Science and Practice of Medicine 100
Isidore Cohn, Jr., M.D. Student Learning Center

SPM 100 is an interdisciplinary course required of all first year medical students.  The course aims to integrate clinical medicine with the basic science that students are learning in the mornings (anatomy, histology, biochemistry, physiology).  Basic clinical skills and competencies are emphasized: history taking, clinical problem solving, critical thinking, procedural skills, and professionalism.  The course also assesses fundamental knowledge of clinical medicine, medical ethics, and doctor-patient communication via multiple choice examinations. 

COURSE OBJECTIVES

Medical Knowledge

1. Students must demonstrate knowledge of common disease processes encountered in the clinical sciences to a degree commensurate with their level of training.  This includes a basic understanding of the pathophysiology, clinical presentation, and diagnosis of diseases in the following categories: musculoskeletal disease, acute respiratory disease, acute and chronic cardiac disease, central and peripheral neurologic disease, acute infectious disease, acute and chronic abdominal disease, hematologic and malignant disease (from institutional program objective #2)
2. Students must demonstrate an understanding of the safe techniques for and complications of basic medical procedures, including basic life support, sterile technique, simple suturing, and cardiac monitoring.
3. Students must be able to identify and apply principles of medical ethics to patient care (from institutional program objective #3)

Patient Care

• Students must demonstrate the ability to gather appropriate patient information from patients via history taking and physical examination. (from institutional program objective #5)   

1. Students must demonstrate the ability to make an accurate diagnosis of common conditions listed above using skills of clinical problem solving. (from institutional program objective #6)
2. Students must demonstrate the ability to perform basic procedures in accordance with best practice standards for patient safety and patient comfort.

Practice Based Learning and Improvement

• Students must use appropriate sources of medical information to answer clinical questions related to the diagnosis of disease (from institutional program objective #11)

Interpersonal Relationships and Communication

• Students must demonstrate effective working relationships and communication with team members when participating in small group discussions and role play exercises.  (from institutional program objective #16)

Professional Behavior

• Students must maintain integrity and personal responsibility in adherence to course policies and completion of course requirements.  (from institutional program objective #19)

1. Students must demonstrate dependability, respectfulness, and responsibility to their colleagues when participating in small group discussions and role play exercises.  (from institutional program objective #20)

•  Students must understand their own limits and ensure their own competence.  (from institutional program objective #21)

COURSE DESCRIPTION

SPM 100 consists of three components which are described below. 

DxR Computer-based Cases

Computer-based cases are assigned to all students on a weekly basis.  These assignments ensure that students develop some skill at clinical problem solving.  Cases are selected to reflect complaints that are commonly seen in clinical practice.  They are also selected to reinforce concepts learned in the basic science classes.  As students progress through the freshman year, they are expected to demonstrate a higher level of proficiency in solving the cases.  Learning objectives focus on the history and physical findings that are pertinent to the patient’s complaint, the differential diagnosis for the patient’s clinical presentation, and the underlying anatomy, biochemistry, or physiology that is pertinent to the case.  After completing each case, the entire class meets for a clinical discussion.  Common mistakes in diagnosis and evaluation are addressed. Over the year-long course, students are exposed to many clinical cases and witness a variety of expert approaches to clinical problem solving.  Repeated active working of these cases allows students to develop their own problem solving skills.

Specific learning objectives for each case are provided at the time of the case discussion.  These objectives and lecture content are the basis for examination questions.

Clinical Forums

Medical ethics, professionalism, patient-physician communication, human development, social issues, and cultural competency lend themselves to discussion in a small group format. These and other topics are addressed in a longitudinal series of small group seminars with clinical faculty.  Groups contain 12-13 students and meet regularly throughout both semesters.  Role-playing is often employed to illustrate important concepts about the patient-physician relationship and history taking.  The continuity of discussions from one seminar to the next, reading assignments, and active learning on the part of the students are expected. The overall goals of the clinical forums are:

• To teach professionalism and encourage a collegial atmosphere among fellow students and with the faculty. 
• To develop competence in the fundamental interpersonal skills necessary to be a good physician: interviewing techniques, cultural awareness, handling difficult patient situations, giving bad news, discussing end of life issues and spirituality.
• To foster the development of independent, lifelong learning skills.
• To have a basic understanding of the following areas as they relate to the practice of clinical medicine:
• the patient-physician relationship
• behavioral science and human development
• medical ethics
• social and cultural issues that impact on the patient-physician relationship

Specific learning objectives and assigned readings for each clinical forum are provided on the SPM 100 website.  These objectives and assigned readings are the basis for examination questions.

