This form is to be completed by segment chairs and nurse educators to track Doctoring Curriculum Objectives.

Segment Chair/Nurse Educator: 

Segment/Block: 

Date: 

ALL YEARS

Section 1:  PROFESSIONALISM

All - 1.1  Recognize the following issues that could affect a patient's management and modify management as appropriate:

    All - 1.1.1  Legal issues (such as informed consent, malpractice)

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

    All - 1.1.2  Ethical issues (such as confidentiality, truth-telling)

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

    All - 1.1.3  Conflict of values between the patient and the community

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

    All - 1.1.4  Psychosocial issues

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

    All - 1.1.5  Religious issues

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 1.2  Project a professional image in manner, dress, grooming, speech, and interpersonal relationships that is consistent with the medical profession's accepted contemporary standards in the community

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

Section 2:  PHYSICIAN/PATIENT RELATIONSHIP

All - 2.1  Treat the patient as a person, not a disease; and understand that the patient is a person with values, goals, and concerns which must be respected and which may influence how the patient responds to his or her disease and its management

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 2.2  Respect the patient's rights and privacy and maintain confidentiality of patient information

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 2.3  Interact with the patient in a way that will allow the patient to feel he/she has received medical care that was provided in a caring, compassionate, and humane manner

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

Section 3:  PHYSICIAN-SELF CARE AND PERSONAL DEVELOPMENT

All - 3.1  Behave in a self-motivated, responsible, reliable, and dependable manner.

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 3.2  Demonstrate personal integrity, honesty, and self-discipline

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 3.3  Recognize personal limitations, whether they are intellectual, physical, or emotional, and work with or adapt to them.

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 3.4  Demonstrate the professional and emotional maturity to take appropriate steps to resolve tensions and conflicts that occur among professional, personal, and family responsibilities, seeking professional help if necessary.

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 3.5  Demonstrate the ability to think critically and exercise sound judgement

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 3.6  Provide patient care without allowing personal biases to interfere

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

Section 4:  COMPLIMENTARY ALTERNATIVE MEDICINE

All - 4.1  Knowledge

    All - 4.1.1  Students will understand how to elicit a history from a patient about their use of these therapies

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

    All - 4.1.2  Students will understand how to search available medical resources to determine the safety and efficacy of such therapies

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 4.2  Attitudes

    All - 4.2.1  Students will understand and respect cultural/ethnic influences on health beliefs and health care choices

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

    All - 4.2.2  Students will be able to discuss with patients their use of such therapies as a necessary part of finding a common ground when practicing patient-centered integrative medicine

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

All - 4.3  Skills

    All - 4.3.1  Students will develop the ability to inquire into patients' use of these therapies in a non-threatening, non-judgmental manner

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: 

    All - 4.3.2  Students will develop the ability to provide complete and balanced patient education to those patients inquiring about these complementary/alternative therapies

      Select one Yes No If yes, Select one Didactic/Hours Workshop/Hours Tutor Group/Number of Cases Reading/Number of Articles    

    Other Comments: