Direct Observation Learner Expectations

Inpatient Medicine Direct Observation Learner Expectations

Scenario: You will be asked to participate in the discharge for a patient who has been hospitalized for 3 days. Your goal is to transition the patient from hospital to home by providing effective education, counseling, and follow up.

The student is expected to demonstrate the following behaviors:

• Setting the stage/preparation

  • Student reviews the presenting scenario and the patient information prior to the encounter.

• Greeting the patient/Establishing initial rapport

  • Student introduces self, using first and last name

  • Student states their current level of training as a medical student

  • Student states the primary purpose of the encounter

  • Student actively verifies the patient’s name and date of birth

TARGETED PHYSICAL EXAM

Note: Do not examine the patient over the gown. Physical exam maneuvers performed over the gown will result in partial or no credit for the item.

Student washes hands before the physical examination.

• Cardiovascular Exam

  • Student auscultates heart in areas specific to the 4 heart valves (aortic, pulmonic, tricuspid, mitral)

• Pulmonary Exam

  • Student auscultates posterior chest (checks both sides; auscultates at least 3 levels; asks patient to take deep breath)

  • Student auscultates anterior chest (checks both sides; auscultates at least 2 levels; asks patient to take deep breath)

• Lower extremity exam

  • Student examines both lower extremities

• Draping

  • Student utilizes proper draping of the patient during the physical exam

Student washes hands after the physical examination

EXPLAINS DIAGNOSIS & HOSPITAL COURSE

• Asks permission to discuss hospital course

ASSESS portion of APIE framework (APIE=Assess, Plan, Implementation, Evaluation)

• Explains diagnosis

• Explains etiology of diagnosis

• Explains inpatient management / hospital course summary

• Explains inpatient medication (i.e. which medications were used as inpatient and rationale)

• Explains patient is now stable and safe for discharge

PLAN portion of APIE

• Asks permission to discuss discharge and Introduces topic of discharge

MEDICATION REVIEW

IMPLEMENT portion of APIE

• Names and explains the discharge medication (MUST include both generic and brand name, dose, route, frequency)

• Describes duration

• Describes how the medication works

• Confirms access to meds / any barriers

WARNING SIGNS / WHEN TO SEEK HELP

• Explains major side effects (of medication)

• Counsels on worsening symptoms & action plan

FOLLOW UP & COORDINATION OF CARE

• States need for follow-up

• Reviews appointment details

• Confirms transportation to appointment

• Asks about support systems

EVALUATE portion of APIE:

• Uses teach-back to confirm patient understanding of medications

• Uses teach-back to confirm patient understanding of return precautions

Closing the encounter

• Student directly asks for any additional questions or concerns the patient may have

• Student verbalizes appropriate wrap-up and reference to next steps

• Student shows consideration for patient comfort by active inquiry