Clinics+Med-OP+Learning+Objectives+2012-2013

=**Learning Objectives for Adult Medicine Outpatient Rotations**= **And Recommended Reading Prior to Various Clinics from //The Resident’s Guide to Ambulatory Care.toc//**

Overall**:** >> **__Dermatology __** >> **Suggested reading: **
 * 1) Gain concentrated skill sets to improve care in family medicine clinic.
 * 2) Learn when you can treat a condition on your own in family medicine clinic and when you need to refer.
 * 3) Gain familiarity with specialty care so you can help support family medicine patients through such care.
 * 1) 1. Describe skin lesions accurately
 * 2) 2. Perform punch and shave skin biopsies
 * 3) 3. Accurately select lesions for appropriate destructive therapy
 * 4) 4. Manage common chronic skin problems such as eczema and psoriasis and acne
 * 5) 5. Able to recognize potentially malignant skin lesions and select appropriate biopsy technique.
 * Selected Articles from the [|Skin Conditions] AFP Topic Page:
 * § Common Benign Skin Tumors, 2003
 * Pages 325-342 of __The Resident’s Guide to Ambulatory Care__//.//
 * Atypical Moles, 2008
 * [|Clinical Diagnosis of Melanoma]  (November 2008)
 * Recognizing Neoplastic Skin Lesions- A Photo Guide, 2008
 * Shave and Punch biopsy for Skin Lesions, 2011
 * Dermatologic Conditions in Skin of Color, <span style="color: windowtext; font-family: Arial,sans-serif; font-size: 10pt;">[|Part I] <span style="font-family: Arial,sans-serif; font-size: 10pt;">, <span style="color: windowtext; font-family: Arial,sans-serif; font-size: 10pt;">[|Part II] <span style="font-family: Arial,sans-serif; font-size: 10pt;"> (June 2013)
 * <span style="color: windowtext; font-family: Arial,sans-serif; font-size: 10pt;">[|Diagnosis and Treatment of] <span style="font-family: Arial,sans-serif; font-size: 10pt;"> Acne (October 2012)
 * <span style="color: windowtext; font-family: Arial,sans-serif; font-size: 10pt;">[|Minocycline for Acne Vulgaris] <span style="font-family: Arial,sans-serif; font-size: 10pt;"> (September 2013)
 * <span style="color: windowtext; font-family: Arial,sans-serif; font-size: 10pt;">[|Psoriasis] <span style="font-family: Arial,sans-serif; font-size: 10pt;"> (May 2013)
 * <span style="color: windowtext; font-family: Arial,sans-serif; font-size: 10pt;">[|Atopic Dermatitis: An Overview] <span style="font-family: Arial,sans-serif; font-size: 10pt;"> (July 2012)

__**Neurology**__

 * 1) Demonstrate competence in performance of basic neurological exam
 * 2) Discuss diagnostic and therapeutic approach to headaches
 * 3) Describe the risks and benefits of common seizure medications and review what labs need to be monitored for the various seizure medicines
 * 4) Review basic work up of Multiple Sclerosis
 * 5) Review common movement disorders such as Parkinson’s disease.
 * **Recommended reading: Pages 206-222 of //The Resident’s Guide to Ambulatory Care.//**

Play here (below) or
 * Recommended listening:**
 * Headache Update. Audio Digest** <span style="font-family: arial,helv,verdana;">Family Practice | Volume 58, Issue 15 | April 21, 2010

media type="file" key="fp5815_1.mp3" width="240" height="20"

__**Radiology**__

 * 1) Perform basic interpretation of chest x-rays and skeletal films


 * __<span style="font-family: Arial,sans-serif; font-size: 15.5pt;">Minor Procedures __**
 * 1) <span style="font-family: Arial,sans-serif; font-size: 10pt;">1. Demonstrate competence with simple interrupted skin closure
 * 2) <span style="font-family: Arial,sans-serif; font-size: 10pt;">2. Demonstrate competence with the removal of simple skin lesions
 * 3) <span style="font-family: Arial,sans-serif; font-size: 10pt;">3. Name and utilize common surgical tools for minor outpatient procedures
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Suggested reading: **
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Fusiform (Elliptical) Excision] (AFP April 2003)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Minimal Excision Technique for Epidermoid (Sebaceous) Cysts] (AFP April 2002)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Pages 333-335 of The Resident’s Guide to Ambulatory Care.

