Objectives for Graduation

Objectives for graduation have a number of important functions. They provide:

1. A description of the basic skills, knowledge, and behavior expected of graduates of the School of
Medicine;
2. A basis for evaluation of student performance;
3. A guideline for developing and implementing the curriculum (see also Curriculum Guidelines);
4. A basis for evaluation of the curriculum;
5. A framework for life-long learning.

I. THE PATIENT ENCOUNTER – CLINICAL SKILLS

When the student encounters a patient with any presenting complaint or complaints as defined
by the objectives for each curricular segment and as outlined in Appendices A and B, the
student should be able to:
A. Obtain an accurate medical history.
B. Perform a complete and appropriately focused organ system specific examination.
C. Accurately interpret patient responses and physical findings.
D. Develop a problem list that includes the consideration of all psychosocial and social
variables. The differential diagnosis should emphasize all likely causes of each problem.
E. Develop a plan for any necessary further investigations to confirm the diagnosis. The
following should be considered:
a. Availability, reliability, and validity of the requested tests or procedures. In doing so,
students must:
i. Appropriately use sensitivity, specificity, and predictive values of the test.
ii. Understand the importance of the prevalence of disease in interpretation of
tests.
iii. Estimate pre-test and post-test probability of disease.
b. Risks and complications;
c. Discomfort and inconvenience to the patient;
d. Cost and its impact on the patient and society;
e. The patient’s wishes and values.
F. Accurately interpret the results of all tests ordered and modify the problem list and the
differential diagnoses accordingly.
G. Design and implement a comprehensive management plan for the patient. The following
should be considered:
a. Therapeutic goals;
b. Informed consent, including benefits, risks, and treatment alternatives of the
proposed interventions;

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 c. Discomfort and inconvenience to the patient;
d. The patient’s goals, literacy level, expectations, and ability to adhere to treatment
proposals;
e. The patient’s cultural and religious values;
f. The indications, contraindications, and side effects of therapies involved;
g. Available resources (including patient, family, health care system and community);
h. Legal and ethical requirements;
i. The structure and function of health care delivery and payment systems, and how
payments for medical care affect decision making and care provision.
H. Consult other physicians and/or other health care professionals to enhance the quality of
care.
I. Arrange for follow-up on all problems identified.
J. Monitor the effectiveness of therapy and modify when indicated.
K. Recognize patients with immediate life-threatening conditions and institute initial therapy.
L. Identify and design plans to manage situations that require on-going support: chronic,
complex illness; chronic pain; permanent disability; death and dying.
M. Provide appropriate health maintenance, health counseling, and disease-prevention
strategies.
N. Comply with infection control guidelines and the use of universal precautions.
O. Perform common technical procedures.

II. KNOWLEDGE
Students should be highly knowledgeable about medicine to provide the best possible care for
patients; they should demonstrate:
A. An understanding of the importance of the scientific foundation upon which medicine is
based and a recognition of the need for lifelong learning and the scholarly practice of
medicine.
B. Knowledge of the normal structure and function of the body and each of its major organ
systems.
C. Knowledge of the molecular, biochemical, and cellular mechanisms that are important in
maintaining the body’s homeostasis.
D. Knowledge of the altered structure and function of the body and its major organ systems
that are seen in various diseases and conditions and patient presentations (Appendices A
and B).
E. Knowledge of the social and behavioral factors that influence patients’ responses to health
and disease. Such factors include:
a. Specific cultural, ethnic, and societal beliefs and behaviors;
b. Patients’ age, literacy level, education, finances, and family resources;
c. Alternative or complementary medical practices within patients’ communities.
F. Knowledge of contemporary health care policy and practice issues.
G. Knowledge of the capabilities and limitations of information technology, electronic health
records, and the management of knowledge, including:
a. Searching, collecting, organizing, and interpreting health and biomedical information
from different databases and sources;
b. Retrieving patient-specific information from a clinical data system;

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 c. Using information and communication technology to assist in diagnostic, therapeutic,
and preventive measures, and for surveillance and monitoring health status;
d. Maintaining practice records for analysis and improvement.
H. Knowledge of the rational use, risks, and benefits of medical therapies, including
pharmacotherapeutic agents.

