Professional Competencies 4, Week 7 Probably some of the most discussed issues in health ethics are raised in the context of end-of-life care. Questions around when to provide or stop treatment and how best to respect individuals' wishes have been debated publicly and personally for generations. In this session you will have a chance to explore some debates around withholding and withdrawing treatment, decision-making and advanced directives and notions of futility or burdensome treatment.	General Objectives Employ and critically evaluate ethical theories and principles when exploring learning scenarios and reasoning about ethical challenges in the clinical setting. Summarize the ethical, legal obligations and duty of care that physicians have for patients, colleagues and, communities, and the tensions that may arise from these responsibilities. Integrate moral reasoning and judgment with communication, interpersonal, and clinical skills to provide the patients with effective and ethical care.	Part 4 Professional Competencies 4 Week 7	Legal system The Dying Patient
Tutorial: Arielle D Part 5, Integration Foundation Arielle is a 41 yr old female presenting to her family doctors office with concerns of irregular menstrual cycles and painful intercourse. Arielle states she has noticed increased episodes of spotting in between her menstrual cycles over the past 8 months. Arielle has also noticed increased vaginal discharge and abdominal cramping at times with associated swelling of her legs. Arielle thought her lower leg symptoms were a result of her long work hours and standing for long periods of time. Arielle immigrated to Canada from the United States 15 years ago. She works as a daycare attendant and a waitress on the weekends to support her parents who reside with her and her partner. Arielle did not have regular access to healthcare as a teenager while living in Florida with her parents who immigrated to the US from Mexico shortly after Arielle was born. Arielle did not receive any vaccinations as a child or as a teenager. Arielle was sexually active at the age of 14 with multiple partners before her husband. She has been in a monogamous relationship for the past 6 years. Arielle reports she has given birth to 3 children which she gave up for adoption and underwent 2 pregnancy terminations prior to meeting her husband. Her husband does not know about any of the previous pregnancies or procedures she underwent prior to meeting him.	Global Objectives Upon completion of this problem, students will be able to review risk factors for cervical cancer and the role of vaccines in decreasing these risks and describe different pathological results for cervical cancer screen and their associated treatments. Students will also examine barriers to successful cervical screening programs and implementation amongst marginalized populations.	Part 5 Integration Foundation	Vaginal Discharge / Vulvar Pruritis / STI
Clinical Skills Sessions: Palliative Care Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4 Describe and Identify patients who would benefit from a palliative care approach early in their illness trajectory. Systematically assess symptoms in patients with palliative care needs and participate in the evidence-based holistic and interprofessional management of these symptoms. Identify the components of a holistic, interprofessional management plan for a patient with palliative care needs. Describe the hierarchy for Substitute Decision Making for a patient who lacks Capacity. Describe the role of POAs or SDMs in palliative and end-of-life care planning.		Part 5 Integration Foundation Host Defense and Neoplasia Week 4	Consent The Dying Patient
Tutorial: Albert Johnson IF Host Defence and Neoplasia Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4 Mr. Johnson is a previously fit, retired 70-year old Afro-Canadian gentleman. His son and daughter-in-law live several hundred miles away in another city and maintain contact with him by telephone. They return home on a Friday evening to surprise him for his birthday and find his apartment in disarray and Mr. Johnson in bed, in too much pain to move. He seems unable to stand independently, though it is hard to tell if this is a result of his overall weakness, or the pain. They call an ambulance and he is taken to the Emergency Department of the local community hospital.	General Objectives Recognize how an interdisciplinary team can help manage a patient with complex chronic disease. Identify a patient centered approach to care for individuals with chronic illnesses. Describe common oncologic emergencies. Describe the principles of pain and symptom management in cancer. Global Objectives Upon completion of this problem, students should be able to describe cancer-directed and non-cancer-directed treatments in the management of metastatic cancer. Students should be able to explain the need for urgent treatment in some instances of incurable cancer.	Part 5 Integration Foundation Host Defense and Neoplasia Week 4	The Dying Patient Non-Articular Musculoskeletal Pain
Active Large Group Session: End-of-Life Care Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4	Activity Objectives Address end-of-life decision making and planning, including advance care planning and goals of care discussions. Identify appropriate care for dying patients and their families. Identify psychosocial and spiritual needs of the dying patient and family, including grief and bereavement.	Part 5 Integration Foundation Host Defense and Neoplasia Week 4	The Dying Patient Dyspnea Vomiting and/or Nausea Delirium
PC Session: From White Coat to Blue Gown Part 5, Professional Competencies IF, Week 2 This session highlights concepts and competencies covering end of life care, professionalism/self-awareness and self-care/compassion in Barbara Tatham’s journey from a physician to patient through to her final stages of comfort measures and palliative care.	General Objectives Illustrate strategies to cope adaptively with stresses likely to occur during medical training and practice. Summarize different “ways of knowing” about the body and how these ways affect the clinical encounter. Illustrate the difference between disease and illness, and plan an approach to understanding the patient’s illness experience. Understand the importance and impact of interpersonal interactions in both professional and personal settings. Identify and address problems/issues that might affect one’s own health, well-being, or professional capabilities.	Part 5 Professional Competencies IF Week 2	The Dying Patient
PC Session: Grief Part 5, Professional Competencies IF, Week 3 Students will develop an understanding of grief and its diverse forms. Critically examine and reflect on attitudes and beliefs about grief. Develop an appreciation of sociocultural influences on the experience of grief, including grief in the context of COVID-19. Challenge Western concepts of grief and consider cultural variation in the expression and management of grief. Develop an understanding of how to respond to grieving patients.	Activity Objectives To critically examine and reflect on one's attitudes and beliefs about grief and loss. To examine some of the larger held cultural myths held about grief and loss. To appreciate the challenges faced by those who are grieving in a culture that is widely death-denying. To identify and incorporate respectful and compassionate behaviors for those who are bereaved in everyday contexts and professional practice. General Objectives Illustrate the difference between disease and illness, and plan an approach to understanding the patient’s illness experience. Illustrate how diverse factors (sociocultural, psychological, economic, occupational, environmental, legal, political, spiritual, and technological) interact to influence the health of an individual and the population. Demonstrate sensitivity to the value system of patients (colleagues, other health care providers – ethical vs professionalism) and others.	Part 5 Professional Competencies IF Week 3
PC Session: Brain Death and Organ Donation Part 5, Professional Competencies IF, Week 4 At the end of this session, students will be able to: Describe their role and responsibility as physicians with respect to potential organ donors; Describe how the Trillium Gift of Life program supports organ donation; Better manage sensitive communications about brain death and organ donation drawing on SPIKES guidelines; Recognize that circumstances, past experiences, and/or values may render discussions of brain death and organ donation difficult for families and health care professionals.	General Objectives Demonstrate how to develop with patients, families, and other professionals a common understanding on issues and a shared plan of care, as defined by the Kalamazoo Consensus Statements. (CanMEDS 2015). Describe the medical and ethical principles of organ transplantation and living and deceased donation. Summarize the ethical, legal obligations and duty of care that physicians have for patients, colleagues and, communities, and the tensions that may arise from these responsibilities.	Part 5 Professional Competencies IF Week 4	Head Trauma / Brain Death / Transplant Donations
