medportal CDB | Grid: Internal Medicine Clerkship Objectives

Internal Medicine Clerkship Objectives

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Objectives	Linked Activities	Linked Assessments	McMaster Program Competencies
Approach to the Patient
Patient History
Conduct an effective patient interview to elicit appropriate information in patients presenting with the required presentations/conditions listed in the priority topics below.	Clinical Exposure: Patient History Clinical Skills Practice Sessions: Patient History These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.	Direct Observation Tool: Obtain a history and perform a physical examination adapted to the patient’s clinical situation	1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 4.4 Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions, including the ability to manage one’s own interpersonal responses 5.1 Demonstrate accountability to patients, society, and the profession 5.12 Present oneself professionally to patients, families, and members of the health care team 5.2 Demonstrate compassion, integrity, and respect for others 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law. 5.9 Maintain appropriate boundaries with patients and other professionals
Perform patient interview in a patient centered manner, using verbal and non-verbal means to create an empathetic and respectful environment for a variety of patients (including the frail elderly).		Direct Observation Tool: Obtain a history and perform a physical examination adapted to the patient’s clinical situation	1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 4.4 Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions, including the ability to manage one’s own interpersonal responses 5.1 Demonstrate accountability to patients, society, and the profession 5.12 Present oneself professionally to patients, families, and members of the health care team 5.2 Demonstrate compassion, integrity, and respect for others 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law. 5.9 Maintain appropriate boundaries with patients and other professionals
Validate and obtain historical information from other relevant informants (eg. partner, caregiver, Community Care Access Centre, family physician) where indicated.	Clinical Exposure: Patient History		1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 3.8 Obtain and use information about individual patients and their caregivers, populations of patients, or communities with which patients identify to improve care 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 4.4 Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions, including the ability to manage one’s own interpersonal responses 5.1 Demonstrate accountability to patients, society, and the profession 5.12 Present oneself professionally to patients, families, and members of the health care team 5.2 Demonstrate compassion, integrity, and respect for others 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law. 5.9 Maintain appropriate boundaries with patients and other professionals
Take a history from a geriatric patient with special emphasis on physical and mental functioning.			1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 4.3 Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics 4.4 Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions, including the ability to manage one’s own interpersonal responses 5.1 Demonstrate accountability to patients, society, and the profession 5.12 Present oneself professionally to patients, families, and members of the health care team 5.2 Demonstrate compassion, integrity, and respect for others 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law. 5.9 Maintain appropriate boundaries with patients and other professionals
Document the patient interview in a concise, organized written and verbal report.	Clinical Exposure: Patient History Clinical Skills Practice Sessions: Patient History These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.		4.5 Maintain comprehensive, timely, and legible medical records
Functional Assessment
Collect accurate information regarding function in basic and instrumental activities of daily living.	Clinical Exposure: Functional Assessment Collect accurate information regarding function in basic and instrumental activities of daily living.		1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy
Communicate results of the functional assessment in well-organized written & oral reports.	Clinical Exposure: Functional Assessment Collect accurate information regarding function in basic and instrumental activities of daily living.		4.5 Maintain comprehensive, timely, and legible medical records 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy
Physical Examination
Perform an appropriate physical examination relevant to the patient’s presentation, the history obtained, and the acuity of the encounter (includes mental status examination).	Clinical Exposure: Physical Examination Clinical Skills Practice Sessions: Physical Examination	Direct Observation Tool: Obtain a history and perform a physical examination adapted to the patient’s clinical situation	1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 5.2 Demonstrate compassion, integrity, and respect for others 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law.
Perform a physical examination and functional assessment on an elderly patient, adapting it to possible conditions of frailty, mobility, hearing loss, memory loss and other impairments.			1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 4.3 Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics 5.2 Demonstrate compassion, integrity, and respect for others 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law.
Perform a mental status examination to evaluate confusion and/or memory loss in an elderly patient.			1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 4.3 Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics 5.2 Demonstrate compassion, integrity, and respect for others 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law.
Demonstrate appropriate infection control practices and patient draping during physical examination to ensure patient safety and comfort.			1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 1.2 Organize and prioritize responsibilities to provide care that is safe, effective, and efficient 6.3 Advocate for quality patient care and optimal patient care systems that support patient- and population-centred care that is safe, timely, efficient, effective, and equitable
Document the findings of the physical exam in a concise, organized written or oral report.	Clinical Exposure: Physical Examination Clinical Skills Practice Sessions: Physical Examination		4.5 Maintain comprehensive, timely, and legible medical records 5.4 Demonstrate respect for patient confidentiality, privacy and autonomy

