Clinical Skills Integration 200 (201 fall; 202 spring)
Co-Course Director: Robin English, MD
Co-Course Director: Catherine Hebert, MD
CSI 200 is an interdisciplinary course required of second year medical students. This course builds upon the clinical skills and medical knowledge emphasized in year 1. In particular, it builds upon the CSI 100, Human Behavior and Development, and Foundations of Population Medicine and Health Systems courses. Throughout the second year of medical school, students will be expected to advance their clinical skills in the context of the knowledge being taught within the organ systems courses. Basic clinical skills and competencies are emphasized: clinical problem solving, critical thinking, history taking, motivational interviewing, physical diagnosis, procedural skills, critical evaluation of the medical literature, reflection, and professionalism. Successful completion of this course should help prepare students for their third year clerkships and subsequent clinical training.
Course Objectives (with corresponding school of medicine program objectives)
- Gather appropriate patient information from patients via history taking. (from program objective #1)
- Gather appropriate patient information from patients via physical examination. (from program objective #1)
- Demonstrate the ability to make an accurate diagnosis of common conditions using skills of clinical problem solving. (from program objective #2)
- Counsel patients for behavior change in order to prevent health problems, maintain health, or change behavior. (from program objective #3)
- Perform basic procedures in accordance with best practice standards for patient safety and patient comfort.
- Apply knowledge of the pathophysiology, clinical presentation, and diagnosis of common diseases during history taking exercises, DxR write-up exercises, and H&P write ups based on patients encountered in the hospital. (from program objective #8)
- Demonstrate an understanding of the indications, contraindications, safe techniques, and complications of basic medical procedures in the skills laboratory.
- Identify and apply principles of medical ethics, and demonstrate an awareness of state and federal laws that provide the foundation for policies and practices that affect patient care. (from program objective #9)
- Apply knowledge of healthcare services that are aimed at preventing health problems and maintaining good health during motivational interviewing exercises. (from program objective #10)
Practice Based Learning and Improvement
- Review and evaluate appropriate sources of medical information to answer clinical questions related to disease prevention, treatment, or health disparities. (from program objective #13)
- Appraise medical literature using critical thinking skills, knowledge of study design, and basic understanding of statistical methods. (from program objective #14)
Interpersonal Relationships and Communication
- Take a thorough history, while utilizing communication skills taught in CSI 100. (from program objective #16)
- Write an organized and thorough history or present illness. (from program objective #18)
- Write an organized and thorough complete history and physical. (from program objective #18)
- Effectively counsel and educate patients for behavior change. (from program objective #16)
- Maintain integrity and personal responsibility in adherence to course policies and completion of course requirements. (from program objective #19)
- Demonstrate dependability, respectfulness, and responsibility to colleagues when collaborating on work assignments. This includes contributing to the education of classmates and honestly assessing the performance of other team members. (from program objective #20)
Systems based practice
- Propose methods to reduce errors and improve patient safety using principles of quality improvement and outcomes analysis. (from program objective #22)
Personal and professional development
- Engage in activities that promote their personal and professional growth. (from program objective #28)
The course includes five components: Hospital Rounds and H&Ps, Required DxR Write-ups, Clinical Forums, a Longitudinal Selective, and Skills Labs. Each is described below. In addition, students should continue to work with their clinical mentors in ways that are also suggested below.
1. Hospital Rounds and H&Ps
Students are assigned to attend 3 scheduled sessions at internal medicine morning report at either University Medical Center (UMC) or Touro Infirmary. Students will observe formal patient presentations at morning report, and will then go on hospital rounds with a medicine hospitalist ward team. Students will be expected complete two tasks during and after these rounds:
- Practice the following parts of the physical examination under the guidance of faculty, residents or upper level students: head and neck exam (including retinal and tympanic membrane), neurological exam, cardiac exam, lung exam, and abdominal exam.
- Later on rounds, students will be assigned a patient for practice at the complete history and physical (H&P). At their first session, students will be assigned a patient on whom to take a complete history. That history will be written up (along with a problem list and differential diagnosis) and turned into the CSI office within 3 working days. Send a second copy to your House/CSI clinical mentor for review and critique. At the second and third sessions, students will be assigned a patient on whom to take a complete history and physical (excluding the breast, genital, and rectal exams). Each of these H&Ps will be written up (with a problem list and differential diagnosis) and turned in to the CSI office within 3 working days. A copy will be sent to the student’s CSI clinical mentor for review and critique.
Students must attend these scheduled hospital rounds, and complete the write ups in order to successfully complete the course. More detailed instructions about the write-ups will be provided during the course, and can be found elsewhere on the CSI 200 Moodle page. A student schedule for hospital rounds can also be found on the CSI 200 Moodle page.
