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Educational Program Objectives

Introduction

How do administrators, faculty members and students know that an FSU COM student has successfully completed the education program and is eligible to graduate with the degree "Doctor of Medicine"? Currently, the answer to that question is, "When the student has: 1) passed all courses and clerkships; 2) passed Step 1, Step 2-CK and Step 2-CS of the United States Medical Licensing Examinations; and, 3) avoided serious reprimand for unprofessional behavior."

Though these global criteria for graduation provide some assurance that graduates from FSU COM have achieved certain benchmarks, they provide little specific detail about what each graduate has accomplished and can be expected to do—specifically, what levels of professional performance a graduate has demonstrated. The education program objectives (competency statements) below specifically state what students must demonstrate prior to graduation.

These education program objectives (competency statements) also help organize, coordinate and integrate the often independent pieces of the FSU COM education program—courses and clerkships, lectures, small groups, laboratory experiences, simulations, self-directed learning exercises, etc.—to assist faculty in structuring educational activities, specific learning objectives and assessments that enable students to achieve and document successful completion of these education program objectives.

The Competency Domains

The education program objectives (competency statements) for the FSU COM are organized into 6 competency domains, consistent with the 6 general competencies of the Accreditation Council for Graduate Medical Education. These competency domains are: 1) Patient Care; 2) Medical Knowledge; 3) Practice-based learning and improvement; 4) Interpersonal and communication skills; 5) Professionalism; and, 6) Systems-based practice.

The unique mission* and vision** of the COM highlight two concepts that require special emphasis within the 6 competency areas. These two concepts are "patient-centered care" and "communities of greatest need".

Patient-centered care is medical care where each patient is respected and treated as the ultimate expert on him/herself. To operationalize the concept of patient-centered care, both the provider and the system must demonstrate awareness and responsiveness to each patient's "unique context", and show consideration for his/her preferences, needs and values. Additionally, the practitioner must be willing to share decision-making and collaborate with the patient to design and implement a unique and personalized plan of care.

Communities of greatest need are those traditionally medically-underserved groups within the state of Florida: elderly people, rural residents, members of under-represented minorities and urban poor.

Both of these concepts—patient-centered care and communities of greatest need--are central to the mission and vision of the FSU COM and must be consistently articulated within our education program objectives (competency statements) and regularly assessed in our students.

Competency Domain 1: Patient Care

General Competency Statement:Students must be able to appropriately engage and evaluate patients, developing and communicating differential diagnoses and initial management plans for patients who present with commondiseases/conditions or requests for health maintenance services.

This domain involves building professional relationships with patients and other health care professionals, gathering appropriate clinical information, analyzing and processing this information, identifying likely diagnoses, and, creating an initial plan for appropriate diagnostic and therapeutic interventions.

