Approved by Curriculum Committee via e-mail vote June 2006

The University of Texas Medical School at Houston expects all of its students to demonstrate the following competencies prior to graduating with the M.D. degree. 1. PATIENT CARE a. Examination of the patient: The graduating student will be able to: (1) Obtain an accurate, comprehensive history from the patient and/or caregiver to include:  Chief complaint  History of present illness  Past medical and surgical history  Current health status, including risk factors for disease  Nutritional history  Allergies (medication, food and environmental)  Medications  Sexual history  Family history  Psychosocial history (including spiritual history)  Habits  Psychiatric history  Review of systems (2) Perform a focused history, if indicated. (3) Perform a complete physical examination including:  General appearance  Vital signs  Skin  Nutritional status  Head, eyes, ears, nose, throat  Neck  Lymphatics  Chest wall and back  Heart  Lungs  Breasts  Abdomen  External genitalia (male and female)  Pelvic examination

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Rectal and prostate examination Extremities Musculoskeletal Pulses and peripheral vascular examination Complete neurologic examination (including reflexes, motor, sensory, cranial nerves and cerebellar exam)

(4) Perform a focused physical examination when indicated. (5) Perform a complete/mini-mental status examination. (6) Perform a comprehensive/focused pediatric history to include:  Birth history  Feeding history  Growth and development  Childhood illnesses  Family history of congenital or genetic disease  HEADDSSS (Home, Education/Employment, Activities, Diet, Drugs, Safety, Sex, Suicide) style interview with confidentiality for adolescent patients (8) Perform a comprehensive/focused pediatric physical examination. (9) Accurately document and interpret the findings from the history and physical examinations. (10) Synthesize data from the history and examination to construct a provisional differential diagnosis of the patient’s problems and formulate an appropriate plan for investigation and management. (11) Apply the scientific method (including evidence-based medicine principles), to patient care whenever it is applicable and feasible. (12) Appropriately select (with awareness of sensitivity, specificity and cost) and interpret diagnostic tests in order to confirm or exclude a clinical diagnosis. (13) Competently perform routine clinical procedures (see 2 below). (14) Initiate therapeutic interventions for common conditions and assess the effects of these interventions. (15) Recommend age-specific, preventive and health maintenance practices appropriate for the patient based on the best available evidence. (16) Plan and execute appropriate plans for patient care, referral and follow-up.



BASIC CLINICAL PROCEDURES a. The graduating student will be competent in performing routine clinical procedures including:  Throat swab  Venipuncture (including obtaining blood cultures)  Starting peripheral IV  Arterial puncture  Use of sterile techniques (e.g., gloving, sterile dressing change)  Suturing of lacerations  Drainage of a simple abscess  Basic wound care  Obtain cervicovaginal smear samples  Obtain and interpret vaginal wet mount specimens  Performance of lumbar puncture  Placement of Foley catheter; male and female  Insert nasogastric tube  Basic CPR and ACLS procedures (bag-valve-mask ventilation, oral and nasal airway placement, defibrillation, and cardioversion)  Normal vaginal delivery b. The graduating student will have observed and may have assisted with or performed the following specialized clinical procedures:  Thoracentesis  Paracentesis  Orotracheal intubation  Reduction of common fractures and dislocations  Control of gross external hemorhage  Major gynecological surgery  Laparoscopic surgery  Hernia repair  Major GI procedure (e.g., EGD, colonoscopy)  Laparoscopy for trauma or acute abdomen  A major vascular procedure  Caesarean delivery

3. MEDICAL KNOWLEDGE a. The graduating student will be competent in: (a) evaluating each of the symptoms and problems specified below; (b) developing a differential diagnosis of the illness most likely related to the patient’s specific signs and symptoms, within the context of the patient’s age, background and natural history of illness; (c) ordering the appropriate studies to investigate the proposed diagnosis; and (d) initiating treatment for the patient.  Constitutional symptoms/problems - Tiredness and fatigue 3

