 Course Name: Patients, Physicians and Society
 Class Hours: 1:00-5:00 pm (variable), two to three days per week
 Instructors:
Course Director:
Phebe Tucker, M.D.
 Office:
WP 3440
 Telephone:
405 271-4488
 Email :
phebe-tucker@ouhsc.edu
 Office:
WP 3440
 Telephone:
405 271-4488
Co-Directors:
Rhonda Sparks, M.D. Sheila Crow, Ed.D. Shouvik Chakrabarty, M.D.
Rhett Jackson, M.D.
Email, Office Rhonda-sparks@ouhsc.edu
FMC2615
271-7827
& Phone:
Sheila-crow@ouhsc.edu
BSEB 115A
271-8001
Shouvik-chakrabarty@ouhsc.edu
WP1160
271-3445
Rhett-Jackson@ouhsc.edu
WP1130
271-5882
 Course Description
This 18 month afternoon course provides clinical correlations to all morning foundations courses,
first building effective communication skills in the doctor-patient relationship. Students learn to
conduct patient interviews and general and focused physical examinations under supervision of
physician preceptors, using simulators, live models and patients. Topics include ethics,
professionalism, evidence-based medicine, human development, emotions and personality, and
cultural and gender sensitivity.
 Learning Objectives
Patient Care: Students will provide supervised patient care that is compassionate, appropriate,
and effective for the treatment of health problems and the promotion of health.

Contrast types and characteristics of effective doctor-pt relationships (Fall I, Prologue).

Recognize & compare primary emotions, how patients present them, and how to respond
effectively in therapeutic sequence; experiential (Fall I, Prologue).

Integrate learned skills to check vital signs and perform a complete physical exam on a
standardized patient with feedback in practice session (Fall I, MCS)

Synthesize & accurately record information from medical interview into comprehensive
written medical history (Fall I, MCS).

Perform detailed ophthalmologic and pediatric exams in lecture and under guidance of
specialist preceptor (Fall I, HS, DDT).

Assimilate lecture material with preceptor-guided geriatrics, lymphatic, abdominal, thyroid and
endocrine exams (Spring I, BHL, GIH, MN).

Apply learned information to clinician-guided, comprehensive exam of the heart, peripheral
vasculature, lungs and genitourinary tract in males and females (Fall II, CRR).

Integrate knowledge of CNS and human behavior with complete, clinician-guided
neurological and Mental Status exams in patient or standardized patient interviews and
evaluations (Fall II, NP).

Conduct a proper basic examination of the head, eyes, ears, mouth and neck in class and
guided by clinician preceptors (Fall II, NP).

Integrate learned information on breast, gynecological and musculoskeletal and
dermatological exams in conducting a detailed exam on live models (Spring II, RWH, MSI).

Assimilate knowledge to perform guided complete physical exams and basic clinical
procedures (IV's, intubation, venipuncture, note writing, etc.) with simulators and live models
and pts. (Spring II, pre-clinical).
Medical Knowledge: Students will gain medical knowledge about established and evolving
biomedical, clinical, epidemiological and social-behavioral sciences and the application of this
knowledge to patient care

Compare and contrast different personality styles in patients and challenges they present to
caregivers.

Compare sources of stress in physicians with coping strategies; identify signs that caregivers
need help.

Differentiate aspects of medical professionalism and ethics relevant to everyday practice,
including confidentiality, informed consent and self-regulation.

Compare & contrast normal developmental stages and tasks from infancy to old age.

Compare & contrast stages and tasks of adulthood; coordinate with general physical exam
review material.

Apply the concept of uncertainty in medical decision making to medical practice.

Differentiate psychosocial, physical and economic issues related to aging as they present in
patients.

Integrate concepts of stages of dying and grief, end of life issues in health care delivery,
resources to help dying pts and their families.

Differentiate eating disorders and behaviors as they affect patient care.

Compare levels of intelligence, tests to evaluate IQ and personality.

Identify normal & abnormal aggression & causes; Recognize & report domestic violence in
children and partners.

Describe sexual response cycle, safe sex practices, different sexual preferences, sexual
problems presenting in medical practice.

