Introduction to Clinical Medicine (ICM) - IDIS 301 Academic Year 2013-2014 (See student calendar)

Course Director: Scott Cohen MD, MPH, FASN Associate Professor of Medicine Division of Renal Diseases and Hypertension Ambulatory Care Center, Suite !" # Medical Faculty Associates $eor%e &ashin%ton 'niversity (ffice hours) by appointment* +mail to set up a meetin%* scohen,mfa*%-u*edu phone ./0/1 2"3!//# Course Coordinator: Nic4 $ree4, msdnh%,%-u*edu, /0/!55"!//0", $&' Hospital 6th floor C7ASS Center Course O er ie!: 8CM strives to provide a frame-or4 for medical students and physician assistant students to thin4 clinically about disease* 9his course -ill provide a clinical conte:t for the information you -ill concurrently learn in your other courses) the pathophysiolo%ic mechanisms of disease covered in Patholo%y and the medications covered in Pharmacolo%y* 8n many -ays, the real ;test< for the 8CM course is your entire medical career = from your clinical cler4ships, to your residency and>or fello-ship trainin%, to your career as a practicin% clinician* 9he content of this course is divided into 3 sections .lar%ely or%an!system!based1, -hich ran%e in duration from one day to t-o -ee4s* 9he sections are) Cardiovascular System? Hematolo%y!(ncolo%y? Respiratory System? Renal? $astrointestinal? Neurolo%y? Musculos4eletal and Colla%en @ascular System? Reproductive System? +ndocrinolo%y? Human Se:uality? (phthalmolo%y? Dermatolo%y? and $eriatrics* &hile Dr* Cohen is the overall 8CM Course Director, each section also has its o-n Section Director* Re%ardless of -hich field or specialty you may select, it is important to achieve at least a basic level of understandin% of disease mechanisms in all human or%an systems, and to develop a %eneral clinical approach to each in order to be a competent clinician* Historical data about student performance in our 8CM course sho-s a close correlation bet-een mastery of 8CM course content and subseAuent performance durin% clinical cler4ships in the third year of medical school* O erall Course O"#ecti es:
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9he purpose of this course is to provide a frame-or4 for students to thin4 clinically)
! 9o reco%niBe classic clinical presentations .symptoms and si%ns1 of diseases of the maCor or%an systems? ! 9o formulate differential dia%noses of common symptoms and si%ns? ! 9o understand and interpret appropriate dia%nostic testin%? ! 9o identify %eneral pro%noses for common diseases? ! 9o identify basic principles of treatment of common diseases of maCor or%an systems? ! 9o reco%niBe ho- or%an function chan%es over the lifespan? ! 9o reco%niBe the diversity of human se:ual behavior and -hen treatment is appropriate*

DDDDDDDDDDDDDDDDDDDD*.a*4*a* the reason you chose med>PA schoolE1*

Curriculum Inter$ace: 9his course contributes to the follo-in% pro%ram obCectives) Medical Fno-led%e) ! ! ! ! ! ! ! ! Apply the scientific basis of the normal structure, development, function, and relationships amon% the maCor or%an systems of the body to concepts of health and disease* Apply principles of pathophysiolo%y to diseases and disorders* +valuate the role of immunolo%y and microbiolo%y in health and disease* Compare and contrast the %enetic processes and environmental influences on health and on disease and its treatment* 8nterpret the role of normal human biolo%ical, co%nitive, psycholo%ical, and behavioral development across the life span as determinants of health and illness* 8nterpret the clinical, laboratory, patholo%ic, and radiolo%ic manifestations of common diseases in patient care* Apply pharmacolo%ical principles to medical therapeutics* Describe ho- the principles of complementary medicine apply to patient care*

Patient Care ! ! Formulate a plan for the dia%nosis and treatment of common medical conditions* Select appropriate physical e:amination techniAues, laboratory tests, radiolo%ic, and other clinical studies and interpret the results*

Systems!Gased Practice ! 8nterpret information about the health of patient populations and communities to identify needs and plan appropriate interventions in support of population health*

