PATIENT CARE that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

1. Conduct patient-centered encounters that balance the needs of the patient with time constraints of practice. Such encounters include:
   1. ascertaining the patient's goals for the encounter,
   2. appreciating the patient's experience of illness,
   3. performing a focused physical examination, and
   4. negotiating diagnostic and management priorities.
2. Accurately perform and document both complete and focused histories and physical examinations that are based on the pathophysiology of presenting complaints, and that address relevant psychosocial and family issues.
3. Prioritize patients' problems, formulate appropriate differential diagnoses, and develop appropriate plans for diagnosis and/or management.
4. Perform the following basic diagnostic and therapeutic procedures:
   • Basic first aid
   • Basic Life Support (BLS Certification)
   • Suturing simple lacerations
   • Drawing venous blood
   • Starting an IV
   • Basic airway management
5. Be familiar with the technique for a normal vaginal delivery.
6. Be able to discuss the principles of and the relative advantages and disadvantages of various therapeutic modalities, including surgery, pharmacology, physical rehabilitation, mental health care, behavioral modification and complementary and alternative medicine, as applied to common clinical situations.
7. Use epidemiological principles and data to formulate measures for the care of individuals and communities and be able to read the medical literature.
8. Evaluate the roles that unemployment, poverty, and lack of education play as obstacles to quality health care.
9. Develop and implement individualized risk reduction plans based on a culturally-sensitive assessment of important medical and social conditions including sexually transmitted diseases, substance abuse, and interpersonal violence.

MEDICAL KNOWLEDGE about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care

1. Know the scientific principles that underlie current understanding of normal human development, function, and disease. Be able to accurately express and use these principles in discussing health maintenance, common disease processes, and disease evaluation and management.
2. Demonstrate an understanding of social and behavioral factors that influence patients' responses to health and disease. Such factors include:
   1. specific cultural, ethnic and societal beliefs and behaviors,
   2. patients' age, education, finances, and family resources,
   3. alternative or complementary medical practices within patients' communities.
3. Understand the scientific basis and interpretation of common diagnostic modalities, including: imaging, electrocardiograms, blood and urine chemistries, pathologic studies, and functional assessment tests. Discuss the indications, contraindications and cost-effectiveness of common diagnostic studies.
4. Demonstrate knowledge of common problems and diseases for diverse populations:
   1. Presenting complaints
      1. Abdominal pain
      2. Anxiety
      3. Change in mental status
      4. Chest pain
      5. Chronic pain
      6. Cough
      7. Diarrhea
      8. Headache
      9. Obesity
      10. Trauma
      11. Heartburn
      12. Low back pain
      13. Shortness of breath
      14. Substance abuse
      15. Pharyngitis
   2. Diseases
      1. Alcoholism
      2. Arthritis
      3. Asthma
      4. Cancer
      5. Dementia
      6. Depression
      7. Diabetes
      8. Osteoporosis
      9. HIV
      10. Hypertension
      11. Hyperlipidemia
      12. Otitis Media
      13. Pneumonia
      14. Psychosis
      15. TB
      16. UTI
      17. Upper respiratory infection
      18. Vaginitis
   3. Conditions
      1. Pregnancy
      2. Menopause
      3. Domestic violence
      4. End-of-life issues
5. Understand basic issues for promoting health and preventing disease, including nutrition, exercise, psychological health, preventive pharmacology, genetic predisposition to disease, sanitation, environmental and workplace hazards, life-styles, immunizations, and apply this understanding to patient management.
6. Assess the health status, demographics and socioeconomic characteristics of medically underserved populations.
7. Recognize differences in belief systems, values, languages, religions, and health practices that impact the medical care of culturally diverse medically underserved populations.
8. Know when and how to report incidents of domestic violence including: child, elder, and spousal abuse.

