PA 739 Family Medicine Syllabus

Transcription

1 PA 739 Family Medicine Syllabus COURSE CONTACTS: Beverly Speece, MTS, PA-C Director of Clinical Education 1260 HSLC, 750 Highland Ave. Madison, WI Lauren Trillo, MMS, PA-C Clinical Faculty 1264 HSLC, 750 Highland Ave. Madison, WI Rosa Retrum, MSE Clinical Coordinator 1262 HSLC, 750 Highland Ave., Madison, WI PA Program Office 1278 HSLC, 750 Highland Ave., Madison WI Toll Free: FAX: PA Program Website: PA Program Preceptor Resources: COURSE OVERVIEW: The Family Medicine (primary care) clinical rotation is a required, 8-credit module that occurs over a two-month period. The student will predominantly learn in a community-

2 based outpatient setting; yet given the opportunity, any inpatient or nursing home experience is encouraged. FAMILY MEDICINE PRECEPTORSHIP COURSE GOALS: 1. Provide the student with the opportunity and access to a diverse population of patients and a variety of diseases and injuries involving all body systems across the life span and commonly encountered in outpatient primary care medicine. 2. Support ongoing development and mastery of the student's ability and skill in obtaining a patient centered medical history, conducting a physical examination, recommending diagnostic studies and discussing and recommending treatment plans with the guidance of a preceptor. 3. Provide ongoing interactive opportunities for the student to deepen their knowledge regarding various diagnostic studies used in the evaluation of disease and injury and disease prevention. 4. Provide supervised patient care based opportunities, which foster the development of the student's ability to recommend, select and interpret (where applicable) appropriate diagnostic methods in the evaluation of a patient. 5. Provide clinical based opportunities to continue to develop the student's ability to generate differential diagnoses. FAMILY MEDICINE PRECEPTORSHIP LEARNING OUTCOMES: At the end of this eight-week experience students will be able to: 1. Recognize and accurately assess common medical and behavioral diseases and conditions through the application and integration of core medical knowledge (etiology, risk factors, pathophysiology, prevalence, clinical presentation, diagnostic evaluation and interpretation) and the use of evidence based decision making toward the diagnosis, management and treatment of patients encountered in the primary care setting. 2. Recognize and approach the evaluation and initial management of acute presentations commonly seen in the office setting. 3. Recognize and teach the approach to the management of chronic illnesses that are commonly seen in the office setting. 4. Conduct a wellness visit for a patient of any age or gender 5. Recognize and/or provide evidence-based health promotion and disease prevention guidance as well as patient education and counseling. 6. Perform concise, articulate and effective oral case presentations. 7. Recognize and engage in effective on-going (continuity) patient care in an empathetic fashion that demonstrates awareness and sensitivity to diverse religious, cultural, ethnic, gender and sexual orientation patient populations over

3 the course of preceptorship. 8. Recognize, apply and demonstrate effective communication skills. 9. Perform common office based procedures. 10. Effectively and professionally navigate the role and responsibilities as a physician assistant (within the confines of the student role) practicing in a family practice setting. FAMILY MEDICINE ROTATION -SPECIFIC OBJECTIVES: These objectives are to guide the student in preparing for the Post Rotation examination by defining areas of content to be emphasized and studied as well as the clinical skills and professional behavior required and expected during this practicum. Outline to this information is as follows: Alignment to the PA Core Competencies Adult Medical Conditions Health Maintenance/Preventative Pediatrics Women s Health Alignment to the PA Core Competencies Interpret the clinical features, differential diagnosis, and Medical Knowledge management of common acute and chronic medical conditions seen in the ambulatory medical setting. Recognize the impact of disease on individuals and societal levels Compare preventive strategies for common acute and chronic medical conditions seen in the ambulatory setting, in the clinic, and at the population level. Patient Care Perform focused histories and physical exams relevant to common acute and chronic medical conditions. Perform comprehensive wellness exams relevant to