%%&o! to stud' $or ICM:%% .31 Revie- the physiolo%y of each or%an system .i*e* last yearHs notes1 before each or%an system be%ins as a refresher ./1 Read the assi%ned readin% material before each lecture and ta4e your o-n notes on it* . 1 Attend lecture and ta4e your o-n notes* ."1 Revie- all of the above notes periodically* .I1 Gefore an e:am .and for Step 81 revie- all of your above notes and the section obCectives* Please note: This course operates on the assumption that you have already mastered Anatomy and Physiology
as first year medical students. While the most pertinent anatomy and physiology may be revisited by lecturers in section blocks, this may only be done in a cursory way and we recommend you review pertinent physiology and anatomy prior to each block. Not only will this help you to do well in !", it will also help you for #$"%& $tep ' preparation and to build your own medical knowledge base.

J8CM is li4ely the lar%est course in medical school in terms of information covered* Please stay on top of your readin%s and study your notes freAuently so that you donHt fall behindE 8f you are havin% difficulty understandin% material, please contact the lecturers and>or Section Directors as soon as possible* 8f you are havin% problems in %eneral -ith any aspect of the course, please contact Nic4 for administrative needs or Dr* Cohen for other needs*J

Section S'lla"i and O"#ecti es: Kou -ill receive a separate syllabus for each section of this course* Please read your syllabi for the schedule, obCectives of each lecture, readin% assi%nments, mandatory sessions, and contact information for Section Directors and lecturers* Attendance: Attendance at all lectures is hi%hly encoura%ed but typically not mandatory, e:cept as specified* &e hope that you -ill choose to attend all lectures for this course, and doin% so -ill brin% %reat benefits .e*%* 4no-led%e of in!class material -hich -ill be on e:ams, not havin% to trust the note!-riterLs errors, en%a%in% and as4in% Auestions of your professors, learnin% cuttin% ed%e or in!depth information -hich may be Mbeyond the boo4,< etc1* Audio recordin%s of lectures are available per our schoolHs usual avenues* 9here are some %round rules for class attendance in order to maintain an appropriate environment for learnin%* 3*1 Arrive on!time* 8f you must arrive late, please ta4e a seat near the door>bac4 of the room so as not to disturb your classmates and professors* 9his is common courtesy and an important s4ill that your future patients -ill appreciate*