PRACTICE-BASED LEARNING AND IMPROVEMENT that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

1. Understand importance of life-long learning to adequately care for patients, to participate in patient education, and to pursue creative scholarly endeavors
2. Use computer-based techniques, including PubMed and other relevant databases, to acquire new information and resources for learning.
3. Identify and use reliable, authoritative sources of medical information.
4. Organize personal resources efficiently and systematically using electronic tools and other methods.
5. Describe and assess common scientific methodologies used in clinically-relevant medical research.
6. Identify the evidential value, organization and logistics of various types of clinical trials, and be able to advise patients concerning their participation in or interpretation of these.
7. Read, summarize and critique research and disease review articles in peer-reviewed journals such as New England Journal of Medicine.
8. Use evidence-based approaches as tools to decide whether to accept new findings, therapies and technologies for incorporation into medical practice.
9. Utilize decision-support systems and guidelines for clinical decision making, including an understanding of the roles of preferences and probabilities.
10. Understand and use continuous quality improvement practices
11. Translate questions that arise from daily clinical practice into formal research hypotheses.
12. Utilize computer technology to aid in the design, writing, analysis, and presentation of data from a clinical research project (this competency is currently unique to the Drew program).
13. Design, implement, and complete a clinical research project that will meet the criteria for a Thesis (this competency is currently unique to the Drew program).

INTERPERSONAL AND COMMUNICATION SKILLS that result in effective information exchange and teaming with patients, their families, and other health professionals

1. Demonstrate interpersonal skills that build rapport and empathic communication with patients and their families across socioeconomic, racial, and cultural boundaries.
2. Make both complete and focused case presentations that are accurate and well-organized; prepare and maintain complete, accurate, well-organized medical records
3. Demonstrate a commitment to and skill in teaching medical students, colleagues, and other members of the allied health profession using the concepts and vocabulary of contemporary basic and clinical science.
4. Function as a productive member of a team.
5. Work collaboratively with health professionals from other disciplines.
6. Skillfully address sensitive issues in an effective, compassionate, non-judgmental manner. Such issues include
   1. screening for alcohol and drug abuse, domestic violence, and sexual activities,
   2. screening for cancer risks
   3. giving "bad news".
7. Describe and use sound principles for changing patients' behavior in order to promote and improve their health.
8. Inform patients and their families about health and illness in a way that is culturally-sensitive, jargon-free and appropriate to their needs, including counseling on prevention and psychosocial issues.
9. Obtain informed consent from patients by clearly explaining the risks, benefits, and alternatives for common medical and surgical procedures in a culturally sensitive manner.

PROFESSIONALISM, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

1. Demonstrate reliability, dependability, and integrity in interactions with colleagues and patients.
2. Deal with professional mistakes openly and honestly in ways that promote patient trust and self-learning.
3. Accurately assess one's personal strengths and limitations, relevant to one's practice of medicine and continued learning.
4. Develop abilities to receive and provide constructive feedback as part of peer and self-assessment of professional behaviors.
5. Understand appropriate coping mechanisms for dealing with stress, intellectual uncertainty, interpersonal conflict, and issues related to power.
6. Use basic ethical concepts and approaches to identify and analyze the ethical dimensions of common situations in medical practice, health policy, and research.
7. Understand the obligation to treat the individual patient, and discuss the conflicts between caring for a patient and caring for a population.
8. Recognize an obligation to the health of society, locally, regionally, and nationally
9. Demonstrate the ability to provide leadership to groups of colleagues or patients.

SYSTEM-BASED PRACTICE, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

1. Know the structure and functions of the health care delivery and insurance systems currently in place in California and the United States.  Compare and contrast these to alternative systems used in other industrialized countries.
2. Describe major current health system reform initiatives, including possible benefits and barriers to achieving them.
3. Discuss the concept of a medical safety net and strategies for lowering access barriers for vulnerable populations.
4. Define an integrated delivery system, list its key components and describe how they function together to deliver optimal patient care and outcomes.
5. Discuss applications of health information technologies including electronic health records, patient registries, and computerized order entry and prescribing.
6. Understand and explain the concept of value in health care, and provide examples of methods physicians use to improve value, including comparative effectiveness research, evidence-based guidelines and quality improvement.
7. Compare current and emerging physician reimbursement methodologies, and discuss their likely impacts on utilization, costs, quality, access and provider incomes.
8. Distinguish the roles of primary care providers and specialists, and discuss the options communities have to achieve an appropriate balance between primary and specialty care.
9. Understand the flow of funds through the U.S. health care system, from their points of origin through public (Medicare and Medicaid) and private (insurance companies and health plans) intermediaries, down to the provider tier (physicians and hospitals). Distinguish between costs and charges.
10. Identify and use resources and ancillary health care services for patients in situations in which social and economic barriers to access exist
11. Articulate the physician's special responsibilities toward both individual patients and society at large, and discuss ways to balance these competing needs and priorities.

Revised and Approved by the MEC: June 2019