PC Session: Serious Illness Conversations Part 5, Professional Competencies IF, Week 5 Students will be introduced to the SPIKES protocol. During tutorial students will practice the application of the SPIKES protocol using role plays .	General Objectives Illustrate how being a good communicator is a core clinical skill for physicians, and how effective physician-patient communication can foster patient satisfaction, physician satisfaction, adherence and improved clinical outcomes (CanMEDS 2015). Summarize the concepts, principles, and research evidence that support the importance and efficacy of developing communication and interpersonal skills in medicine. Demonstrate the acquisition of communications skills (defined by the Kalamazoo Consensus Statements as a set of conscious and behavioural norms) required to build a therapeutic relationship, to conduct an interview with a patient, to communicate about a patient, and to communicate about medicine and science.	Part 5 Professional Competencies IF Week 5	The Dying Patient
e-Learning Module: Integration Foundation Rapid Fire Cases: Medical decision making in the acute care setting Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 4 12-15 cases of rapid action required or immediate clinical decision making. Content of these modules: Internal Medicine, Surgery, Obstetrics, Paediatrics, Geriatrics and Radiology.	General Objectives Review common scenarios involving urgent decision making processes encountered in the acute care setting. Demonstrate application of subjective and objective patient information to support decision making and critical thinking in urgent care situations. Modify treatment plans and clinical decision making skills when required with review of rationale for each scenario encountered. Demonstrate synthesis of clinical knowledge gained throughout the Pre-Clerkship Curriculum in Rapid Fire Cases Evaluate and identify any learning challenges or learning needs in Rapid Fire case scenarios following review of rationale for clinical actions and completion of modules.	Part 5 Integration Foundation Maternal Health Risks/Aging-Related Care Week 4	Abdominal Distension Chest Pain Dizziness, Vertigo The Dying Patient Dyspnea Headache Jaundice Palpitations Vomiting and/or Nausea Acute Abdominal Pain Acute Diarrhea Delirium Hyperkalemia Hypotension/Shock Polyuria and/or Polydipsia Pediatric Respiratory Distress Fever and Hyperthermia
Clinical Skills Sessions: Dyspnea in Adult Palliative Care Part 5, Integration Foundation, Complexity and Chronicity, Week 2 To practice a palliative care assessment, including symptom assessment, detailed social and functional history, and practice a goals of care discussion using the Serious Illness Conversation Guide (Click for link) as a template. To practice using likelihood ratios from the JAMA Rational Clinical Exam Article Does this patient have a pleural effusion? to formulate a post-test probability of pleural effusion in this case. To discuss common clinical tools helpful in a palliative care assessment, including the Edmonton Symptom Assessment Scale (ESAS – Click for link), and Palliative Performance Scale (PPS). To discuss core principles of primary palliative approach to care. Pro Comp Connection – Palliative care for marginalized populations.		Part 5 Integration Foundation Complexity and Chronicity Week 2	The Dying Patient Dyspnea
Tutorial: Hannah Rosen Part 2 IF Chronicity and Complexity Part 5, Integration Foundation, Complexity and Chronicity, Week 4 Hannah Rosen is 18-year-old female who presents to the outpatient clinic after a frantic call to the receptionist earlier during the day. Hannah has been coming to the clinic for the past 16 years for treatment and monitoring of her cystic fibrosis. Her parents, who have been supportive, are out of town on an anniversary cruise and Hannah didn’t know who to call. Hannah states she has been having increased sputum production, low grade fever and difficulty catching her breath over the past few days. She took the action plan of ciprofloxacin she has at home. She takes this when her respiratory symptoms worsen. Hannah states she has been compliant with her antibiotics, but her symptoms suddenly got worse overnight. Hannah does not want her parents to know about this and asks that they not be contacted about her hospital visit. On examination, Hannah appears in distress. She is using her intercostal muscles to help her breathe and appears cyanotic and diaphoretic. Her vitals are taken by the clinic nurse while they are waiting for her pediatric respirologist to finish with the previous patient. Hannah’s temperature is 39.1, oxygen saturation is 91 percent, heart rate is 115 and her blood pressure is 100/60. The nurse calls for immediate help and Hannah is taken to the ICU where she is placed on oxygen. Chest x-ray and additional blood work including ABGs are ordered.	General Objectives Describe the medical and ethical principles of organ transplantation and living and deceased donation. Global Objectives Upon completion of this problem, students should be able to describe the pathophysiology of chronic respiratory failure and associated clinical decision-making with regard to organ transplantation and donation.	Part 5 Integration Foundation Complexity and Chronicity Week 4	Cyanosis, Hypoxia The Dying Patient
Standardized Patients: Goals of Care Transition to Clerkship This Goals of Care simulation session has been developed to provide students an opportunity to hone their skills in conducting effective GoC discussions. It will provide you with a chance to practice your skills with Standardized Patients, and to receive feedback and suggestions from skilled clinicians in a constructive way.		Transition to Clerkship
Clinical Skills Sessions: Fever x 24 hours in a Patient Living in Long-Term Care Transition to Clerkship, Week 3 You are on a rural family medicine clerkship rotation. In addition to working in a family medicine clinic, your preceptor works in the ER, assists in the OR and has patients in the community’s Long-Term Care Facility (LTC). LTC can collect bloodwork to be sent offsite and can check urine dipsticks at the bedside. Imaging tests would require transfer of the patient offsite. Your preceptor’s clinic receives a message from the community LTC facility. The RN working on the LTC unit, Nate, shares that a patient under the care of your preceptor, Morgan Wright, has a new onset of fever x 24 hours, where the RN is concerned about the patient’s health. Your preceptor is busy with a patient in the clinic and asks you to take the call to complete an initial assessment, with a low threshold to call for help if you are concerned.	Activity Objectives Learn and practice the SBAR (Situation, Background, Assessment, Recommendation) tool for verbal handover of patient care. Learn and to practice the SOAP (Subjective, Objective, Assessment, Plan) tool for written handover of patient care. Review a differential diagnosis for fever. Practice a focused assessment of a patient over the telephone in coordination with a bedside nurse. Review non-verbal signs of pain for patients unable to communicate verbally (e.g. for patients with dementia). Review common medications used for control of symptoms in end-of-life care Practice holding a goals of care discussion with a substitute decision-maker for an incapable patient using the Serious Illness Conversation Guide framework.	Transition to Clerkship Week 3	Major/Mild Neurocognitive Disorders (Dementia) Fever and Hyperthermia
Clinical Exposure: EM Medical Expert (presenting problems) Clerkship, Emergency Medicine Rotation Demonstrate an approach to patients presenting to the ED with the following problems listed below (including basic differential diagnosis, initial investigations, and initial treatments)	Clerkship Objectives Chest pain Shortness of breath Altered level of consciousness - including the recognition and management of acute stroke Anaphylaxis / severe allergic reaction Abdominal pain Loss of consciousness (syncope) Shock - Recognize shock and predict underlying etiology (distributive, cardiogenic, hypovolemic, obstructive). Seizure Cardiorespiratory arrest Headache Minor trauma / MSK injuries (including fracture / dislocation/ sprain). Explain the ABCDE approach to major and minor trauma, identify resuscitative priorities and recognize injuries which require acute management. Abnormal behavior (psychosis, delirium, intoxication, violence). Head injury - minor Fever Dizziness / vertigo Cardiac dysrhythmias. Synthesize ACLS (Advanced Cardiovascular Life Support) algorithms, recognize unstable ACLS states and use ACLS algorithms to guide treatment. Vaginal bleeding - pregnant Poisoning Burns - minor / major Urinary symptoms Neck and back pain Eye pain (including red eye)	Clerkship Emergency Medicine Rotation	Lower urinary tract symptoms Allergic Reactions and Atopy Back Pain and Related Symptoms (e.g., Sciatica) Neck Pain Burns Cardiac Arrest Chest Pain Dizziness, Vertigo Dyspnea Eye Redness Headache Poisoning Early Pregnancy Loss / Spontaneous Abortion Psychosis Seizures / Epilepsy Syncope and Pre-Syncope Trauma Vaginal Bleeding, Excessive/Irregular/Abnormal Abnormal Heart Sounds and Murmurs Acute Abdominal Pain Delirium Dysuria, Urinary Frequency and Urgency, and/or Pyuria Fever in the Immune Compromised Host / Recurrent Fever Hypotension/Shock Abdominal Pain (Children) Bone or Joint Injury Chronic Abdominal Pain Fever and Hyperthermia Head Trauma / Brain Death / Transplant Donations