/*1 8f you have an appointment that -ill reAuire your leavin% class early, please sit near the door>bac4 of the room and leave as Auietly>unobtrusively as possible so as not to disturb your classmates and professors* 7eavin% class in the midst of a lecture should be minimiBed and done only -hen absolutely necessary* .(bviously, if you have an emer%ency or need to use the restroom, you may leave lecture, but please do so Auietly and unobtrusively*1 *1 Control your electronic devices* Cell phones, pa%ers and anythin% you are not actively ta4in% notes on should be turned (FF* .@ibrate is not (FF*1 Note) lecturers are %enerally reAuired to 4eep their devices on for emer%ency patient and hospital contact* Kes, one %lorious day, you too -ill be tethered to this electronic leash? but for no-, youLre not, so please turn your phone off* "*1 No social media or internet surfin% durin% lectures* 9his not only dilutes your o-n learnin%, but it unfairly distracts your classmates and professors* I*1 9a4e notes* 9a4in% notes -ill help you reinforce your learnin% and also to or%aniBe your thou%hts* (n revie- of note!ta4er notes in years past, your professors have found many errors* Nothin% substitutes for your o-n notes* Note) in!class discussion can be so interestin% that it veers off the slides* 9his is a $((D thin% -hen it happens, and you should ta4e notes on -hatever is bein% discussed* 6*1 9here 8S one bad Auestion) M&ill this be on the testNM .and its variable permutations1* Please do not as4 it* &e are not a Faplan course* 9he purpose of 8CM is to create a solid foundation for your medical career, not Cust for multiple choice tests* 9est material -ill be dra-n from the obCectives for each lecture* JC(ec) 'our section s'lla"i $or mandator' course e ents, includin% small %roup -or4shops and days -hen -e have a real live patient presentEJ Some of the sections -ithin 8CM have invited patients as part of the class* 8f there are patients invited to spea4 at a lecture, audio recordin% that particular lecture &877 N(9 be allo-ed and attendance is reAuired* 8n addition, please ma4e sure that you -ear your -hite Cac4et, arrive on time, and act professionally .li4e a professional clinician1 for these patient sessions* Su**ested +e,t "oo)s and -eadin*s: Readin% is reAuired for this course* .And for the rest of your life as a clinician, so establish the habit no-E1 Su%%ested 9e:tboo4s from prior years are listed belo- and may be subCect to chan%e at the individual section director discretion so chec4 the individual section syllabi -hen they are uploaded to blac4board) ! Human se:uality and $eriatrics) All readin%s are posted to Glac4board* ! Cardiovascular system) 7illy, 7* S*, O Harvard Medical School* ./0331* Pathophysiology of heart disease: A collaborative pro(ect of medical students and faculty .Ith ed*1* Galtimore, MD) &olters Flu-er>7ippincott &illiams O &il4ins* Hard copies are available on reserve in the Himmelfarb 7ibrary*
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- Hematolo%y>(ncolo%y? Respiratory? $astroenterolo%y, Musculos4eletal and colla%en vascular? +ndocrinolo%y) Andreoli, 9* +*, O Cecil, R* 7* ./0301* Andreoli and !arpenter)s !ecil essentials of medicine .#th ed*1* Philadelphia, PA) Saunders>+lsevier* Available electronically or on reserve in hardcopy at Himmelfarb 7ibrary* !Respiratory system .in addition to !ecil*s &ssentials1) 7S Gic4ley, P$ SBila%yi, O G Gates* ./0051* +ates) guide to physical e,amination and history taking .30th ed*1* Philadelphia) &olters Flu-er Health>7ippincott &illiams O &il4ins* Hard copies are available on reserve in the Himmelfarb 7ibrary* !Renal) H Renn4e, G Den4er* -enal Pathophysiology: The &ssentials. ./nd or rd edition1* Philadelphia, PA) 7ippincott, &illiams O &il4ins* Hard copies are available on reserve in the Himmelfarb 7ibrary* ! (phthalmolo%y) Publicly available -ebsite) http)>>---*ophthoboo4*com> ! Neurolo%y) D $elb* ./0331 ntroduction to !linical Neurology* ."th ed*1 Ne- Kor4, NK) (:ford 'niversity Press, 8nc* Hard copies are available on reserve in the Himmelfarb 7ibrary* ! Musculos4eletal .in addition to !ecil*s &ssentials1) 7 Solomon, D &ar-ic4, S Na%ayam* ./0301* Apley*s $ystem of .rthopedics and /ractures* .5th ed*1 Ne- Kor4, NK) (:ford 'niversity Press, 8nc* Available electronically or in hardcopy at Himmelfarb 7ibrary* !Reproductive system) Hac4er and MooreHs &ssentials of .bstetrics and 0ynecology* .Ith ed*1 Available electronically throu%h Himmelfarb* Hard copies are also available on reserve in the Himmelfarb 7ibrary* ! Dermatolo%y) Mar4s, P* $*, Miller, P* P*, 7oo4in%bill, D* P*, 7oo4in%bill, D* P*, O ScienceDirect* ./0061* %ookingbill and "arks) Principles of 1ermatology ."th ed*1* Philadelphia, PA) Saunders +lsevier* Available electronically or in hardcopy at the Himmelfarb 7ibrary* 8f you prefer to use an alternate, similar te:t for this class .such as 2arrison*s Principles of nternal "edicine, !ecil Te,tbook of "edicine, etc1, you may do so, ho-ever you are responsible for findin% the correct chapters>pa%es to coordinate -ith the classHs readin%* Note: +oard review books are meant for review. This means their intended use is for reading after you have already learned the sub(ect from a primary source. 3our future patients will thank you for not making these your primary reading source. Additional readin*: Additional readin%s may be assi%ned for each or%an bloc4 and -ill be noted as they come up in their respective sections* Please be sure to chec4 Glac4board and your syllabi for these readin%s* Some e:amples of this include) ! Dubin, D* ./0031* -apid interpretation of &40)s: An interactive course .6th ed*1* 9ampa, Fla*, '*S*A*) Cover Pub* Co* Available electronically or in hardcopy at Himmelfarb 7ibrary*
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.lac)"oard: Please ma4e sure that you chec4 Glac4board and your email on a consistent basis* &e -ill do our best to 4eep you all informed of any chan%es -ithin the course and email is the best -ay to send updates to the -hole class* /o!er0oint Slides: Po-erpoint slides are not an appropriate reference tool for this course and are not reAuired readin%* 9hey are meant to be a visual %uide for lectures* For your reference, Po-erpoint slides used to accompany lectures -ill %enerally be posted to Glac4board at least I days before the tal4* Please note) your professors -ill not respond to reAuests for chan%es on their Po-erpoint slides .e*%* re! sendin% them, chan%in% thin%s on them, re!postin% slides in a ne- order if they decided to chan%e the order at the last minute, chan%in% formattin%, etc*1* Note also that Powerpoint slides and lecture content are to be considered the intellectual property of the lecturer. This means that it is inappropriate to share them with anyone who is not a student at the 0W# $chool of "edicine and 2ealth $ciences. 1mail 2uestions: 8t is a smart practice to first loo4 up Auestions yourself in the assi%ned readin%* 8f you have further Auestions, you may contact faculty via email or set up a meetin% to discuss in person* Note that emails reAuire at least one business day to return, and please do not e:pect faculty to chec4 in on email more than once daily* Please ma4e sure your subCect line contains ;8CM student Auestion< other-ise your email may fall throu%h the crac4s* 8f you have not heard bac4 after /" hours, please feel free to -rite a%ain* 1,ams: +:ams -ill cover reAuired readin%, handouts, and in!class material for this course* Note) a lac4 of desire to read the te:tboo4, a mista4e in note!ta4er notes, or absence from>inattention in class does not ma4e a test Auestion unfair* &ritten section e:aminations -ill consist of multiple!choice!type Auestions* 9here -ill be a comprehensive,
summative multiple choice final e:amination administered at the end of the Sprin% semester durin% e:am -ee4 dra-n from all of the subCect matter presented durin% the 8CM course* As in your other courses, only Dean

