Introduction: This module will guide clinical faculty as they organize and present a learning session for preclerkship medical students on the clinical work-up of a patient with diarrhea. During the session, students individually (or in pairs) work through the interview and perform the examination of a standardized patient presenting with diarrhea. After this encounter, students write a subjective, objective, assessment, and plan (SOAP) note, receive feedback from the standardized patient (and from their peer observer, if present) and debrief in a group discussion with a faculty member. Methods: Provided materials include a readiness assurance quiz, preparatory exam room guide and video, summary outline for use during the standardized patient encounter, a checklist to guide peer observer feedback, and a standardized patient case blueprint. These materials would be of interest to preclerkship clinical skills instructors who would like to teach a presentation-based, focused history and physical exam to their trainees. Methods: These materials were originally developed for the Medical Skills Course at the Texas Tech University Paul L. Foster School of Medicine (PLFSOM) in El Paso, Texas. Over the 5 years that we have used this case at PLFSOM, our first-year students have included the diagnosis of Crohn's disease in their top three diagnoses about 80% of the time. Discussion: Our conclusion is that the majority of pre-clerkship medical students are indeed able to perform a structured interview and exam of this complexity, use their findings to successfully navigate the scheme diagram, and assign a high likelihood to the correct disease mechanism and diagnosis.
- Apply the principles of effective communication to facilitate relationship building, data-gathering, and patient education.
- Use focused questioning and physical examination to categorize diarrhea has either acute or chronic.
- Use questioning and findings to discriminate between an infectious and noninfectious cause for acute diarrhea.
- Use questioning and findings to discriminate between watery, inflammatory, and fatty diarrhea, if the patient has chronic diarrhea.
- Write a subjective, objective, assessment, and plan note that captures the important points of the history narrative, past history including pertinent negative and positive points, important physical exam findings and essential features of diagnostic reasoning, likely diagnoses, and plan.
- Bordage G. Elaborated knowledge: a key to successful diagnostic thinking. Acad Med. Nov 1994;69(11):883-885. http://dx.doi.org/10.1097/00001888-199411000-00004
- Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. Apr 2009;43(4):312-319. http://dx.doi.org/10.1111/j.1365-2923.2009.03295.x
- Bordage G. Why did I miss the diagnosis? Some cognitive explanations and educational implications. Acad Med. Oct 1999;74(10 Suppl):S138-143. http://dx.doi.org/10.1097/00001888-199910000-00065
- Distlehorst LHP, Dawson EP, Robbs RSMBA, Barrows HSMD. Problem-Based Learning Outcomes: The Glass Half-Full. Academic Medicine. 2005;80(3):294-299. http://dx.doi.org/10.1097/00001888-200503000-00020
- Loya R, Woods GL. Group notes promote student collaboration in clinical decision making. Medical Education. 2013;47(5):520-521. http://dx.doi.org/10.1111/medu.12165
- Mandin H, Harasym P, Eagle C, Watanabe M. Developing a "clinical presentation" curriculum at the University of Calgary. Acad Med. Mar 1995;70(3):186-193. http://dx.doi.org/10.1097/00001888-199503000-00008
- McGee SR. Evidence-based physical diagnosis. 3rd ed. Philadelphia: Elsevier/Saunders; 2012. http://dx.doi.org/10.1016/b978-1-4377-2207-9.00001-x
- McLaughlin K, Coderre S, Mortis G, Mandin H. Expert-type knowledge structure in medical students is associated with increased odds of diagnostic success. Teach Learn Med. Winter 2007;19(1):35-41. http://dx.doi.org/10.1080/10401330709336621
- Novak K, Mandin H, Wilcox E, McLaughlin K. Using a conceptual framework during learning attenuates the loss of expert-type knowledge structure. BMC Med Educ. 2006;6:37. http://dx.doi.org/10.1186/1472-6920-6-37
- Shanley PFMD. Viewpoint: Leaving the "Empty Glass" of Problem-Based Learning Behind: New Assumptions and a Revised Model for Case Study in Preclinical Medical Education. Academic Medicine. 2007;82(5):479-485. http://dx.doi.org/10.1097/ACM.0b013e31803eac4c
- Steele DJ, de la Rosa JM, Tobin BW. Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Acad Med. Sep 2010;85(9 Suppl):S555-557. http://dx.doi.org/10.1097/ACM.0b013e3181ea96ea
- Woloschuk W, Harasym P, Mandin H, Jones A. Use of scheme-based problem solving: an evaluation of the implementation and utilization of schemes in a clinical presentation curriculum. Med Educ. Jun 2000;34(6):437-442. http://dx.doi.org/10.1046/j.1365-2923.2000.00572.x
This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.