The Department participates extensively in medical student education during the pre-clinical years in the following courses:
- Introduction to Clinical Medicine: The Doctor-Patient Relationship
- Introduction to Clinical Medicine: The Mental Status Examination
- Doctoring I and II
- Brain and Behavior
This course is about the art of being a physician. It is about bedside manner. It is about patients. Regardless of your mastery of physiopathology, you will not be able to elicit signs and symptoms in your patients if they do not feel that they have established a therapeutic relationship with you. This is why Curriculum 2000 was designed to introduce you early on in your training to the art of the patient interview.
The Doctor-Patient Relationship course is the first installment in the Introduction to Clinical Medicine (ICM) curriculum:
- MD 301 The Doctor-Patient Relationship
- MD 302 Medical History Taking
- MD 303 Introduction to the Physical Examination
- MD 304 The Combined History and Physical
- MD 305 Intermediate Clinical Skills
Throughout these courses, you will acquire and develop the basic skills required to become a physician. MD 301 will take place over eight weeks during Module I. It is taught through a joint effort from the Departments of Psychiatry and Family Practice and Community Medicine. During this course, you will learn the skills required to establish a relationship with a patient. This will be done partially through practice interviews with standardized patients in small group sessions. You will also learn through "shadowing sessions" where you will be assigned to observe faculty members from different specialties as they interact with their patients. In so doing, you will be able to observe different relational styles.
After the completion of this course, you will be able to:
- Understand the functions of the patient interview
- Comprehend the basic skills required to conduct a satisfying patient interview
- Demonstrate these skills, in an elementary fashion, during a patient interview
- Develop the skills of observation in the context of the doctor-patient interactions
Small Group Teaching Sessions
The class has already been divided into small groups of 5-6 students. Each of these groups will be assigned to a preceptor from the Department of Psychiatry or Family Practice and Community Medicine. During your first two sessions, you will learn about specific interview skills using standardized patients. During your third session, you will interview a hospitalized patient, in the presence of your preceptor, in one of our affiliated hospitals and discuss your performance with your preceptor and your peers.
During three half-days, you will be assigned to observe faculty members from different specialties in the Perelman School of Medicine. Your task will be to observe the different relationship styles physicians adopt. Your sharpened observation skills will also become useful when you deal with your own patients, as non-verbal communication is an important part of what your patients convey.
We highly recommend The Medical Interview: The Three Function Approach by Steven A. Cohen-Cole. This text is an authoritative work on the art and the science of the medical interview. Parts of this book were excerpted and provided to you along with this syllabus. However, we recommend that students interested in further reading purchase a copy or consult it at the Biomedical Library. It is brief, concise, and reasonably priced. It is available at the University Medical Bookstore and at Dolby’s Medical Bookstore.
This is a two-part introduction to the MSE. The first session, the entire class must attend a lecture for an introduction to the Mental Status Exam. The class is then divided into two groups, Group A & Group B. Group A students will meet with preceptors for a videotape review directly after the introductory lecture. Group B students will meet the following day for a videotape review with preceptors. Sessions 3 and 4 are held at various teaching sites (HUP, VA, Presby, 3535 Market Street, Pennsy) and consist of interviews of actual patients. Faculty members are assigned to three students who are each given a patient to interview.
For students to:
- Develop trust and solidarity with other students and preceptors in their group
- Receive peer and preceptor support for professional and personal experiences
- Understand societal expectations for physicians in terms of medical professionalism
- Appreciate how to achieve those expectations and begin to acquire knowledge and skills in meeting those expectations
- Better understand biopsychosocial aspects of illness through the Longitudinal Experience To Appreciate Patient Perspectives (LEAPP) and other experiences
- Be more comfortable and skilled in self-refection about becoming a physician
Doctoring Small Groups and Course Curriculum
The first year class has been divided into 13 Doctoring Small Groups so that each group has a diverse membership. Students are not permitted to switch groups or to attend another group's meeting without Course Director’s permission.
Three Penn faculty or Penn Med affiliated physicians have been assigned to be preceptors for each Small Group. Their primary roles are to serve as facilitators for discussions and other class activities and to help students in their group make progress toward reaching the Course Goals. Preceptors should function more like "Coaches" for what is basically a "learning team" and not as conventional Section instructors or lecturers. Each group's preceptors are also purposefully diverse, including both genders and various medical specialties.
In general, Preceptors have committed to stay with their Small Group for the next two and one-half years, i.e., during Doctoring I, Doctoring II and Doctoring III. Some have taught in Doctoring previously and have volunteered to do it again. None get paid to teach in Doctoring. Their reward is from the satisfaction that they get by contributing to medical student education and helping the students in their professional development.
Curriculum and Educational Approaches
Doctoring I uses three educational approaches. The first approach is process-oriented learning. This arises from participating in Small Group discussions, which benefits from the presence of group trust, solidarity and support by peers and Preceptors. The second is content-oriented learning. This occurs during the Small Group Sessions, the Plenary Sessions and the assigned readings and other homework. The Doctoring I Schedule of Events indicates the scope of the content of the curriculum. The third approach is experiential learning. This occurs during the Longitudinal Experience to Appreciate Patient Perspectives (LEAPP) as well as the Wheelchair Experience.
The Plenary Sessions have been chosen and scheduled to complement Small Group Sessions occurring in the same week or LEAPP activities. It is expected that all students will attend the Plenary Sessions. They are NOT "optional". In general, the Plenary Sessions will be held on Mondays from 12 to 1 in Doctoring weeks. Attendance at the Fall semester’s Plenary Session on Home Visits (or viewing it on VC2000) is mandatory.
Readings for Sessions
All Small Group Sessions generally (and some Plenary Sessions) have one or more "Key Readings", all of which will be in the Course Book and VC2000. It is required that all students will read these "Key Readings" before class. Students are on their Honor to indicate if they’ve done the Key Readings or not. "Supplementary Readings", which are also posted on VC2000 [and some of which may also be in the Course Book], are optional. They are there to be used as resources for more in-depth study of a topic by interested students or for use in Student Presentations.
Virtual Curriculum 2000
All course information, including room assignments and assignments for Student Presentations, will be posted on the VC2000 web site for Doctoring I (under Module VI in the pull-down menu under Modules/Courses in the top left corner of the home page of VC2000).
Doctoring I, II and III together form an integrated curriculum covering a sequence of topics and experiences in Professionalism and Humanism. In Doctoring II, the same group of students and preceptors continue to meet at monthly intervals throughout Module 4, the year of core clinical clerkships. Although Doctoring II revisits some of the same Topics discussed in Doctoring I, it approaches the topic in greater depth or with a different focus. Doctoring II also incorporates discussion of experiences of students on their clinical clerkships. Doctoring III continues for the spring semester after Module 4 ends.
Longitudinal Experience to Appreciate Patient Perspectives (LEAPP)
LEAPP is integrated into the Doctoring course. It provides longitudinal experiential learning from patients with chronic health conditions and their families (Appendix C-1). It is integrated into Doctoring by means of regular Go-Rounds in which students share descriptions of their patients, their medical and biopsychosocial issues. Written and other assignments are also required.
Integrative Systems and Disease
Topics are organized by organ systems in the following standardized structure:
- Normal development
- Normal processes
- Abnormal processes
- Therapeutics and disease management
- Epidemiology and evidence-based medicine
- Prevention and nutiricion
- Interactive, small group sessions.
- Basic and Clinical science with seminars/workshops and computer-assisted instruction.
- Didactic (lecture) experience.