Rhonda $oldber% may approve of movin% or missin% e:aminations* Please contact her in advance via your usual avenues*
+:am 3 .(ct /3st1) Cardiovascular +:am / .Dec 36th1) Hematolo%y>(ncolo%y +:am .Pan /2th1) Pulmonary O Renal +:am " .Feb /"th1) $astroenterolo%y O Musculos4eletal>Colla%en @ascular +:am I .March 3st1) Reproductive>Neurolo%y>(phthalmolo%y 6

+:am 6 .April /3st1) $eriatrics>+ndocrine>Dermatolo%y Final +:am) Cumulative %3ote: &uman Se,ualit' !ill "e tested !it( a 4ui5 on t(e da' o$ e er' lecture and !ill add u0 to 'our *rade $or t(e section6 Please see the 8CM Human Se:uality syllabus for further details*J 9ests -ill often consist of multiple or%an section bloc4s to%ether, ho-ever you -ill receive a separate %rade for each section bloc4* 9hus, the e:am that contains only the cardiovascular system -ill yield your cardiolo%y %rade, but the e:am that contains Pulmonary and Renal -ill yield t-o %rades = one for each or%an section bloc4 tested*

No challen%es to any e:am Auestions -ill be accepted* Statistical analysis of each Auestion -ill be performed and -ill be revie-ed by the 8CM course director* Note that at each 8CM e:am, students -ill be %iven a sheet of 'SM7+ normal lab values for reference* Kou may not brin% your o-n reference sheet to the e:am* A copy is available on Glac4board for any student -ho -ould li4e to practice -ith it before e:ams*

