Selecting Cases that Facilitate Achievement of Course Objectives There is probably no better way to achieve the ambitious learning agenda of this course than to provide students with responsibility for the care of patients whose problems require acquisition and application of the core generalist competencies specified above. The breadth and depth of the requisite knowledge, skills, and attitudes places considerable pressure on faculty to select cases that will advance course objectives. The tradition of almost any inpatient case sufficing to teach the principles of internal medicine is unlikely to hold up in this curriculum, especially with the spectrum of inpatients continuing to narrow and their numbers declining. The pressures of case selection are eased considerably by use of ambulatory patients and by careful faculty development that refocuses attention on generalist competencies and away from subspecialty concerns. Although patient care responsibilities and the critical review of clinical work are the principal instructional methods of the clerkship, a host of other learning experiences and instructional methods can complement and enhance the educational process.
Some schools utilize standardized patients.
The student is highly motivated to solve the patient's problems, which facilitates acquisition, retention, and application of knowledge. Such exercises are an excellent complement to clinical work in a content-intensive curriculum such as this one, where one cannot guarantee that all students will encounter patients with the requisite problems. However, their passivity limits their contribution to a competency-based curriculum. Faculty modeling of a physician-patient interaction can be especially influential in the early phases of the clerkship. However, without an opportunity for practice, the gains from observation are marginal at best.