Diagnosis
Formulate an initial problem-oriented list of patient issues and a differential diagnosis for each issue.	Clinical Exposure: Diagnosis e-Learning Module: Diagnosis	Direct Observation Tool: Formulate and justify a prioritized differential diagnosis e-Learning Module Completion: Diagnosis	1.4 Make informed decision about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Outline initial diagnostic investigations for the patient’s problem(s).	Clinical Exposure: Diagnosis e-Learning Module: Diagnosis	Direct Observation Tool: Formulate an initial plan of investigation based on the diagnostic hypotheses e-Learning Module Completion: Diagnosis	1.2 Organize and prioritize responsibilities to provide care that is safe, effective, and efficient 1.4 Make informed decision about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Interpret an electrocardiogram and a chest X-ray	Clinical Exposure: Diagnosis e-Learning Module: Diagnosis	e-Learning Module Completion: Diagnosis	1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice
Interpret the results from: Cerebrospinal fluid: patterns of meningitis; subarachnoid hemorrhage. Paracentesis: use of SAAG; identification of spontaneous bacterial peritonitis. Pleural fluid: differentiate transudate vs. exudate; diagnose empyema.			1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice
Record the results of laboratory tests in an organized manner.			4.5 Maintain comprehensive, timely, and legible medical records
Integrate epidemiologic skills into choosing diagnostic strategies including: likelihood ratio, sensitivity, specificity, post-test probability, etc.			1.4 Make informed decision about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations
Understand responsibility associated with ordering investigations including: resource stewardship and high value care, awareness of range of normal, responsibility to follow-up and review results.	Clinical Exposure: Diagnosis e-Learning Module: Diagnosis	e-Learning Module Completion: Diagnosis	1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making 1.8 Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations 6.7 Incorporate cost, risk-benefit analysis and resource stewardship in patient and/or population-based care.
Interpret the laboratory tests and findings of ancillary investigations consistent with the required diagnostic conditions.			1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice
Identify information resources for selecting diagnostic investigations for patients with common and uncommon medical problems.			2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations 3.6 Locate, appraise, and incorporate evidence from research related to patients’ health problems and the provision of healthcare 3.7 Use information technology and information systems to optimize patient care 8.5 Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty
Clinical Management
Develop a management plan including: Pharmacologic treatment and non-pharmacologic treatment.	Clinical Exposure: Management Plan e-Learning Module: Management Plan	e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	1.5 Develop and carry out patient management plans 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations 2.5 Apply principles of socio-behavioural sciences to the provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care concordance, care adherence and barriers to and attitudes toward care.
Write prescriptions accurately (under supervision).		Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making 4.5 Maintain comprehensive, timely, and legible medical records 6.7 Incorporate cost, risk-benefit analysis and resource stewardship in patient and/or population-based care. 6.9 Perform administrative and practice management responsibilities commensurate with one’s role, abilities, and qualifications 7.2 Use the knowledge of one’s own role and the roles of other health professionals to appropriately assess and address the health care needs of the patients and populations served 7.3 Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the provision of healthcare in individual patients and populations 7.4 Demonstrate the ability to consult with and to other health professionals
Assess for risk of drug interactions (including an approach to polypharmacy in the elderly)	Clinical Exposure: Management Plan e-Learning Module: Management Plan	e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	1.5 Develop and carry out patient management plans 1.9 Provide health care services to patients, families, and communities aimed at preventing health problems or maintaining health 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare 3.7 Use information technology and information systems to optimize patient care 7.2 Use the knowledge of one’s own role and the roles of other health professionals to appropriately assess and address the health care needs of the patients and populations served 7.4 Demonstrate the ability to consult with and to other health professionals
Assess for risk of iatrogenic complications (including increased risk among the elderly).	Clinical Exposure: Management Plan e-Learning Module: Management Plan	e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 1.2 Organize and prioritize responsibilities to provide care that is safe, effective, and efficient 1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice 1.9 Provide health care services to patients, families, and communities aimed at preventing health problems or maintaining health 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations
Monitor for response to therapy including compliance and potential adverse effects.	Clinical Exposure: Management Plan e-Learning Module: Management Plan	e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice 1.5 Develop and carry out patient management plans 1.8 Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes
Understand the roles of and collaborate with allied health professionals in a patient’s care.	Clinical Exposure: Management Plan e-Learning Module: Management Plan	e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	6.6 Coordinate patient care within the health care system relevant to a variety of clinical specialties 7.2 Use the knowledge of one’s own role and the roles of other health professionals to appropriately assess and address the health care needs of the patients and populations served 7.3 Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the provision of healthcare in individual patients and populations 7.4 Demonstrate the ability to consult with and to other health professionals 7.6 Participate in different team roles and appropriately apply leadership skills to establish, develop, and continuously enhance team function.
Assess a patient’s competence to make decisions regarding therapy.	Clinical Exposure: Management Plan e-Learning Module: Management Plan	e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making 2.5 Apply principles of socio-behavioural sciences to the provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care concordance, care adherence and barriers to and attitudes toward care. 5.7 Demonstrate the application of ethical principles to commonly encountered ethical issues such as the provision or withholding of care, confidentiality, informed consent, and including compliance with relevant laws, policies, and regulations
Participate in a care plan discussion with a patient understanding the role of shared-decision making.	Clinical Exposure: Management Plan e-Learning Module: Management Plan	e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	1.4 Make informed decision about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations 2.5 Apply principles of socio-behavioural sciences to the provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care concordance, care adherence and barriers to and attitudes toward care. 3.8 Obtain and use information about individual patients and their caregivers, populations of patients, or communities with which patients identify to improve care 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 4.2 Participate in the education of patients, families, students, trainees, peers and other health professionals
Undertake discharge planning including arranging and communicating follow-up plans.	Clinical Exposure: Management Plan e-Learning Module: Management Plan	Direct Observation Tool: Provide and receive the handover in transitions of care e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making 1.8 Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes 4.2 Participate in the education of patients, families, students, trainees, peers and other health professionals 4.5 Maintain comprehensive, timely, and legible medical records 6.6 Coordinate patient care within the health care system relevant to a variety of clinical specialties 6.9 Perform administrative and practice management responsibilities commensurate with one’s role, abilities, and qualifications 7.3 Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the provision of healthcare in individual patients and populations
Consider the concepts of resource stewardship and high value care in making treatment decisions.	Clinical Exposure: Management Plan e-Learning Module: Management Plan	e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations 3.6 Locate, appraise, and incorporate evidence from research related to patients’ health problems and the provision of healthcare 5.1 Demonstrate accountability to patients, society, and the profession 6.7 Incorporate cost, risk-benefit analysis and resource stewardship in patient and/or population-based care.
Consider legal and/or ethical issues as well as psychosocial aspects in deciding on an appropriate treatment.	Clinical Exposure: Management Plan e-Learning Module: Management Plan	e-Learning Module Completion: Management Plan Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	1.4 Make informed decision about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 2.5 Apply principles of socio-behavioural sciences to the provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care concordance, care adherence and barriers to and attitudes toward care. 5.7 Demonstrate the application of ethical principles to commonly encountered ethical issues such as the provision or withholding of care, confidentiality, informed consent, and including compliance with relevant laws, policies, and regulations
Identify resources to help determine appropriate treatment options for common and uncommon medical problems.	Tutorial: Clinical Clerk Internal Medicine Tutorials Tutorials are held at least once a week, for two to three hours per session. They are attended by all clerks, the tutor, and, on many occasions, a co-tutor (CMR). The tutorials allow the clerks to distance themselves from the minute-to-minute management of patients on the medical wards and gain a better perspective on the strategies of patient problems and management. The objectives for the medicine rotation should be used as a guide by the tutorial group in setting weekly objectives. The tutor and the students should set the objectives together. Priority problems not covered on the ward, or of sufficient importance to be re-emphasized, should be reviewed during the tutorials. During tutorials, more time can be spent on particular learning issues than is appropriate during a ward round. Therapeutic issues (i.e., pharmacological and non- pharmacological management) are often emphasized in tutorials. Tutorials can also be used to improve oral presentations, group and communication skills, and to develop a deeper understanding of the principles of bioethics.	Clerkship Tutorial Evaluation: Internal Medicine Tutorials A summative evaluation of the student’s performance in tutorial sessions. Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	1.4 Make informed decision about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare 3.6 Locate, appraise, and incorporate evidence from research related to patients’ health problems and the provision of healthcare 3.7 Use information technology and information systems to optimize patient care 3.9 Continually identify, analyze, and implement new knowledge, guidelines, standards, technologies, products, or services that have been demonstrated to improve outcomes