Differentiate mental health issues related to women's reproductive cycle.

Contrast traditional and non-traditional families and groups, and their importance in health
care.
Experience-Based Learning and Improvement: Students will incorporate experience-based
learning and improvement that involves investigation and evaluation of patient care, appraisal
and assimilation of scientific evidence and improvements in patient care.

Demonstrate the ability to use medical information to improve knowledge and skills.

Incorporate feedback from mentors, preceptors, office staff, and other course personnel to
improve patient care.
Interpersonal and Communication Skills: Students will develop interpersonal and
communication skills that result in effective information exchange and team building with
patients, their families, and other health professionals.

Demonstrate foundations of effective and confidential communication with patients, their
families, health care team.

Demonstrate integration of communication skills and knowledge about mental disorders in
effective interview of patients with mental disorders.

Demonstrate interviewing skills, integrating components of comprehensive medical history.
Professionalism: Students will develop professionalism as manifested through a commitment
to carrying out professional responsibilities with adherence to ethical principles, and sensitivity to
a diverse patient population.

Integrate humanistic principals presented in medical literature and humanities into
compassionate medical treatment.

Behave in an ethical manner and exhibit honesty and integrity.

Display intellectual curiosity and dedication to excellence.

Recognize, acknowledge, and takes actions to improve deficiencies in behavior, knowledge,
and skills.

Fulfill the responsibilities and obligations of the course.
Systems-Based Practice: Students will begin to experience systems-based practice, as
manifested by actions that demonstrate an awareness of and responsiveness to the larger
context and system of health care and the ability to effectively call on system resources to provide
care that is of optimal value.

Integrate concepts related to gender and different cultures into effective and compassionate
health care delivery.

Begin to work effectively in a health care team with an awareness of personal and economic
limitations in clinical practice

Conduct of the Course

Format – Didactic lectures; case-based exercises (Team-Basesd Learning,
Problem-Based Learning with clinician preceptors, online clinical vignettes,
OSCE’s, guided physical examinations using live models, patients and
simulators); online syllabus; in-class and take-home assignments.

