M2 Sequence Overview
Clinical Foundations of Medicine
Sequence Director
Robert Lash, M.D.
Professor, Internal Medicine
Email: rwlash@umich.edu
Sequence Description

Clinical Foundations of Medicine (CFM) is a two-year course that prepares students for the clinical care of patients. During this course, students learn physical diagnosis, history taking, and diagnostic reasoning. They also address a variety of interdisciplinary topics (e.g., health disparities, interpersonal violence, complementary and alternative medicine) in lecture, small group, and patient care settings.

Settings used for teaching: Lectures and small group sessions take place in medical school classrooms. Clinical skills teaching occurs in three clinical skills areas, which are adjacent to one another in the Learning Resources Center. Each clinical skills area has 8-10 video-capable examination rooms essentially identical to examination rooms in patient care settings surrounding a central core that is used for larger group demonstrations. Other available resources include interactive web-based tools for cardiac auscultation, assessment of chest pain, and taking a sexual history, and simulation models for the ophthalmologic examination.

Patient base: Community volunteer patients are used in the interviewing modules, and history and physical examination sessions. These volunteers are taught specific clinical scenarios covering topics such as chest pain, shortness of breath, back pain, syncope, cough, and headache. Student-patient interactions are tracked so that a student will not see the same volunteer-patient twice during the two-year course. A large number of patients are independently recruited with specific physical findings for the Classic Findings sessions.

Clinical skills are taught primarily in small group settings, with students having the same assigned instructor during the M1 and M2 years of Clinical Foundations of Medicine as well as their M3 Feedback on Clinical Skills exercises. Critical medical judgment based on evidence, as well as clinical problem solving, are emphasized in a series of small group sessions where students practice history taking and diagnostic reasoning under faculty guidance. The same mentors also observe students performing physical exams, taking histories, as well as writing up and presenting cases. Formative feedback is provided on an ongoing basis throughout the first two years of medical school, and into the third year. This formative feedback forms the basis of self-directed learning objectives and independent study.

Also included in Clinical Foundations of Medicine are standardized patient experiences with a small group and one-on-one medical interview and sessions on performing breast, pelvic, and male genitourinary exams.

Interdisciplinary topics are led by content experts from across the University of Michigan, and small group sessions are facilitated by Social and Behavioral Issues in Medicine faculty. These faculty members also have ongoing contact with their students over the M1 and M2 years, thereby providing a safe environment for discussion of sensitive topics such as interpersonal violence. A list of interdisciplinary topics covered in Clinical Foundations of Medicine is at the end of this required course form.

Students also participate in two six-hour elective small group seminars during their M2 year on a variety of topics ranging from health economics to art in medicine. The goal of these sessions is to enable medical students to explore areas of interest that may not be covered in the traditional medical school curriculum. Medical School and other University faculty organize and teach these courses on a voluntary basis. These sessions are taught in the style of a graduate school seminar.

Intended Learning Outcomes for CFM
Intended learning outcomes (ILOs) specify what faculty expect students to learn, and to inform students specifically about the knowledge, skills, and attitudes they will be expected to acquire through a particular course or set of courses.

By the end of the M1 and M2 Clinical Foundations of Medicine, it is expected that students will:

  1. Be able to elicit general information/basic history from patients (skill)
  2. Be able to perform a basic physical exam on a patient (skill)
  3. Have a basic understanding of relationships and influences between cultural diversity and health and health care (knowledge)
  4. Have a basic understanding of health care disparities (knowledge)
  5. Have acquired deeper knowledge in selected medical topic areas (knowledge)
  6. Appreciate the diversity of health beliefs (including spirituality), and their impact on health and health care (knowledge, attitude)
  7. Possess necessary communication skills for appropriate interactions with patients (skill, attitude)
  8. Understand and begin to practice tenets of professionalism (knowledge, skill, attitude)
  9. Appreciate the philosophical issues underlying medical ethics (knowledge, attitude)
  10. Recognize potential conflicts between societal expectations and the realities of medical practice (knowledge)
  11. Appreciate the relationship between medicine and society as seen through non-medical sources (knowledge)
  12. Understand the basics of health economics, including models of health insurance (knowledge)
  13. Understand strategies for searching the medical literature, including formulating key clinical questions (knowledge, skill)
  14. Have a basic understanding of end-of-life issues (knowledge)