7radin* o$ 1,ams: For each Section +:am and for the Final +:am, the pass!fail cut!off is t-o standard deviations belo- the mean, or a 20*0Q, -hichever is lo-er* Any %rade lo-er than this is a failin% %rade* .8 -ill not round = if t-o standard deviations belo- the mean is 6 , then a 6/*5 is a failin% %rade*1 9here are no honors or conditional %rades for individual Section +:ams or for the final e:am* 8f you fail an e:am, please contact Dr* Cohen and the Section Director as soon as possible? our %oal is to help you learn the material and come up -ith a study plan for future success* All Section +:am scores -ill be posted on Glac4board and the course coordinator -ill email you -hen those scores have been posted* Kou mi%ht thin4 this should happen very Auic4ly since e:ams are multiple choice = but more happens in this step than you thin4E After e:ams are %raded .Auic4lyE1, statistics are compiled and revie-ed to evaluate the performance of each test Auestion .more slo-lyE1* 9his is for your benefit, so please be patient* $enerally, scores -ill be released -ithin about / -ee4s* Kou -ill be told .31 your score? ./1 the mean score? and . 1 the standard deviation* Missin* Mandator' Sessions: See the syllabus for each section bloc4 for mandatory class sessions* Kou must stay for the F'77 class time of each mandatory session .i.e. leavin% early or comin% late counts as an absence1* For each mandatory session missed, you -ill lose 0*I points on your Section +:am %rade* 9his half point -ill be subtracted after the class avera%e, standard deviation, and pass>fail cut!off score have been determined? if after losin% this point a previously passin% %rade drops belo- the pass>fail cut!off, you -ill receive a failin% %rade on the Section +:am* Note that A%% sessions are mandatory in 2uman $e,uality. Please see the 2uman $e,uality syllabus for more detailed information on penalties for missing one of those sessions. Attendance at mandatory sessions -ill be ta4en -ith a si%n!in sheet* (n occasion, there may be si%n!out sheets to be sure students have stayed for the entire class session*

8inal Course 7rade: At the end of the semester, the overall class mean and standard deviation -ill be calculated usin% the -ei%hts listed belo- for each e:am .includin% any deductions for missin% mandatory sessions1* +!o standard de iations "elo! t(e mean is t(e 0ass-$ail cut-o$$* Any score lo-er than that .even by fractions of a point1 is a failin% %rade* $rades -ill not be rounded*

Cardiovascular system Hematolo%y>(ncolo%y Respiratory system Renal $astroenterolo%y Musculos4eletal and Colla%en @ascular System Neurolo%y Reproductive System +ndocrinolo%y Human Se:uality (phthalmolo%y Dermatolo%y $eriatrics Final e:am = 3"Q

#Q each R #0Q

/Q each R 6Q

Honors) your overall class avera%e is S3*I SD above the mean or T5/*0Q, -hichever is lo-er AND you have not failed any individual Section +:ams AND you pass the final e:am* .Dr* Cohen reserves the ri%ht to chan%e this as dictated by the statistical spread of %rades in this course*1 Pass) Kour overall class avera%e is better than /SD belo- the mean AND you have not failed more than 3*I bloc4s AND you pass the final e:am* Note for this purpose ophthalmology, geriatrics, and dermatology will each count as 5.6 block. Conditional) either .31 your overall class avera%e is better than /SD belo- the mean AND you fail / bloc4s* JorJ ./1 you meet all of the above criteria for passin% but you fail the final e:am* Note for this purpose, ophthalmology, geriatrics, and dermatology will each count as 5.6 block. Kou are reAuired to contact Dr* Cohen and the Section Directors for the bloc4s you have failed to desi%n an appropriate remediation strate%y* Fail) your overall class score is -orse than /SD belo- the class mean (R you fail more than t-o bloc4s, re%ardless of your overall class avera%e* .(R you do not other-ise meet the above criteria for honors, pass, or conditional*1 Note, for this purpose, ophthalmology, geriatrics, and dermatology will each count as 5.6 block. Per the SMHS Re%ulations for MD Candidates, any student -ho believes their final %rade is ;unCust or inaccurate may, -ithin 3" calendar days of receivin% the %rade, appeal in -ritin%< to Dr* Cohen -ith a copy to the Dean* See the Re%ulations for further information*

