Robert Wood Johnson Medical School Curricular Competencies

I. Patient Care

Students must be prepared to provide patient care that is compassionate, appropriate and effective.

Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
1. PreClerkship
  - Students will establish a therapeutic relationship.
  - Students will use techniques which foster effective communication.
  - Students will assess the psychosocial and cultural context of the patient.
  Measurement/Evaluation: Faculty observations and feedback, OSCE’s
2. Clerkship/Advanced
  - Students will establish therapeutic relationships with diverse patients through the lifespan.
  - Students will recognize and discuss the importance of family dynamics in health care decision making.
  - Students will utilize the psychosocial and cultural context of the patient for effective communication.
  Measurement/Evaluation: Faculty observations and feedback, case logs, clinical passport, clerkship evaluations, OSCE’s, USMLE 2 CS
Gather essential and accurate information about their patients.
1. PreClerkship
  - Students will conduct effective interviews with patients.
  - Students will take a complete medical history.
  - Students will use proper technique when performing a physical exam.
  - Students will perform a focused physical exam.
  - Students will perform a complete physical examination.
  Measurement/Evaluation: Faculty observations and feedback, OSCE’s
2. Clerkship/Advanced
  - Students will conduct effective interviews with patients.
  - Students will take a complete medical history.
  - Students will take focused medical histories relevant to the cc.
  - Students will perform focused physical exams relevant to the cc.
  - Students will identify abnormal findings.
  - Students will identify components of the physical exam that are critical to the clinical presentation.
  - Students will relate differential diagnosis and exam findings
  Measurement/Evaluation: Faculty observations and feedback, case logs, clinical passport, clerkship evaluations, OSCE’s, USMLE 2 CS
Make informed decisions about diagnostic and therapeutic interventions based on patient information and
preferences, up-to-date scientific evidence, and clinical judgment.
1. PreClerkship
  - Students will identify differential diagnoses for cardinal presentations. (See Appendix.)
  - Students will indicate appropriate evaluation and management plans for patients utilizing evidence based medicine.
  Measurement/Evaluation: Faculty observations and feedback, performance on MCQ
2. Clerkship/Advanced
  - Students will describe relevant diagnoses for cardinal presentations.
  - Students will identify diagnostic testing and management plans for patients they follow on clerkships.
  - Students will modify diagnostic strategies in response to test results.
  - Students will develop appropriate patient management plans and indicate how these would be carried out.
  Measurement/Evaluation: Faculty observations and feedback, case logs, clinical passport, clerkship evaluations, OSCEs, USMLE 2 CS
Counsel and educate patients and their families.
1. PreClerkship
  - Students will evaluate a patient’s level of understanding and its potential impact on education and counseling.
  - Students will use lay person terminology to explain disease processes and procedures.
  Measurement/Evaluation: Faculty observations and feedback, OSCE’s
2. Clerkship/Advanced
  - Students will develop approaches to counsel and educate patients.
  - Students will deliver counseling to patients and families which is individualized to the patient/family situation.
  Measurement/Evaluation: Faculty observations and feedback, clerkship evaluations, OSCE’s
Use information technology to support patient care decisions and patient education.
1. PreClerkship
  - Students will identify credible information sources for research and education.
  Measurement/Evaluation: Faculty observations and feedback
2. Clerkship/Advanced
  - a. Students will use best evidence to develop diagnostic and management plans and to provide patient education.
  Measurement/Evaluation: Faculty observations and feedback, OSCE’s
Perform required clinical procedures.
1. PreClerkship
  - Students will perform the steps of basic life support.
  - Students will understand the major principles of Universal Precautions.
  - Students will describe techniques for basic procedures. (See Appendix.)
  Measurement/Evaluation: Completion of BLS requirement, pass Universal Precautions course, faculty observations
2. Clerkship/Advanced
  - Students will perform designated essential procedures (See Appendix.) with proper technique and consideration of patient’s rights.
  - Students will utilize universal precautions.
  Measurement/Evaluation: Faculty observations and feedback, procedure logs, OSCE’s
Work with patients in preventing health problems or maintaining health.
1. PreClerkship
  - Students will identify risk factors for illness or injury within the context of the individual, the family, work, and the social environment.
  Measurement/Evaluation: Faculty observations/evaluations, MCQ’s, pass Clinical Prevention course
2. Clerkship/Advanced
  - Students will identify standardized approaches for changing health behavior.
  - Students will describe regimens for health maintenance.
  Measurement/Evaluation: Clerkship evaluations, NBME evaluations, case logs
Work as members of multi-disciplinary health care teams to provide patient-focused care.
1. PreClerkship
  - Students will identify and describe the components of patient centered care in practice environments.
  - Students will interact appropriately with others.
  - Students will identify the many roles that health care members have in patient care.
  Measurement/Evaluation: Student portfolios, peer evaluations
2. Clerkship/Advanced
  - Students will interact appropriately with other healthcare team members.
  Measurement/Evaluation: Case conferences, clerkship evaluations

II. Medical Knowledge

Students must demonstrate knowledge about established & evolving basic & clinical biomedical sciences, including epidemiological and social/behavioral sciences, & their application of this knowledge to patient care.