2. DxR Write-ups for Feedback
Students will complete DxR cases for discussion in their systems courses at various times during the year. Three of the cases (to be determined by the CSI 200 directors) will be selected for write-ups of the history of present illness (HPI), problem list, and differential diagnosis based on these cases. Students will be reminded of the elements and organization of a good HPI, as well as provided with examples. The write ups must be submitted to the CSI 200 office, and they will be evaluated based on a checklist of items that should be included in the HPI. A ‘passing threshold’ of checklist items will be determined for each case based on class performance. Students whose write-ups fall below this threshold will be required to repeat the assignment with another DxR case. Students will receive feedback on their write-ups. Improvement based on this feedback is a professional expectation in the course.
3. Clinical Forums
There will be 13 small group clinical forums throughout the year, and attendance is required. Topics discussed in each forum will correlate with the concurrent systems course. A schedule is posted in the clinical forums section of the course Moodle page. Students will lead several presentations to their group during the course of the year. Each student will do one ‘journal club’ presentation of a primary study. A feedback form is posted on the clinical forums section of the course Moodle page to serve as a guide for the presentation of a paper. Each student will also participate in one counseling exercise in which they will present some background information about a clinical problem, the rationale for physician intervention, and the data regarding the efficacy of the intervention. Then the student will pair up with a partner to demonstrate how to counsel and motivate a patient for behavioral change. A feedback form is posted on the clinical forums section of the course Moodle page to serve as a guide for the counseling exercise. Each student will also pair up with a partner to present a quality improvement proposal to the group. This will also include some background information/data about the scope of the problem (nationally or locally), a proposed intervention to drive improvement in that data at the local or national level, and a discussion about how you would monitor for success. More detailed instructions for all of these presentations will be provided during the course. Each CSI group will be asked to assign specific students to these presentations at the start of the course.
In addition, three forums will focus on history taking (one during the neuro-psych course, one during the pulmonary course, and one during the gastrointestinal course). These sessions will reinforce and advance the history taking skills learned in CSI 100, with additional emphasis on relating the questions you ask to the pathophysiology of disease. Each student will be assigned to role play history taking once during the year.
4. Longitudinal Selective
Each student selects from a list of options to explore an area of interest during the first or second semester. Most options are clinical shadowing experiences. Some are formalized elective courses (End of Life Care, Nutrition, Interprofessional Care Management) that will appear on the student’s transcript. Students may also opt to continue their summer research, with the requirement that they submit an abstract or case report. The time commitment for the shadowing experiences is a minimum of 5 half-days during the semester, but students may go more often if convenient for them and their preceptor. At the end of the semester, students who shadow a practicing physician must reflect on their experience with a short written essay. Topics for this essay might include 1) the application of basic science to clinical practice in the care of a patient the student saw; 2) an ethical dilemma that arose during the care of a patient; or 3) the role of health disparities in the care of a patient. More detailed instructions about the essay can be found on the course webpage. A reflective essay is not required for those students who are taking a formal elective course (or continuing their summer research) as these students will generally have a larger time commitment.
Students should recognize that this selective is an opportunity to explore an area of interest, gain some additional clinical experience, and further their personal and career development. It is not your only opportunity to explore an area of interest. We will do everything we can to give students their first choice of selective, but it will not always be possible to do so.
Students who are having academic difficulty in the second year, or who experienced academic difficulty during the first year, may be asked to work toward improving their academic record as their longitudinal selective. A decision will be reached after discussions between the student, the Office of Student Affairs, and the course directors. If a student is assigned to academic enhancement for their selective, a schedule for meetings with course directors or tutors will be established. This will be a professional expectation (with a time commitment similar to that of other students on the longitudinal selective).
5. Clinical Skills Lab
The Clinical Skills Lab provides hands-on experience and the opportunity for students to practice some basic procedural skills in a safe environment and with focused feedback. Training sessions (venipuncture, lumbar puncture, abnormal heart sounds, arrhythmia recognition and treatment, airway management, simple suturing, GU (foley) catheterization, rectal and pelvic examination, and (optional) surgical scrub) are conducted in the Clinical Skills Lab during the CSI 200 courses. These labs provide supervised practice and assurance of very basic competency in these medical procedures. The procedures and skills taught in the second year have increased complexity from those taught in the first year skills lab sessions. Students must achieve a passing average in the lab in order to pass the CSI 200 courses.