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Pages **222-240 of //The Resident’s Guide to Ambulatory Care.//**
 * __<span style="font-family: Arial,sans-serif; font-size: 15.5pt;">Gastroenterology __**
 * 1) <span style="font-family: Arial,sans-serif; font-size: 10pt;">1. Discuss diagnostic and therapeutic approach to GERD and peptic ulcer disease
 * 2) <span style="font-family: Arial,sans-serif; font-size: 10pt;">2. Discuss diagnostic and therapeutic approach to hepatitis C
 * 3) <span style="font-family: Arial,sans-serif; font-size: 10pt;">3. Discuss diagnostic and therapeutic approach to irritable bowel syndrome
 * 4) <span style="font-family: Arial,sans-serif; font-size: 10pt;">4. Understand GI tests and what they will and won’t do for you
 * 5) <span style="font-family: Arial,sans-serif; font-size: 10pt;">5. Learn the relevant components of a GI history
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Suggested reading: **
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Managing Chronic Gastroesophageal Reflux Disease] (AFP October 2012)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Diagnosis and Management of IBS in Adults] (AFP September 2012)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Peptic Ulcer Disease] (AFP October 2007)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Selected Articles from the [|Dyspepsia] and [|Hepatitis / Liver Disease AFP] Topic Pages:
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|AGA Releases Updated Recommendations on Dyspepsia] (July 2006)
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Update on the Evaluation and Management of Functional Dyspepsia] (March 2011)
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Nonalcoholic Fatty Liver Disease: Diagnosis and Management] (July 2013)
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Hepatitis B: Diagnosis and Treatment] (April 2010)
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Hepatitis C: Diagnosis and Treatment] (June 2010)
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Cirrhosis: Diagnosis, Management and Prevention] (December 2011)


 * __<span style="font-family: Arial,sans-serif; font-size: 15.5pt;">Internal Medicine __**
 * 1) <span style="font-family: Arial,sans-serif; font-size: 10pt;">1. Discuss diagnostic and therapeutic approach to coronary artery disease
 * 2) <span style="font-family: Arial,sans-serif; font-size: 10pt;">2. Discuss diagnostic and therapeutic approach to congestive heart failure
 * 3) <span style="font-family: Arial,sans-serif; font-size: 10pt;">3. Discuss diagnostic and therapeutic approach to hypertension
 * 4) <span style="font-family: Arial,sans-serif; font-size: 10pt;">4. Discuss diagnostic and therapeutic approach to diabetes
 * 5) <span style="font-family: Arial,sans-serif; font-size: 10pt;">5. Review work-up and management of hypo and hyperthyroidism
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Suggested reading: **
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Medical Management of Stable Coronary Artery Disease] (AFP April 2011)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Diagnosis and Evaluation of Heart Failure] (AFP June 2012)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults (JNC 8)] (JAMA February 2014)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Diabetes Type 2] (AFP April 2014)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Hypothyroidism: An Update] (AFP August 2012)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Hyperthyroidism: Diagnosis and Treatment] (AFP August 2005)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Pages 146-155, 189-205 of The Resident’s Guide to Ambulatory Care.

__**Treadmill**__

 * 1) Competently perform an exercise stress test with stand-by supervision
 * 2) Accurately interpret the results of a stress test
 * 3) Discuss indications for treadmill stress test versus other testing options
 * 4) Improve EKG reading skills
 * Recommended reading: Pages 121-129, 161-166 of //The Resident’s Guide to Ambulatory Care.//**

__**Flexible Sigmoidoscopy**__

 * 1) Competently perform flex sig with stand-by supervision by the end of third year
 * 2) Accurately identify abnormal findings during the flex sig procedure
 * 3) Discuss colon cancer screening in the normal risk vs. high risk patient
 * Recommended reading: Pages 107-109 of //The Resident’s Guide to Ambulatory Care.//**

