ATSU-SOMA's Clinical Presentation Curriculum

[primadonna22274]

Hello all,

I'd like to post this here to get a little more traffic than just the ATSU-SOMA threads.

As someone who's been through PA school a decade ago and out practicing for the past 8 years, but who wants to be a physician, I'm intrigued by the revolutionary curriculum at ATSU-SOMA. See this link: http://www.osteopathic.org/pdf/acc_postdoc_ome08wood.pdf

It's called Clinical Presentation Curriculum, and is similar/based on the Harvard/Cambridge integrated model. To me it looks like the bastardized PBL I taught PA students 6-7 years ago...with a systems-based twist.

The idea is that patients present in approximately 120 ways, give or take a few. Now, before you shoot this idea down too quickly, think of the ER board: how many chief complaints do you see? abdominal pain; chest pain; SOB; pregnant and bleeding; arm pain; leg pain; back pain; headache; dizzy; you get the idea. There are some very frequent fliers on that list. When I first learned general medicine in my PA didactic year in 98-99, it was very traditional: first anatomy and physiology, then pharmacology, then each system one at a time (cardiac, pulmonary, GI, GU...). Not until we got to clinical rotations was there really any move to integrate it all. We did have some "clinical problem-solving" scenarios once a week or so--and nobody ever missed class because it was definitely the most fun and made it all relevant.

Now, I can see the advantage of medical education by tradition, because obviously it has worked very well for a lot of years, but I'm interested in hearing what current medical students think about this new-fangled curriculum. I do have some reservations, like how will these students do on boards? Well, we said that about PBL too, and by and large PBL students have passed their boards, and generally by a very comfortable margin. But this is different, I grant you.

Thanks for your thoughts.

Lisa

---

Members don't see this ad.

 

[GreenShirt]

Minor corrections to above OP:

1) The "Clinical Presentation Model" was developed by Calgary University in Canada. First and second year didactics are modeled around this model as well as systems.
2) Harvard University developed the "Integrated Clerkship" program that we use in our second year clinical rotations. This involves following patients through all aspects of the healthcare system as opposed to rotating through each specialty individually.
3) The current teaching is a cross between PBL and lecture-based learning. There are some sessions involving small group problem solving but there are also standard lecture hours.

 

[primadonna22274]

Thanks GreenShirt. Still trying to figure it all out.

would very much appreciate the insight of current osteopathic and allopathic students....

 

[Mary Lacerda]

Hey Lisa!

I am a first year student at ATSU-SOMA, and as soon as I read your post I wanted to hit a good reply. The curriculum at SOMA is pretty much the main reason that I decided to come here, and I really believe in it.

It seems like you have the basic understanding of it already. It's all based on the idea that diseases can be presented in about 120 ways and any complication can be branched out of these. At first, the "schemes" - as they are called - seem a little confusing but when analyzed, they just make sense. Right now we are working on the sore throat scheme, and everything that we do in class relates back to the throat and possible complications. During the lectures, all of the material presented to the students are focused on that scheme and link back to it in one way or another. In Microbio for example, the instructor focuses on the pathogens that are often seen in throat infections. Of course, we can't cover ALL of the pathogens, but we will certainly learn the ones that are found 9/10 times. During histology, it's all about throat anatomy and anything that can go wrong in its tissue composition. Same thing happens for all of the other lectures like pathology, pharmacology, immunology, etc, including OMM and lab. We are also working on clinical cases that involve all of the material presented during lectures, so not only we are learning via books, but we are already applying our knowledge into practice. Later on, when we start dealing with patients, seeing a sore throat condition won't be anything new and problem-solving the issue will be much easier with the help of the schemes.

The scheme is simply a way to help you analyze the symptoms and history taken, helping you to reach a possible diagnoses with ease. Instead of playing the "guessing game" and trying to sort all of what you learned in your head, the scheme does that for you, allowing you to arrive at a correct dignoses 95% of the time.

Traditional medical schools teach you all of the sciences during the first 2 years, and you only start putting what you learned in a clinical scenario at the end of the 2nd year, or beginning of the 3rd during rotations. At ATSU-SOMA, we spend the first two years learning how to clinically apply what we learned in class, so dealing with patients later on is just practice and nothing new.

Next summer the class of 2011 will take the first step of the boards and the entire school is eager to see the results. I have faith in the curriculum and I think last year's students will do fine, just like my class will and the following class thereafter. I'm pretty happy with SOMA and I'm sure that the innovative curriculum will suceed in many ways.