Demonstrate knowledge and application of the basic and clinical sciences relevant and appropriate to the clinical practice of medicine.
1. PreClerkship
  - Students will demonstrate knowledge of the molecular, biochemical, genetic and cellular mechanisms that are important in normal human development, aging, and in maintaining the body's homeostasis.
  - Students will demonstrate knowledge of the physical structure of the human body, of its tissues and organs, of how organs and tissues function, and how these functions are regulated and integrated, through the life cycle.
  - Students will demonstrate knowledge of the various acquired and congenital causes of disease or injury in individuals and in populations.
  - Students will demonstrate knowledge of how nutrition, health behaviors and preventive measures influence health and disease in individuals and in populations.
  - Students will demonstrate knowledge of the altered structure and function of the human body and its cells, tissues and organs, which are seen in various disease conditions or with aging, and of the fundamentals of diagnosis and treatment regimens that may be applied to address these conditions.
  - Students will demonstrate knowledge of the physical and functional determinants of human cognition, awareness, behavior and personality, of how alterations of these result in disease conditions, and of the fundamentals of diagnosis and treatment regimens that may be applied to address these conditions.
  - Students will demonstrate knowledge of the power of the scientific method in establishing cause and effect in human health and disease, the efficacy of traditional and non-traditional therapies, and the ability to critically evaluate contemporary reports in basic and clinical sciences.
  Measurement/Evaluation: MCQ exams; Faculty observations and feedback
2. Clerkship/Advanced
  - Students will demonstrate application of knowledge in the basic sciences fundamental to clinical practice, to the processes of diagnosis, treatment, and prevention in the clinic and in the community.
  Measurement/Evaluation: Faculty observations and feedback; Clerkship Evaluations; NBME Subject exams
Demonstrate an investigatory and analytic thinking approach to clinical situations.
1. PreClerkship
  - Students will demonstrate the ability to seek and identify credible data that addresses issues in basic sciences fundamental to clinical practice and in clinical practice itself, and to interpret that data.
  Measurement/Evaluation: MCQ exams: Faculty observations and feedback
2. Clerkship/Advanced
  - Students will demonstrate knowledge about established and evolving clinical biomedical sciences and the application of this knowledge to patient care.
  Measurement/Evaluation: Faculty observations and feedback; Clerkship Evaluations; NBME Subject exams

III. Practice-Based Learning and Improvement

Students must be able to engage in self-evaluation regarding their academic & clinical performance, develop plans for personal improvement, and recognize how the application of new learning can be used to improve patient care.

