Family Medicine Clerkship

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Coronary Artery Disease / Chest Pain

OVERVIEW

Because cardiovascular disease is one of the leading causes of death and disability in the United States, family physicians are involved in the diagnosis and ongoing management of coronary artery disease (CAD) with their patients. Family physicians place emphasis on prevention of disease and analysis of population risks for CAD.

TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately assess signs and symptoms of coronary artery disease.

OBJECTIVES: Student will be able to:

• Perform appropriate examination of the heart, lungs, and chest.
• Elicit a history that investigates fully risks, signs, and symptoms of coronary artery disease.
• Interpret laboratory data related to the diagnosis of chest pain, focusing on the ability to diagnose accurately coronary artery disease.
• Interpret laboratory data related to the prevention of coronary artery disease.
• Assess and interpret target goals for cholesterol and lipoproteins using the best available guidelines (e.g. NCEP ATP III guidelines).

GOAL: Students will appropriately discuss coronary artery disease with patients.

OBJECTIVES: Students will be able to:

• Explain indicators of risk, disease control, and complications of coronary artery disease to their patients.
• Describe to patients the risks of coronary artery disease and goals of management.
• Counsel patients on lowering their risk of coronary artery disease.

GOAL: Students will be sensitive to individual and cultural differences in their development of treatment plans.

OBJECTIVES: Students will be able to:

• Discuss with patients and families the importance of lifestyle changes in the prevention or management of coronary artery disease.
• Work with patients and their families to develop treatment plans in the context of each patient's life.

Medical Knowledge

GOAL:   Students will understand the significance of risk factors that lead to the development of coronary artery disease.

OBJECTIVES: Students will be able to:

• Discuss the epidemiology of coronary artery disease, including racial and gender differences.
• Describe the USPSTF recommendations for screening for the risk factors that lead to the development of coronary artery disease.

GOAL: Students will understand the pathophysiology and risks of untreated coronary artery disease.

OBJECTIVES: Students will be able to:

• Describe the vascular changes that lead to coronary artery disease.
• Describe the appropriate outpatient work-up for the diagnosis of coronary artery disease.
• Discuss and defend the initial evaluation of a patient with chest pain in the outpatient setting.

GOAL: Students will understand the rationale for treatment plans for coronary artery disease.

OBJECTIVES: Students will be able to:

• Describe the appropriate use of medical therapy for prevention or treatment of coronary artery disease.
• Discuss the evidence for the role of lifestyle changes, such as exercise, smoking cessation, and dietary modification.
• Discuss the side effects and costs of commonly used medications.
• Recommend and defend the treatment plan for a patient newly discharged from the hospital with a diagnosis of coronary artery disease.
• Detail the influence of hypertension, diabetes, hyperlipidemia, and genetics on the management of coronary artery disease.

Practice-Based Learning and Improvement

GOAL: Students will understand the impact of coronary artery disease in practice and community settings.

OBJECTIVES: Students will be able to:

• Describe how risks and/or presence of coronary artery disease are monitored in the assigned clerkship site.
• Discuss the impact of environment and neighborhood on adherence to treatment plans and lifestyle changes.

GOAL: Students will understand the role of practice-based improvement in treating heart disease.

OBJECTIVES: Students will be able to:

• Analyze the practice population with regards to coronary artery disease.
• Describe how the care of patients with CAD might be improved in the assigned clerkship site.
• Describe the national or regional standards for the quality care of patients with coronary artery disease, and explain how and why these standards differ.

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

OBJECTIVES: Students will be able to:

• Identify gaps in their own knowledge and frame appropriate clinical questions in regards to coronary artery disease.
• Use best evidence to answer clinical questions about coronary artery disease.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication between physicians, students, patients, and families in the management of coronary artery disease.

OBJECTIVES: Students will be able to:

• Accurately present information obtained from patients with coronary artery disease to their supervising physician and accurately record the encounter (as appropriate).
• Facilitate the patient's understanding of the risk vascular disease may add to other disease conditions, such as heart failure, renal failure, or stroke.
• Effectively conduct a patient encounter that includes family members or significant others (as appropriate) that leads to an improved understanding of the treatment plan for coronary artery disease.
• Demonstrate effective listening skills and empathy to improve patient adherence to the management plan for coronary artery disease.

Professionalism

GOAL: Students will demonstrate the ability to care for patients with coronary artery disease from diverse patient backgrounds and at different points in their illness.

OBJECTIVES: Students will be able to:

• Respond helpfully to 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 coronary artery disease to culture, age, gender, and disabilities.

GOAL: Students will demonstrate respect, confidentiality, and professionalism in their interactions with patients with coronary artery disease.

OBJECTIVES: Students will be able to:

• Maintain confidentiality in regard to patient information and patient records.
• Reflect upon their own attitudes or behaviors that affect their ability to provide respectful care to patients with coronary artery disease, for example, attitudes about patients who smoke or who have not adhered to the management plan.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of coronary artery disease.

OBJECTIVES: Students will be able to:

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

EDUCATIONAL METHODS AND RESOURCES

Published Material

• Glanz K, Gilboy MB. Physicians, preventive care, and applied nutrition: selected literature. Acad Med. 67 (1992) 11: 776-781, 8 November 1, 1992.
  Abstract at PubMed
  
• Pomrehn PR, Davis MV,   Chen DW, Barker W. Prevention for the 21st century: setting the context through undergraduate medical education. Acad Med. 75 (2000) 7, 8 July 1, 2000.
  Abstract at PubMed
  Article at Academic Medicine
  
• Casebeer LL, Klapow JC, Centor RM, Stafford MA, Renkl LA, Mallinger AP, Kristofco RE. An intervention to increase physicians' use of adherence-enhancing strategies in managing hypercholesterolemic patients. Acad Med. 74 (1999) 12: 1334-1339, 8 December 1, 1999.
  Abstract at PubMed

Web Sites

• Center for Disease Control-Cardiovascular Disease:
  http://www.cdc.gov/

Lead Authors: Alexander Chessman, MD and Caryl Heaton, DO
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 October 15, 2005