Mary
ATSU-SOMA
c/o 2012

 

[DocFox]

This type of curriculum sounds really cool- I have no idea wether it will translate into making better clinicians or not though (If I could choose I would have like to had a curriculum like this).

However, am I the only one that finds this type of approach to be a bit ironic at a DO school? All the DO propaganda about "treating the whole patient" and focusing on "people, not diseases" seems to be contrary to this type of approach.

I could be wrong and maybe I just don't understand the curriculum's concept.

 

[primadonna22274]

Thank you to those who responded.

I think learning this way would make one a very good diagnostician--you have to have a pretty broad differential to think in this way.

I mean, let's think about it: CC: "sore throat"
viral URI/pharyngitis
sinusitis/bacterial, allergic, inflammatory
allergic rhinitis/postnasal drainage/vasomotor rhinitis
strep throat
mononucleosis
peritonsillar abscess
Ludwig's angina
gonorrheal pharyngitis
OP/laryngeal carcinoma
GERD
atypical cardiac angina
laryngospasm
croup
benign tonsilloliths
thyroiditis
head/neck cancer (OK, a lazy approach)
radiation exposure
oropharyngeal candidiasis
...???plenty more, but it's been a long week and my brain is worn out.
If I were more motivated I would organize this into a "VINDICATE PLEES" list.



Lisa

 

[Ukuleleryan]

Hey all-
As a fellow SOMA student, I hope to shed a little more light on our curriculum. I'm a huge fan so far, and let me tell you why. We are taught from the beginning how to use "inductive" reasoning, therefore not making a differential by ruling out all the possibilities one by one, but chunking them into categories. That way, it allows us with very little clinical experience to start applying our learning to real cases. Here is what the sore throat scheme looks like:

So you can see how your list above is what we're looking for, but it is in categories that you can break down based on history or specific tests (Rapid Strep with Culture, Monospot, CBC/CMP, or helps you determine need for imaging, larygoscopy, etc.)

Our faculty emphasizes that 90% of this is viral, but we are trained to think through it on a systems-based approach and how to move from one branch to another. Our curriculum builds around each scheme, as Mary said, and we learn the path, micro, hist, pharm, genetics, anatomy, etc. that applies to each system and each specific complaint.

In response to the comment about it not necessarily being a "whole person" approach, I couldn't disagree more. This curriculum forces you to be inclusive in your though process and reinforces the skills of good history and physical exam taking. In our small group discussions and in our OPP classes, we learn treatments and strategies that apply to the care of these specific complaints and how to address each complaint in a holistic and comprehensive way. What I especially like is that I feel that we have something applicable from the first day, and we don't have to learn all the science up front and try to remember (and synthesize) it later.

It's a very innovative system, with great curriculum and faculty. I'm excited to hear how our colleagues in 2011 do on their boards, but the future looks really promising.

Let me know if there are any other questions. If you haven't thought of checking this out, I'd definitely encourage it...

Best,
Ryan
OMS-I
ATSU-SOMA 2012 .. ..

 

[primadonna22274]

Gosh Ryan, thanks for posting!! This topic has been a little slow to catch on...but I'm intrigued.
Yeah, I appreciate the schema too. It is a more system-based approach than the "VINDICATE PLEES" (vascular, inflammatory, neoplastic, yada yada) I taught PA students in PBL several years ago. Of note, my PA program has transitioned away from PBL to systems-based curriculum just this past year or two. I haven't really had a chance to see how it works since I'm not in education now but I want to be down the road...as a physician.
Looking forward to hearing from more of you.
L.

 

[primadonna22274]

Oh also of note: I don't think the clinical presentation curriculum is "reductionist" at all; in fact I think of it more as a synthesis, very much in line with the holistic ideals of osteopathic medicine.
(Now, if anybody asks, I don't really believe that DOs have the corner on holistic medicine, because most physicians I've known and worked with have tried to see/treat the "whole person", but maybe I've worked with lots of great physicians. Dunno.)

 

[Ukuleleryan]

Lisa-
My best to you as well! We have a current PA in our class who worked in rural medicine in alaska for 15 years, and she so far has said she enjoys how this curriculum is a great transition for her back into academia. Let us know how your applications go, and when (not if!) you come down to SOMA, we're happy to show off what we're proud of. I didn't get the non-osteopathic thing from you, but from a previous post. You have had some great docs! I love the osteopathic philosophy (and our OMM preceptors are all practicing DOs in the community that are great!)

Keep us informed!

Peace,
Ryan

 

[brucecanbeatyou]

I will be attending SOMA in fall 09. The curriculum and the amazing people behind it sold me on it. I am very excited about this school.