Demonstrate strategies to analyze academic and clinical performance over the course of their professional careers, and develop improvement plans, in a methodical fashion.
1. PreClerkship
  - Students will assess their needs in basic science and clinical courses and establish strategies for improvement.
  - Students will develop reflective practice habits using analysis of academic and clinical experiences to improve clinical performance.
  - Students will demonstrate skills in self-directed learning by developing clinical questions about patients and using credible information sources to find relevant medical information to answer them.
  Measurement/Evaluation: Faculty observations and feedback; (a) progress in preclinical courses; (b) OSCEs; (c) portfolios
2. Clerkship/Advanced
  - Students will identify strategies to continuously update personal clinical knowledge and skills.
  - Students will develop reflective practice habits using analysis of academic and clinical experiences to improve clinical performance.
  - Students will determine the limits of their expertise and consult with others residents, attending, etc. when needed.
  Measurement/Evaluation: OSCE: Faculty observations and feedback; clerkship evaluations; conference participation.
Locate, appraise, and assimilate evidence from scientific & clinical studies related to patients’ health problems.
1. PreClerkship
  - Students will use information sources and journals to locate information related to patient health.
  Measurement/Evaluation: Faculty observations and feedback; portfolio
2. Clerkship/Advanced
  - Students will systematically appraise and assimilate scientific evidence through reading of articles related to patient health.
  Measurement/Evaluation: Faculty observations and feedback; clerkship evaluations; EBM Presentations
Obtain and use information about patients they care for and the larger population from which these patients are drawn.
1. PreClerkship
  - Students will define basic epidemiological terms and concepts.
  - Students will identify the appropriate use of frequently used study designs.
  - Students will understand the application of basic biostatistical calculations.
  Measurement/Evaluation: Course performance; MCQ exams; faculty observations and feedback
2. Clerkship/Advanced
  - Students will apply concepts of epidemiology and biostatistics for diagnostic screening, risk management, and therapeutic decision making.
  - Students will obtain and use information about the patients they care for and the larger population of patients with similar clinical conditions to refine their diagnostic, management and prognostic elements.
  Measurement/Evaluation: Clerkship Evaluations; case logs; case management conferences; OSCEs
Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
1. PreClerkship
  - Students will use credible information sources to locate information related to diagnostic and therapeutic clinical decision making.
  - Students will identify the appropriate use of frequently used study designs.
  - Students will understand the application of basic biostatistical calculations.
  Measurement/Evaluation: Faculty observations and feedback
2. Clerkship/Advanced
  - Students will critically appraise clinical trials.
  - Students will describe the principles of prudent ordering of diagnostic and screening tests and use these principles in devising management plans.
  Measurement/Evaluation: Faculty observations & feedback; clerkship evaluations: EBM presentation
Use information technology to manage information, access on-line medical information; and support their own education.
1. PreClerkship
  - Students will access online information to prepare for case discussions and engage in clinical reasoning.
  Measurement/Evaluation: Faculty observations and feedback
2. Clerkship/Advanced
  - Students will demonstrate facility with the use of information technology to meet learning demands.
  Measurement/Evaluation: Faculty observations and feedback; clerkship evaluations
Facilitate the learning of other students and health care professionals.
1. PreClerkship
  - Students will work collaboratively in small groups.
  - Students will participate in teaching activities.
  Measurement/Evaluation: Faculty observations and feedback; peer assessment; evaluation of teaching effectiveness.
2. Clerkship/Advanced
  - Students will work collaboratively with students and other health care professionals
  - Students will appropriately share and elucidate clinical information.
  - Students will participate in teaching activities.
  Measurement/Evaluation: Faculty observations; clerkship evaluations; case presentations

IV. Interpersonal and Communication Skills

Students must be able to demonstrate interpersonal & communication skills, both verbal and written, that result in effective information exchange with patients, patients’ families, peers, and other health professions colleagues.

Create and sustain a therapeutic and ethically sound relationship with patients in order to effectively communicate their health care needs, including situations involving sensitive, technically complex, or distressing information.
1. PreClerkship
  - Students will communicate respectfully with diverse patients.
  - Students will discuss and apply principles of medical ethics to patient cases.
  - Students will demonstrate appropriate behavior when interacting with patients and other health professionals providing care.
  Measurement/Evaluation: Faculty observations and feedback; professional citations
2. Clerkship/Advanced
  - Students will demonstrate ethically appropriate interactions with patients.
  - Students will effectively establish a therapeutic relationship with all patients and their families.
  - Students will adapt their communication style to the individual needs of the patient and the urgencies of the situation.
  Measurement/Evaluation: Faculty observations and feedback; clerkship evaluations; professionalism citations
Utilize appropriate and effective communication strategies, including nonverbal, explanatory, questioning and writing skills, to both elicit and provide health care information to patients and their families.
1. PreClerkship
  - Students will use techniques which foster effective communication including active listening, clarification of patient responses, encouragement of sharing concerns and questions.
  - Students will deliver information to patients with appropriate communication strategies including use of the explanatory model, assessing the patient’s understanding with direct questioning, and with written instructions.
  Measurement/Evaluation: Faculty observations and feedback; OSCE’s
2. Clerkship/Advanced
  - Students will use techniques which foster effective communication including active listening, clarification of patient responses, encouragement of sharing concerns and questions.
  - Students will deliver information to patients with appropriate communication strategies including use of the explanatory model, assessing the patient’s understanding with direct questioning, and with written instructions.
  - Students will conduct a culturally-competent encounter, including use of an interpreter when necessary.
  - Students will create and maintain appropriate records of clinical encounters using standard terminology and formats, including written patient history and physicals, in-patient and out-patient encounter notes and case log information.
  Measurement/Evaluation: Faculty observations and feedback; clerkship evaluations; OSCEs; USMLE Step 2 CS
Work effectively with others as members of a health care team, including peers, residents, faculty and other health care professionals.
1. PreClerkship
  - Students will participate effectively in small groups.
  - Students will identify and discuss working relationships between health care professionals.
  - Students will demonstrate team behavior in academic and clinical settings.
  Measurement/Evaluation: Faculty observations and feedback; OSCEs
2. Clerkship/Advanced
  - Students will participate effectively in small groups; students will participate effectively in clerkship clinical activities with attendings, residents, and other health professionals
  - Students will provide concise, accurate, verbal summaries of patient situations to a faculty member, resident or peer, prioritizing the most significant factors for clinical decision-making.
  - Students will identify their responsibilities as members of a health care team
  - Students will establish effective communication among members of the health care team, including appropriate written and other communications.
  Measurement/Evaluation: Faculty observations and Feedback; Clerkship Evaluations; OSCEs; USMLE Step 2CS