Assigned reading
Ethics: CLASS 2: DECISION-MAKING CAPACITY & REFUSAL OF TX
Lo, B. Resolving Ethical Dilemmas, chapter 10, "Decision-making Capacity"
Lo, B. Resolving Ethical Dilemmas, chapter 11, "Refusal of Treatment by Competent,
Informed Patients"
Isaac Bashevis Singer, “The Safe Deposit” in Kerry M. Olitzky, Ed., "The Safe Deposit"
And Other Stories About Grandparents, Old Lovers, and Crazy Old Men. New York: M.
Wiener Pub., 1989. (available on blackboard)
Key Historical/Legal Case
"Elizabeth Bouvia Case," and "David Rifkin Case" in J Shapiro, No Pity, 274-275. New
York: Random House, 1993. (available on blackboard)
CLASS 3: CONFIDENTIALITY AND DISCLOSURE
Lo, B. Resolving Ethical Dilemmas, chapter 5, “Confidentiality”
Lo, B. Resolving Ethical Dilemmas, chapter 6 "Avoiding Deception and Nondisclosure"
Lo, B. Resolving Ethical Dilemmas, chapter 27 "Secret Information about Patients"
Klass, P. Invasions. In R. Reynolds & J. Stone (Eds.), On Doctoring, p. 10.
Graham-Pole, J. (1998). Candor. In A. Belli & J. Coulehan (Eds.), Blood and Bone:
Poems by Physicians. (pp. 27). University Of Iowa Press. (available on blackboard)
Key Historical/Legal Case
Macklin, Ruth. "Tatiana Tarasoff." Mortal Choices. Pantheon, 1987. 172-73.
(available on blackboard)
CLASS 4: INFORMED CONSENT
Lo, B. Resolving Ethical Dilemmas, chapter 3, "Informed Consent"
Lo, B. Resolving Ethical Dilemmas, chapter 11, "Refusal of Treatment by Competent,
Informed Patients"
Gawande, A. (2002). "Whose Body Is It, Anyway." In Complications: A Surgeon's Notes
on an Imperfect Science. Picador: 208-227. (available on blackboard)
Key Historical/Legal Case
Caplan, A. "Twenty Years After: The Legacy of the Tuskegee Syphilis Study." Hastings
Center Report, 22(6), 29-32. (available on blackboard)
CLASS 5: END-OF-LIFE CARE ISSUES
Lo, B. Resolving Ethical Dilemmas, chapters 15-22, section on “Decisions About LifeSustaining Interventions.”
HBO Film, Wit.
CLASS 6: HIV / AIDS
Excerpts from My Own Country, A. Verghese.
Film, Philadelphia
CLASS 7: COMPLEMENTARY MEDICINE
CLASS 8: ORGAN TRANSPLANTATION
Lo, B. Resolving Ethical Dilemmas, chapter 41, "Ethical Issues in Organ
Transplantation.”
Selzer, R. (1990). Wither Thou Goest, Imagine a Woman, Random House. (available
on blackboard)
CLASS 9: SELF-REGULATION
Lo, B. Resolving Ethical Dilemmas, chapters 34-46, section on “Conflicts of Interest.”
David Hilfiker. “Mistakes.” On Doctoring (2001).
Abraham Verghese. Excerpt from The Tennis Partner. A Life in Medicine: A Literary
Anthology (The New Press, 2002), pp 316-317.
Human Development and Behavior: PROLOGUE: COMMUNICATION SKILLS, DR.-PT.
RELATIONSHIP, EMOTIONS, PERSONALITY
Mosby, pages 1-37
Goldman, H, Chapter 10: The Psychiatric Interview
Goldman, Chapter 24
Online syllabus: https://hippocrates.ouhsc.edu/curric/ms1/hb1/Practice (slides on human
emotions)
HUMAN STRUCTURE: CULTURAL COMPETENCE AND HUMANISM:
Goldman, pages 102-104
DIAGNOSIS, DISEASE & THERAPY: CHILD/ADOLESCENT DEVELOPMENT:
