Prevention, Screening and Health Maintenance


 Course Description: Competencies & Outcomes

Course Title: Longitudinal Curriculum in Prevention, Screening and Health Maintenance

                    Keith Muccino, S.J., M.D.

Course Directors:
                   Aaron Michelfelder, M.D.           --        PCM I
                    Mary Boyle, M.D.                       --        PCM II
                    Eva Bading
, M.D.                      --        PCM III
                    Mark Kuczewskr, Ph.D.             --        PCM III

Clerkship Directors:
                    Scott Levin, M.D.                       --        Family Medicine
                    Matthew Fitz, M.D.                    --        Internal Medicine
                    Bridget Boyd, M.D.                   --        Pediatrics
                    Scott Graziano, M.D.                 --       Ob/Gyn
                    Adam Kabaker, M.D.                --       Surgery
                    David Shilling, M.D.                   --       Psychiatry

Curricular Objectives:

By the end of their third year it is expected that the students will be able to:

-         List the characteristics of screening tests in both ideal and real time settings.

-         Cite the operating characteristics of screening tests (sensitivity, specificity).

-         Describe impact of disease prevalence on predictive values (positive & negative).

-         Recognize the target populations to be screened for various conditions, and describe when screening should commence and cease.

-         Analyze the cost/benefit and risk/benefit variables for screening modalities.

-         Cite the levels of evidence (quality of evidence) associated with recommendations and guidelines.

-         Rank research experiments according to a determined hierarchy of experimental study design.

-         Recite by specialty and by patient population, the current recommendations for screening, disease prevention and health maintenance.

-         Demonstrate ability to assess risk factors for disease, and provide counseling on health maintenance.

-         List the societal implications (positive and adverse) of screening for disease and efforts to promote health and prevent disease occurrence.


Description of Curriculum 

The foundational concepts and practical clinical applications of Prevention, Screening and Health Maintenance are addressed throughout the
 four years of medical education at Loyola University Chicago-Stritch School of Medicine.

This curriculum, by its nature, is designed to be mastered longitudinally (sequentially) within a variety of courses and clerkships.

Beginning with Patient Centered Medicine in the first three years, and throughout their clinical clerkships in years three and four,
students are introduced to the essential elements in Prevention, Screening and Health Maintenance including:


            Research Study Design & Hierarchy

Levels of Experimental Evidence

            Recommendations and Guidelines for Prevention and Screening

During their time on clinical rotations students learn how to incorporate clinical activities related to Screening for Disease, and Promotion of Health
 into practice-based patient encounters. 

Course and clerkship directors have agreed that the USPSTF recommendations for Screening and Prevention are to serve as the organizing framework
for this longitudinal curriculum. The USPSTF recommendations have been made easily accessible to students via the Prevention, Screening and Health
Promotion course web page.

Clerkship Directors may, however, choose to nuance their approach to prevention and screening with other formal recommendations (i.e., as advocated
 by organizations or specialty bodies such as the APA-American Pediatric Association or ACOG -American College of Obstetrics & Gynecology).


 Curricular Elements by Course and Clerkship


 Students are introduced to basic concepts of biostatistics, study design, and levels of evidence.

 Students explore risk factors for illness and are introduced to the USPSTF recommendations for Prevention and Screening.

 Issues in Public and Occupational Health and Smoke cessation are addressed.



In this course which explores in a comprehensive way the physician-patient-society relationship, students are expected to acquire and
to demonstrate a knowledge and understanding of health and its promotion, as well as disease and its prevention in the context of the
whole individual in his or her place in the family or society.

Students are expected to develop an understanding scientific method and the way research effects patient care.



Students explore the constitutive elements of Evidence Based Medicine, including study design, result validity, and impact of findings
on practice behavior. Journal articles of clinical relevance (Prostate Cancer, Breast Cancer) are then looked at in order to familiarize
students with the process of critically reviewing the results of research studies as reported in journal articles.


Clinical Clerkships

(Medicine, Surgery, Pediatrics, Family Medicine, Ob/Gyn,  Psychiatry)


Students are exposed to the clinically relevant issues in screening and prevention related to a wide variety of diseases or disorders -
Cardiovascular, Occupational, Nutritional, Metabolic, Environmental, and Neoplastic.


Students are expected to begin developing proficiency in counseling patients on disease prevention and health maintenance.
They learn how to assess a patient’s risk factors, and they are exposed to immunization recommendations and schedules,
as well as the role for chemoprevention in addressing conditions like osteoporosis.


Clerkships provide case based scenarios to facilitate discussion of prevention and screening issues, and to simulate both
routine and challenging decision-making circumstances.