V. Professionalism

Students must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Demonstrate respect, compassion, and integrity in interactions with peers, patients, and other health professionals.
1. PreClerkship
  - Students will engage in truthful interactions with peers, faculty & staff.
  - Students will dress and act in a professional manner.
  - Students will demonstrate preparedness for class, meetings and patient care activities.
  - Students will maintain appropriate boundaries in all learning situations.
  - Students will relate collegially to fellow students, faculty and staff in learning environments; will listen to others respectfully and attentively; will resolve conflicts in a collegial manner.
  - Students will demonstrate attitudes and behaviors which convey respect for other students, faculty and staff in all situations and will be receptive to diverse opinions and values.
  Measurement/Evaluation: (a, b, c, d) Peer assessment; professionalism citations
  (e) Faculty observations and feedback; Peer assessment; OSCEs; professionalism citations
  (f) Faculty observations and feedback; clerkship evaluations; OSCEs
2. Clerkship/Advanced
  - Students will demonstrate preparedness for class, meetings and patient care activities.
  - Students will convey information honestly and tactfully; will engage in truthful interactions with patients, peers, and in professional work.
  - Students will act and dress in a professional manner.
  - Students will maintain appropriate boundaries in work/learning/patient care situations.
  - Students will demonstrate respect for the wishes of patients; will attend to patient needs for comfort and privacy.
  - Students will demonstrate respect in relationships toward other health care team members and patients.
  Measurement/Evaluation: Faculty observations and feedback; clerkship evaluations; OSCEs
Demonstrate accountability to patients, society, and the profession, and a commitment to excellence and on-going professional development.
1. PreClerkship
  - Students will demonstrate self motivation and accountability for their own learning.
  - Students will be prepared for class.
  - Students will complete assignments in a timely manner.
  - Students will maintain good attendance and punctuality for scheduled activities and appointments.
  Measurement/Evaluation: Faculty observations and feedback
2. Clerkship/Advanced
  - Students will maintain good attendance and punctuality for scheduled activities and appointments.
  - Students will demonstrate initiative in fulfilling responsibilities to patients, and responsibility to others on the healthcare team.
  - Students will perform tasks independently as appropriate to current level of training.
  Measurement/Evaluation: Faculty observations and feedback; clerkship evaluations; OSCEs
Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, and informed consent.
1. PreClerkship
  - Students will not discriminate regardless of race, gender, religion, sexual orientation, age, disability, intelligence and socio-economic status; will react appropriately to other’s lapses in conduct and performance.
  - Students will maintain the confidentiality of examination material.
  - Students will identify the principles of patient confidentiality, informed consent, and information sharing.
  - Students will recognize the importance of ethical decision making.
  Measurement/Evaluation: (a) Peer assessment; faculty observation & feedback; professionalism citations
  (b) Completion of HIPAA training; (c, d) Review of Portfolio entries
2. Clerkship/Advanced
  - Students will not discriminate regardless of race, gender, religion, sexual orientation, age, disability, intelligence and socio-economic status; will react appropriately to other’s lapses in conduct and performance.
  - Students will discuss the importance of patient confidentiality and informed consent.
  Measurement/Evaluation: Faculty observations and feedback; clerkship evaluations; case management conferences
Demonstrate sensitivity and responsiveness to patient individuality including the role of culture, ethnicity, gender, age, disabilities, and other aspects of health practices and decisions.
1. PreClerkship
  - Students will demonstrate sensitivity and respect in patient interactions regardless of race, gender, religion, sexual orientation, age, disability, intelligence, and socio-economic status.
  Measurement/Evaluation: Faculty observations and feedback; OSCEs
2. Clerkship/Advanced
  - Students will demonstrate sensitivity and respect in patient interactions regardless of race, gender, religion, sexual orientation, age, disability, intelligence, and socio-economic status.
  - Students will recognize the need for patient involvement in decision making and the incorporation of patients’ values and beliefs into management plans.
  Measurement/Evaluation: Faculty observations and feedback; clerkship evaluations; OSCEs
Recognize and address personal limitations, attributes or behaviors that might influence their effectiveness as a physician.
1. PreClerkship
  - Students will demonstrate self motivation & accountability for own learning; will seek help when needed.
  - Students will accept constructive criticism & will modify behavior based on feedback.
  - Students will maintain responsibility for the physical and mental health of themselves and their peers
  Measurement/Evaluation: Academic progress; faculty observations and feedback; professionalism citations
2. Clerkship/Advanced
  - Students will seek help at appropriate times.
  - Students will admit to errors of omission and commission and assume responsibility; inform a supervisor when mistakes occur.
  - Students will maintain responsibility for the physical and mental health of themselves and their peers.
  - Students will accept constructive criticism in an appropriate manner.
  - Students will recognize areas that need improvement, seek advice, and demonstrate that they are able to incorporate feedback in order to make changes in behavior.
  - Students will maintain composure during difficult interactions.
  Measurement/Evaluation: (a, b) Faculty observations and feedback; clerkship evaluations; professional citations; OSCEs
  (c, d, e, f) Clinical observations, clerkship evaluations, OSCEs