Clinical Experience / Skills Lab

The Clinical Skills Lab section of the course provides hands-on experience and the opportunity for students to practice the skills of clinical medicine with focused feedback in a safe arena.  Seven training sessions (sterile technique, vital signs, basic life support, c-spine immobilization, cardiac monitoring, simple suturing, and emergency assessment) are conducted in the Clinical Skills Lab (see Skills Lab policies).  These labs provide supervised practice and assurance of student competency in basic medical procedures. 

Basic physical examination skills (heart and lung, head and neck, and abdomen) are also taught in this course.  All students arrange a one-week preceptorship with a primary care physician at the beginning of the second semester, at which time they practice the history taking and physical examination skills learned in the first semester.

Specific written learning objectives for each skills lab and physician examination session are available on the SPM 100 website.  These objectives and assigned readings are the basis for examination questions.

REQUIRED TEXTBOOKS

• Bates Guide to Physical Examination and History Taking, 10th Edition. Lynn S. Bickley, Peter G. Szilagyi. 2009. Lippincott Williams and Wilkins, Philadelphia, PA.
  
• The Medical Interview: Mastering Skills for Clinical Practice, 5th Edition; John L. Coulehan and Marian R. Block; F.A. Davis Company; 2006.
  
• Resolving Ethical Dilemmas: A Guide for Clinicians, 4^th Edition. Bernard Lo. 2009. Williams and Wilkins, Baltimore, MD.
  
• Basic Life Support for Healthcare Providers; American Heart Association, Dallas TX.  This book will be provided as part of the skills lab.

Other required readings for Clinical Forums are provided on the SPM 100 website.

SPM 100 GRADING AND POLICIES

1. Students will receive a grade of honors (3 points), high pass (2 points), pass (1point), or fail (0 points) for each component of the course: exams, DxR cases, skills labs, and clinical forums.  These scores will be used to calculate the final grade for the course.
2. When calculating the final grade for the course, each component will be weighted as follows:

Exams                  40% (1.2 points for honors, 0.8 points for high pass, 0.4 points for pass)

DxR                      20% (0.6 points for honors, 0.4 points for high pass, 0.2 points for pass)

Skills lab               20% (0.6 points for honors, 0.4 points for high pass, 0.2 points for pass)

Clinical forum         20% (0.6 points for honors, 0.4 points for high pass, 0.2 points for pass)

The final grade will be calculated as follows:

                            Honors                             2.6 – 3.0 points

                            High Pass                        2.0 – 2.4 points              

                            Pass                               1.0 – 1.8 points

1. Students must receive a passing grade for each of the components listed above in order to pass the course. Students must also meet attendance requirements to receive the grade they achieve.  (See Attendance Policies below)   A failing average/grade in any of these 4 areas will result in an overall failing grade for the course.
2. Professionalism is expected at all times.  This includes adherence to all course policies and your interactions with faculty, staff, patients, hospital staff, and your classmates.  Unprofessional behavior may be addressed by the completion of a Physicianship Evaluation Form by the course director or a referral to the Council on Professional Conduct.  A pattern of unprofessional behavior may be reflected in written comments that will appear in your MSPE letter when applying to residency programs.  (See Physicianship and Medical Professionalism on the UME website for more details regarding this process). 
3. Students who fail the course will be discussed at a meeting of the Pre-clinical Sciences Promotions Committee in the spring.  Remediation will be required and will depend on the portion of the course that is failed; in some cases it may entail repeating the entire freshman year in keeping with the school’s promotions policies.
4. Students may request to discuss their grades on examinations, DxR cases, or other components of the course by contacting the course director via email.  Students who are struggling in the course are strongly encouraged to meet with the course director to discuss improvement strategies.
5. Notification of schedule changes and other important announcements regarding the course will be made by email from the course director or undergraduate medical education coordinator.  

The conscientious student who attends all required sessions and makes a reasonable effort to prepare ahead of time should have little difficulty passing the SPM 100 course.  Details of how each of the four grades is calculated are provided below.

Examination Grade (40% total grade)

Multiple choice examination questions will be based on information from the lectures, DxR case discussions, skills labs, physician examination sessions, clinical forums, and all assigned readings for the above sessions.  Examinations will be given in conjunction with the basic science lectures throughout the year, with the exception of the first exam in the spring, at which time no SPM exam will be given.  Consequently, there are 5 exams over the duration of the year and they are weighted as follows when calculating your exam average:

              Exam 1                                                                                       15%

              Exam 2                                                                                       15%

              Exam 3 (midterm – cumulative for semester)                                   25%

              Exam 4                                                                                       15%

              Exam 5 (final) – cumulative for year)                                               30%

An exam average of 90 – 100 is honors; 80 – 89 is high pass; 65 – 79 is pass; and <65 is fail.