4 patient s age and comorbidities. Formulate treatment plans for common acute and chronic ambulatory medical problems. Use test characteristics, predictive values, and likelihood ratios to enhance clinical decision making. Distinguish preventive screening tests for individual patients, acknowledging prevalence, risk factors, and outcomes. Formulate answerable clinical questions from patient interactions Practice-Based Learning and Improvement Practice life-long learning skills, including the use of evidence based medicine at point of care. Differentiate and appraise preventive service guidelines and recommendations from various organizations. Interpersonal and Communication Skills Identify individual learning goals, and self-assess knowledge and behaviors Present cases to preceptor in a patient-centered manner, integrating further testing recommendations, diagnostic probabilities, and evidence-based treatment recommendations as indicated. Document clinical encounter in written SOAP note form. Establish effective relationships with patients and families. Ascertain patient and family beliefs regarding common

5 acute and chronic medical conditions. Educate patients and families regarding common acute and chronic medical conditions. Demonstrate the process of negotiating management plans with patients, incorporating patient needs and preferences into care. Check for patient s understanding of follow-up plan, including treatments, testing, referrals, and continuity of care. System Based Practice Identify community assets and system resources to improve the health of individuals and populations. Demonstrate a clinical perspective that recognizes the impact of multiple systems on patient health. Professionalism Recognize and address self-care and personal issues that affect one s ability to fulfill the professional responsibilities of being a physician. Assume responsibility, behave honestly, and perform duties in a timely, organized, respectful, and dependable manner. Seek, accept, and apply constructive feedback appropriately..

6 Learning Objectives for Adult Medical Conditions Know etiology, risk factors, signs and symptoms, diagnostic work up and treatment of the following: (Table 1). Table 1. Organ Based for Adult Medicine Conditions Organ Symptoms Conditions Procedural Skills/Other Cardiovasular Chest pain, SOB, fever, DOE, claudication Hypertension, Coronary artery disease, Peripheral vascular disease, Arrhythmias, Endocarditis, Hyperlipidemia, Hypertriglyceridemia, Angina, Congestive heart failure, Chest pain, Valvular disease Interpret EKG Become familiar with stress test and echo Pulmonary SOP, cough, Chest pain, Fever, Asthma, Bronchitis, Chronic obstructive pulmonary disease, Pneumonia, Tuberculosis, Lung cancer, Sleep disorders/apnea, Tobacco use/dependence Interpret CXR Interpret PFTs Read peak flows Gastrointestinal Abdominal pain, diarrhea/consti pation, fever, N/V, jaundice Colorectal cancer/colonic polyps, Anal fissure, Peptic ulcer disease, Gastritis Gastroenteritis, Pancreatitis, Inflammatory bowel disease, Appendicitis, Gastrointestinal bleeding, Hemorrhoids, Stool guiac testing Interpret abdominal films Bowel obstruction, Viral hepatitis, Jaundice,

7 Cholecystitis/cholelithiasis,Cirrhosis Giardiasis and other parasitic infections, Hiatal hernia, Gastroesophageal reflux disease Irritable bowel syndrome. Esophagitis Orthopedic/ Rheum Pain, deformity, swelling, arthralgias Acute and chronic lower back pain, Costochondritis, Bursitis/tendonitis, Rheumatoid arthritis Joint aspirations Fracture care Reactive arthritis, Osteoarthritis,Gout, Sprains/strains, Ganglion cysts, Systemic lupus erythematosus, Osteoporosis Fibromyalgia, Plantar fasciitis, Overuse syndrome Urology/ Renal Flank pain, hematuria, abdominal pain, dysuria Hernias, Cystitis, Pyelonephritis, Glomerulonephritis, Nephrolithiasis, Benign prostatic hypertrophy, Prostatitis Epididymitis, Gonorrhea, Chlamydia, Urethritis, Orchitis, Balanitis, Testicular cancer UA analysis Urince dipstick Digital rectal exam Neurology AMS, paresthesias, headache, fever, loss of memory, paralysis, dizziness Vertigo, Syncope, Seizure disorders Transient ischemic attack, Cerebral vascular accident, Alzheimer disease, Parkinson disease, Essential tremor, Bell palsy, Dementia, Delirium. Headaches (cluster, migraine, tension) Perform mini mental exam