Understand responsibility associated with treatment strategies: cost, ensuring the patient understands and is able to adhere to the treatment plan.			1.4 Make informed decision about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 1.5 Develop and carry out patient management plans 1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making 1.8 Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations 2.5 Apply principles of socio-behavioural sciences to the provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care concordance, care adherence and barriers to and attitudes toward care. 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 6.7 Incorporate cost, risk-benefit analysis and resource stewardship in patient and/or population-based care.
Adjust therapeutic plans appropriately when required (i.e., when new diagnostic information is available; when there is a change in patient preference or goals of care).			1.4 Make informed decision about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 1.5 Develop and carry out patient management plans 1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making 1.8 Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations 2.5 Apply principles of socio-behavioural sciences to the provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care concordance, care adherence and barriers to and attitudes toward care. 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds
Understand the symptoms sometimes seen during end-of-life care and the basic principles of their management (e.g., pain, dyspnea, nausea and vomiting, anorexia, fatigue, depression, delirium, constipation).			1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 1.5 Develop and carry out patient management plans 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations 2.5 Apply principles of socio-behavioural sciences to the provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care concordance, care adherence and barriers to and attitudes toward care.
Communication Skills
Demonstrate timely and effective communication with patients, caregivers, and community care teams including primary care physicians.		Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 7.3 Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the provision of healthcare in individual patients and populations
Accurately and succinctly communicate case presentations through written and verbal formats in various contexts (inpatient, outpatient, new patient, follow-up).		Direct Observation Tool: Provide and receive the handover in transitions of care	4.5 Maintain comprehensive, timely, and legible medical records 6.6 Coordinate patient care within the health care system relevant to a variety of clinical specialties 6.9 Perform administrative and practice management responsibilities commensurate with one’s role, abilities, and qualifications 7.3 Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the provision of healthcare in individual patients and populations
Participate (with guidance and supervision) in breaking bad news to patients.			4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 4.3 Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics
Demonstrate an appreciation of patient values when communicating with patients in order to understand their goals of care.			2.5 Apply principles of socio-behavioural sciences to the provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care concordance, care adherence and barriers to and attitudes toward care. 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 5.2 Demonstrate compassion, integrity, and respect for others 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law. 5.7 Demonstrate the application of ethical principles to commonly encountered ethical issues such as the provision or withholding of care, confidentiality, informed consent, and including compliance with relevant laws, policies, and regulations
Participate in discussions (with guidance and supervision) about the basic issues regarding advanced directives and/or end-of-life care with patients and their caregivers.			4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds 4.3 Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics 4.4 Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions, including the ability to manage one’s own interpersonal responses 5.2 Demonstrate compassion, integrity, and respect for others 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law. 5.7 Demonstrate the application of ethical principles to commonly encountered ethical issues such as the provision or withholding of care, confidentiality, informed consent, and including compliance with relevant laws, policies, and regulations
Dictate clear, succinct, and timely discharge plans.			4.5 Maintain comprehensive, timely, and legible medical records 6.6 Coordinate patient care within the health care system relevant to a variety of clinical specialties
Hospital Information Systems and Regulatory Documents:
Know and understand the policies around patient privacy and confidentiality of healthcare information			5.4 Demonstrate respect for patient confidentiality, privacy and autonomy 5.7 Demonstrate the application of ethical principles to commonly encountered ethical issues such as the provision or withholding of care, confidentiality, informed consent, and including compliance with relevant laws, policies, and regulations