__**Rheumatology**__
<span style="font-family: arial,helv,verdana;">**ARTHRITIS** <span style="font-family: arial,helv,verdana;">Internal Medicine | Volume 60, Issue 28 | July 28, 2013 []
 * 1) Discuss diagnostic and therapeutic approach to rheumatoid arthritis
 * 2) Discuss diagnostic and therapeutic approach to systemic lupus
 * 3) Discuss diagnostic and therapeutic approach to psoriatic arthritis
 * Recommended reading: Pages 257-273 of //The Resident’s Guide to Ambulatory Care.//**
 * Recommended listening:**

__**Urology**__

 * 1) Accurately assess the size and texture of the prostate on digital rectal exam
 * 2) Discuss diagnostic and therapeutic approach to urinary incontinence
 * 3) Discuss diagnostic and therapeutic approach to management of kidney stones
 * 4) Discuss diagnostic and therapeutic approach to prostate cancer and benign prostate hypertrophy
 * 5) Learn the work up for hematuria
 * 6) Learn the work up for sexual dysfunction
 * Recommended reading: Pages 274-284 of //The Resident’s Guide to Ambulatory Care.//**

__**ENT**__

 * 1) Discuss diagnostic and therapeutic approach to recurrent otitis media
 * 2) Discuss diagnostic and therapeutic approach to chronic hoarseness
 * 3) Discuss diagnostic and therapeutic approach to chronic cough
 * 4) Discuss diagnostic and therapeutic approach to chronic sinusitis
 * Recommended reading: Pages 28-33, 250-256 of //The Resident’s Guide to Ambulatory Care.//**

__**Ophthalmology**__

 * 1) Learn to read an ophthalmology clinic note
 * 2) Learn how to accurately assess ocular pressure with hand held pressure gauge
 * 3) Observe a basic diabetic retinal exam
 * 4) Review differential diagnosis of the red eye
 * 5) Review ophthalmologic emergencies
 * Recommended reading: Pages 246-249 of //The Resident’s Guide to Ambulatory Care.//**

__**Pain and Wellness Clinic**__

 * 1) Become familiar with group visit model
 * 2) Observe psychologist interaction with group with regard to chronic pain management
 * Recommended reading: Pages 359-361 of //The Resident’s Guide to Ambulatory Care.//**

__ **Positive Health Clinic** __
-Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/0
 * 1) Describe the current guidelines as to when to start antiviral therapy
 * 2) Describe current guidelines regarding when to start and stop opportunistic infection prophylaxis
 * 3) Describe two preferred regimens for initial antiviral therapy
 * 4) Describe an initial workup for a newly diagnosed HIV positive patient
 * 5) Able to recognize thrush and differentiate it from hairy leukoplakia
 * Recommended reading: **

<span style="font-family: arial,helv,verdana;">**HUMAN IMMUNODEFICIENCY VIRUS/HEPATITIS C** <span style="font-family: arial,helv,verdana;">Internal Medicine | Volume 60, Issue 24 | June 28, 2013 []
 * Recommended listening:**

__**Surgery**__

 * 1) Recognize normal and problematic healing of post-op wounds
 * 2) Learn pre-op assessment to determine if surgery will be beneficial
 * 3) Learn the pre-operative work-up of breast masses, thyroid nodules, and gall bladder disease
 * 4) Review diabetic wound care
 * Recommended reading: Pages 347-358 of //The Resident’s Guide to Ambulatory Care.//**

__**Breast Health Clinic**__

 * 1) Show competence in performing a clinical breast exam
 * 2) Show competence in performing a core biopsy of a breast lump and fine needle aspirations of breast cysts
 * 3) Discuss diagnostic and therapeutic approach to managing breast lumps
 * 4) Understand mammogram and ultrasound reports and learn some basic concepts of reading mammograms
 * Recommended reading: Pages 98-99 of //The Resident’s Guide to Ambulatory Care.//**