8 Endocrinology Hematology Fatigue, fever, easily bruising, bleeding Diabetes mellitus, Adrenal insufficiency, Cushing disease, Hyperthyroidism Hypothyroidism Anemia,Leukemia, Thrombocytopenia, Clotting disorders, Lymphoma, Polycythemia Accucheck Perform a diabetic foot exam Psychiatry Infectious Dermatology Highly variable Fever, chills, diarrhea, lymphadenop athy, rash, weight loss Rash, vesicles, pruritis, erythemia Major Depressive Disorder, Anxiety Disorders, Panic Disorder, Social Phobia, Substance Abuse Disorders, Post-traumatic Stress Disorder, Bipolar Disorder, Anorexia nervosa, Bulimia nervosa, Suicide, Spouse or partner neglect/violence HIV, Lyme Disease, Influenza, Shigellosis, Salemonella, Meningitis Dermatitis (eczema, seborrhea), Nummular eczema, Dyshidrosis simplex chronicus Drug eruptions, Lichen planus, Pityriasis rosea, Psoriasis, Erythema multiforme, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Bullous pemphigoid, Acne vulgaris, Rosacea, Actinic keratosis, Seborrheic keratosis, Spider bites, Basal cell carcinoma, Kaposi sarcoma, Melanoma, Alopecia, Onych omycosis, Paronychia, Condyloma acuminatum, Exanthems, Molluscum SBIRT KOH scraping Suturing Punch biopsy Shave biopsy

9 EENT Ear pain, ear discharge, sore throat, sneezing, rhinorrhea, eye pain, decreases vision, tinnitus contagiosum, Verrucae Cellulitis, Erysipelas, Impetigo, Acanth osis nigricans, Hidradenitis suppurativa, Lipomas/epithelial inclusion cysts, Melasma, Pilonidal disease, Pressure ulcers, Urticaria, Vitiligo Fo ll infections Tineaversicolo r Pharyngitis/tonsillitis, Acute/chronic sinusitis, Aphthous ulcers, Blepharitis, Conjunctivitis, Dacryocystitis, Hordeolum, Labyrinthitis Laryngitis, Otitis externa, Otitis media, Tympanic membrane perforation, Ectropion Entropion, Corneal abrasion, Corneal abrasion/ulcer, Glaucoma, Hyphema M acular degeneration, Papilledema, Pterygium Retinal detachment, Retinal vascular occlusion, Retinopathy, Cholesteatoma, Ménière disease, Allergic rhinitis, Epistaxis, Nasal polyps, Peritonsillar abscess, Parotitis, Sialadenitis Urgent Care Highly variable Respiratory failure/arrest, Deteriorating mental status/unconscious patient, Allergic reaction/anaphylaxis, Acute abdomen, Burns, Third trimester

10 *Based on the PAEA EOR exams bleeding Bites/stings, Foreign body aspiration, Cardiac failure/arrest, Fractures/dislocations, Sprains/strains, Myocardial infarction, Hypertensive crisis, Pulmonary embolus, Pneumothorax, Ingesting harmful substances (poisonings), Orbital cellulitis Learning Objectives for Prevention and Health Promotion Define primary, secondary and tertiary prevention Identify risks for specific illnesses that affect screening and treatment strategies Provide counseling related to health promotion and disease prevention Discuss an evidence-based, stepwise approach to counseling for tobacco cessation Find and apply the current guidelines for adult immunizations. For each core health promotion condition listed in table 2, discuss who should be screened, risk factors and the methods of screening along with developing a health promotion plan for a patient of any age of either gender. Table 2. Core Health Promotion Conditions for Adults Cervical Cancer Colon Cancer CAD Depression Breast Cancer Depression Fall risk in elderly patients Intimate partner violence Obesity Osteoporosis Prostate Cancer STIs Substance abuse

