Science and Practice of Medicine (SPM) 200
Isidore Cohn, Jr., M.D. Student Learning Center

SPM 200 is an interdisciplinary course required of all second year medical students.  It continues the clinical education of medical students that began in the first year with SPM 100. The course aims to integrate clinical medicine with the basic science curriculum (microbiology, pathology, and pharmacology).  Basic clinical skills and competencies are emphasized: clinical problem solving, critical thinking, procedural skills, and professionalism.  The course also assesses fundamental knowledge of clinical medicine and community health via multiple choice exams. 

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, diagnosis, and treatment of diseases in the following categories: acute and chronic respiratory disease, acute and chronic cardiac disease, central and peripheral neurologic disease, acute and chronic infectious disease, gastrointestinal bleeding, acute and chronic abdominal disease, hematologic and malignant disease, endocrine disease, musculoskeletal and rheumatologic disease. (from institutional program objective #2)
2. Students must demonstrate an understanding of the indications, contraindications, safe techniques, and complications for basic medical procedures.
3. Students must be able to 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 institutional program objective #3)
4. Students must demonstrate knowledge of healthcare services that are aimed at preventing health problems and maintaining good health. (from institutional program objective #7)

Patient Care

1. Students must demonstrate the ability to gather appropriate patient information from patients via history taking and physical examination. (from institutional program objective #5)   
2. 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)
3. 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

1. Students must demonstrate the ability to find, review, and evaluate appropriate sources of medical information to answer clinical questions related to disease prevention or treatment. (from institutional program objective #11)
2. Students must know how to appraise medical literature using critical thinking skills, knowledge of study design, and basic understanding of statistical methods.  (from institutional program objective #12)

Interpersonal Relationships and Communication

1. Students must demonstrate effective working relationships and communication with team members when finding, evaluating, and presenting answers to clinical questions.   (from institutional program objective #16)

Systems Based Practice

1. Students must demonstrate a basic understanding of the healthcare system as a whole, the types of delivery systems, differing payment methods, the roles of other health care providers, and the use of systems methods to reduce errors and improve patient safety. (from institutional program objective #17)

Professional Behavior

1. Students must maintain integrity and personal responsibility in adherence to course policies and completion of course requirements.  (from institutional program objective #19)
2. Students must demonstrate dependability, respectfulness, and responsibility to their colleagues when collaborating on work assignments.  This includes contributing to the education of classmates and honestly assessing the performance of other team members. (from institutional program objective #20)

COURSE DESCRIPTION

SPM 200 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 sophomore 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; the underlying pathophysiology, microbiology, or pharmacology that is pertinent to the case; and fundamental approaches to empiric decision-making and patient management.  After completing each case, the entire class meets for a clinical discussion.  Common mistakes in diagnosis or management 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.

Clinical Forums

Population medicine, community health, disease prevention, epidemiology, biostatistics, evidence-based medicine, and medical informatics are taught through a combination of didactic lectures and small group sessions.  Basic principles are taught in a series of lectures.  Students meet in small groups regularly throughout the year.  Each student brings his/her laptop computer to these small group forums.  The forums consist of 7 modules. The first five cover problem areas identified by the U.S. Department of Health and Human Services in Healthy People2020.  The last two modules examine the health care system as a whole and systems based mechanisms to improving healthcare quality, patient safety, and reducing cost.  While working through each module, students learn how to search for appropriate medical information (librarians will meet with each group on a regular basis), read some seminal papers, discuss case vignettes, and research a question related to the topic of discussion.  At the end of each module, several groups meet together to give presentations in a “symposium” format.  Faculty members moderate the symposium, discuss the major learning objectives, and provide feedback on student presentations.  Two additional sessions are devoted to a discussion of health law and medical ethics.

More detailed instructions and learning objectives for each of the modules are available online.

Skills Lab

This component 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 area.  Eight training sessions (heart sounds, EKG interpretation, trauma resuscitation, NG tube and airway management, GU catheter, venipuncture/IV, local anesthesia, and lumbar puncture) 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.  The procedures and skills increase in complexity from those taught in the first year sessions.  Students will become familiar with procedures and protocols for Advanced Cardiac Life Support (ACLS) in the spring semester.

