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COMPETENCIES

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					                                 Approved by Curriculum Committee via e-mail vote June 2006




                             CORE COMPETENCIES

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
              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.




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2.      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

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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

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           - 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 cost-
       effectiveness 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)



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          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)

(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, pre-
          eclampsia, diabetes and pregnancy, asthma and pregnancy, post-
          partum 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




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4.   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.

5.   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.

6.   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.

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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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