&onor Code: All e:aminations and assi%nments are to be completed in conformance -ith the $eor%e &ashin%ton 'niversity School of Medicine and Health Sciences Honor Code* 7i4e other professors here, 8 ta4e the Honor Code very seriously* @iolations of the Honor Code -ill not be tolerated, as they sho- a lac4 of professionalism and an inability to respect the oath and ethical norms reAuired of physicians and physician assistants* 8CM -ill strictly follo- the $& Med +:am $uidelines* 9hese are posted on our Glac4board site for your easy reference* Any student in violation of the %uidelines -ill receive a Bero for the 8CM e:am* O$$ice &ours: .' a00ointment Grin% your Auestions, concerns, 4udos, and career advisin% needs* 8 recommend you email me to set up a time, as my schedule can be variable* +mail is the best -ay to reach me 8eed"ac): 8 definitely -ant your specific, constructive feedbac4 on any and all aspects of the 8CM courseEE $reat methods to %ive me this feedbac4 include) 3* Participate in the interactive, small!%roup feedbac4 team* 9his participation is a reAuirement .see belo- and on Glac4board1* For the section to -hich you are not assi%ned, you may leave stand!out feedbac4 in the 8CM Feedbac4 mailbo: near the MS/ mailbo:es* /* Fill out the DeanHs office online evaluations at the end of each bloc4* 9hese are anonymous, and data %oes directly to the Deans and Course Director* .Please fill them out ri%ht a-ayE 8 promise 8 read themE1 * +mail me, come to my office or catch me on campus to discuss it* 9his is not anonymous*

Small-7rou0 8eed"ac) S'stem: &e hope to continue to improve the 8CM course for you* 9o do that, -e need timely, specific, constructive feedbac4* 8t is your responsibility as a student to %ive that feedbac4* 8t is my responsibility as a course director to address that feedbac4*

9o that end, -e -ill create Feedbac4 9eams for each section bloc4 of 8CM* 9he feedbac4 team -ill meet appro:imately at the end of each maCor section bloc4 for a mandatory lunch!time meetin%* +very
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student -ill be assi%ned to rotate on a feedbac4 team* Kou must attend the meetin% of your Feedbac4 9eam* Students -ill be arbitrarily appointed to be ;Class 7iaison< for each team*

Please email Dr* Cohen and Nic4 $ree4 at least one -ee4 in advance if you thin4 you have to miss your team meetin% for an e:cused reason .i.e. a medical or family emer%ency1* +:cused absences must be made up by participatin% in another Feedbac4 9eam, to -hich Nic4 -ill assi%n you* 'ne:cused absences .or e:cused absences that are not made up1 -ill cause you to lose 0*I points from your Final +:am %rade* 9his half point -ill be subtracted after the class avera%e, standard deviation, and pass>fail cut!off score have been determined? if after losin% this point a previously passin% %rade drops belo- the pass>fail cut!off, you -ill receive a failin% %rade on the Final +:am*

&hen it is your time to participate in a feedbac4 %roup, each team member should do-nload the ;Noteta4in% Sheet< from Glac4board and ta4e notes on each 8CM class session* &e -ill focus the feedbac4 on the follo-in% Auestions) 31 &hat -as done -ellN /1 &hat could be improved and ho-N 1 Ho- -ell did this session coordinate -ith the other classesN &e are loo4in% for specific constructive feedbac4 -ith a specific recommendation for improvement* .Note) you cannot %ive useful feedbac4 if you do not attend class*1

9he Feedbac4 9eam -ill meet over lunch provided by the DeanHs office* 9his meetin% -ill be facilitated either by Dean @eronica Michaelsen or by Stephanie Sarandos of the DeanHs office* &hen it is not your assi%ned time, please feel free to %ive any stand!out feedbac4 by fillin% out a form in the desi%nated 8CM Feedbac4 mailbo: located near the MS/ student mailbo:es* 8t is the desi%nated Class 7iaisonHs Cob to empty the mailbo: before each feedbac4 meetin% and brin% the comments to the meetin% for revie-*

After the meetin%, Dean Michaelsen -ill summariBe the most important constructive feedbac4 and recommendations into a summary document that -ill be posted as a Discussion board on Glac4board* Members of that feedbac4 team -ill have one -ee4 to comment on contents for accuracy* 8 -ill reviethe feedbac4 and -or4 -ith the individual course section directors to ma4e any appropriate adCustments* At the end of the fall semester, -e -ill send out an online anonymous class survey to revie- the current feedbac4 system*

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