Specific written learning objectives for each of the required lab sessions are available online: http://www.medschool.lsuhsc.edu/medical_education/Undergraduate/CSI/Skills_Lab/CSI_201-202.aspx
Clinical Skills Lab policies and grading guidelines are also available online: http://www.medschool.lsuhsc.edu/medical_education/Undergraduate/CSI/Skills_Lab/Skills_Lab_Policies.aspx
6. Mentorship Rounds
Each student was assigned to a clinical mentor in their CSI small group during year 1. Students should meet with their mentors once each semester (2 times during the year). This can include a clinical experience (e.g. going to a clinic, hospital rounds, surgery, hospital lab, etc) or a ‘check-in’ (discussion about school, academic performance, career planning, etc). In addition, your mentor should review your write-ups (one complete history and two complete history & physicals) with you. Students should use these opportunities to advance their career planning and or to improve their clinical skills.
This is a Pass/Fail course. Students must satisfactorily complete all course requirements listed below, and demonstrate professionalism in order to pass. Failure to complete all requirements in a satisfactory and timely fashion, or unprofessional behavior may result in a failing grade. Students who fail the course will be referred to the Pre-clinical Promotions Committee. Students who fail the course may appeal their grade to the course directors, and eventually to the school administration, in accordance with the guidelines and school policy that can be found on the Student Affairs website: http://www.medschool.lsuhsc.edu/student_affairs/grading.aspx#appeal . This process should begin with an initial informal appeal that consists of a meeting with the course directors. If a student is not satisfied with the outcome of this meeting, a formal written appeal to the course directors should be made within 10 working days of receiving the final grade in the course.
Portfolio of Course Requirements
- Morning Report and Hospital Rounds #1
- Morning Report and Hospital Rounds #2
- Morning Report and Hospital Rounds #3
- History Write-Up (with problem list and differential diagnosis)
- History & Physical Write-Up #1 (with problem list and differential diagnosis)
- History & Physical Write-Up #2 (with problem list and differential diagnosis)
- DxR HPI Write-up #1
- DxR HPI Write-up #2
- DxR HPI Write-up #3
- Counseling or motivational interview in the clinical forums
- Journal club presentation in the clinical forums
- Quality improvement presentation the clinical forums
- History taking interview in the clinical forums
- Longitudinal Selective attendance form
- Written reflection for the longitudinal selective
- Skills Lab 1 - IV and Venipuncture
- Skills Lab 2 - Lumbar puncture
- Skills Lab 3 - Abnormal heart sounds
- Skills Lab 4 - Arrhythmia recognition and treatment
- Skills Lab 5 - Airway management
- Skills Lab 6 - Simple suturing
- Skills Lab 7 - Foley catheterization and rectal/pelvic examinations
As mentioned in the course objectives, professionalism is an expectation of all students and faculty in this course. Exemplary professionalism or lapses in professionalism may be reported to or by the course director. Course directors will follow school policies on professionalism, and
this may include a discussion with the student, and completion of a Physicianship Enhancement Form. The school’s policies on professionalism can be found at:
Attendance at the scheduled hospital rounds, attendance at all clinical forums, and attendance at all skills labs is required in order to pass the course. Students should place these items on their calendar at the start of the semester. Course directors should be notified in advance for unavoidable conflicts, so sessions can be rescheduled ahead of time. If a student misses a clinical forum or hospital rounds because of illness or family emergency, the course directors should be notified as soon as possible so remediation can be scheduled. If a student misses the skills lab due to illness or family emergency, the skills lab director should be notified as soon as possible so the lab can be rescheduled (please see the skills lab policies). Unexcused absences indicate a lack of professionalism.
Books and Resources
- All students should have a copy of Bates Guide to the Physical Examination or another standard text on the physical examination. This should be used as a reference for physical diagnosis rounds. Students should review the chapters that correspond to the systems course they are taking: head and neck, mental status, and nervous system chapters during the neurological-psychiatric systems course; musculoskeletal and skin chapters during the musculoskeletal-dermatologic systems course; cardiovascular and peripheral vascular chapters during the cardiovascular course; thorax and lung chapter during the pulmonary system course; abdomen, male genitalia, female genitalia, anus/rectum chapters during the renal and GI systems courses. Bates is available electronically from the library website (see the Lib Guides page for second year medical school courses.
- Suggested references will be provided for clinical forum exercises.
- A good, quick reference for the clinical approach to common diseases is Harrison’s Manual of Medicine, which is available electronically through AccessMedicine (an electronic database of texts that all students have access to through the library)
For questions about the class schedule, course policies, or grading please contact:
Dr. Robin English (firstname.lastname@example.org)
Assistant Dean, Undergraduate Medical Education
Director, CSI 201 & 202
Alisa Roy, M.Ed. (email@example.com) 568-4620
Coordinator, Undergraduate Medical Education