Essential Clinical Experience: Palliative Care (Disease Management) Clerkship, Family Medicine Rotation	Essential Clinical Experience Palliative Care (Disease Management)	Clerkship Family Medicine Rotation	The Dying Patient
e-Learning Module: Family Medicine Palliative Case Clerkship, Family Medicine Rotation Describe the palliative care approach to care, and who may benefit from it. Assess and manage pain and other common symptoms in palliative care. Understand the interprofessional approach to providing palliative care. Organize care for the actively dying patient and family. Describe an approach to responding to grief, bereavement, and suffering	Clerkship Objectives End of Life Management	Clerkship Family Medicine Rotation	The Dying Patient Dyspnea Vomiting and/or Nausea Adult Constipation Delirium Generalized Pain Disorders
Essential Clinical Experience: Participate in a discussion on end-of-life care. Clerkship, Family Medicine Rotation, Internal Medicine Rotation	Essential Clinical Experience Participate in a discussion on end-of-life care.	Clerkship Family Medicine Rotation Internal Medicine Rotation	The Dying Patient
Tutorial: Head Injury Clerkship, Pediatrics Rotation Outline an approach to the diagnosis, investigation and management of children with mild to moderate head injury. Discuss specific anticipatory guidance for head injury prevention and treatment in children.	Clerkship Objectives Headache: Brain tumor, Concussion, Increased intracranial pressure, Migraine	Clerkship Pediatrics Rotation	Head Trauma / Brain Death / Transplant Donations
Large Group Session: Trauma Clerkship, Surgery Rotation Demonstrate concepts of primary and secondary patient assessment. Establish management priorities in trauma situations. Initiate primary and secondary management as necessary. Arrange appropriate disposition.	Clerkship Objectives Describe the causes, diagnosis, and treatment of spontaneous pneumothorax. Describe the priorities and sequence of a trauma patient evaluation (ABC's). Define shock. Discuss the risks of pneumothorax which could prove life-threatening. Describe the four classes of hemorrhagic shock and how to recognize them. Differentiate the signs, symptoms, and hemodynamic features of shock: hemorrhagic; cardiogenic; septic; neurogenic; anaphylactic. Discuss priorities and specific goals of resuscitation for each form of shock: define goals of resuscitation; defend choice of fluids; discuss indications for transfusion; discuss management of acute coagulopathy; discuss indications for invasive monitoring; discuss use of inotropes; afterload reduction in management Discuss the underlying pulmonary pathology you might expect to find. (pneumothorax) Describe the appropriate fluid resuscitation of a trauma victim. Discuss the role of: Observation; Tube thoracostomy; Chemical sclerosis; Surgical management of this condition (pneumothorax). Discuss choice of IV access (of a trauma patient). Describe the common etiologies for hemothorax. Discuss the choice of fluid and use of blood components (for a trauma patient). Discuss an appropriate diagnostic evaluation for a patient with hemothorax. Discuss the differences between adult and pediatric resuscitation. Discuss the appropriate management of blood in the pleural cavity. Discuss the types, etiology and prevention of coagulopathies typically found in patients with massive hemorrhage. Which patients (with hemothorax) need an operation? Describe the appropriate triage of a patient in a trauma system. What are the risks in leaving the blood diagnostic in the chest? Describe the diagnostic evaluation, differences between blunt and penetrating mechanisms of injury and the initial management of: Spine injury; Thoracic injury; Abdominal injury; Urinary injury. Discuss the most common non-traumatic causes of hemothorax. Discuss fluid resuscitation, choice of fluid and monitoring for adequacy of resuscitation (rule of 9's, differences in pediatric and adult management).	Clerkship Surgery Rotation	Trauma Abdominal Injuries Chest Injuries Head Trauma / Brain Death / Transplant Donations Spinal Trauma
Large Group Session: Neurosurgery Clerkship, Surgery Rotation Epidural hematoma. Subdural hematoma. Cerebral Contusion. Basal Skull Fractures. Intracranial Hemorrhage. Diffuse Axonal Injury. Pathophysiology of supratentorial brain herniation. Grading of consciousness - Glasgow Coma Scale (GCS). Clinical classification of Traumatic Brain Injury (TBI). ICP = Intracranial Pressure. Munro-Kellie doctrine. Brain tumor. Intracerebral hemorrhage. Management of severe pediatric TBI.	Clerkship Objectives Describe the physiology of intracerebral pressure (ICP) and cerebral perfusion pressure (CPP), including the effects of blood pressure, ventilatory status, and fluid balance on ICP and CPP. Recognize the Cushing reflex and its clinical importance (brain herniation). Describe the signs, etiology and treatment of intracranial hemorrhage (subarachnoid hemorrhage and intracerebral hemorrhage). Describe the relative incidence and location of the most common brain tumors, their clinical manifestations, their diagnosis, and general treatment strategies. Differentiate TIA, RIND, and CVA. Describe the presentation and management of hydrocephalus. Compare and contrast adult and pediatric hydrocephalus. Students will understand the importance of early diagnosis and treatment in subarachnoid hemorrhage and epidural hematomas.	Clerkship Surgery Rotation	Headache Acute Visual Disturbance/Loss Head Trauma / Brain Death / Transplant Donations
e-Learning Module: Trauma resuscitation Clerkship, Surgery Rotation This module reviews the basics of trauma resuscitation and the management of the severely injured patient.	Clerkship Objectives Define shock. Describe the priorities and sequence of a trauma patient evaluation (ABC's). Differentiate the signs, symptoms, and hemodynamic features of shock: hemorrhagic; cardiogenic; septic; neurogenic; anaphylactic. Describe the four classes of hemorrhagic shock and how to recognize them. Discuss priorities and specific goals of resuscitation for each form of shock: define goals of resuscitation; defend choice of fluids; discuss indications for transfusion; discuss management of acute coagulopathy; discuss indications for invasive monitoring; discuss use of inotropes; afterload reduction in management Describe the appropriate fluid resuscitation of a trauma victim. Discuss choice of IV access (of a trauma patient). Discuss the choice of fluid and use of blood components (for a trauma patient). Discuss the differences between adult and pediatric resuscitation. Discuss the types, etiology and prevention of coagulopathies typically found in patients with massive hemorrhage. Describe the appropriate triage of a patient in a trauma system. Describe the diagnostic evaluation, differences between blunt and penetrating mechanisms of injury and the initial management of: Spine injury; Thoracic injury; Abdominal injury; Urinary injury.	Clerkship Surgery Rotation	Trauma Abdominal Injuries Chest Injuries Head Trauma / Brain Death / Transplant Donations Spinal Trauma Urinary Tract Injuries Vascular Injury
Clinical Exposure: Head injury/Altered Neurological status Clerkship, Surgery Rotation		Clerkship Surgery Rotation	Cerebrovascular Accident and Transient Ischemic Attack (Stroke) Head Trauma / Brain Death / Transplant Donations
Concept Integration and Review: Trauma Post-clerkship, Concept Integration and Review, Week 4 Trauma exam pearls: When in doubt stick to ATLS (Advanced Trauma Life Support); shock is hemorrhagic until proven otherwise (1. Find the bleeding 2. stop the bleeding) ; If any step delays definitive (operative) management and is not life-saving, skip it. ; be thorough; be suspicious.		Post-clerkship Concept Integration and Review Week 4	Allergic Reactions and Atopy Trauma Abdominal Injuries Hypotension/Shock Bone or Joint Injury Chest Injuries Facial Injuries Head Trauma / Brain Death / Transplant Donations Vascular Injury