 * __<span style="font-family: Arial,sans-serif; font-size: 15.5pt;">Hematology-Oncology __**
 * 1) <span style="font-family: Arial,sans-serif; font-size: 10pt;">1. Discuss post treatment management of common malignancies (e.g. breast cancer, lung cancer, colon cancer, prostate cancer)
 * 2) <span style="font-family: Arial,sans-serif; font-size: 10pt;">2. Discuss the common side effects of common chemotherapeutic agents and radiation therapy
 * 3) <span style="font-family: Arial,sans-serif; font-size: 10pt;">3. Discuss presentation of common malignancies
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Suggested reading: **
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Selected Articles from the [|Cancer] AFP Topic Page:
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Managing the Adverse Effects of Radiation Therapy] (August 2010)
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Primary Care of the Patient with Cancer] (April 2007)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Pages 243-245, 107-109 of //The Resident’s Guide to Ambulatory Care.//


 * __<span style="font-family: Arial,sans-serif; font-size: 15.5pt;">Chronic Renal Disease __**
 * 1) <span style="font-family: Arial,sans-serif; font-size: 10pt;">1. Discuss work-up and differential for chronic kidney disease including diabetic and hypertensive renal disease
 * 2) <span style="font-family: Arial,sans-serif; font-size: 10pt;">2. Discuss indications for ace inhibitors
 * 3) <span style="font-family: Arial,sans-serif; font-size: 10pt;">3. Discuss the utility of ultrasound in the context of chronic renal disease
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Suggested reading: **
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Selected articles from the [|AFP topic page on Kidney Disease]:
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Update on the Management of Chronic Kidney Disease] (October 2012)
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Screening for Chronic Kidney Disease] (February 2014)
 * o <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Urinalysis: A Comprehensive Review] (March 2005)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Pages 280-282 of __The Resident’s Guide to Ambulatory Care__//.//

__**Pulmonary Clinic**__

 * 1) Show competence in basic interpretation of chest x-rays and CT scans
 * 2) Discuss diagnostic and therapeutic approach to severe persistent asthma
 * 3) Discuss diagnostic and therapeutic approach to interstitial lung disease/bronchiectasis
 * 4) Discuss management of obstructive lung disease, and discuss when to order O2, steroids, antibiotics, pulmonary rehab
 * Recommended reading: Pages 167-188 of //The Resident’s Guide to Ambulatory Care.//**

__**Musculoskeletal Clinic**__

 * 1) Discuss diagnostic and therapeutic approach to non-operative musculoskeletal injuries
 * 2) Learn basic joint injection techniques
 * 3) Learn preventive treatment for overuse injuries
 * Recommended reading: Pages 299-324 of //The Resident’s Guide to Ambulatory Care.//**


 * __<span style="font-family: Arial,sans-serif; font-size: 15.5pt;">High Risk Preoperative Clinic __**
 * 1) <span style="font-family: Arial,sans-serif; font-size: 10pt;">1. Learn how to accurately assess a patient’s surgical risk
 * 2) <span style="font-family: Arial,sans-serif; font-size: 10pt;">2. Discuss indications for cardiac and sleep apnea testing in the preoperative setting
 * 3) <span style="font-family: Arial,sans-serif; font-size: 10pt;">3. Learn to take and document an appropriate preoperative history and physical
 * 4) <span style="font-family: Arial,sans-serif; font-size: 10pt;">4. Learn the importance of functional capacity in the preoperative assessment
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Suggested reading: **
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery]
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">[|Preoperative Testing Before Noncardiac Surgery: Guidelines and Recommendations] (AFP March 2013)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Pages 362-370 of //The Resident’s Guide to Ambulatory Care.//

__**Allergy clinic**__

 * 1) Learn when to order allergy testing
 * 2) Review when allergy injections are appropriate
 * 3) Review basic treatment of allergic conditions
 * Recommended reading: Pages 250-253 of //The Resident’s Guide to Ambulatory Care.//**

__**Cardiology**__

 * 1) Discuss diagnostic and therapeutic approach to coronary artery disease
 * 2) Discuss diagnostic and therapeutic approach to congestive heart failure
 * 3) Discuss indications for placement of pacemakers and implantable cardioverter defibrillators (AICDs)
 * 4) Review indications for cardiac catheterization
 * Recommended reading: Pages 121-129, 146-162 of //The Resident’s Guide to Ambulatory Care.//**

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