With the development of the web page for the longitudinal curriculum on Prevention, Screening and Health Maintenance,
students are now able to centrally access all Screening and Prevention requirements for each course and clerkship.




 Evaluation of Student Performance

 A variety of methods are used to assess student performance within this longitudinal curriculum on prevention and screening.

The Prevention and Screening curriculum is not a course or clerkship unto itself students do not receive a separate formal
grade for Prevention and Screening. Questions related to Prevention and Screening are incorporated where appropriate
within course and clerkship evaluation instruments and exams.

Prevention and Screening competence is also assessed as one component within the Topics in Clinical Medicine (TCM) course.
This is a graded vertical course composed of Radiology/Imaging, Prevention and Screening, End of Life Care, Disaster
Preparedness, and Nutrition.

A separate composite graded written exam occurs at the end of Third Year.

Students must past both the composite exam, and cannot fail any one section of the exam.

Remediation of failures is at the discretion of the TCM III Course Director, and the individual vertical curricula Course Directors.



 Core Competencies

 In Stritch’s competency-based curriculum, the longitudinal curriculum in Prevention and Screening provides opportunities
 for learning and evaluation in the following competencies:


Competency 1: Medical Knowledge

By the end of the undergraduate medical education students will be able to:

1.     Describe the essential methodological, statistical, and research related elements of health promotion
and disease prevention including biostatistics, study design and evidence analysis.

2.     Demonstrate an understanding of levels of evidence, risk–benefit analysis and cost-effectiveness.

3.      Access the commonly referred to resources of evidence based medical information, particularly the
 recommendations and guidelines related to health promotion and disease prevention (i.e. USPSTF).                                                                                                                      

4.     Demonstrate awareness of the key areas targeted for health promotion, or those medical conditions
that are acknowledged to be appropriate for screening and disease prevention.                                  


Competency 2: Communication and Interpersonal Skills

By the end of the undergraduate medical education students will be able to:

1.     Demonstrate the ability to educate patients and engage their cooperation in health promotion and disease prevention.

2.     Effectively communicate to patients and colleagues the medical evidence that supports or discourages
specific clinical testing related to prevention and screening.

3.     Explain risk assessment and communicate the findings of screening studies in a reassuring fashion that facilitates decision making.

4.     Instruct patients and families to develop or modify lifestyle practices related to health promotion or disease prevention.

5.     Demonstrate awareness of the patient and society as important stakeholders in health promotion and disease prevention.


Competency 3: Professionalism, Moral Reasoning, and Ethics

By the end of the undergraduate medical education students will be able to:

1.     Demonstrate awareness of the societal impact and ethical considerations related to promoting health
awareness and carrying out disease prevention strategies.

2.     Demonstrate a professional commitment to incorporate health promotion and disease prevention within their practice of medicine.

3.     Advocate the interests of patients and society at large by promoting prevention and screening activities.

4.     Work collaboratively as a member of the broader health care system that is charged with health promotion and disease prevention.


Competency 4: Patient Care

By the end of their undergraduate medical education students will be able to:

1.     Name the relevant medical categories targeted for health promotion, and/or disease prevention and screening.

2.     Name the current recommendations as promulgated by the USPSTF and other professional bodies and the quality of supportive evidence.

3.     Describe the clinical considerations that can create the need for more nuanced recommendations for certain populations of patients.

4.     Demonstrate awareness of the methods and timing of prevention screening activities within clinical practice.

5.     Demonstrate ability to educate patients and engage their compliance in health promotion and disease prevention.


Competency 5: Problem Solving and Life Long Learning

By the end of their undergraduate medical education students will be able to:

1.     Identify and use resources to obtain up-to-date information and recommendations on issues in health promotion,
disease prevention and screening.

2.     Use information technology to access up-to-date guidelines and recommendations, and review the research studies
that provided the evidence for such recommendations.

3.     Search, evaluate, and present a critical review of scientific information in the medical literature on topics related to prevention and screening.

4.     Use electronic self-evaluation surveys to assess knowledge and practice and target further learning activities.

5.     Demonstrate a willingness to update knowledge of and incorporate into practice recommendations regarding prevention and screening issues.


Competency 6: Social and Community Context of Healthcare

By the end of their undergraduate medical education students will be able to:

            1.    Understand health and disease within the context of society and social structures.

2.     Describe the role of prevention and screening in serving the needs of the larger society.

3.    Name the economic and risk-benefit considerations which are applicable when recommendations
for screening and prevention are being determined.

4.     Name and access the organizations and resources that provide information on public health and disease prevention.