Activities

Linked Objectives

Curriculum Block

MCC Presentations

Active Large Group Session: Decolonization of Anatomy

Part 1, Medical Foundation 1, Introduction to Medicine, Week 1

Bias in anatomy.

Activity Objectives

Compare and contrast different views and perspectives about anatomy and physiology principles for medical learners.

Explore how personal experiences and cultural practices can impact the relevance of anatomy as a physician and a patient.

Enhance awareness of the historical impact of colonization on anatomy principles and identify methods to address these concepts as a medical student.

General Objectives

Demonstrate specific actions that build an inclusive and respectful learning environment.

Discuss the historical and contemporary events and the systemic factors influencing current practices and issues regarding Indigenous Health and anti-Indigenous racism, all of which impact current and future practitioners, individuals, and communities.

Part 1

Medical Foundation 1

Introduction to Medicine

Week 1

Active Large Group Session: Palliative Care: A Good Death

Part 2, Medical Foundation 2, Hematology, Week 4

Part 2

Medical Foundation 2

Hematology

Week 4

The Dying Patient

Tutorial: Charlotte Bouchard MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 4

Charlotte Bouchard is a 31 year old female who has presented to the ER with new onset shortness of breath. She is previously healthy with no history of medical problems and is not on any medications. She tells you her chest pain and shortness of breath started roughly six weeks prior and have gotten worse to the point she can barely take a few steps without having to stop. She’s also lost about 15 lbs in this time and has noted night sweats such that she has had to change her pajamas during the night. On exam, her pulse is 105, BP 115/87, SpO2 97% on R/A, Temp 37.2. She is not visibly distressed. Respiratory exam reveals decreased air entry on the left and you are able to palpate lymph nodes along her bilateral cervical chains and supraclavicular regions. You also appreciate enlarged lymph nodes in her bilateral axillae and inguinal regions. Her spleen is palpable 5 cm below the costal margin. Chest x-ray performed in the ER reveals a left-sided pleural effusion and is suspicious for a mediastinal mass. You order a follow up CT and this confirms a 15.3 cm mediastinal mass as well as diffuse hilar and axillary adenopathy.

General Objectives

Describe the differentiation and development of white blood cells.

Describe the classification of the types of white blood cells.

Describe the roles of neutrophils, monocytes, and lymphocytes.

Describe the pathophysiology that leads to white cell malignancies.

Recognize the most common types of white cell malignancies.