11 Type 2 DM Learning Objectives for Well Child and Adolescents Preventative Care Describe the core components of child preventative care-health history, physical examination, immunizations, screening/diagnostics tests, and anticipatory guidance (table 3) Identify health risks, including accidental and non-accidental injuries and abuse or neglect Conduct a physical examination on a child Identify development stages and detect deviations from the anticipated growth and development levels. Recognize normal and abnormal physical findings in the various age groups Find and apply the current guidelines for immunizations and be able to order them as indicated. Identify and perform recommended age-appropriate screenings. Communicate effectively with children, teens and families. Table 3. Core Health Promotion Conditions for Children and Adolescents Topic Diet/excercise Family/social support Growth and Development Hearing Vision Lead Exposure Potential for injury Nutritional deficiency Sexual activity Substance abuse Learning Objectives for Pediatrics Conditions

12 Know etiology, risk factors, signs and symptoms, diagnostic work up and treatment of the following: (Table 4). Table 4. Organ-based Pediatric Conditions Organ Symptom Condition Procedural skill/ other ENT Pulm Cardiac Ophth GI Orthopedics/ Rheum Hematology Ear pain, ear discharge, sore throat, sneezing, rhinorrhea Cough, SOB, fever, stridor Chest pain, SOB, cyanosis Eye discharge, eye pain, decreased vision Abdominal pain, diarrhea/constipat ion, fever, N/V, jaundice Pain, deformity, swelling, arthralgias Fatigue, fever, easily bruising, bleeding Otitis media, strep pharyngitis, allergic rhinitis, hearing impairment, otitis externa, epistaxis, acute pharngotonisillitis epiglottis, oral candidiasis, peritonsillar abscess, Foreign body Pneumonia (bacterial, viral), acute bronchiolitis, croup, respiratory syncytial virus (RSV), asthma, foreign body, hylaline membrane disease, cystic fibrosis Congenital Heart Diseases (atrial septal defect, coarctation of the aorta, patent ductus arteriosis, tetraology of fallot, ventricular septal defect), acute rheumatic fever, kawasaki disease, hypertrophic cardiomyopathy Conjunctivitis, orbital cellulitis, strabismus, corneal abrasion Gastritis, dehydration, appendicitis, colic, GERD, constipation, pyloric stenosis, intussusception, Hirshrung disease, foreign body, encopresis, jaundice, duodenal atresia, inguinal hernia, umbilican hernia, niacin deficiencies, vitamin A deficiencies, vitamin D deficiencies, vitamin C deficiencies, lactose intolerance Nursemaids elbow, slipped capital femoral epiphysis, Osgood-Schlatter disease, Scoliosis, Congenial hip dysplasia, avascular necrosis of the proximal femur, neoplasia, juvenile rheumatoid arthritis Anemia, bleeding disorders, leukemia, lymphoma, neutropenia, brain tumors, hemophilia, lead poisoning FB removal Interpret CXR Administer neb treatment Slit lamp Interpret abdominal films Fracture care Joint reduction