  Education Program Objectives (Competency Statements) Suggested Assessment
A. Demonstrate the ability to assess the "patient's unique context" (including family, community, cultural, spiritual, historical and legal factors) and incorporate that information into his/her care. Reflective writing, Observation by doctoring faculty, Observation by standardized patients, Observation by clerkship faculty, OSCE, Small group exercises.
B. Organize and conduct a medical encounter, including the use of an appropriate greeting/opening, gathering information and providing closure. Observation by Doctoring faculty, Observation by standardized patients, Observation by clerkship faculty, OSCE, Small group exercises.
C. Demonstrate the ability to elicit an accurate and thorough medical history appropriate for the patient's reason for visit. Observation by Doctoring faculty, Observation bystandardized patients, Observation by clerkship faculty; OSCE; Small group exercises.
D. Conduct accurate and thorough physical and mental status examinations appropriate for the patient's reason for visit. Observation by Doctoring faculty, Observation by standardized patients, Observation by clerkship faculty, OSCE, Small group exercises.
E. Recognize physical exam findings that are common variations of "normal" and those physical exam abnormalities that are frequently found in patients with common diseases/conditions. Observation by Doctoring faculty, Observation by standardized patients, Observation by clerkship faculty, OSCE, Small group exercises, simulation activities.
F. Understand the purpose and limitations of screening and diagnostic tests and utilize this understanding appropriately in clinical situations. Observation by Doctoring faculty, Observation by clerkship faculty, OSCE, Small group exercises.
G. Demonstrate the ability to assess a patient's functional capacity. Observation by Doctoring faculty, Observation by standardized patients, Observation by clerkship faculty, OSCE, Small group exercises.
H. Demonstrate the ability to clearly and accurately summarize patient findings in verbal presentations and common written formats. Observation by Doctoring faculty; Observation by clerkship faculty, OSCE, Small group exercises.
I. Describe the indications and complications for all required procedures, and demonstrate the appropriate techniques when performing these procedures. Observation by Doctoring faculty; Observation by clerkship faculty; OSCE; simulation activities
J. Formulate accurate clinical hypotheses (differential diagnosis) based on an analysis of the patient's clinical presentation, the "patient's unique context" and knowledge of clinical epidemiology. Observation by Doctoring faculty; Observation by clerkship faculty; OSCE; small group exercises.
K. Negotiate a plan of care with the patient utilizing shared decision-making techniques. Observation by Doctoring faculty; Observation by clerkship faculty; OSCE; small group exercises.
L. Demonstrate the ability to employ a comprehensive, integrated and multidisciplinary approach to the care of patients. Observation by Doctoring faculty; Observation by clerkship faculty; OSCE; small group exercises.
M. Demonstrate appropriate medical records skills:
  1. Utilize an electronic health record;
  2. Record a comprehensive evaluation of a new patient, including the creation of a patient problem list;
  3. Record an organized and complete patient progress note appropriate for the patient's presentation and setting;
  4. Record a patient treatment/management plan ("set of orders") appropriate for the patient's presentation and setting.
Observation by Doctoring faculty; Observation by clerkship faculty; OSCE; small group exercises.
N. Demonstrate the ability to:
  1. educate patients about their health.
  2. assist patients who want to change health behaviors.
  3. assess and encourage patient adherence.
Observation by Doctoring faculty; Observation by clerkship faculty; OSCE; small group exercises.
O. Apply evidence-based information to identify and implement preventive services that are appropriate for the patient's age and gender. Observation by Doctoring faculty; Observation by clerkship faculty; OSCE; small group exercises.

Competency Domain 2: Medical Knowledge

General Competency Statement:Students must be able to explain the basis for medical practice at the molecular, cellular, organ, whole body, environmental and psychosocial levels for states of health and disease based upon current understanding and emerging advances in contemporary medicine. Students must be capable of using this information to diagnose, manage and present the common health problems of individuals, families, and communities. Students should be able to develop a differential list, obtain additional investigations, choose and implement interventions with consultation and referral as needed. In addition, students must be able to propose a diagnosis, analyze the outcomes of interventions, utilize prevention strategies, monitor patient progress, share information with others, and adjust therapy according to results.

  Education Program Objectives (Competency Statements) Suggested Assessment
A. Describe the development, structure and function of the healthy human body and each of its major organ systems at the macroscopic, microscopic, and molecular levels. Observation by faculty, quizzes, internal and external examinations, OSCE’s, presentations and small group exercises.
B. Recognize and discuss the implications of altered structure and function (pathology and pathophysiology) of the body and its major organ systems that are seen in various diseases and conditions. Observation by faculty, quizzes, internal and external examinations, OSCE’s, presentations and small group exercises.
C. Identify changes in the structure and function of the human body associated with the aging process and be able to distinguish normal changes associated with aging from those that denote disease. Observation by faculty, quizzes, internal and external examinations, OSCE’s, presentations and small group exercises.
D. Describe basic bio-behavioral and clinical science principles used to analyze and solve problems related to the diagnosis, treatment and prevention of disease.

Observation by faculty, quizzes, internal and external examinations, OSCE’s, presentations and small group exercises.

Student oral presentations critiqued through faculty and peer feedback.

