Transcript Practice of Medicine (POM) INDE 201

Welcome!
Practice of Medicine (POM)
INDE 201
Tracy Rydel, MD
Jacqueline Tai-Edmonds, MD
Course Director, POM Year 1
POM Quarter 1 Director
Clinical Assistant Professor
Clinical Assistant Professor
General Medicine Disciplines
General Medicine Disciplines
(Family and Community Medicine)
(Internal Medicine)
Session Overview
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What is POM and your role in the course?
Introductions to the POM team
Communication Framework
Demonstration Interview
Debrief
Wrap-up
Learning Objectives
At the end of this session, you will be able to:
 Understand the goals, expectations, and sequence
of POM (INDE 201)
 Describe the different components of the INDE
201 course
 Identify key people on the POM team
Developing a professional identity
The journey has already begun
Learning from one another
“Every patient you see is
a lesson in much more
than the malady from
which he suffers.”
— William Osler, from The Student
Life, in Aequanimitas
What Does It Mean To Be A Physician?
What Does It Mean To Be A Physician?
Adult, life-long learning
 Collaborative learning
 Knowledge, skills, and self-awareness
 Awareness of the context of medical practice:
the “themes” of POM
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What Does It Mean To Be A Physician?
History
Exam
Patient
Family
Care Team
Communities
What is POM?
 Six-quarter course spanning
two years
 Pre-clerkship preparation in:
◦ Clinical skills
◦ Clinical problem-solving
◦ Foundations of patient care…
Foundations of Patient Care
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Ethics
Epidemiology
Evidence-based practice
Nutrition
Health policy
Cultural awareness
Psychiatry and behavioral science
Public Health
health policy
psychiatry &
behavioral science
ethics
public health
information literacy
epidemiology
nutrition
Patient – Physician
multicultural
medicine, CAM
Desired outcomes in POM
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Conduct thorough patient interview
Complete an accurate physical exam
of an adult
Synthesize findings
Identify relevant signs & symptoms,
abnormal tests
Construct problem lists
Begin to develop differential
diagnoses
Desired outcomes (continued)
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Discuss ethical/policy implications and ethical
responsibility when science moves forward
Define clinical questions and critically review literature
Recognize health care challenges for elderly and other
special populations
Understand the impact of mental health on well-being
Discuss nutrition in overall health and in prevention and
treatment of obesity, cardiovascular disease, diabetes
Act as change agent in informing health policy
INTRODUCING…
THE POM TEAM
Biomedical Ethics
 Topic lead:
◦ Katrina Karkazis, PhD,
MPH
◦ Danton Char, MD
 TA:
◦ Jason Batten
Biomedical Ethics
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Topics
◦ Intro to Ethical Principles
◦ Privacy and Confidentiality
◦ Informed Consent and Capacity
◦ (additional topics Q3, Q6)
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image source: http://careers.bmj.com/careers/
advice/view-article.html?id=943
Format
◦ Video modules
◦ Case discussions
Clinical Skills
 Topic lead:
◦ Jacqueline
Tai-Edmonds, MD
 TAs:
◦ Nathaniel Fleming
◦ Mia Kanzawa
Clinical Skills
 Topics – Q1
◦ Medical interview
◦ Communication skills
 Format
◦ Small group,
experiential
◦ Peer, SP, real patients
◦ Cardinal Free Clinic
Population Health
Topic lead
◦ Jennifer Newberry, MD, JD
 TA: Jecca Steinberg
 Coordinator: Jorge De Luna,
MPH
 Office of Community Health
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Population Health
 Topics
◦ Individual to population
 Format
◦ Didactic, small group
◦ Community Engagement
Experience
image source: Exworthy M Health Policy Plan. 2008;23:318-327
Psychiatry
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Topic leads:
◦ Chris Hayward, MD,
MPH
◦ Yasmin Owusu, MD
Psychiatry
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Topics
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Behavioral Determinants of Health
Evaluating Alcohol and Drug use
Communication Breakdown Strategies
Models and Access to Psychiatric Care
Format
◦ Didactic
◦ Patient interview observation
source: Addiction Medicine: Closing the Gap between Science and
Practice.
The National Center on Addiction and Substance Abuse at Columbia
University. June 2012.
Quantitative Medicine
 Topic lead:
◦ Rita Popat, PhD
 TA
◦ Justin Norden
Quantitative Medicine
 Topics
◦ Clinical Epidemiology
◦ Biostatistics
 Format: Blended
◦ Video modules
◦ Quizzes
◦ In-class application sessions
Nutrition
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Topic lead:
Christopher Gardner, PhD
Nutrition
 Topics
◦ National
Recommendations
◦ Food Inadequacy
 Format
◦ Didactic / case
vignettes
◦ Online modules
2011
1946
INDE 201 Faculty and Staff
Tracy Rydel, MD
Madika Bryant, MA
Kambria Hooper
Evans, MEd, MA
INDE 201 TAs
Jason
Nathaniel
Justin
Mia
Chase
Jecca
Relationship between E4C and POM
E4C
Foundations of
Patient Care
Clerkship
teaching
Mentoring
Advising
Pre-Clerkship
Clinical Skills
Teaching
Standardized
Patient
POM Core
Faculty
POM
Standardized Patient Program
(photos via Stanford
Ed Tech)
Practical Details
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Syllabus
◦ Coursework: Schedule, assignment, readings
◦ Course requirements, grading, & exam
◦ Equipment: Stethoscope, pen light, ophthalmoscope/ otoscope,
reflex hammer
◦ Assignment, attendance policy
◦ Dress code, professionalism, confidentiality
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Universal Precautions and Needlestick Policy
Small group assignments
HIPAA certification completion: In-class patient interview TODAY
Where am I going on Monday?