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- Weight loss/weight gain/anorexia and cachexia - Fever (to include fever of unknown origin) HEENT - Earache - Eye pain/visual disturbances/eye trauma Cardiovascular - Palpitations - Chest pain - Hypotension/shock - Hypertension - Edema (to include Pulmonary and Systemic edema) Pulmonary - Shortness of breath - Cyanosis - Cough and hemoptysis Gastrointestinal - Dysphagia/Odynophagia - Gastrointestinal bleeding - Vomiting/diarrhea/constipation - Abdominal pain (acute and chronic) - Jaundice - Abdominal distension Genito-urinary - Abnormal menstrual bleeding - Sexual dysfunction - Dysuria - Hematuria Neurologic - Back pain (upper and lower) - Syncope - Seizures - Dizziness/vertigo - Headache - Weakness in the arms and legs - Sensory deficits - Dysreflexia - Ataxia Musculoskeletal - Arthritis/arthralgias - Myalgias Hematologic - Petechiae/purpura - Bruising and bleeding (generalized/localized) Psychiatric - Altered mental status - Depression - Suicidal ideation - Aggression 4

- Anxiety - Psychosis - Abnormal grief  Skin - Rashes - Local and disseminated lesions b. The graduating student will: (1) Understand and have knowledge of the scientific principles including genetic, molecular, and physiologic mechanisms basic to the practice of clinical medicine, and be able to use these principles in providing health care of common diseases. (2) Demonstrate an understanding of the environmental, social, and behavioral determinants of patient’s responses to health and disease states. including the following factors:  Specific cultural, ethnic, religious and societal beliefs and behaviors;  Patient’s age, education, resources and support groups; and  Alternative or complementary medical practices within patient’s community. (3) Understand the scientific basis and interpretation of common laboratory and diagnostic tests while recognizing the indications, complications, limitations and costeffectiveness of each study. These will include: imaging studies, electrocardiograms, blood and urine analyses, and pathologic studies. (4) Understand the principles of disease prevention and health promotion in individuals and populations, including the importance of nutrition, exercise, psychological health, and genetic pre-disposition to health and disease, and to apply this understanding to individual patient care. (5) Understand the organization, financing, and delivery of health care in the U.S., both in the hospital and in the community, and to appreciate the role of the physician as an advocate for patients. (6) Demonstrate knowledge of common clinical emergencies, acute and chronic problems/diseases, and their basic management:     Cardiovascular problems (congestive heart failure, arrhythmias, coronary artery disease, myocardial infarction, hypertension) Pulmonary problems (pneumonia, C.O.P.D., bronchitis, asthma) Endocrine/metabolic problems (diabetes mellitus, diabetic ketoacidosis, adrenal, parathyroid and thyroid disease) Autoimmune problems (S.L.E., rheumatoid arthritis)



Neurologic problems (epilepsy and seizure disorders, multiple sclerosis, myasthenia gravis, migraine/headaches, Parkinson’s disease, cerebro-vascular accident, Guillan Barré syndrome, spinal cord compression, meningitis/ encephalitis, delirium/dementia, sleep disorders) Hematologic/neoplastic problems (anemia, malignancy, bleeding/clotting disorders) Renal/urologic problems (pyelonephritis, glomerulonephritis, acute and chronic renal failure, prostatic hypertrophy, electrolyte/acid/base disorders, nephrolithiasis) Gastrointestinal problems (Dyspepsia, GI bleed, peptic ulcer, irritable bowel, gastroesophageal reflux, pancreatitis, liver/gallbladder disease) Musculoskeletal problems (Myalgias, Arthralgias, degenerative joint disease, osteoporosis, sciatica) Infectious disease problems (URIs, UTIs, HIV/AIDS, cellulitis, gastroenteritis) Psychiatric disorders (mood disorders, schizophrenia and other psychotic disorders, anxiety disorders, personality disorders, somatoform disorders, substance abuse/alcoholism, factitious disorders, disorders of impulse control)

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(7) Special Populations/Problems  Infants and Children  Normal growth and development  Developmental delays and mental retardation  Impact of growth and development on disease and disease management  Infectious disease (viral syndrome, meningitis)  Urinary tract infection  Upper respiratory tract infection Adolescents  Pubertal development  Testicular self-examination  Testicular torsion  Pelvic inflammatory disease  Emergency contraception