DxR Grade (20% total grade)

Each DxR case is graded.  The grades will be calculated by a software program.  The grade for each case will be primarily based on the student’s thinking process, as evidenced by the historical information, patient examination, and laboratory data the student requests, rather than whether or not the student arrives at the correct diagnosis.  A student’s lowest grade for the year will be dropped and an average will be calculated from the remaining cases.  An average below 70 is fail; 70 – 80 is pass; 81 – 88 is high pass; and > 89 is honors.  All DxR cases must be completed by 7:00 AM on the morning that they are due.  Failure to complete a case on time can result in a grade of 0 for that case.

Clinical Forum Grade (20% total grade)

Students will be evaluated by their small group faculty member based on their performance in the small group sessions.  Students will receive a numerical score based on their interviewing ability, professionalism, and understanding and application of ethical principles to patient care. 

General professional expectations of students include: 

• Attendance at and participation in one’s own small group forums.
• Preparation for and meaningful contribution to discussions.
• Participation in role-playing of physicians and patients.

The final two sessions for the year will be devoted to observing each student perform a complete history which will incorporate all of the interviewing skills learned throughout the year.  This final observation will be scored according to the checklist included in the required observed competency booklets.   A perfect score is 10 points.   The course director will assign a forums grade based on this score and the score given on the evaluation form.

Excused absences for the forums include family or medical emergencies, other unforeseen emergencies, and school-related travel or other school-related responsibilities.  All other absences are considered unexcused.  An excused absence requires that the student notify both his/her faculty group leader and the course director via e-mail or phone as soon as possible.  If it is possible to attend another session that week, this will be allowed for excused absences only.  This is the only allowance for attendance of another group’s session.  If it is not possible to attend another session, the student must remediate the session by preparing a paper with the following expectations:

- For Clinical Forums: Write a 3 page paper on a topic related to the learning objectives for that session (student’s choice) to be submitted to the faculty group leader and the course director within 2 weeks of the missed session.

- For Ethics Forums: Prepare an original case on the ethics topic of the missed session and discuss the ethical issues raised by the case, then submit to Joanne Marier for discussion within two weeks of the missed session.

If a student with an excused absence sufficiently remediates the absence in accordance with the above requirements, his/her grade for the forums will not be affected.  If a student has one unexcused absence or does not sufficiently remediate an excused absence, the highest grade he/she can receive for the forums component of the course is a “Pass”.  If a student has more than one unexcused absence, a grade of “Fail” for the forums (and subsequently the SPM 100 course) will be assigned. 

Unprofessional behavior for the forums, including unexcused absences or failure to properly remediate excused absences, will be addressed immediately. In such cases, the course director will meet with the student and complete a Physicianship Evaluation Form (PEF) or refer the student to the Council on Professional Conduct, as previously discussed. 

Skills Lab Grade (20% total grade)

Successful completion of all skills labs is a requirement to pass the SPM 100 course.  Any tardiness or absence must be remediated.  All pre-tests must be completed prior to attending each of the scheduled lab sessions, and a printed copy must be turned in to the skills lab coordinator, Mr. Daryl Lofaso.  Professional behavior is expected at all times.  The final grade in the skills lab is comprised as follows:

50% from the cumulative score on pre-tests and practical quiz

50% based on professionalism

Unacceptable behavior in the lab, tardiness for a scheduled lab, failure to complete one’s pre-test, photocopying another student’s pre-test or allowing another student to photocopy one’s pre-test, unexcused absences from a schedule lab, failure to turn in competency slips on time, and failure to complete remediation assignments on time will all result in deductions from the professionalism score.    (See Clinical Skills Lab policies for more details about the grading and requirements for this component of the SPM 200 course.)

Attendance Policies

There are a total of 26 lectures for SPM 100 throughout the year, including introductory lectures, DxR case discussions, and special topic lectures in the spring.  Students are strongly encouraged to attend all lectures because of the clinical nature of the discussions, which may be difficult to fully learn from reading materials; however, they are required to attend 21 of these lectures (80%) in order to receive their overall grade in the course.   Failure to attend 21 of the 26 lectures will result in a lowering of the overall SPM 100 grade to a Pass.  Attendance at all lectures will be recorded by use of a sign-in sheet.  Honesty in filling out the sign in sheet is one of the professional expectations for the course.  Signing in for a colleague or signing in and then leaving are considered significantly unprofessional behaviors and will be addressed immediately. 

Attendance policies for the clinical forums and clinical skills lab are outlined above.  Students must also attend all physical examination sessions and must adhere to any policy regarding attendance as determined by their clinical preceptors in the spring.

Review of Professionalism Expectations

Fulfillment of all attendance policies

• Timely remediation of absences when required
• Honesty and integrity in all documentation
• Signing in for lectures
• Completing one’s own skills labs pre-tests
• Maintaining honor code when taking examinations
• Completing course and faculty evaluations
• Respect for fellow students, administrative staff, and faculty
• Persistent motivation to learn in order to ensure competence
• Active participation in all learning activities
• Seeking help with needed

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