E. Recognize the scientific basis of health, disease, and medicine in the management of common, chronic and high impact medical conditions. Observation by faculty, quizzes, internal and external examinations, OSCE’s, presentations and small group exercises.
F. Describe normal human psychosocial development across the life-span and recognize deviations requiring further evaluation and intervention.  Observation by faculty, quizzes, internal and external examinations, OSCE’s, presentations and small group exercises.
G. Discuss the application of psychodynamic theories of human thought and behavior in describing and analyzing patient behavior.  
H. Demonstrate the effective use of pharmocotherapeutic agents and other therapeutic modalities.  
I. Demonstrate the ability to acquire new data and information and to critically appraise its validity and applicability.  

Competency Domain 3: Practice-Based Learning & Improvement

General Competency Statement: Students must be able to investigate and evaluate patient care practices, appraise and assimilate scientific evidence to improve patient care practices. Students must: 1) analyze practice experience using a systematic methodology; 2) locate, appraise and assimilate evidence from scientific studies related to their patients' health problems; 3) obtain and use information about patients population; 4) apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness; 5) use information technology to manage information and access on-line medical information in support of their own education and the learning of other students.

  Education Program Objectives (Competency Statements) Suggested Assessment
A. Employ the principles of Practice-based Quality Improvement, including the investigation, evaluation and systematic analysis of one's clinical practices and practice population.

Graduation OSCE

Written reflections

B. Obtain and utilize public health information (demographic, cultural and socioeconomic information) to improve the health of the community and/or practice.

 Written reflections with portfolio entry and feedback.

Summative OSCE

C. Recognize and demonstrate the ability to address the unique needs of patients from underserved environments Written reflections with portfolio entry and feedback.
D. Apply the principles and methods of Evidence-Based Medicine to acquire, appraise, and assimilate new clinical information to improve patient care. Summative OSCE; Written reflections with portfolio entry and feedback; Graduation OSCE
E. Demonstrate knowledge of learning styles, preferences or strategies to facilitate lifelong learning.  Written reflection in Doctoring 1 course with
portfolio entry and feedback
F. Demonstrate knowledge of the occurrence of medical errors/adverse events throughout the continuum of care or demonstrate appreciation for the culture of patient safety. Knowledge?based examinations; Written reflections in Health Issues course

Competency Domain 4: Interpersonal & Communication Skills

General Competency Statement: The ability to engage and communicate with a patient and to build a physician-patient relationship for the purposes of information gathering, guidance, education, and support. This competency includes the ability to interact with patients and their families under a broad range of personal and clinical circumstances. It necessarily includes the ability to also build effective* relationships with peers, teachers, healthcare professionals, and others who may be involved in the care of patients and in the education thereof. (From: AAMC Recommendations for Clinical Skills Curricula for undergraduate medical education. *our addition)

  Education Program Objectives (Competency Statements) Suggested Assessment
A. Demonstrate respect, empathy, compassion, responsiveness and concern regardless of the patient's problems, personal characteristics. Standardized patient interactions in Doctoring 1 and 2 courses with both patient feedback and faculty facilitator feedback
B. Communicate diagnostic information and reasoning, intervention options, and a suggested plan of care with truthfulness, sensitivity and empathy. Peer and self?assessment of skill in small group interpersonal communication
C. Demonstrate effective oral communication skills with colleagues and other health professionals. Formative OSCE performance with feedback from both patients and faculty observers; Summative OSCE
D. Demonstrate effective written communication with colleagues and other health professionals. Written assignments in multiple course
E. Demonstrate appropriate and effective use of alternative communication methods including but not limited to telephone and electronic methods. Formative OSCE performance with feedback from both patients and faculty observers; Summative OSCE
F. Evaluate health literacy by assessing patient's comprehension of verbal & written health information, and assist patients in obtaining and understanding health information. Knowledge?based examinations; Written reflections in multiple courses; OSCE performance examinations
G. Recognize and respond professionally to various common forms of behavioral and emotional presentations. Formative OSCE performance with feedback from both patients and faculty observers; Summative OSCE
H. Elicit and constructively provide performance feedback with patients and other healthcare professionals (including situations of medical error and conflict resolution). Formative OSCE performance with feedback from both patients and faculty observers; Summative OSCE
I. Recognize and evaluate the ethical and legal issues involved in patient-doctor communication. Formative OSCE performance with feedback from both patients and faculty observers; Summative OSCE
J. Illustrate effective end-of-life communication. Formative OSCE performance with feedback from both patients and faculty observers; Summative OSCE
K. Demonstrate culturally and linguistically appropriate interviewing skills with patients from diverse backgrounds (inc. appropriate use of an interpreter).