Global Objectives

Upon completion of this problem, students will be able to describe the role of the lymphocyte in the immune system, develop an introductory approach to the manifestations, diagnosis, and complications of lymphoma, and will be able to describe a palliative approach to care.

Part 2

Medical Foundation 2

Hematology

Week 4

Abdominal masses and pelvic masses

Lymphadenopathy

Mediastinal Mass

Small Group Session: Neuro Team based learning session #1

Part 4, Medical Foundation 4, Neuroscience, Week 1

Neuroanatomic Localization, Spinal Cord Pathology, Concussion

Activity Objectives

Develop an approach to localize the cause of neurologic weakness.

Appreciate the role of cortical, brainstem, and spinal cord neuroanatomy in clinical localization.

Appreciate the importance of left/right lateralization and UMN vs. LMN findings in localization.

Describe spinal cord anatomy.

Describe the clinical presentation seen with different patterns of spinal cord lesions (e.g., complete transection, hemicord lesion, etc.).

List the clinical signs and symptons that suggest spinal cord involvement.

Relay how to clear a c-spine.

Discuss the Return to Play guidelines.

Be aware of red flags when evaluating traumatic head injury.

Understand the pathophysiology of concussion and its heterogenous presentation as it pertains to cortical function.

Part 4

Medical Foundation 4

Neuroscience

Week 1

Weakness (not caused by Cerebrovascular Accident)

Head Trauma / Brain Death / Transplant Donations

Spinal Trauma

Large Group Session: Neuroimaging

Part 4, Medical Foundation 4, Neuroscience, Week 2

Activity Objectives

Develop a basic approach to interpreting head CT in the emergent and “on-call” setting.

Identify major emergent findings on head CT.

Understand appropriate imaging workup for various common clinical presentations: head trauma, headache, stroke, seizure, altered mental status, low back pain.

Part 4

Medical Foundation 4

Neuroscience

Week 2

Cerebrovascular Accident and Transient Ischemic Attack (Stroke)

Seizures / Epilepsy

Major/Mild Neurocognitive Disorders (Dementia)

Head Trauma / Brain Death / Transplant Donations

PC Session: Ethical Issues in End-of-Life Care

Part 4, Professional Competencies 4, Week 7

Probably some of the most discussed issues in health ethics are raised in the context of end-of-life care. Questions around when to provide or stop treatment and how best to respect individuals' wishes have been debated publicly and personally for generations. In this session you will have a chance to explore some debates around withholding and withdrawing treatment, decision-making and advanced directives and notions of futility or burdensome treatment.

General Objectives

Employ and critically evaluate ethical theories and principles when exploring learning scenarios and reasoning about ethical challenges in the clinical setting.

Summarize the ethical, legal obligations and duty of care that physicians have for patients, colleagues and, communities, and the tensions that may arise from these responsibilities.

Integrate moral reasoning and judgment with communication, interpersonal, and clinical skills to provide the patients with effective and ethical care.

Part 4

Professional Competencies 4

Week 7

Legal system

The Dying Patient

Tutorial: Arielle D

Part 5, Integration Foundation

Arielle is a 41 yr old female presenting to her family doctors office with concerns of irregular menstrual cycles and painful intercourse. Arielle states she has noticed increased episodes of spotting in between her menstrual cycles over the past 8 months. Arielle has also noticed increased vaginal discharge and abdominal cramping at times with associated swelling of her legs. Arielle thought her lower leg symptoms were a result of her long work hours and standing for long periods of time. Arielle immigrated to Canada from the United States 15 years ago. She works as a daycare attendant and a waitress on the weekends to support her parents who reside with her and her partner. Arielle did not have regular access to healthcare as a teenager while living in Florida with her parents who immigrated to the US from Mexico shortly after Arielle was born. Arielle did not receive any vaccinations as a child or as a teenager. Arielle was sexually active at the age of 14 with multiple partners before her husband. She has been in a monogamous relationship for the past 6 years. Arielle reports she has given birth to 3 children which she gave up for adoption and underwent 2 pregnancy terminations prior to meeting her husband. Her husband does not know about any of the previous pregnancies or procedures she underwent prior to meeting him.

Global Objectives

Upon completion of this problem, students will be able to review risk factors for cervical cancer and the role of vaccines in decreasing these risks and describe different pathological results for cervical cancer screen and their associated treatments. Students will also examine barriers to successful cervical screening programs and implementation amongst marginalized populations.

Part 5

Integration Foundation

Vaginal Discharge / Vulvar Pruritis / STI

Clinical Skills Sessions: Palliative Care

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Describe and Identify patients who would benefit from a palliative care approach early in their illness trajectory. Systematically assess symptoms in patients with palliative care needs and participate in the evidence-based holistic and interprofessional management of these symptoms. Identify the components of a holistic, interprofessional management plan for a patient with palliative care needs. Describe the hierarchy for Substitute Decision Making for a patient who lacks Capacity. Describe the role of POAs or SDMs in palliative and end-of-life care planning.

Part 5

Integration Foundation

Host Defense and Neoplasia

Week 4

Consent

The Dying Patient

Tutorial: Albert Johnson IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Mr. Johnson is a previously fit, retired 70-year old Afro-Canadian gentleman. His son and daughter-in-law live several hundred miles away in another city and maintain contact with him by telephone. They return home on a Friday evening to surprise him for his birthday and find his apartment in disarray and Mr. Johnson in bed, in too much pain to move. He seems unable to stand independently, though it is hard to tell if this is a result of his overall weakness, or the pain. They call an ambulance and he is taken to the Emergency Department of the local community hospital.

General Objectives

Recognize how an interdisciplinary team can help manage a patient with complex chronic disease.

Identify a patient centered approach to care for individuals with chronic illnesses.

Describe common oncologic emergencies.

Describe the principles of pain and symptom management in cancer.

Global Objectives

Upon completion of this problem, students should be able to describe cancer-directed and non-cancer-directed treatments in the management of metastatic cancer. Students should be able to explain the need for urgent treatment in some instances of incurable cancer.

Part 5

Integration Foundation

Host Defense and Neoplasia

Week 4

The Dying Patient

Non-Articular Musculoskeletal Pain

Active Large Group Session: End-of-Life Care

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Activity Objectives

Address end-of-life decision making and planning, including advance care planning and goals of care discussions.

Identify appropriate care for dying patients and their families.

Identify psychosocial and spiritual needs of the dying patient and family, including grief and bereavement.