III. COMMUNICATION/TEAM SKILLS

Students should be able to communicate effectively with individuals and health care teams to
ensure delivery of high quality patient care. In all health care settings, the students should be
able to:
A. Communicate with patients, families, caregivers, and medical translators with respect,
sensitivity, and compassion in a culturally sensitive and jargon-free manner.
B. Provide a well-organized, concise, and thorough oral presentation of a patient’s problem.
C. Produce proper documentation to facilitate patient care, including initial history and physical
examination, follow-up notes, physician orders, and prescriptions.
D. Function as an effective member of a health care team through cooperative interactions with
health and social service professionals, families, and other caregivers.
E. Participate in the education of patients, families, students, trainees, peers and other health
professionals.

IV. COMMUNITY/PUBLIC HEALTH/PREVENTIVE MEDICINE

Students should be highly knowledgeable about community and public health to provide the
best possible care for populations. Students should be able to:
A. Articulate the importance of public health measures in promoting health and wellness and
preventing disease.
B. Describe the health status of a defined population and identify subgroups whose health
status differs significantly from the population at large.
C. Define specific public health problems in terms of incidence, prevalence, risk factors, and
socioeconomic impact.
D. Define the roles for the physician in relation to other service providers and community
agencies in addressing the health problem.
E. Apply the principles of preventive medicine, including screening and case findings, for
individual patients and populations.
F. Treat patients of all races and cultures with respect, striving to understand how spirituality
and cultural beliefs impact the encounter, treatment, and health care in general.
G. Know when and how to identify, address, and/or report incidents of domestic violence
including: child, elder, and intimate partner abuse.
H. Describe other legal and regulatory reporting responsibilities.

V. SELF-ASSESSMENT/PROFESSIONAL DEVELOPMENT SKILLS

Students should be able to assess their own skills, those of their peers, and those of the
programs in which they participate. This assessment should provide thoughtful, appropriate, and
constructive feedback for professional development. To enhance life-long learning, continuous
improvement, and professional development, students should be able to:
A. Evaluate their own skills, practice patterns, fund of knowledge and communication abilities.
In areas that are lacking, the student should have the ability to commit him or herself to
making a change and seeking appropriate resources and guidance to do so.

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 B. Evaluate the practice patterns and communication skills of their peers and offer meaningful
formative feedback.
C. Participate in continuing educational programs and activities to improve skills and be able to
evaluate program effectiveness with meaningful feedback.
D. Access information related to practice and professional development, critically analyze their
own practice habits and outcomes, and learn and incorporate new skills.
E. Critically analyze the medical literature using the principles of evidence-based medicine,
including:
a. Understanding the statistical methods basic to clinical trials (relative risk, relative risk
reduction, absolute risk, absolute risk reduction, and number needed to treat or
harm).
b. Understanding the statistical methods basic to case control and observational
studies (2 x 2 tables, odds ratio and confidence intervals).

VI. PROFESSIONAL AND ETHICAL BEHAVIOR

The student should accept the responsibilities of the profession of medicine, which expects the
highest level of competence with regard to knowledge, skills, attitudes, and behavior in the care
of patients and/or the generation and dissemination of knowledge. The student should be able
to demonstrate in daily activities:
A. Recognition of the primacy of patient welfare, including the treatment of the patient as a
person, not a disease, and understanding that the patient is a person with values, goals, and
concerns which must be respected and which may influence how the patient responds to his
or her disease and its management.
B. Respect of the patient’s rights and privacy and maintaining confidentiality of patient
information.
C. Interaction with the patient in a way that will allow the patient to feel he/she has received
medical care in a caring, compassionate, and humane manner.
D. Self-motivation; self-discipline; and personal integrity, including both honesty and reliability.
E. A professional image in manner, electronic etiquette, dress, grooming, speech, and
interpersonal relationships that is consistent with the medical profession’s accepted
contemporary standards in the community.
F. Recognition of personal limitations, whether they are intellectual, physical, or emotional, and
work with or adapt to them.
G. Recognition of the importance of personal and family roles and the need to balance them
with professional demands.
H. Provision of patient care without allowing personal biases or conflicts of interest to interfere.
I. Caring for individuals who are members of underserved populations.
J. Application of principles that govern critical decision-making to common ethical dilemmas
faced by physicians.