Goldman, H. Review of General Psychiatry, Chapter 4, pages 21-42.
ADULT DEVELOPMENT: Lang, Chapter 4, pages 42-45.
BLOOD, HEMATOPOESIS & LYMPHATICS: AGING, DEATH & DYING:
Goldman, page 45, pages 513-520,
ENDOCRINE, METABOLISM & NUTRITION: EATING DISORDERS
Goldman, Chapter 26
Andreasen
NEUROSCIENCES & PSYCHIATRY: MENTAL STATUS EXAM
Goldman, pages 127-135
https://hippocrates.ouhsc.edu/curric/ms1/hb1/mentstat/msetest.html (video on mental
status exam)
IQ & PERSONALITY ASSESSMENT
Goldman, pages 151-159
REPRODUCTION & WOMEN’S HEALTH: DOMESTIC VIOLENCE
Goldman, pg. 415-416, 496, 500, 545-547
HUMAN SEXUALITY
Goldman, pages 36-37, 38-39, 40, 41, Chapter 27
Andreasen
WOMEN’S MENTAL HEALTH ISSUES: Online syllabus material
MARRIAGE & FAMILY
Goldman, pages 100-101, Chapter 35
Evidence-Based Medicine: (to integrate with Foundations Courses)
Straus SE, Evidence-Based Medicine: How to Practice and Teach EBM, 3rd ed, pgs. 199, 115-197.
Selected journal articles and online syllabus:
https://hippocrates.ouhsc.edu/curric/ms1/ebm/syllabi/
Clinical Medicine: PROLOGUE: COMMUNICATION SKILLS, INTRO TO INTERVIEWING
Mosby, pgs 1-37
MOLECULAR & CELLULAR SYSTEMS
MEDICAL HISTORY: Mosby’s, pages 38-50 and Interview Rating Scale (online)
VITAL SIGNS AND GENERAL PHYSICAL EXAM: Online physical exam training
manual
Mosby’s, pages 859-872
HUMAN STRUCTURE: ORL EXAM
Bates, pages 147-162, 179-193
OPTHALMOLOGIC EXAM: Online syllabus
DISEASE, DIAGNOSIS & THERAPY: PEDIATRIC EXAM
BLOOD, HEMATOPOEISIS & LYMPHATICS: GERIATRIC EXAM:
Online syllabus
LYMPHATIC EXAM: 7-22BATES: 6TH ED., PP. 162-165, 186-190,
Bates, pages 162-165, 186-190
GASTROINTESTINAL & HEPATOBILIARY: ABDOMINAL EXAM
Bates, 6th ed., pgs. 331-360
METABOLISM & NUTRITION: THYROID AND ENDOCRINE EXAM
Bates, pages 589-592
CARDIOVASCULAR, RESPIRATORY & RENAL:
CARDIOVASCULAR EXAM:
Mosby’s Guide to the Physical Examination
The Physiologic Origins of Heart Sounds and Murmurs (Blaufuss Medical
Multimedia, Little-Brown, 1995)
PULMONARY EXAM:
Bates, pgs. 229-257
Guarino, JF, Guarino, JC Auscultatory Percussion: A Simple Method to Detect Pleural
Effusion. J. Gen. Intern Med: 1994:9:71-74.
GENITOURINARY EXAM:
Mosby’s and Online syllabus
NEUROSCIENCE & PSYCHIATRY: NEUROLOGICAL EXAM:
Mosby’s
Kinglsey, RE, Pourmand R: Signs in Neurology: A Student’s Guide to the Neurological
Exam, Indiana University School of Medicine
HEAD, EARS, NOSE, MOUTH, THROAT EXAM:
Bates, pages 147-162, 179-193
REPRODUCTION & WOMEN’S HEALTH: BREAST EXAM
Bates, 6th ed., Chapter 10, pages 38, 119, 313-329
GYNECOLOGICAL EXAM:
Mosby’s and Online Syllabus
MUSCULOSKELETAL-INTEGUMENT: MUSCULOSKELETAL EXAM:
Online Standardized Physical Exam Videos: Knee, Low Back, Shoulder
Mosby’s
SKIN EXAM:
PRE-CLINICAL:
o Assignments – list all homework assignments, their due dates, the policy on late
submissions, and all expectations for homework. (TBD)
o Examinations – Multiple Choice Exam at the end; PBL’s, TBL’s, OSCE’s, guided