Part 5

Integration Foundation

Host Defense and Neoplasia

Week 4

The Dying Patient

Dyspnea

Vomiting and/or Nausea

Delirium

PC Session: From White Coat to Blue Gown

Part 5, Professional Competencies IF, Week 2

This session highlights concepts and competencies covering end of life care, professionalism/self-awareness and self-care/compassion in Barbara Tatham’s journey from a physician to patient through to her final stages of comfort measures and palliative care.

General Objectives

Illustrate strategies to cope adaptively with stresses likely to occur during medical training and practice.

Summarize different “ways of knowing” about the body and how these ways affect the clinical encounter.

Illustrate the difference between disease and illness, and plan an approach to understanding the patient’s illness experience.

Understand the importance and impact of interpersonal interactions in both professional and personal settings.

Identify and address problems/issues that might affect one’s own health, well-being, or professional capabilities.

Part 5

Professional Competencies IF

Week 2

The Dying Patient

PC Session: Grief

Part 5, Professional Competencies IF, Week 3

Students will develop an understanding of grief and its diverse forms. Critically examine and reflect on attitudes and beliefs about grief. Develop an appreciation of sociocultural influences on the experience of grief, including grief in the context of COVID-19. Challenge Western concepts of grief and consider cultural variation in the expression and management of grief. Develop an understanding of how to respond to grieving patients.

Activity Objectives

To critically examine and reflect on one's attitudes and beliefs about grief and loss.

To examine some of the larger held cultural myths held about grief and loss.

To appreciate the challenges faced by those who are grieving in a culture that is widely death-denying.

To identify and incorporate respectful and compassionate behaviors for those who are bereaved in everyday contexts and professional practice.

General Objectives

Illustrate the difference between disease and illness, and plan an approach to understanding the patient’s illness experience.

Illustrate how diverse factors (sociocultural, psychological, economic, occupational, environmental, legal, political, spiritual, and technological) interact to influence the health of an individual and the population.

Demonstrate sensitivity to the value system of patients (colleagues, other health care providers – ethical vs professionalism) and others.

Part 5

Professional Competencies IF

Week 3

PC Session: Brain Death and Organ Donation

Part 5, Professional Competencies IF, Week 4

At the end of this session, students will be able to: Describe their role and responsibility as physicians with respect to potential organ donors; Describe how the Trillium Gift of Life program supports organ donation; Better manage sensitive communications about brain death and organ donation drawing on SPIKES guidelines; Recognize that circumstances, past experiences, and/or values may render discussions of brain death and organ donation difficult for families and health care professionals.

General Objectives

Demonstrate how to develop with patients, families, and other professionals a common understanding on issues and a shared plan of care, as defined by the Kalamazoo Consensus Statements. (CanMEDS 2015).

Describe the medical and ethical principles of organ transplantation and living and deceased donation.

Summarize the ethical, legal obligations and duty of care that physicians have for patients, colleagues and, communities, and the tensions that may arise from these responsibilities.

Part 5

Professional Competencies IF

Week 4

Head Trauma / Brain Death / Transplant Donations

PC Session: Serious Illness Conversations

Part 5, Professional Competencies IF, Week 5

Students will be introduced to the SPIKES protocol. During tutorial students will practice the application of the SPIKES protocol using role plays .

General Objectives

Illustrate how being a good communicator is a core clinical skill for physicians, and how effective physician-patient communication can foster patient satisfaction, physician satisfaction, adherence and improved clinical outcomes (CanMEDS 2015).

Summarize the concepts, principles, and research evidence that support the importance and efficacy of developing communication and interpersonal skills in medicine.

Demonstrate the acquisition of communications skills (defined by the Kalamazoo Consensus Statements as a set of conscious and behavioural norms) required to build a therapeutic relationship, to conduct an interview with a patient, to communicate about a patient, and to communicate about medicine and science.

Part 5

Professional Competencies IF

Week 5

The Dying Patient

e-Learning Module: Integration Foundation Rapid Fire Cases: Medical decision making in the acute care setting

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 4

12-15 cases of rapid action required or immediate clinical decision making. Content of these modules: Internal Medicine, Surgery, Obstetrics, Paediatrics, Geriatrics and Radiology.

General Objectives

Review common scenarios involving urgent decision making processes encountered in the acute care setting.

Demonstrate application of subjective and objective patient information to support decision making and critical thinking in urgent care situations.

Modify treatment plans and clinical decision making skills when required with review of rationale for each scenario encountered.

Demonstrate synthesis of clinical knowledge gained throughout the Pre-Clerkship Curriculum in Rapid Fire Cases

Evaluate and identify any learning challenges or learning needs in Rapid Fire case scenarios following review of rationale for clinical actions and completion of modules.

Part 5

Integration Foundation

Maternal Health Risks/Aging-Related Care

Week 4

Abdominal Distension

Chest Pain

Dizziness, Vertigo

The Dying Patient

Dyspnea

Headache

Jaundice

Palpitations

Vomiting and/or Nausea

Acute Abdominal Pain

Acute Diarrhea

Delirium

Hyperkalemia

Hypotension/Shock

Polyuria and/or Polydipsia

Pediatric Respiratory Distress

Fever and Hyperthermia

Clinical Skills Sessions: Dyspnea in Adult Palliative Care

Part 5, Integration Foundation, Complexity and Chronicity, Week 2

To practice a palliative care assessment, including symptom assessment, detailed social and functional history, and practice a goals of care discussion using the Serious Illness Conversation Guide (Click for link) as a template. To practice using likelihood ratios from the JAMA Rational Clinical Exam Article Does this patient have a pleural effusion? to formulate a post-test probability of pleural effusion in this case. To discuss common clinical tools helpful in a palliative care assessment, including the Edmonton Symptom Assessment Scale (ESAS – Click for link), and Palliative Performance Scale (PPS). To discuss core principles of primary palliative approach to care. Pro Comp Connection – Palliative care for marginalized populations.

