Undergraduate Medical Education
- Robin English, MD
- 2020 Gravier Street, Suite 602
New Orleans, LA 70112
Clinical Skills Integration 200
(201 fall;202 spring)
Course Director: Catherine Hebert, MD
Assistant Course Director: Ross McCarron, MD
Assistant Course Director: Jessica Patrick, MD
CSI 200 is an interdisciplinary course required of second year medical students. This course builds upon the clinical skills and medical knowledge emphasized in year 1. In particular, it builds upon the CSI 100, Human Behavior and Development, and Foundations of Population Medicine and Health Systems courses. Throughout the second year of medical school, students will be expected to advance their clinical skills in the context of the knowledge being taught within the organ systems courses. Basic clinical skills and competencies are emphasized: clinical problem solving, critical thinking, history taking, motivational interviewing, physical diagnosis, procedural skills, critical evaluation of the medical literature, reflection, and professionalism. Successful completion of this course should help prepare students for their third-year clerkships and subsequent clinical training.
(with corresponding school of medicine program objectives)
- Gather appropriate patient information from patients via history taking. (EPO1a)
- Gather appropriate patient information from patients via physical examination. (EPO1b, EPO6)
- Demonstrate the ability to make an accurate diagnosis of common conditions using skills of clinical problem solving. (EPO2a)
- Counsel patients for behavior change in order to prevent health problems, maintain health, or change behavior. (EPO3)
- Perform basic procedures in accordance with best practice standards for patient safety and patient comfort.
- Apply knowledge of the pathophysiology, clinical presentation, and diagnosis of common diseases during history taking exercises, DxR write-up exercises, and H&P write ups based on patients encountered in the hospital. (EPO8)
- Demonstrate an understanding of the indications, contraindications, safe techniques, and complications of basic medical procedures in the skills laboratory.
- Apply ethical principles to maintain patient confidentiality and identify legal exceptions(EPO9b)
- 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. (EPO9f)
- Apply knowledge of healthcare services that are aimed at preventing health problems and maintaining good health during motivational interviewing exercises. (EPO9c, EPO10a)
- Recognize causes of health disparities and recognize methods and initiatives to reduce health disparities (EPO11b)
Practice Based Learning and Improvement
- Review and evaluate appropriate sources of medical information to answer clinical questions related to disease prevention, treatment, or health disparities. (EPO13)
- Appraise medical literature using critical thinking skills, knowledge of study design, and basic understanding of statistical methods. (EPO14, EPO10b)
Interpersonal Relationships and Communication
- Take a thorough history, while utilizing communication skills taught in CSI100. (EPO1a, EPO16a)
- Write an organized and thorough history or present illness. (EPO6c, EPO18a)
- Write an organized and thorough complete historyandphysical. (EPO6c,EPO18a)
- Effectively counsel and educate patients for behavior change. (EPO3, EPO4a,EPO16b)
- Maintain integrity and personal responsibility in adherence to course policies and completion of course requirements. (EPO19)
- Demonstrate dependability, respectfulness, and responsibility to colleagues when collaborating on work assignments. This includes contributing to the education of classmates and honestly assessing the performance of other team members. (EPO20)
Systems based practice
- Propose methods to reduce errors and improve patient safety using principles of quality improvement and outcomes analysis. (EPO22)
- Recognize how patient care affects healthcare and educational systems. (EPO23)
Personal and professional development
- Students work together to explain or expand on knowledge to enhance knowledge of peers through journal club presentations, QI modules presentations, and role play. (EPO26)
- Demonstrate flexibility and the ability to utilize appropriate resources in the face of adversity (EPO27)
- Engage in activities that promote their personal and professional growth. (EPO28)
The course includes five components: Hospital Rounds and H&Ps, Required DxR Write-ups, Clinical Forums, a Longitudinal Selective, and Skills Labs. Each is described below. In addition, students should continue to work with their clinical mentors in ways that are also suggested below.
1. Hospital Rounds and H&Ps
Students are assigned to attend 2 scheduled sessions of hospital rounds at Touro Infirmary, University Medical Center, or the LSU Medicine Clinic at UMC. Students can observe formal patient presentations, and go on hospital rounds with a medicine hospitalist ward team.
Students will be expected to complete two tasks during and after these rounds:
- Practice the following parts of the physical examination under the guidance of faculty,
residents or upper-level students: cardiac exam, lung exam, and abdominal exam.
- On rounds, students will be assigned a patient for practice of the complete history
and physical (H&P). At their first session, students will be assigned a patient on whom to take a complete history. That history will be written up (along with a problem list and differential diagnosis)
and emailed to their House/CSI mentor within 3 working days for review and critique.
At the second session, students will be assigned a patient on whom to take a complete history and physical (excluding the breast, genital, and rectal exams).
