Goals & Objectives
The overall expectation for the clerkship is that you will develop and extend your foundation of attitudes, knowledge and skills that you will use in dealing with patients with chronic illnesses and who are facing death, regardless of the specialty you enter. The knowledge and skills are described in the following goals for the clerkship:
The student will be able to sensitively and effectively communicate a poor prognosis to patients and families, and provide appropriate counseling around this information using best demonstrated clinical practices.
The student will be constructively involved in a team approach to care of patients with chronic illnesses. The student will:
- Understand and appreciate the roles of team members in providing care in chronic illness. Team members frequently include: Physical Therapists, Occupational Therapists, Vocational Therapists, Speech and Communication Therapists, Case Managers, Nurses, Social Workers, Home Health Aids, Chaplains, and Volunteers.
- Participate in team conferences for patients.
- Observe and participate in therapies given by non-physician team members.
The student will be able to identify and perform appropriate clinical and functional assessments of patients with chronic disease, disability, and life limiting illness. The student will:
- Understand the distinction between pathophysiology, functional limitations, disability, societal limitation, actively-dying care and end-of-life care
- Develop a functionally-oriented problem list.
- Develop a patient-centered set of goals for patients and families living with life-limiting illness near the end of life.
The student will be able to identify how systems of care affect the delivery of care for patients with chronic disease, disability, and life-limiting illness. The student will:
- Identify community resources available to assist patients and families for providing care in the patient's home or community.
- Identify health services delivery issues that either hinder or support care of patients and family.
- Understand how health care financing issues, e.g., Insurance, determine the level and type of care available to patients in the home or community.
- Appreciate how systems of health care interact with ethical concerns in patient care.
- Appreciate the effects of health care systems on vulnerable populations, particularly those with limited means to pay for care.
The student will be able to apply the following basic concepts in designing a care plan for patients with chronic disease, disability, or life-limiting illness. The student will understand:
- Providing care while not being able to cure disease.
- Quality of life is defined by the patient and may not correlate with the severity of the pathophysiology, impairment, functional limitations, disability, or expectations of society.
- Influences of physical, psychosocial, and environmental factors on vocational and avocational function.
- Influences of the physical, psychosocial and environmental factors on quality of life as defined by the patient and family.
The student will be able to use approaches to patients and families that support appropriate management of medical conditions outside of the hospital and clinic setting. The student will:
- Identify aspects of the patient's environment that would prevent implementation of care recommendations, such as architectural barriers, availability of caregivers, housekeeping services, etc.
- Appreciate the process of adaptation to chronic illness and reintegration of the patient into the family, community, and workplace.
- Identify and manage the common physical and psychological symptoms experienced by patients and families at the end of life.
The student will be able to elicit and understand the patient and family's perspective on the management of medical issues, including individual preferences, cultural perspectives, and religious beliefs as they affect the perception of care. The student will be able to:
- Develop a set of patient/family-centered goals of care defined by the patient and family.
- Provide a plan of care that supports the desired patient /family centered goals.