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Objectives for Graduation
Appendix A
(Must be seen and documented by students)

A1. abdominal mass A42. murmur/abnormal heart sounds

A2. abdominal pain A43. numbness/tingling/paresthesias
A3. abnormal ECG A44. painful limb
A4. abnormal serum lipids A45. panic/anxiety
A5. acid base disorders A46. pap abnormality
A6. acute illness in an infant/child A47. pelvic mass
A7. allergic reactions A48. pelvic pain/dysmenorrhea
A8. anemia/pallor A49. periodic health examination/growth &
A9. back pain development
A10. breast disorders A50. pregnancy/delivery
A11. chest discomfort/angina pectoris A51. preventive health care/cancer
A12. contraception screening/STI screening
A13. dementia/memory disturbances A52. psychotic patient/disordered thought
A14. diarrhea/constipation A53. renal failure: acute or chronic
A15. dizziness/vertigo A54. rhinosinusitis (rhinorrhea/sneezing/nasal
A16. difficulty swallowing congestion/sinus congestion)
A17. domestic violence A55. scrotal mass/pain
A18. dyspnea/breathlessness A56. seizures (epilepsy)
A19. ear pain A57. sexual dysfunction
A20. electrolyte disorders A58. shock/hypotension
A21. eye redness/pain A59. skin lesions
A22. falls A60. sleep disturbances
A23. fatigue A61. sore throat
A24. fever/chills A62. speech and language abnormalities/
A25. fractures/dislocations/joint injuries dysphonia/hoarseness
A26. gait disturbances A63. substance abuse/drug addiction/withdrawal
A27. gastrointestinal bleeding A64. suicidal behavior/prevention
A28. genetic/hereditary concerns A65. syncope/pre-syncope/loss of
A29. headache consciousness
A30. hearing loss/deafness A66. thromboembolic disorders
A31. hemoptysis A67. trauma
A32. hyperglycemia/diabetes mellitus A68. urinary disorder/incontinence/incomplete
A33. hypertension emptying/frequency
A34. immunocompromise/immunodeficiency A69. vaginal bleeding-abnormal
A35. impaired consciousness A70. vaginal/penile discharge
A36. jaundice (adult & infant) A71. visual disturbance/loss
A37. joint pain, non-traumatic A72. vomiting/nausea
A38. leukocytosis/leukopenia A73. weakness/paralysis
A39. lymphadenopathy A74. weight gain/obesity
A40. menstrual cycle – abnormal A75. weight loss
A41. mood disorders A76. wheezing/cough

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Objectives for Graduation
Appendix B
(Must be known by students)
B1. abdominal distention B24. issues of dying patients/delivering bad
B2. abnormal liver function tests news
B3. abnormalities of white blood cells B25. limp/pain in lower extremity in children
B4. attention deficit/learning disorder/school B26. menopause
failure B27. mouth/oral disorders
B5. behavior disorder B28. neck mass/goiter
B6. bleeding tendency/bruising B29. personality disorders
B7. burns B30. poisoning
B8. cardiac arrest/respiratory arrest B31. polycythemia/elevated hemoglobin
B9. cyanosis/hypoxia B32. pregnancy loss
B10. depressed newborn B33. prematurity
B11. development disorder/development delay B34. pelvic relaxation/pelvic organ prolapse
B12. diplopia B35. proteinuria
B13. eating disorders B36. pruritus
B14. edema/anasarca/ascites B37. pupil abnormalities
B15. failure to thrive B38. sexual maturation
B16. fetal distress/non-reassuring fetal status B39. sexually concerned patient, gender identity
B17. hair and nail disorders disorder
B18. head injuries/brain death/transplant B40. sudden infant death syndrome
donation B41. spinal injuries
B19. hematemesis B42. splenomegaly
B20. hematuria B43. strabismus and/or amblyopia
B21. hirsutism and virilization B44. tall stature, short stature
B22. infertility B45. tinnitus
B23. involuntary movement disorders/tic B46. torticollis
disorders

Revised 06/13/2005
Revised 04/08/2013

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