- Each of these H&Ps will be written up (with a problem list and differential diagnosis) and within 3 working days, the student should send a copy to the student’s CSI clinical
mentor for review and critique. In addition, the assignment must be uploaded to the course Moodle page after the CSI
mentor has reviewed it.
Students must attend these scheduled hospital rounds and complete the write ups in order to successfully pass the course. More detailed instructions about the write-ups will be provided during the course and can be found elsewhere on the CSI 200 Moodle page. A student schedule for hospital rounds can also be found on the CSI 200 Moodle page.
2. DxR Write-ups for Feedback
Students will complete DxR cases at various times during the year. Three of the cases (to be determined by the CSI 200 directors) will be selected for write-ups of the history of present illness (HPI), problem list, and differential diagnosis based on these cases. Students will be reminded of the elements and organization of a good HPI, as well as provided with examples. The write ups must be uploaded to the CSI 200 Moodle page, and they will be evaluated based on a checklist of items that should be included in the HPI. A ‘passing threshold’ of checklist items will be determined for each case based on class performance. Students whose write-ups fall below this threshold will be required to repeat the assignment. Students will receive feedback on their write-ups. Improvement based on this feedback is a professional expectation in the course.
3. Clinical Forums
There will be 9 small group clinical forums throughout the year, and attendance is required. Topics discussed in each forum will correlate with the concurrent systems course. A schedule is posted in the clinical forums section of the course Moodle page. Students will lead several presentations to their group during the course of the year. Each student will do one ‘journal club’ presentation of a primary study. A feedback form is posted on the clinical forums section of the course Moodle page to serve as a guide for the presentation of a paper. Each student will also participate in one counseling exercise in which they will present some background information about a clinical problem, the rationale for physician intervention, and the data regarding the efficacy of the intervention. Then the student will pair up with a partner to demonstrate how to counsel and motivate a patient for behavioral change. A feedback form is posted on the clinical forums section of the course Moodle page to serve as a guide for the counseling exercise. Each student will also present the PICO question for a given case. All students will be required to complete 6 QI Modules. The modules are in the Institute for Healthcare Improvement (IHI) open school, a free on- line resource about quality improvement for all health care professionals. The IHI open school classes comprise 32 on- line modules in quality improvement, patient safety, leadership, person- centered care, and population medicine. The certificate of completion of each module must be uploaded to the CSI 200 Moodle page to pass the course. More detailed instructions for these presentations will be provided during the course. The assignments for journal clubs, patient counseling exercises, PICO/ EBM, and QI modules have been made by the course director and can be found on the Moodle page.
4. Longitudinal Selective
Each student selects from a list of options to explore an area of interest during the first or second semester. Most options are clinical shadowing experiences. Some are formalized elective courses (End of Life Care, Nutrition, Humanities in Medicine) that will appear on the student’s transcript. Students may also opt to continue their summer research, with the requirement that they submit an abstract or case report. The time commitment for the shadowing experiences is a minimum of 5 half-days during the semester, but students may go more often if convenient for them and their preceptor. At the end of the semester, students who shadow a practicing physician must reflect on their experience with a short- written essay. Topics for this essay might include 1) the application of basic science to clinical practice in the care of a patient the student saw; 2) an ethical dilemma that arose during the care of a patient; or 3) the role of health disparities in the care of a patient. More detailed instructions about the essay can be found on the course webpage. A reflective essay is not required for those students who are taking a formal elective course (or continuing their summer research) as these students will generally have a larger time commitment. Students should recognize that this selective is an opportunity to explore an area of interest, gain some additional clinical experience, and further their personal and career development. It is not your only opportunity to explore an area of interest. We will do everything we can to give students their first choice of selective, but it will not always be possible to do so. Students who are having academic difficulty in the second year, or who experienced academic difficulty during the first year, may be asked to work toward improving their academic record as their longitudinal selective. A decision will be reached after discussions between the student, the Office of Student Affairs, and the course directors. If a student is assigned to academic enhancement for their selective, a schedule for meetings with course directors or tutors will be established. This will be a professional expectation (with a time commitment similar to that of other students on the longitudinal selective).
5. Clinical Skills Lab
The Clinical Skills Lab provides hands-on experience and the opportunity for students to practice some basic procedural skills in a safe environment and with focused feedback. Training sessions (venipuncture, lumbar puncture, abnormal heart sounds, arrhythmia recognition and treatment, airway management, simple suturing, GU (foley) catheterization, rectal and pelvic examination, and (optional) surgical scrub) are conducted in the Clinical Skills Lab during the CSI 200 courses. These labs provide supervised practice and assurance of very basic competency in these medical procedures. The procedures and skills taught in the second year have increased complexity from those taught in the first-year skills lab sessions. Students must achieve a passing average in the lab in order to pass the CSI 200courses.