Demonstrate the ability to operate electronic patient information systems.		Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	3.7 Use information technology and information systems to optimize patient care 6.1 Understand the systems of healthcare, including federal, provincial, municipal and local, and the influences they have on the health of individuals and populations 6.9 Perform administrative and practice management responsibilities commensurate with one’s role, abilities, and qualifications
Demonstrate the ability to write physician orders under supervision.			3.7 Use information technology and information systems to optimize patient care 6.1 Understand the systems of healthcare, including federal, provincial, municipal and local, and the influences they have on the health of individuals and populations 6.9 Perform administrative and practice management responsibilities commensurate with one’s role, abilities, and qualifications
Understand how to complete a death certificate.			6.1 Understand the systems of healthcare, including federal, provincial, municipal and local, and the influences they have on the health of individuals and populations 6.9 Perform administrative and practice management responsibilities commensurate with one’s role, abilities, and qualifications
Demonstrate awareness of hospital policies affecting patient care (e.g., use of restraints, infection control practices).	Clinical Exposure: Patient care policies		6.1 Understand the systems of healthcare, including federal, provincial, municipal and local, and the influences they have on the health of individuals and populations 6.3 Advocate for quality patient care and optimal patient care systems that support patient- and population-centred care that is safe, timely, efficient, effective, and equitable 6.5 Work effectively in various health care delivery settings and systems relevant to a variety of clinical specialties
Demonstrate awareness of regulations concerning psychiatric confinement of medical patients.	Clinical Exposure: Psychiatric confinement of patients		6.1 Understand the systems of healthcare, including federal, provincial, municipal and local, and the influences they have on the health of individuals and populations
Self-directed Learning
Accurately assess own learning needs and set own objectives.			3.3 Set learning and improvement goals 3.4 Identify and perform learning activities that address one’s gaps in knowledge, skills, and/or attitudes
Demonstrate how to set a learning plan through using evidence-based medicine to answer clinically relevant questions.			3.4 Identify and perform learning activities that address one’s gaps in knowledge, skills, and/or attitudes
Demonstrate the application of newly acquired knowledge into patient care.		Final Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review. Mid-Rotation Assessment: Internal Medicine Rotation Domains assessed: Fund of Knowledge, Knowledge Integration, History taking, Clinical Examination, Clinical Management, Learning Skills, Communication Skills, Professional Responsibility and Integrity, Pursuit of Excellence and Insight, Personal Interactions. Essential Clinical Encounters review.	3.6 Locate, appraise, and incorporate evidence from research related to patients’ health problems and the provision of healthcare 3.9 Continually identify, analyze, and implement new knowledge, guidelines, standards, technologies, products, or services that have been demonstrated to improve outcomes
Recognize the limits of one’s own knowledge and seek assistance when required ensuring patient safety is respected at all times.			3.1 Solicit and respond to feedback from peers, teachers, supervisors, patients, families, and members of health care teams regarding one’s knowledge, skills, attitudes and professional behaviours 3.2 Integrate feedback, external measures of performance and reflective practices to identify strengths, deficiencies, and limits in one’s knowledge, skills, attitudes and professional behaviours
Specific Clinical Presentations and Disease Problems in Internal Medicine: Describe key illnesses in the elderly, focusing on their often atypical presentation. (eg. Urinary tract infection, pneumonia, tuberculosis, depression, thyroid disease, myocardial infarction).		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
High Priority Topics
Shortness of breath		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Respiratory failure	Clinical Exposure: Respiratory failure	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Pneumonia	Clinical Exposure: Pneumonia	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Empyema		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Pleural effusion	Clinical Exposure: Pleural effusion	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Asthma	Clinical Exposure: Asthma	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Venous thromboembolism (specifically: deep vein thrombosis and pulmonary embolism)	Clinical Exposure: Venous thromboembolism	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Anemia	Clinical Exposure: Anemia	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Hemolysis		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Vitamin B12 deficiency		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Thrombocytopenia	Clinical Exposure: Thrombocytopenia	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Leukocytosis		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Leukopenia		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Hypo/hypercalcemia	Clinical Exposure: Hypo/hypercalcemia	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Hypo/hypernatremia	Clinical Exposure: Hypo/hypernatremia	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Hypo/hyperkalemia	Clinical Exposure: Hypo/hyperkalemia	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Acid-base