2015-16 INDE
W
MON
8:00-13:30
13:30-14:20
14:30-15:50
16:00-17:20
Quantitative Medicine: Overview and Introduction (LK130)
Population Health: Introduction to Clinical Skills: Opening and HPI
Population Health (LK102)
(LK203/LK204, LK205/206,
LK208, LK209)
Clinical Skills: Opening and HPI Population Health: Introduction
(LK203/LK204, LK205/206,
to Population Health (LK102)
LK208, LK209)
TU
Dates to note
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Thanksgiving Break = November 23-27
End-of-Quarter Standardized Patient Assessment
◦ Week of November 30-December 4, Immersive
Learning Center
Written Final Examination
◦ Tuesday, December 8, 9:30 am – 12:30 pm, LK120/130
Looking Ahead: First day of Quarter 2
◦ Monday, January 4, 2016
Equipment
Universal Precautions
Protect you and your patients
• Reduce the risk of transmission of infectious
agents from recognized and unrecognized sources
• Apply to the handling of blood, body fluids*, and
human tissue
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**Universal = use on ALL patients**
Universal Precautions
Use:
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Hand-washing
Mask, eye protection, face shield
Gloves
Gown
In handling:
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Patient care equipment
Linens
Needles, sharp instruments
Direct patient care
Needlestick Protocol
If you believe you have had a significant exposure to blood or
other potentially infectious material (OPIM):
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IMMEDIATELY wash wound or exposed tissue thoroughly
with soap and water.
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Rinse copiously.
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Call The Exposure and Needle Stick hotline
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650-723-8222 then pager 1-STIX
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222 then 1-STIX from hospital or medical school phone
Needlestick Protocol
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You will talk to a staff person 24/7 who is trained and
on call specifically for this purpose. This hotline has
been set up for medical students and Stanford
employees.
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There is no charge for blood tests, medications, or
follow-up care following a blood or OPIM exposure.
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Records are confidential in accordance with applicable
laws.
Take home points
Develop your professional identity
 Promote teamwork
 Value life-long learning:
◦ mentors, peers, and patients
 Develop a toolkit of skills
 Practice, practice, practice!
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Questions
COMMUNICATION MATTERS:
THE ART AND SCIENCE OF
TALKING WITH PATIENTS
Learning Objectives
At the end of this session, you will be able to:
1. Discuss the importance of effective communication in
the medical interview
2. Describe 3 functions of the medical interview
3. Identify specific behaviors within those 3 functions
4. Give productive feedback on that interview
The Medical Interview: Importance
Core clinical skill
 Communication skills are not innate or fixed
 Skills can be learned and improved
 Improve clinical accuracy and outcomes by
learning how and when to use specific
communication techniques
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Maiman, 1988 Lipkin, 1997
Communication Impact
Diagnosis
• Adherence
• Patient health
• Patient satisfaction
• Physician satisfaction
• Malpractice litigation
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Framework for the Medical Interview
Three functions:
1. Building the patient-physician relationship
2. Assessing the patient’s problems
3. Managing the patient’s problems
1. Build a Relationship
Patient-centered
model
 Physician-Patient
partnership
 Families, support
networks,
communities
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image source: https://www.visitorpasssolutions.com
1. Build the Relationship: Emotion Handling
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Partnership
Empathy
Apology
Respect
Legitimization
Support
Coulehan et al, Ann Intern Med 2001;135:221-7; Suchman et al, JAMA 1997;277:678-682.
2. Assessing the Patient’s Problem
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Goal: “collect accurate,
sufficient, and relevant data
from the patient in as
efficient manner as
possible”
Accurate diagnosis and
treatment?
Efficiency vs. accuracy
image source: http://www.letshavefunwithenglish.com
2. Assessing the Patient’s Problem: Tools
Allow the patient to complete his/her opening
statement
 Elicit the full spectrum of patient concerns
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◦ “Door knob questions”
Marvel, et al, JAMA 1999;281:283-287
2. Assessing the Patient’s Problem: Tools
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Open- to closed-ended questioning
Begin with eliciting the initial story
Active listening, minimize interruptions
Clarify, summarize, review to check facts of the story,
invite more
3. Managing the Patient’s Problem
Diagnose
 Educate
 Negotiate a Plan
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image source: http://www.medicinenet.com
End'Quarter'SP'Assessment
Bringing'It'All'Together
Intimate'Partner'Violence
Challenging'Patient'Encounter
Motivational'Interviewing
Structural'Factors'in'Chronic'Illness'Management
Third:Party'Interviewing
Sharing'Information
Review'of'Systems
Social'History'#2
Social'History'#1
Past'Medical'and'Family'Medical'History
Opening'and'HPI
Baseline'Standardized'Patient'Encounter
Good Communication
Easy rule to live by– the patient in front of you is
someone’s mother, father, daughter, son, brother,
or sister
 You are entrusted with this person’s health and
livelihood
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Interview observation
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Write down specific examples of physician
behaviors in each of “three functions”
◦ Building relationship
◦ Assessing problems
◦ Managing problems
Feedback
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Keep
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Stop
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Start