Specific written learning objectives for the skills labs are available online (see SPM 200 Clinical Forums).

History taking and physical examination skills are also taught in the second year as part of the Introduction to Clinical Medicine Course which is taught by the Department of Medicine. 

RECOMMENDED TEXTBOOKS

• Cecil’s Essentials of Medicine, 8th edition. Andreoli TE, et al. edited.  2010. 
  WB Saunders, Philadelphia, PA.
• High-Yield Biostatistics, 3rd edition.  Glaser AN.  2005.  Lippincott Williams and Wilkins, Philadelphia, PA.
• AHA Handbook of Emergency Cardiovascular Care for Healthcare Providers, 2010(to be purchased prior to ACLS lectures in the spring semester).
• Bates Guide to Physical Examination and History Taking (recommended for SPM 100) will also be used extensively for this course.

SPM 200 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.  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 reflected in written comments that will appear in your MSPE letter when applying to residency programs.
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; in some cases it may entail repeating the entire sophomore 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.
5. Notification of schedule changes and other important announcements regarding the course will be made by email from the course director or 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 200 course.  Details of how each of the four grades is calculated are provided below.

Exam Grade

Questions from the introductory lectures, DxR case discussions, biostatistics and epidemiology lectures, and core topics presented in the clinical forums will appear on SPM 200 examinations which are given in conjunction with exams in other courses.  There are 6 exams over the duration of the year and they are weighted as follows when calculating your exam average:

              Exam 1                             10%

              Exam 2                             10%

              Exam 3 (midterm)              25%

              Exam 4                             10%

              Exam 5                             10%

              Exam 6 (final)                    35%

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

DxR Grade

Each DxR case is graded.  Your lowest score for the year will be dropped and an average will be calculated from the remaining cases.  An average below 70 is fail; 70 – 81 is pass; 82 – 87 is high pass; and > 88 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.

Attendance at all case discussions is expected and 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. Medical illness orfamily/personal emergencies are reasonable excuses for missing a case discussion, but the course director should be notified as soon as possible in the event of an excused absence. If a student has more than one unexcused absence, the highest grade he/she can receive for this component of the course is a pass.  If a students misses more than 25% of the DxR case discussions for any reason, he/she will fail the SPM 200 course.

Clinical Forum Grade

Each student is required to take a leading role in at least one presentation during the year.  These presentations will be graded.  In addition, each student will be evaluated by his or her small group peers at the end of the year. (See Overview of SPM 200 Clinical Forums for these evaluation forms).   50% of the clinical forum grade will come from the presentation, 25% will come from an online library informatics test in the fall and spring semesters, and 25% will come from the peer evaluations.

Students are expected to attend and participate in all clinical forums with their assigned group.  Medical illness or family/personal emergencies are reasonable excuses for missing a clinical forum session, but remediation (usually in the form of a written paper) will be required. Please notify the course director as soon as possible if you miss a clinical forum session.  Unexcused absences from the clinical forums will require remediation (usually in the form of a written paper) and may result in a reduction of your grade for this component of the course. If a student has more than one unexcused absence, the highest grade he/she can receive for this component of the course is a pass.  If a student has more than two unexcused absences from the clinical forum sessions, he/she will fail the SPM 200 course.

Skills Lab Grade

Successful completion of all skills labs is a requirement to pass the SPM 200 course.  Ttardiness 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.  Professional behavior is expected at all times.  The final grade in the skills lab is comprised as follows:

          50% from the cumulative score on your pre-tests and post-test

          50% based on professionalism

Unacceptable behavior in the lab, tardiness for a scheduled lab, failure to complete your pre-test, photocopying another student’s pre-test or allowing another student to photocopy your 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 your professionalism score.    (See Clinical Skills Lab policies for more details about the grading and requirements for this component of the SPM 200 course.)

For questions about the class schedule, course policies, or grading please contact:

Dr. Richard DiCarlo (rdicar@lsuhsc.edu)

Assistant Dean, Undergraduate Medical Education

Director, SPM 200

 Or

Jennifer Jeansonne (jjean2@lsuhsc.edu)

Coordinator, Undergraduate Medical Education

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