Oral presentations of clinical topics from basic
sciences orientation with faculty, peer and self-assessment

Oral presentations of clinical topics from
basic sciences orientation with faculty, peer and self-assessment

Competency Domain 5: Professionalism

General Competency Statement: Students must recognize the powerful impact of their professional attitudes and behavior on others and consistently demonstrate high standards of excellence, duty, and accountability to the patient. Students must be responsible, reliable, dependable, and will demonstrate integrity, honesty, courtesy and self-discipline in both the classroom and the clinical setting. Students must approach the practice of medicine with an awareness of personal limits, strengths, weaknesses and vulnerabilities, while working to find ways to overcome and adapt to them: establishing an appropriate balance for personal and professional commitments, setting clear goals for lifelong learning, exploiting new opportunities for intellectual growth and professional enlightenment; and applying knowledge gained to the practice of medicine. The domain encompasses respect for patient rights and privacy in accord with the inherent value in the humanity of all patients, emphasizing the importance of rigorous adherence to established policies while maintaining an awareness of ethical and legal issues in medical practice.

  Education Program Objectives (Competency Statements) Suggested Assessment
A. Formulate and use strategies to support life-long learning to remain current with advances in medical knowledge and practice (e.g., medical information data bases), utilizing technology to record, research, present, critique and manage medical information. Evaluation will include detail about various forms of life-long learning including print, electronic, communities of practice, networking, etc. that support professional practice. Potential for checklist format.
B. Demonstrate respect for the contributions of medical colleagues, other health care professionals, agencies, and families, to the health of the individual and the health of the community. Reflective writing, Observation by doctoring faculty, Observation by standardized patients, Observation by clerkship faculty, OSCE, Small group exercises
C. Recognize one's personal abilities and limitations, knowing when to request assistance. Narrative reflection and portfolio evaluation in
multiple courses
D. Display professionalism, high ethical standards, and integrity in relationships in all aspects of medical practice, especially with respect to confidentiality, informed consent, and justice. Formative OSCE performance with feedback from both patients and faculty observers; Summative OSCE
E. Utilize basic ethical principles including autonomy, beneficence non-malfeasance and justice in the care of each patient. Reflective writing, Observation by doctoring faculty, Observation by standardized patients, Observation by clerkship faculty, OSCE, Small group exercises
F. Practice self-evaluation and reflection concerning cultural, moral and ethical issues encountered in the care of patients and the practice of medicine, identifying biases, perceived differences between practitioners and patients, and employing a nonjudgmental approach to patient care. Narrative reflection and portfolio evaluation in
multiple courses

Competency Domain 6: Systems-Based Practice

General Competency Statement: Students must demonstrate an awareness of the larger context and system of health care including the types of medical practice and delivery systems, cost effective health care and resource allocation that does not compromise the quality of care. Students must be advocates for quality patient care and must work in interprofessional health care teams to assess, coordinate, enhance and improve patient safety and patient care.

  Education Program Objectives (Competency Statements) Suggested Assessment
A. Demonstrate basic knowledge of the health care delivery system in the community including healthcare providers, hospitals, facilities, home health and community agencies. Knowledge-based examinations
Oral presentations
Observation by clinical faculty
B. Demonstrate an understanding of the role of the physician in working with home health and community agencies to benefit patients. Staff evaluation of students on required clerkships; assessment of student performance in Community Medicine clerkship.
C. Demonstrate the ability to work effectively as a member of a health care team. 360 degree evaluation
D. Demonstrate respect for the roles of other healthcare providers and of the need to collaborate with others in caring for individual patients and communities. Observational assessment by faculty office staff and others (including learners from medicine and other professions).
E. Advocate for and assist patients in coordinating care and in dealing with system complexities. Observational assessment by clerkship faculty, staff and patients.
F. Recognize that errors occur in providing health care and how providers and system flaws contribute to hazards in care; seeks to improve systems and prevent future errors. Observational assessment by clerkship faculty.