physical exams and online cases will be assessed throughout course (TBD)
Method of Evaluation and Grading (to be finalized)
o 3 components are graded separately. Each component must be passed for the
student to pass this course.
1. Multiple Choice Exam
2. Case-Based Learning (PBL’s, TBL’s, online cases, in-class cases)
3. Professionalism (self , group and facilitator assessments of student’s
preparation, participation, cooperation with others, respect of others)
o Consistent with standardized COM grading policies for Basic Sciences Years,
each of 3 components will be graded as Honors Pass, Pass or Fail.
Course Materials
o Mosby, Mosby’s Guide to the Physical Exam, 5th ed.
o The Physiologic Origins of Heart Sounds and Murmurs (Blaufuss
Medical Multimedia, Little-Brown, 1995)
o Straus, Sharon E. et al: Evidence-Based Medicine: How to Practice and Teach
EBM, 3rd ed., Elsevier Churchill Livingston, 2005
o Goldman: review of General Psychiatry, 5th ed., Appleton & Lange, 2000 (on
reserve in Bird Library, also online through Bird Library, e-resources in Stat!Ref)
o Lo, Bernard. Resolving Ethical Dilemmas: A Guide for Clinicians, 3 rd ed., 2005,
Lippincot Williams & Wilkins, Philadelphia, PA
o Vannatta, J.B., Schleifer, R., & Crow, S.M.: Medicine and Humanistic
Understanding: The Significance of Narrative in the Practice of Medicine, 2005.
University of Pennsylvania Press, Philadelphia, PA.
o Reynolds, R., & Stone, J., Eds.: On Doctoring: Stories, Poems, Essays. Simon &
Schuster, New York, NY.
o Kinglsey, RE, Pourmand R: Signs in Neurology: A Student’s Guide to the
Neurological Exam, Indiana University School of Medicine
o Online:
1. https://hippocrates.ouhsc.edu/curric/ms1/ebm/syllabi/ (evidence-based
medicine)
2. https://hippocrates.ouhsc.edu/curric/ms1/hb1/Practice (slides on human
emotions)
3. https://hippocrates.ouhsc.edu/curric/ms1/hb1/mentstat/msetest.html
(video on mental status exam)
4. https://hippocrates.ouhsc.edu/videos/scenarios/index.cfm (videoclips)

