Clinical Foundations of Medical Practice is a two-year longitudinal course designed to teach students clinical skills and clinical reasoning which will serve as the foundation for their clinical work in years 3 and 4.  CFMP-1 will introduce students to multiple clinical concepts and CFMP-2 will build on this introduction.  CFMP-1 will be presented in two specific components.  Tuesday afternoons will be small-group case studies while Thursday mornings will cover clinical skills. 

The purpose of the Tuesday afternoon small-group sessions is to help the student integrate basic science concepts and clinical science concepts into a specific case or a specific patient problem and help the student develop clinical reasoning skills.  Each student will be assigned to a small group which will meet every Tuesday afternoon throughout the entire academic year, and groups will be assigned a clinical faculty facilitator who will help guide the discussion of each case throughout the academic year.  Groups will be given a new case each month.  Groups will discuss this case over a three- or four-week period of time.  Students will be expected to prepare for these case discussions by reading the syllabus, reviewing their basic science lecture notes and searching for further information in other sources.  Students are expected to participate in the case discussions and assist other students in their endeavors to understand the clinical ramifications of the cases.  These sessions are considered professional responsibilities, the same as patient-care sessions in the third or fourth year.

The major concepts of the basic sciences will be reviewed as they pertain to each specific case.  In some instances, the basic science concepts will be previewed, since the cases will utilize concepts that the students will be taught in the basic science courses over the next few weeks.  This approach is used to show the students how the basic sciences are critical in analyzing any clinical scenario.  Clinical concepts that will be reviewed in each case include; medical ethics, clinical nutrition, human sexuality, cultural competency, grieving and loss, health payment systems, chronic illness care, evidence-based medicine and public health.  Students will be given questions for discussion in their small group which will show how these concepts are integrated into each clinical case. 

The Tuesday afternoon sequence will begin with Orientation and Introductory large group lectures covering basic concepts given during August.  The first case will begin on the first Tuesday of September.  A new case will begin the first Tuesday of October and another new case will begin on the first Tuesday of November.

The Thursday morning clinical skills component will begin with Medical Interviewing, designed to teach the students how to obtain a medical history from a patient.  This component begins in August and ends in December.  Instruction is mostly in small groups.  Students will have an opportunity to interview standardized patients, actual hospitalized patients, and to be videotaped doing an interview. 

The first half of the CFMP-1 course will end in December with a practical exam (where the student will take a videotaped history from a standardized patient and will be graded on that history), followed by a written examination which will cover all of the material discussed in the small groups and in the medical interviewing component.  This first written exam will cover all the material in the CFMP-1 course from August through December.  The small group facilitators will grade the students on their performances in the small group cases from September to December.

January will begin the second half of the CFMP-1 course.  Tuesday afternoons will remain case-based small group discussions with a new case will starting in January.  The Thursday morning clinical skills component will continue with the Introduction to the Normal Physical Examination.  Students will be given a large group demonstration and lecture, followed by small group practice sessions.

In January through April is a Clinical Opportunities segment where students will be scheduled to work alongside a practicing physician, honing their medical interviewing skills, the physical exam skills that they have learned to that point, seeing real ambulatory patients, learning about the health care team and seeing how the concepts of the Tuesday afternoon cases integrate in a real practice. 

In April and May, the Introduction to the Normal Physical Exam component will continue on Thursday mornings.  At the end of May, the students will take a practical examination by doing a full physical examination on a standardized patient and will be graded on this examination.  This will be followed by the final written examination.  The final written exam will cover materials discussed in the small-group cases from January through May, and the physical examination materials.  The small group facilitators will grade the students on their performance in the small group cases from January through May.

Grading for the CFMP-1 course will consist of six parts.  The practical history exam will be 1/6th of the final grade.  This exam will be scored on a scale of 0-100.  The first written exam in December will be 1/6th of the final grade.  This will also be on a scale of 0-100.  The first evaluation of the students by the small group cases facilitator (Sept – Dec) will be 1/6th of the final grade and will be on a scale of 0-100.  The final practical physical exam will be 1/6th of the final grade, also on a scale of 0-100.  The second written exam in May will be 1/6th of the final grade and will be graded on a scale of 0-100.  The small group facilitator’s final evaluation of the Tuesday afternoon individual student performance (Jan – May) will be 1/6th of the final grade, also on a scale of 0-100.  The scores of each of these six parts of the grade will be added together on a final scale of 0-100.  Passing will consist of a 70% or greater final total score.  High pass will be 85% or greater final total score.  Honors will be 91% or higher on the final total.

Students must pass each part of the six part grading system at a level of 70% or higher.  Any student who does not score 70% or higher on any part of the course receives an ‘R’ for that component of the course, as well as the entire course.  Students must then remediate that part of the course before they can pass the entire course.  Upon satisfactory remediation, the final grade of the course will be reported as P (70-84) since high pass and honors are not possible with any remediation.  For example, if a student scores less than 70% on the history practical, he/she must remediate the Medical Interviewing Course successfully in order to pass CFMP-1.  An “R” unsuccessfully remediated becomes an “F” for the entire course.  A total of two ‘R’s’ on any two portions of the grade results in an “F” for the entire course.  For example, if a student gets less than 70% on the history practical and less than 70% on the final written examination, the student will fail the CFMP-1 course.  If a student gets less than 70% on both of the small group facilitators grades, which is worth 2/6th, they receive two ‘R’s’ and fail the CFMP-1 course.  The small-group facilitator’s evaluation will assess the student’s performance in the small groups, their preparation for the small group sessions, their professionalism, their participation and their assisting other students’ learning endeavors.