Family Medicine Clerkship

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Cancer Screening

OVERVIEW

Screening for early detection of cancers is an important component of practice for family physicians. Students must have the knowledge and skills to address this important topic, learn how to incorporate screening into patient care visits, appropriately counsel patients on the procedures and results, and assess new scientific information about screening.

TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately assess and individualize the indications for cancer screening for common cancers (e.g., lung, cervix, colorectal, breast, skin, and prostate).

OBJECTIVES: Students will be able to:

• Identify risk factors for cancer in patients based on family history, age, gender, and exposures.
• Interpret laboratory data of screening procedures.
• Integrate discussions of cancer screening into clinical practice.
• Identify patients who are not candidates for cancer screening (e.g., patients with significant severe other medical or psychological problems).

GOAL: Students will appropriately discuss the indications for the screening tests and procedures with patients.

OBJECTIVES: Students will be able to:

• Explain indicators based on risks.
• Describe to patients the risks and benefits of the screening tests and procedures.

GOAL: Students will respond to individual and cultural differences in their development of screening plans.

OBJECTIVES: Students will be able to:

• Discuss with patients and families the significance of positive and negative results.
• Develop management plans for further screening or diagnostic tests in the context of each patient's life and risk factors.

Medical Knowledge

GOAL: Students will understand the significance of cancer screening tests and procedures.

OBJECTIVES: Students will be able to:

• Discuss the epidemiology of common cancers.
• Describe the USPSTF recommendations for screening for common cancers.
• Describe controversies regarding cancer-screening tests (e.g. prostate specific antigen (PSA).
• Identify patients at risk for the common cancers.

GOAL: Students will understand the risks, benefits, and costs of cancer screening.

OBJECTIVES: Students will be able to:

• Describe the risks, benefits, and financial costs of cancer screening for the above cancers.
• Describe insurance coverage for screening procedures.
• Discuss and defend the recommendations for cancer screening procedures (e.g., obtaining an exposure history for lung cancer risk.)

GOAL: Students will understand the rationale for cancer screening tests and procedures.

OBJECTIVES: Students will be able to:

• Describe the rationale for cancer screening.
• Discuss the evidence for cancer screening procedures.
• Discuss the possible side effects and costs of cancer screening.
• Describe the possible psychological side effects of cancer screening (e.g., anxiety regarding mammogram results).
• Describe the indications for cancer screening in individual patients.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of screening for cancer in practice and community settings.

OBJECTIVES: Students will be able to:

• Describe how appropriate screening tools are monitored in the assigned clerkship site.
• Propose protocols to improve cancer screening in the assigned clerkship site.

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 at risk for common cancers (e.g., populations in warmer climates with excessive sun exposure or patients over 50 for colorectal cancer screening).

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

OBJECTIVES: Students will be able to:

• Identify gaps in their own knowledge and frame about current cancer screening indications.
• Use best evidence to answer clinical questions about cancer screening.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with patients and families in the approach to cancer screening.

OBJECTIVES: Students will be able to:

• Describe the risks and benefits of cancer screening.
• Include patients and families in the development of screening plans.
• Demonstrate effective listening skills and empathy to improve patient adherence to cancer screening plans.
• Respond appropriately to requests from patients for various procedures.
• Interpret results for patient's understanding.
• Clarify any information patients have obtained from other sources-- popular media, on-line, etc.

Professionalism

GOAL: Students will demonstrate the ability to care for patients with from diverse patient backgrounds.

OBJECTIVES: Students will be able to:

• Demonstrate sensitivity and responsiveness with patients who are not adhering to screening plans.
• Reflect on personal frustrations and transform this response into a deeper understanding when patients are not adherent to plans.
• Demonstrate understanding of the relationship of cancer screening to culture, age, gender, and disabilities.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems on cancer screening adherence.

OBJECTIVES: Students will be able to:

• Describe effective methods for patient (public) education about the importance of cancer screening.
• Analyze barriers to cancer screening.
• Consider mechanisms to improve adherence to and understanding of cancer screening.
• Consider the role of other disciplines in educating patients about cancer screening and improving adherence.

EDUCATIONAL METHODS AND RESOURCES

Published Material

• USPSTF guidelines
  
• American Cancer Society

Web Sites

• Clinical Communication for Male Cancer Screening
  http://www.brown.edu/Research/ICHP/mcshome.shtml
  Showing empathy, establishing a dialogue, and creating a relationship are key to caring for male patients of all ages.
  The National Cancer Institute (#5R25 CA82320) funded this complete curriculum for teaching medical, physician assistant, and nurse practitioner students about communication and screening for prostate, colorectal, and testicular cancers.
  To access the full curriculum, including:
  * Instructional guide
  * Video Discussion Cases
  * Full PowerPoint® presentations and teaching notes
  * Communication skills checklists
  * Handouts
  
  For certain videos please use the following:
  Username: View_Videos
  Password: videos623
  (note: the username and password are case sensitive)
  
  For more information, contact:
  Laura K. Lavallee
  Assistant Education Coordinator
  Predoctoral Clerkship and Faculty Development
  Department of Family Medicine
  Brown Medical School/Memorial Hospital of RI
  (401) 729-2961 Fax: 729-2923
  Email: Laura Lavallee

Lead Author: William B. Shore, MD
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