disorders	Clinical Exposure: Acid-base disorders	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Hyperlipidemia	Clinical Exposure: Hyperlipidemia	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Coma	Clinical Exposure: Coma	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Seizures	Clinical Exposure: Seizure	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Syncope	Clinical Exposure: Syncope	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Delirium	Clinical Exposure: Delirium	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Dementia	Clinical Exposure: Dementia	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Cerebrovascular disease (including stroke)	Clinical Exposure: Cerebrovascular disease	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Recurrent falls	Clinical Exposure: Falls	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Meningitis	Clinical Exposure: Meningitis	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Peripheral neuropathy		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Upper GI bleeding	Clinical Exposure: Upper GI bleeding	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Lower GI bleeding	Clinical Exposure: Lower GI bleeding	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Hepatitis : acute and chronic	Clinical Exposure: Hepatitis	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Cirrhosis	Clinical Exposure: Cirrhosis	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Spontaneous bacterial peritonitis		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Hepatomegaly		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Splenomegaly		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Jaundice	Clinical Exposure: Jaundice	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Diarrhea	Clinical Exposure: Diarrhea	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Inflammatory bowel disease	Clinical Exposure: Inflammatory bowel disease	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Peptic ulcer disease	Clinical Exposure: Peptic ulcer disease	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Acute pancreatitis		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Acute renal failure	Clinical Exposure: Renal failure	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Chronic renal failure		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Nephrotic syndrome		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Urinary tract infection	Clinical Exposure: Urinary tract infection	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Pyelonephritis		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Fever	Clinical Exposure: Fever	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Dehydration	Clinical Exposure: Dehydration	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Substance abuse (specifically: alcohol, opioids, benzodiazepines)	Clinical Exposure: Required Clinical Presentations and Disease Problems Students are required to demonstrate the competencies and achieve the learning objectives defined in the Learning Objectives Sections for the following Clinical Presentations and Disease Problems	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Adverse drug reactions/drug allergies	Clinical Exposure: Adverse drug reactions/drug allergies	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Shock	Clinical Exposure: Shock	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Edema: generalized or peripheral		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Cardiac arrest	Clinical Exposure: Cardiac arrest	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Chest pain/angina		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Valvular heart disease (specifically: mitral stenosis and regurgitation and aortic stenosis)	Clinical Exposure: Valvular heart disease	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Atrial fibrillation		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Ventricular tachycardia		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Bradyarrhythmias and heart block		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Acute coronary syndrome	Clinical Exposure: Acute coronary syndrome	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Congestive heart failure	Clinical Exposure: Congestive heart failure	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Pericarditis		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Endocarditis		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Hypertension	Clinical Exposure: Hypertension	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Chronic obstructive pulmonary disease	Clinical Exposure: Chronic obstructive pulmonary disease	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Types I and II diabetes mellitus	Clinical Exposure: IDDM and NIDDM	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Hypo/hyperthyroidism	Clinical Exposure: Hypo/hyperthyroidism	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Connective tissue diseases (specifically: systemic lupus erythematosus and rheumatoid arthritis)	Clinical Exposure: Connective tissue diseases	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Septic arthritis/osteomyelitis	Clinical Exposure: Septic arthritis/osteomyelitis	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Gout /pseudo-gout		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Cellulitis	Clinical Exposure: Cellulitis	NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Lymphoma (Hodgkin’s and non-Hodgkin’s)		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Multiple myeloma		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Toxidromes (specifically: aspirin, acetaminophen, opioids, cocaine)		NBME Exam (National Board of Medical Examiners): Internal Medicine National Board MedicalExaminer Subject Examination, a standardized US examination for clinical clerks.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