5. https://hippocrates.ouhsc.edu/curric/ms1/hb1/hbmovindex.html (patient
vignettes)
6. https://hippocrates.ouhsc.edu/curric/ms1/pcm1/ (videos on physical
exam and interviews)
7. https://hippocrates.ouhsc.edu/curric/ms2/pcm2/ (videos on physical
exam and interviews)
Course Outline
o Prologue
Day 1: Lecture: Communication Skills, Doctor-Patient Relationship;
Standardized patient interviews
Day 2: Lecture: Human Emotions and Personality Styles
Ethics Introduction: Lecture and small groups
o Fall I: Molecular and Cellular Systems
Week 1: Day 1: Medical History—lecture and interviewing with preceptors
Day 2: Advanced Communication—lecture and interviewing with
preceptors
Week 2: Day 1: Vital Signs: lecture and physical exam practice (SPs)
Day 2: Vital Signs: lecture and physical exam practice (SPs)
Week 3: Day 1: General Physical Exam: lecture and practice (SPs)
Day 2: General Physical Exam: lecture and practice (SPs)
Week 4: Day 1: Evidence-Based Medicine
Day 2: Stress & Coping as a Physician (lecture)
Week 5: Day 1: Ethics: Decision-Making Capacity & Refusal of Treatment
(lecture and small groups)
Day 2: PBL: TBA
Week 6: Examinations
o Fall I: Human Structure
Week 1: Remediation
Week 2: Day 1: ORL exam lecture and preceptor-guided exams
Day 2: ORL exam lecture and preceptor-guided exams
Week 3: Day 1: Opthalmologic Exam lecture and preceptor-guided exams
Day 2: Opthalmologic Exam lecture and preceptor-guided exams
Week 4: Day 1: Cultural Competence—lecture and small groups
Day 2: Humanism and Professionalism—literature in small groups (possibly
Sherlock Holmes and HPI) or PBL Vertigo
Week 5: Day 1: Ethics: Confidentiality and Disclosure (lecture and small
groups)
Day 2: Evidence-Based Medicine
Week 6: Examinations
o Fall I: Disease, Diagnosis & Therapy
Week 1: Remediation
Week 2: Day 1: Child/adolescent development (lecture)
Day 2: Adult Development (lecture); Logic of diagnosis (lecture)
Week 3: Day 1: Pediatric Exam lecture and preceptor-guided exams
Day 2: Pediatric Exam lecture and preceptor-guided exams
Week 4: Day 1: Evidence-Based Medicine
Day 2: PBL: Lung cancer or Thyroid Cancer
Week 5: Day 1: Ethics: Informed Consent (lecture and small groups)
Day 2: PBL: Multisystem atrophy or OSCE
Week 6: Examinations
o Spring I: Blood, Hematopoeisis & Lymphatics
Week 1: Remediation
Week 2: Day 1: Aging, death and dying, adapting to health changes,
palliative care (lectures)
Day 2: Evidence-Based Medicine or Anemia/Hepatitis PBL
Week 3: Day 1: Geriatric Exam lecture and preceptor-guided exams
o
o
o
o
Day 2: Geriatric Exam lecture and preceptor-guided exams
Week 4: Day 1: Lymphatic and thyroid exam lecture and preceptor-guided
exams
Day 2: Lymphatic and thyroid exam lecture and preceptor-guided exams
Week 5: Day 1: Ethics: End of Life Care (small groups)
Day 2: PBL: Chronic Lymphocytic Leukemia or Thyroid Cancer
Week 6: Examinations
Gastrointestinal & Hepatobiliary
Week 1: Remediation
Week 2: Day 1: Abdominal Exam (lecture and preceptor-guided exams)
Day 2: Abdominal Exam (lecture and preceptor-guided exams)
Week 3: Day 1: Evidence-Based Medicine
Day 2: Community Clinical Rotation (patient writeups)
Week 4: Day 1: Community Clinical Rotation (patient writeups)
Day 2: PBL: Portal hypertension
Week 5: Day 1: Ethics: HIV/AIDS (small groups)
Day 2: PBL: Pancreatic Cancer
Week 6: Examinations
Spring I: Metabolism & Nutrition
Week 1: Remediation
Week 2: Day 1: Eating Disorders lecture
Day 2: PBL (Diabetes/Metabolic Syndrome/Eating Disorders/Female Athlete
Triad)—Clinical facilitators
Week 3: Day 1: Endocrine Assessment (lecture and preceptor-guided
exams)
Day 2: Endocrine Assessment (lecture and preceptor-guided exams)
Week 4: Day 1: Evidence-Based Medicine
Day 2: OSCE Evaluation
Week 5: Day 1: Ethics: Complementary Medicine (students present in small
groups)
Day 2: PBL:
Week 6: Examinations
Fall II: Cardiovascular, Respiratory & Renal
Week 1: Remediation
Week 2: Day 1: Cardiovascular Exam (lecture and preceptor-guided exams)
Day 2: Cardiovascular Exam (lecture and preceptor-guided exams)
Week 3: Day 1: Ethics: Organ Transplantation (lecture and small groups)
Day 2: PBL: Rheumatic Heart Disease
Week 4: Day 1: OSCE: Chest Pain
Day 2: PBL: Atrial Septal Defect
Week 5: Day 1: Pulmonary Exam (lecture and preceptor-guided exams)
Day 2: Pulmonary Exam (lecture and preceptor-guided exams)
Week 6: Day 1: PBL: COPD
Day 2: Evidence-Based Medicine
Week 7: Day 1: Day 1: PBL: Congestive Heart Failure
Day 2: OSCE: Shortness of Breath
Week 8: Day 1: Genitourinary Exam of Male and Female (lecture and
preceptor-guided exams)
Day 2: Genitourinary Exam of Male and Female (lecture and preceptorguided exams
Week 9: Day 1: PBL: Post Strep Glomerulonephritis
Day 2: PBL: Prostate Cancer
Week 10: Examinations
Fall II: Neuroscience & Psychiatry
Week 1: Remediation
Week 2: Day 1: Neurologic Exam (lecture and preceptor-guided exams)
o
o
o
Day 2: PBL: Dejerine Roussy Syndrome
Week 3: Day 1: PBL: ALS
Day 2: Day 1: PBL: Myasthenia Gravis
Week 4: PBL: Mental Status Exam (faculty in small groups)
Day 2: Lecture: IQ and Personality Assessment; Interview pts. With mental
disorders (SPs)
Week 5: Day 1: Ethics: Self-Regulation (Lecture and small groups);
Day 2: PBL: Alcohol Dementia
Week 6: Examinations
Spring II: Reproduction & Women’s Health
Week 1: Remediation
Week 2: Day 1: Gyn exam (lecture and preceptor-guided exams)
Day 2: Gyn exam (lecture and preceptor-guided exams)
Week 3: Day 1: PBL: Herpes
Day 2: Domestic Violence, Women’s Mental Health Issues
Week 4: Day 1: Breast exam (lecture and preceptor-guided exams)
Day 2: Breast exam (lecture and preceptor-guided exams)
Week 5: Day 1: PBL: Breast cancer
Day 2: Human Sexuality, Marriage & Family
Week 6: Examinations
Spring II: Musculoskeletal-Integument
Week 1: Remediation
Week 2: Day 1: Musculoskeletal Exam (lecture and preceptor-guided exam)
Day 2: (lecture and preceptor-guided exam)
Week 3: Day 1: Skin Exam (lecture and preceptor-guided exam)
Day 2: Skin Exam (lecture and preceptor-guided exam)
Week 4: Day 1: Evidence-Based Medicine
Day 2:
Week 5:
Week 6: Examinations
Spring II: Pre-Clinical
To include Procedural Skills (IV’s, intubation, prostate exam, venipuncture, etc.)
Note-writing, wardsmanship
Preceptors, OSCE’s, live and simulated models