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Allergic rhinitis Otitis media and otitis externa Gastrointestinal (gastroesophageal reflux, gastroenteritis) Pulmonary (bronchiolitis, asthma) Neurologic Problems (childhood seizures, learning disorders) Psychiatric problems (language disorders, conduct disorders, depression, anxiety, attention deficit/hyperactivity disorders) Child abuse General/Other (dermatitis, eczema, trauma, endocrine disorders, anemia, nutritional problems) Immunization

Female Reproductive Problems  Obstetrics (normal delivery, abnormal delivery, C-section, contraception management)  Complications of pregnancy (first trimester complications, preeclampsia, diabetes and pregnancy, asthma and pregnancy, postpartum complications, seizures during pregnancy, fetal anomalies, isoimmunization, maternal vascular disease, maternal renal disease)  Gynecological problems (uterine fibroids, sexually transmitted diseases, dysfunctional uterine bleeding, infertility, vulvar dystrophies, endocrine disorders, breast mass, hysterectomy, invasive gynecological malignancy) Problems of the Elderly  Cardiovascular problems (temporal arteritis, stroke)  Neurological problems (dementia, pseudodementia, Parkinson’s disease)  Polypharmacy  Urological (incontinence, retention)  GI (constipation, obstipation)  Social dimensions of aging (isolation, family issues, housing, decreased mobility) Surgical Problems  Emergent Surgical Problems (blunt and/or penetrating trauma)  Acute Surgical Problems (acute abdomen, acute appendicitis, small bowel obstruction)  Elective Surgical Problems (hernia repair, cholecystectomy, breast mass)  Post-Surgery Care (wound care, post-operative pain, D.V.T.)  Complications of Surgeries (wound/abscess drainage, fever)  Pre-Operative Evaluation  Post-Operative Care





INTERPRETATION OF MEDICAL DATA/PRACTICE-BASED LEARNING AND IMPROVEMENT The graduating student will be able to: a. Use available technology to access medical information resources needed to expand personal knowledge and make effective decisions in patient care. b. Critically assess the validity of a published medical study by describing its strengths, weaknesses, limitations and applications to clinical practice. c. Use evidence-based approaches as tools to decide whether to accept new findings, therapies and technologies for incorporation into clinical practice.


INTERPERSONAL AND COMMUNICATION SKILLS The graduating student will be able to: a. Make case presentations that are accurate and well organized; accurately record in the patient’s chart the information needed to appropriately address the patient’s problem/condition. b. Convey diagnostic and management plans effectively both orally and in writing. c. Demonstrate interpersonal skills that build rapport and empathic communication with patients and their families, and other health care professionals. d. Demonstrate respect for patients and colleagues that encompasses diversity of background, belief systems, language and culture. e. Demonstrate professionalism and compassion in addressing issues of a sensitive nature with patients and families. f. Help patients make and anticipate end-of-life decisions, and be able to communicate bad news, and obtain consent for treatments. g. Promote the learning of patients, peers and other healthcare providers.


PROFESSIONALISM The graduating student will be able to: a. Demonstrate honesty, trustworthiness and integrity in interactions with patients, families, colleagues and other health care professionals. b. Develop a collaborative relationship with patients by valuing the patient and his/her input, and by maintaining continuing personal responsibility for the patient’s health care. 8

c. Display intellectual curiosity and commitment to excellence in patient care; advocate at all times for the needs of patients. d. Demonstrate respect and compassion towards patients and their families, including sensitivity to patients’ culture, age, sexual orientation and gender. e. Recognize the moral and ethical issues and responsibilities facing physicians as practitioners and members of society. f. Recognize the importance of patient’s rights, including confidentiality of patient information and informed consent. g. Understand the importance of self-awareness, self-care (including risk factors for impairment), life-long learning and professional growth. i. Recognize, acknowledge and take actions to improve deficiencies in personal behaviors, knowledge and skills. j. Understand the broad concepts of what being a medical professional implies, including the obligations to patients and medicine’s contract with society.


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