Part 5

Integration Foundation

Complexity and Chronicity

Week 2

The Dying Patient

Dyspnea

Tutorial: Hannah Rosen Part 2 IF Chronicity and Complexity

Part 5, Integration Foundation, Complexity and Chronicity, Week 4

Hannah Rosen is 18-year-old female who presents to the outpatient clinic after a frantic call to the receptionist earlier during the day. Hannah has been coming to the clinic for the past 16 years for treatment and monitoring of her cystic fibrosis. Her parents, who have been supportive, are out of town on an anniversary cruise and Hannah didn’t know who to call. Hannah states she has been having increased sputum production, low grade fever and difficulty catching her breath over the past few days. She took the action plan of ciprofloxacin she has at home. She takes this when her respiratory symptoms worsen. Hannah states she has been compliant with her antibiotics, but her symptoms suddenly got worse overnight. Hannah does not want her parents to know about this and asks that they not be contacted about her hospital visit. On examination, Hannah appears in distress. She is using her intercostal muscles to help her breathe and appears cyanotic and diaphoretic. Her vitals are taken by the clinic nurse while they are waiting for her pediatric respirologist to finish with the previous patient. Hannah’s temperature is 39.1, oxygen saturation is 91 percent, heart rate is 115 and her blood pressure is 100/60. The nurse calls for immediate help and Hannah is taken to the ICU where she is placed on oxygen. Chest x-ray and additional blood work including ABGs are ordered.

General Objectives

Describe the medical and ethical principles of organ transplantation and living and deceased donation.

Global Objectives

Upon completion of this problem, students should be able to describe the pathophysiology of chronic respiratory failure and associated clinical decision-making with regard to organ transplantation and donation.

Part 5

Integration Foundation

Complexity and Chronicity

Week 4

Cyanosis, Hypoxia

The Dying Patient

Standardized Patients: Goals of Care

Transition to Clerkship

This Goals of Care simulation session has been developed to provide students an opportunity to hone their skills in conducting effective GoC discussions. It will provide you with a chance to practice your skills with Standardized Patients, and to receive feedback and suggestions from skilled clinicians in a constructive way.

Transition to Clerkship

Clinical Skills Sessions: Fever x 24 hours in a Patient Living in Long-Term Care

Transition to Clerkship, Week 3

You are on a rural family medicine clerkship rotation. In addition to working in a family medicine clinic, your preceptor works in the ER, assists in the OR and has patients in the community’s Long-Term Care Facility (LTC). LTC can collect bloodwork to be sent offsite and can check urine dipsticks at the bedside. Imaging tests would require transfer of the patient offsite. Your preceptor’s clinic receives a message from the community LTC facility. The RN working on the LTC unit, Nate, shares that a patient under the care of your preceptor, Morgan Wright, has a new onset of fever x 24 hours, where the RN is concerned about the patient’s health. Your preceptor is busy with a patient in the clinic and asks you to take the call to complete an initial assessment, with a low threshold to call for help if you are concerned.

Activity Objectives

Learn and practice the SBAR (Situation, Background, Assessment, Recommendation) tool for verbal handover of patient care.

Learn and to practice the SOAP (Subjective, Objective, Assessment, Plan) tool for written handover of patient care.

Review a differential diagnosis for fever.

Practice a focused assessment of a patient over the telephone in coordination with a bedside nurse.

Review non-verbal signs of pain for patients unable to communicate verbally (e.g. for patients with dementia).

Review common medications used for control of symptoms in end-of-life care

Practice holding a goals of care discussion with a substitute decision-maker for an incapable patient using the Serious Illness Conversation Guide framework.

Transition to Clerkship

Week 3

Major/Mild Neurocognitive Disorders (Dementia)

Fever and Hyperthermia

Clinical Exposure: EM Medical Expert (presenting problems)

Clerkship, Emergency Medicine Rotation

Demonstrate an approach to patients presenting to the ED with the following problems listed below (including basic differential diagnosis, initial investigations, and initial treatments)

Clerkship Objectives

Chest pain

Shortness of breath

Altered level of consciousness - including the recognition and management of acute stroke

Anaphylaxis / severe allergic reaction

Abdominal pain

Loss of consciousness (syncope)

Shock - Recognize shock and predict underlying etiology (distributive, cardiogenic, hypovolemic, obstructive).

Seizure

Cardiorespiratory arrest

Headache

Minor trauma / MSK injuries (including fracture / dislocation/ sprain). Explain the ABCDE approach to major and minor trauma, identify resuscitative priorities and recognize injuries which require acute management.

Abnormal behavior (psychosis, delirium, intoxication, violence).

Head injury - minor

Fever

Dizziness / vertigo

Cardiac dysrhythmias. Synthesize ACLS (Advanced Cardiovascular Life Support) algorithms, recognize unstable ACLS states and use ACLS algorithms to guide treatment.

Vaginal bleeding - pregnant

Poisoning

Burns - minor / major

Urinary symptoms

Neck and back pain

Eye pain (including red eye)

Clerkship

Emergency Medicine Rotation

Lower urinary tract symptoms

Allergic Reactions and Atopy

Back Pain and Related Symptoms (e.g., Sciatica)

Neck Pain

Burns

Cardiac Arrest

Chest Pain

Dizziness, Vertigo

Dyspnea

Eye Redness

Headache

Poisoning

Early Pregnancy Loss / Spontaneous Abortion

Psychosis

Seizures / Epilepsy

Syncope and Pre-Syncope

Trauma

Vaginal Bleeding, Excessive/Irregular/Abnormal

Abnormal Heart Sounds and Murmurs

Acute Abdominal Pain

Delirium

Dysuria, Urinary Frequency and Urgency, and/or Pyuria

Fever in the Immune Compromised Host / Recurrent Fever

Hypotension/Shock

Abdominal Pain (Children)

Bone or Joint Injury

Chronic Abdominal Pain

Fever and Hyperthermia

Head Trauma / Brain Death / Transplant Donations

Essential Clinical Experience: Palliative Care (Disease Management)

Clerkship, Family Medicine Rotation

Essential Clinical Experience

Palliative Care (Disease Management)

Clerkship

Family Medicine Rotation

The Dying Patient

e-Learning Module: Family Medicine Palliative Case

Clerkship, Family Medicine Rotation

Describe the palliative care approach to care, and who may benefit from it. Assess and manage pain and other common symptoms in palliative care. Understand the interprofessional approach to providing palliative care. Organize care for the actively dying patient and family. Describe an approach to responding to grief, bereavement, and suffering

Clerkship Objectives

End of Life Management

Clerkship

Family Medicine Rotation

The Dying Patient

Dyspnea

Vomiting and/or Nausea

Adult Constipation

Delirium

Generalized Pain Disorders

Essential Clinical Experience: Participate in a discussion on end-of-life care.

Clerkship, Family Medicine Rotation, Internal Medicine Rotation

Essential Clinical Experience

Participate in a discussion on end-of-life care.

