Family Medicine Clerkship

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Asthma / COPD

OVERVIEW

The prevalence of asthma / chronic obstructive pulmonary disease (COPD) is steadily increasing in the United States, and the need for effective primary care is critical. Students need to learn how to manage adults and children who present with acute exacerbations of chronic respiratory conditions, and how to work collaboratively with these patients and families to prevent exacerbations and to maximize exercise tolerance and freedom from symptoms.

TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately assess signs and symptoms of patients who present with shortness of breath, cough, and/or wheezing.

OBJECTIVES: Students will be able to:

• Perform appropriate examination of the respiratory system.
• Interpret chest radiographs and lung function study results.

GOAL: Students will appropriately discuss use of inhalers and peak flow meters with patients.

OBJECTIVES: Students will be able to:

• Explain indicators of control and complications of incompletely controlled asthma and COPD to their patients.
• Describe the risks of uncontrolled asthma / COPD and goals of management to patients.
• Demonstrate use of an inhaler.
• Demonstrate use a peak flow meter and a home monitoring system for exacerbation management.

GOAL: Students will demonstrate sensitivity to individual and cultural differences in the development of treatment plans.

OBJECTIVES: Students will be able to:

• Discuss with patients and families the importance of lifestyle changes, especially reduction of tobacco exposure, in the management of asthma / COPD.
• Develop treatment plans in the context of each patient's life and environment.

Medical Knowledge

GOAL: Students will understand the significance of asthma / COPD in health promotion and disease prevention.

OBJECTIVES: Students will be able to:

• Discuss the epidemiology of asthma and COPD, including racial, ethnic, and socioeconomic differences.
• Describe the USPSTF recommendations for screening for asthma / COPD.

GOAL: Students will understand the pathophysiology and risks of untreated asthma and COPD.

OBJECTIVES: Students will be able to:

• Describe the end-organ complications of incompletely treated asthma / COPD.
• Describe how to make the diagnosis of asthma / COPD.
• Discuss and defend the initial evaluation of a patient with a new diagnosis of asthma / COPD.

GOAL: Students will understand the rationale for treatment plans for asthma / COPD.

OBJECTIVES: Students will be able to:

• Describe the appropriate therapy for asthma / COPD.
• Discuss the evidence for the role of lifestyle changes.
• Discuss the side effects and costs of commonly used medications for chronic respiratory diseases.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of monitoring control of asthma / COPD in practice and community settings.

OBJECTIVES: Students will be able to:

• Describe how chronic respiratory disease control is monitored in the assigned clerkship site.
• Consider the impact of environment and neighborhood on adherence to treatment plans and lifestyle changes.

GOAL: Students will understand the role of practice-based improvement.

OBJECTIVES: Students will be able to:

• Recognize the importance of practice analysis for a population with asthma / COPD.
• Identify opportunities for improving the system of care for patients with asthma / COPD in the practice population.

GOAL: Students will bring up-to-date evidence to the point of clinical care.

OBJECTIVES: Students will be able to:

• Identify gaps in their own knowledge and frame appropriate clinical questions in regard to ongoing care of chronic respiratory disease.
• Use best evidence to answer clinical questions about asthma / COPD.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with patients and families in the management of asthma / COPD.

OBJECTIVES: Students will be able to:

• Describe the long-term treatment plans for asthma / COPD.
• Include patients and families in the development of treatment plans.
• Demonstrate effective listening skills and empathy to improve patient adherence to lifestyle modifications, such as diet and exercise for weight loss, smoking cessation, and medication use.

Professionalism

GOAL: Students will demonstrate the ability to care for patients with chronic respiratory illness who are from diverse patient backgrounds and at different points in their illness.

OBJECTIVES: The student will be able to:

• Demonstrate sensitivity and responsiveness with patients who are not adhering to treatment plans.
• Reflect on personal frustrations when patients are not adherent to plans.
• Demonstrate understanding of the relationship of asthma / COPD to culture, age, gender, and disabilities.
• Accept patients who, despite medical advice, continue with unhealthy behavior, such as tobacco use, despite the risk of adverse consequences.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of asthma / COPD.

OBJECTIVES: Students will be able to:

• Describe cost-effective strategies for treatment of asthma / COPD using different formularies.
• Analyze barriers to effective integrated treatment of asthma / COPD.
• Consider the role of other disciplines (e.g., pharmacy, nursing, social work, and allied health) in the treatment of asthma / COPD.

EDUCATIONAL METHODS AND RESOURCES

Learning Units

• UCLA Doctoring Course

Published Material

• Practical Allergy, Etan Milgrom, MD, Richard P. Usatine, MD, Ricardo A. Tan, MD and Sheldon Spector, MD

Web Sites

• American Academy of Allergy and Immunology
  Offers resources such as guides to allergy and asthma care, asthma handouts, and guideline for care of children who have asthma.
  http://www.aaaai.org/
  
• American Lung Association
  Information on asthma, COPD, hay fever, and lung cancer
  http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22542
  
• National Allergy Bureau
  The National Allergy Bureau(TM) (NAB(TM)) is the section of the   American Academy of Allergy, Asthma and Immunology's (AAAAI)   Aeroallergen Network that is responsible for reporting current pollen and mold spore levels to the media. See the spore and pollen count for your area.
  http://www.aaaai.org/nab/

Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated November 6, 2004