Second Priority Topics
Lung nodule	Clinical Exposure: Lung nodule		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Bleeding disorders (specifically: TTP/HUS, DIC)	Clinical Exposure: Bleeding disorder		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Headache	Clinical Exposure: Headache		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Obesity	Clinical Exposure: Obesity		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Unintended weight loss	Clinical Exposure: Weight loss		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Thyroid nodule			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Joint pain			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Supraventricular tachycardias (other than atrial fibrillation)			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Valvular heart disease (other than mitral stenosis and regurgitation and aortic stenosis).			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Peripheral vascular disease	Clinical Exposure: Peripheral vascular disease		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Ventricular arrhythmias (other than ventricular tachycardia)			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Sleep apnea	Clinical Exposure: Sleep apnea		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Tuberculosis infection	Clinical Exposure: Tuberculosis infection		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Bronchiectasis	Clinical Exposure: Bronchiectasis		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Lung cancer			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Interstitial lung disease			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Spinal cord compression	Clinical Exposure: Spinal cord compression		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Demyelinating disease			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Parkinson's disease	Clinical Exposure: Parkinson's disease		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Osteoporosis	Clinical Exposure: Osteoporosis		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Osteoarthritis	Clinical Exposure: Osteoarthritis		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Connective tissue diseases (other than systemic lupus erythematosus and rheumatoid arthritis).			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Sexually transmitted diseases including HIV infection.	Clinical Exposure: HIV infection		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Mononucleosis	Clinical Exposure: Mononucleosis		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Anaphylaxis/angioedema	Clinical Exposure: Anaphylaxis/angioedema		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Leukemia (AML, ALL, CML, CLL)			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Renal stones			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Substance abuse (other than alcohol, opioids, benzodiazepines and cocaine)			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Chronic pancreatitis			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Sarcoidosis			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Encephalitis			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Bone marrow failure			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Vasculitis syndromes			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Toxidromes (specifically: tricyclic antidepressants, toxic alcohols, SSRIs).			2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Substance abuse (specifically: cocaine and other non-opioid street drugs)	Clinical Exposure: Substance abuse		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Procedural Skills: Level 1) understand: indications, process, and complications (including how to explain to a patient in order to obtain consent). Need to observe during rotation OR watch video of procedure. Level 2) must assist with OR observe directly (but not expected to perform independently). Level 3) perform proper technique independently under supervision including: addressing patient’s concerns during and after the procedure, and maximizing patient comfort during the procedure
Level 1 Procedural skills - Ultrasound guided:
Thoracentesis	Clinical Exposure: Thoracentesis Simulations: Thoracentesis	Simulation Completion: Thoracentesis	1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Abdominal paracentesis	Clinical Exposure: Abdominal Paracentesis Simulations: Abdominal paracentesis	Simulation Completion: Abdominal paracentesis	1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Central line insertion			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Bone marrow aspiration			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Bronchoscopy			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Lumbar puncture	Clinical Exposure: Lumbar puncture Simulations: Lumbar puncture	Simulation Completion: Lumbar puncture	1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Foley catheter			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Joint aspiration			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Cardiac telemetry			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Level 1 and 2 Procedural skills:
Management of unstable patient			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Code blue			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
IV insertion			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
NG (Nasogastric) insertion	Clinical Exposure: NG (Nasogastric) insertion Simulations: NG (Nasogastric) insertion	Simulation Completion: NG (Nasogastric) insertion	1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Venipuncture	Clinical Exposure: Venipuncture Simulations: Venipuncture	Simulation Completion: Venipuncture	1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Level 1, 2 and 3 Procedural skills:
Arterial blood gas	Clinical Exposure: Arterial blood gas Simulations: Arterial blood gas	Simulation Completion: Arterial blood gas	1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
EKG	Clinical Exposure: EKG Simulations: EKG	Simulation Completion: EKG	1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
Pulse oximetry			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.
BP with manual cuff			1.6 Perform or assist with medical, diagnostic, and surgical procedures considered essential for the area of practice.

Objectives

Linked Activities

Linked Assessments

McMaster Program Competencies

Approach to the Patient

Patient History

Conduct an effective patient interview to elicit appropriate information in patients presenting with the required presentations/conditions listed in the priority topics below.

Clinical Exposure: Patient History

Clinical Skills Practice Sessions: Patient History

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Direct Observation Tool: Obtain a history and perform a physical examination adapted to the patient’s clinical situation

1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests.

4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and sociocultural backgrounds

4.4 Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions, including the ability to manage one’s own interpersonal responses

5.1 Demonstrate accountability to patients, society, and the profession

5.12 Present oneself professionally to patients, families, and members of the health care team

5.2 Demonstrate compassion, integrity, and respect for others

5.4 Demonstrate respect for patient confidentiality, privacy and autonomy

5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including all dimensions of diversity such as those that are included in human rights legislation and federal and provincial law.

5.9 Maintain appropriate boundaries with patients and other professionals

Perform patient interview in a patient centered manner, using verbal and non-verbal means to create an empathetic and respectful environment for a variety of patients (including the frail elderly).