Clerkship

Family Medicine Rotation

Internal Medicine Rotation

The Dying Patient

Tutorial: Head Injury

Clerkship, Pediatrics Rotation

Outline an approach to the diagnosis, investigation and management of children with mild to moderate head injury. Discuss specific anticipatory guidance for head injury prevention and treatment in children.

Clerkship Objectives

Headache: Brain tumor, Concussion, Increased intracranial pressure, Migraine

Clerkship

Pediatrics Rotation

Head Trauma / Brain Death / Transplant Donations

Large Group Session: Trauma

Clerkship, Surgery Rotation

Demonstrate concepts of primary and secondary patient assessment. Establish management priorities in trauma situations. Initiate primary and secondary management as necessary. Arrange appropriate disposition.

Clerkship Objectives

Describe the causes, diagnosis, and treatment of spontaneous pneumothorax.

Describe the priorities and sequence of a trauma patient evaluation (ABC's).

Define shock.

Discuss the risks of pneumothorax which could prove life-threatening.

Describe the four classes of hemorrhagic shock and how to recognize them.

Differentiate the signs, symptoms, and hemodynamic features of shock: hemorrhagic; cardiogenic; septic; neurogenic; anaphylactic.

Discuss priorities and specific goals of resuscitation for each form of shock: define goals of resuscitation; defend choice of fluids; discuss indications for transfusion; discuss management of acute coagulopathy; discuss indications for invasive monitoring; discuss use of inotropes; afterload reduction in management

Discuss the underlying pulmonary pathology you might expect to find. (pneumothorax)

Describe the appropriate fluid resuscitation of a trauma victim.

Discuss the role of: Observation; Tube thoracostomy; Chemical sclerosis; Surgical management of this condition (pneumothorax).

Discuss choice of IV access (of a trauma patient).

Describe the common etiologies for hemothorax.

Discuss the choice of fluid and use of blood components (for a trauma patient).

Discuss an appropriate diagnostic evaluation for a patient with hemothorax.

Discuss the differences between adult and pediatric resuscitation.

Discuss the appropriate management of blood in the pleural cavity.

Discuss the types, etiology and prevention of coagulopathies typically found in patients with massive hemorrhage.

Which patients (with hemothorax) need an operation?

Describe the appropriate triage of a patient in a trauma system.

What are the risks in leaving the blood diagnostic in the chest?

Describe the diagnostic evaluation, differences between blunt and penetrating mechanisms of injury and the initial management of: Spine injury; Thoracic injury; Abdominal injury; Urinary injury.

Discuss the most common non-traumatic causes of hemothorax.

Discuss fluid resuscitation, choice of fluid and monitoring for adequacy of resuscitation (rule of 9's, differences in pediatric and adult management).

Clerkship

Surgery Rotation

Trauma

Abdominal Injuries

Chest Injuries

Head Trauma / Brain Death / Transplant Donations

Spinal Trauma

Large Group Session: Neurosurgery

Clerkship, Surgery Rotation

Epidural hematoma. Subdural hematoma. Cerebral Contusion. Basal Skull Fractures. Intracranial Hemorrhage. Diffuse Axonal Injury. Pathophysiology of supratentorial brain herniation. Grading of consciousness - Glasgow Coma Scale (GCS). Clinical classification of Traumatic Brain Injury (TBI). ICP = Intracranial Pressure. Munro-Kellie doctrine. Brain tumor. Intracerebral hemorrhage. Management of severe pediatric TBI.

Clerkship Objectives

Describe the physiology of intracerebral pressure (ICP) and cerebral perfusion pressure (CPP), including the effects of blood pressure, ventilatory status, and fluid balance on ICP and CPP.

Recognize the Cushing reflex and its clinical importance (brain herniation).

Describe the signs, etiology and treatment of intracranial hemorrhage (subarachnoid hemorrhage and intracerebral hemorrhage).

Describe the relative incidence and location of the most common brain tumors, their clinical manifestations, their diagnosis, and general treatment strategies.

Differentiate TIA, RIND, and CVA.

Describe the presentation and management of hydrocephalus. Compare and contrast adult and pediatric hydrocephalus.

Students will understand the importance of early diagnosis and treatment in subarachnoid hemorrhage and epidural hematomas.

Clerkship

Surgery Rotation

Headache

Acute Visual Disturbance/Loss

Head Trauma / Brain Death / Transplant Donations

e-Learning Module: Trauma resuscitation

Clerkship, Surgery Rotation

This module reviews the basics of trauma resuscitation and the management of the severely injured patient.

Clerkship Objectives

Define shock.

Describe the priorities and sequence of a trauma patient evaluation (ABC's).

Differentiate the signs, symptoms, and hemodynamic features of shock: hemorrhagic; cardiogenic; septic; neurogenic; anaphylactic.

Describe the four classes of hemorrhagic shock and how to recognize them.

Describe the appropriate fluid resuscitation of a trauma victim.

Discuss choice of IV access (of a trauma patient).

Discuss the choice of fluid and use of blood components (for a trauma patient).

Discuss the differences between adult and pediatric resuscitation.

Discuss the types, etiology and prevention of coagulopathies typically found in patients with massive hemorrhage.

Describe the appropriate triage of a patient in a trauma system.

Describe the diagnostic evaluation, differences between blunt and penetrating mechanisms of injury and the initial management of: Spine injury; Thoracic injury; Abdominal injury; Urinary injury.

Clerkship

Surgery Rotation

Trauma

Abdominal Injuries

Chest Injuries

Head Trauma / Brain Death / Transplant Donations

Spinal Trauma

Urinary Tract Injuries

Vascular Injury

Clinical Exposure: Head injury/Altered Neurological status

Clerkship, Surgery Rotation

Clerkship

Surgery Rotation

Cerebrovascular Accident and Transient Ischemic Attack (Stroke)

Head Trauma / Brain Death / Transplant Donations

Concept Integration and Review: Trauma

Post-clerkship, Concept Integration and Review, Week 4

Trauma exam pearls: When in doubt stick to ATLS (Advanced Trauma Life Support); shock is hemorrhagic until proven otherwise (1. Find the bleeding 2. stop the bleeding) ; If any step delays definitive (operative) management and is not life-saving, skip it. ; be thorough; be suspicious.

Post-clerkship

Concept Integration and Review

Week 4

Allergic Reactions and Atopy

Trauma

Abdominal Injuries

Hypotension/Shock

Bone or Joint Injury

Chest Injuries

Facial Injuries

Head Trauma / Brain Death / Transplant Donations

Vascular Injury