Specific written learning objectives for each of the required lab sessions are available online:
Clinical Skills Lab policies and grading guidelines are also available online:
6. Team Up
Team UpTM is a required component of this course. Students must pass Team UpTM in order to successfully complete this course. Please see the Team UpTM Moodle page and eBook for more information. Team UpTM is the institution’s primary interprofessional education (IPE) curriculum. IPE occurs “when students f from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes" (World Health Organization, 2010). IPE is a required accreditation standard for the majority of the programs at LSU Health New Orleans. IPE and associated competencies cannot occur in silo with one profession or via lecture.
This is a Pass/Fail course. Students must satisfactorily complete all course requirements listed below and demonstrate professionalism in order to pass. Failure to complete all requirements in a satisfactory and timely fashion, or unprofessional behavior may result in a failing grade.
Any student whose behavior is so unprofessional that they fail the course will be referred to the council on professional conduct. Depending on the council's decision, the student may be allowed to remediate the part of the course that they did not complete.
Students who fail the course may appeal their grade to the course directors, and eventually
to the school administration, in accordance with the guidelines and school policy
that can be found on the Student Affairs website: http://www.medschool.lsuhsc.edu/student_affairs/grading.aspx#appeal
This process should begin with an initial informal appeal that consists of a meeting with the course directors. If a student is not satisfied with the outcome of this meeting, a formal written appeal to the course directors should be made within 10 working days of receiving the final grade in the course.
Portfolio of Course Requirements
Morning Report and Hospital Rounds #1
Morning Report and Hospital Rounds #2
History Write-Up (with problem list and differential diagnosis)
History & Physical Write-Up #1 (with problem list and differential diagnosis)
DxR HPI Write-up #1
DxR HPI Write-up #2
DxR HPI Write-up #3
Counseling/ motivational interview in the clinical forums
Journal club presentation in the clinical forums
PICO/ EBM presentation in the clinical forums
Certificate to show proof of completion of all 6 IHI modules
Skills Lab 1 - IV and Venipuncture
Skills Lab 2 - Lumbar puncture
Skills Lab 3 - Abnormal heart sounds
Skills Lab 4 - Arrhythmia recognition and treatment
Skills Lab 5 - Airway management
Skills Lab 6 - Simple suturing
Skills Lab 7 - Foley catheterization and rectal/pelvic examinations Longitudinal Selective
Pass Team Up
As mentioned in the course objectives, professionalism is an expectation of all students and faculty in this course. Exemplary professionalism or lapses in professionalism may be reported to or by the course director. Course directors will follow school policies on professionalism, and this may include a discussion with the student, and completion of a Physicianship Enhancement Form. The school’s policies on professionalism can be found at: http://www.medschool.lsuhsc.edu/medical_education/Undergraduate/Professionalism.aspx
Attendance at the scheduled hospital rounds, attendance at all clinical forums, and attendance at all skills labs is required in order to pass the course. Students should place these items on their calendar at the start of the semester. Course directors should be notified in advance for unavoidable conflicts, so sessions can be rescheduled ahead of time. Students scheduled for role playing or a presentation in clinical forums should recognize that this takes priority over non-emergent school business. Students should attend the clinical forum and fulfill their responsibility to their group or arrange a switch of their responsibilities after notifying the course directors and small group faculty. If a student misses a clinical forum because of illness or family emergency, the course directors should be notified as soon as possible. If a student misses hospital rounds because of illness or family emergency, the course directors should be notified as soon as possible so remediation can be scheduled. If a student misses the skills lab due to illness or family emergency, the skills lab director should be notified as soon as possible so the lab can be rescheduled (please see the skills lab policies).
Unexcused absences indicate a lack of professionalism. Repeated lapses in professionalism may result in a failing grade for the course.
Books and Resources
- All students should have a copy of Bates Guide to the Physical Examination or another standard text on the physical examination. This should be used as a reference for physical diagnosis rounds. Students should review the chapters that correspond to the systems course they are taking: head and neck, mental status, and nervous system chapters during the neurological-psychiatric systems course; musculoskeletal and skin chapters during the musculoskeletal-dermatologic systems course; cardiovascular and peripheral vascular chapters during the cardiovascular course; thorax and lung chapter during the pulmonary system course; abdomen, male genitalia, female genitalia, anus/rectum chapters during the renal and GI systems courses. Bates is available electronically from the library website (see the Lib Guides page for second year medical school courses.
- Suggested references will be provided for clinical forum exercises.
- A good, quick reference for the clinical approach to common diseases is Harrison’s Manual of Medicine, which is available electronically through Access Medicine (an electronic database of texts that all students have access to through the library)
For questions about the class schedule, course policies, or grading please contact:
Dr. Catherine "Cacky" Hebert
Director of Clinical Science Curriculum
Director, CSI 201 & 202