VI. Systems-Based Practice

Students will be able to function effectively in teams and within a larger organizational structure. They must demonstrate an awareness of the larger context and system of health care and of the resources available within the system to provide optimal care to individual patients and groups. Finally, students must demonstrate an awareness of current barriers to health care and of the various strategies designed to assist patients in gaining access to care.

Demonstrate effective involvement in a health care team and be able to recognize how their involvement in patient care may affect other members of the health care profession.
1. PreClerkship
  - Students will identify the basic components of the health care system and their interdependencies.
  - Students will be able to discuss the interdisciplinary approach to improving health care.
  Measurement/Evaluation: Faculty Observations and feedback; portfolio
2. Clerkship/Advanced
  - Students will participate effectively in small groups; students will participate effectively in clerkship clinical activities with attendings, residents, and other health professionals.
  Measurement/Evaluation: Faculty observations and feedback; clerkship evaluations
Know how types of medical practice and delivery systems differ from one another, including their methods of controlling health care costs and allocating resources.
1. PreClerkship
  - Students will compare and contrast different types of medical practice and delivery systems and identify methods for allocation of resources and controlling health care costs
  Measurement/Evaluation: Faculty observations and feedback; portfolio
2. Clerkship/Advanced
  - Students will recognize that participation in patient care in various settings, e.g., emergent/urgent care facilities, underserved clinics and communities, long-term care facilities and tertiary academic/community hospital settings) has unique priorities, opportunities and constraints that may affect health care delivery.
  - Students will describe how different methods of cost control affect physicians’ relationships with their colleagues, their patients, and society.
  - Students will describe the strengths and shortcomings of the U.S. system for financing and delivering medical care, particularly to those from underserved/minority groups.
  Measurement/Evaluation: Clerkship Evaluation; faculty observations and feedback; case management projects
Describe the principles of cost-effective health care and resource allocation that does not compromise quality of care.
1. PreClerkship
  - Students will learn principles of cost-effective health care and the allocation of resources and describe realities that enhance/ hinder implementation.
  Measurement/Evaluation: Faculty observations and feedback; portfolio
2. Clerkship/Advanced
  - Students will recognize appropriate cost effective decision making and resource allocation.
  Measurement/Evaluation: Clerkship Evaluation; faculty observations and feedback; case management conference
Advocate for quality patient care and assist patients in dealing with system complexities.
1. PreClerkship
  - Students will assess the health care needs of their patients and a community site.
  - Students will use effective communication strategies to educate and counsel patients in dealing with health care complexities.
  Measurement/Evaluation: Faculty observations and feedback; portfolio
2. Clerkship/Advanced
  - Students will use effective communication strategies to educate and counsel patients in dealing with health care complexities, to communicate with peers, and to overcome and address barriers to health care access.
  - Students will recognize appropriate consultation resources that can optimize patient care and management of health behaviors, including different physician specialties, other health care professionals, and community health agencies, and describe strategies to enhance collaboration of these resources.
  Measurement/Evaluation: Clerkship Evaluation; faculty observations and feedback
Be aware of how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.
1. PreClerkship
  - Students will recognize the importance of practice guidelines and quality improvement for patient safety.
  Measurement/Evaluation: Faculty observations and feedback; portfolio
2. Clerkship/Advanced
  - Students will outline strategies for effective quality assurance, including partnership with other health care managers/providers and the utilization of information.
  - Students will recognize the source of common medical errors and discuss strategies to address them.
  Measurement/Evaluation: Clerkship evaluations; faculty observations and feedback; case management conference