13 Endocrine Urology/ Renal Infectious Disease Psychiatry/ Behavioral Medicine Neurology Dermatology Polyuria, polyphagia, heat/cold intolerances Abdominal pain, testicular pain, dysuria, hematuria Fever, pain, erythema, cough (highly variable) Altered mental status, fever Rash, erythema, pustules, pruritis *based on PAEA EOR exams Short stature, hypothyroidism, hyperthyroidism, obesity, diabetes mellitus Cryptorchidism, hydrocele, paraphimosis, phimosis, testicular torsion, enuresis, hypospadias, vesicourethral reflux, glomerulonephrisits, cystitis Atypical mycobacterial disease, pinworms, Epstein-Barr disease, erythema infectiosum, herpes simplex, influenza, mumps, roseaola, rubella, measles, varicella infection, handfoot-and-mouth disease, pertussis Child abuse and neglect, ADD/ADHD, autism spectrum disorder, feeding or eating disorders, depressive disorders, anxiety disorders, disruptice, impulse-control and conduct disorders, suicide Febrile seizures, epilepsy, meningitis, Turner syndrome, Down syndrome Dermatitis (diaper, perioral), drug eruptions, pityriasis rosea, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, acne vulgaris, lice, scabies, examthems, verrucae (warts), burns, uticaria, atopic dermatitis, tinea, impetigo, molluscum contagiosum Urine dipstick UA analysis CSF analysis KOH scraping Scabies scraping Learning Objectives for Women s Health Know etiology, signs and symptoms, diagnostic workup and treatment for the following: (Table 5) Table 5. Gynecological and Obstetrical Conditions Condition Procedural skill/other Gynecology -pelvic pain, vaginal discharge, vaginal Neoplasms Ovarian neoplasms, cervical carcinoma, cervical dysplasia, breast cancer, endometrial cancer, vaginal/vulvar Perform pap and pelvic exam

14 bleeding, fever neoplasms Endometrial biopsy Menstruation Normal physiology, DUB, amenorrhea, dysmenorrhea, menopause, premenstrual syndrome, premenstrual dysphoric disorder Structural abnormalities Cystocele, uterine prolapse, rectocele, ovarian torsion Disorders of the breast Mastitis, breast abscess, breast fibroadenoma, fibrocystic disease, Breast exam Infections Vaginitis (trichomoniasis, bacterial vaginosis, candidiasis, atrophic vaginitis), cervicitis (gonorrhea, chlamydia, human papilloma virus), herpes simplex, pelvic inflammatory disease, syphilis, chancroid) STD cultures Wet prep Other Contraceptive methods, endometriosis, ovarian cysts, leiomyoma, spouse or partner violence, sexual assault, urinary incontinence, infertility Contraceptive counseling Obstetrics -pelvic pain, vaginal bleeding Prenatal care/normal pregnancy Prenatal diagnosis/care, normal labor and delivery (stages, duration, mechanism of delivery, monitoring), physiology of pregnancy, fetal position, multiple gestations APGAR scoring FHT Fundal height measurement Pregnancy Complications Abortion, abruption placentae, ectopic pregnancy, incompetent cervix, placenta previa, gestational diabetes, pregnancy induced hypertension, preeclampsia/eclampsia, molar pregnancy, Rh-incompatibility

15 Labor and Delivery Complications Postpartum Care Dystocia, fetal distress, premature rupture of membranes, prolapsed umbilical cord, preterm labor, breech presentation Postpartum hemorrhage, endometritis, perineal laceration/episiotomy care, normal physiology changes of puerperium APGAR score Other Breastfeeding Breastfeeding counseling *based on the PAEA EOR exams Recommended Resources 1. Goroll A. Primary Care Medicine: Office Evaluation and Management of the Adult Patient. (Available online through 2. Rakel R. Textbook of Family Medicine. (Available online through 3. Fauci A. Harrison s Principles of Internal Medicine. McGraw Hill. (Available online through 4. Hamilton RJ. Tarascon Pharmacopoeia. (Pocket or PDA version) 5. Gilbert DN, Chambers HF, Eliopoulos GM. Sanford Guide to Antimicrobial Therapy. (Pocket or PDA version) 6. Lipsky MS and King, MS. Blueprints Family Medicine. Lippincott Williams & Wilkins. 7. Papadakis, MA, McPee S, Rabow MW. Current Medical Diagnosis & Treatment. McGraw Hill. Recommended Websites UpToDate Guide to Clinical Preventive Services American Academy of Family Physicians (AAFP) American Medical Association (AMA) American Academy of Physician Assistants (AAPA) The Journal of Family Practice Family Practice News (Best Address

16 Practices) Patient-Centered Primary Care Collaborative AAFP Recommended Health Maintenance Guidelines ICD-9 Codes distributed by AAFP UpToDate Family Medicine and General Practice picmoduleid=64