Family Medicine Clerkship

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Fatigue

OVERVIEW

Fatigue is one of the most common concerns of patients coming to the family physician's office. Up to 20% of the general population report feeling persistently fatigued.   Fatigue typically refers to a subjective sense of tiredness or malaise that patients perceive as impairing their ability to function in an optimal way. Fatigue has both physical and mental aspects that make it an ideal issue to be addressed by the family physician because it requires application of the biopsychosocial model.

TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will be able to provide compassionate, appropriate, and effective care to the patient who presents with fatigue.

OBJECTIVES: Students will be able to:

• Perform an appropriate and comprehensive history and physical examination on a patient who presents with fatigue.
• Develop a diagnostic plan, including consideration of appropriate laboratory assessment, of the patient with fatigue.

GOAL: Students will discuss fatigue appropriately with patients.

OBJECTIVES: Students will be able to:

• Explain the mental and physical aspects of fatigue to their patients.

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 environment in the management of fatigue.
• Develop treatment plans in the context of the patient's life and environment.

Medical Knowledge

GOAL: Students will know the physiological and psychological mechanisms that contribute to fatigue.

OBJECTIVES: Students will be able to:

• List the differential diagnosis of fatigue, including the criteria for chronic fatigue syndrome.

GOAL: Students will know the management of fatigue.

OBJECTIVES: Students will be able to:

• Describe the laboratory evaluation of a patient with fatigue.
• Describe to the patient a specific, appropriate therapy for fatigue.
• Discuss the evidence for the role of lifestyle changes (e.g., nutrition or exercise) in treating fatigue.

Practice-Based Learning and Improvement

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 fatigue.
• Use best evidence to answer clinical questions about fatigue.

Interpersonal and Communication Skills

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

OBJECTIVES: Students will be able to:

• Describe the long-term treatment plans for a patient with fatigue.
• Include patients and families in the development of treatment plans.
• Use effective listening skills and empathy to improve outcome in patients with fatigue.

Professionalism

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

OBJECTIVES: Students will be able to:

• Demonstrate sensitivity and responsiveness with patients who are not adhering to treatment plans.
• Demonstrate understanding of the impact of culture, age, gender, and disabilities on fatigue.

Systems-Based Practice

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

OBJECTIVES: Students will be able to:

• Describe cost-effective strategies for evaluation of patients with fatigue.
• Analyze barriers to effective integrated treatment of fatigue.
• Consider the role of other disciplines (e.g., psychology, nursing, social work, and community agencies) in the treatment of fatigue.

EDUCATIONAL METHODS AND RESOURCES

Learning Units

• PBL cases- University of Texas, San Antonio- Richard Usatine

ASSESSMENT STRATEGIES

Objective Structured Clinical Examination (OSCE)

• University of Texas at San Antonio, Richard Usatine

Lead Author: Janice Nevin, 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