From Clinicaltools.com

Contents 1 Meet Your Patients: Case Challenges 1.1 Description 1.2 URL 1.3 Need 1.4 Needs Analysis 1.5 Vision 1.6 Mission 1.7 Goal 1.8 Learning Objectives 2 Case Study 1: John 3 Case Study 2: Sarah 4 Case Study 3: Len 5 Case Study 4: Morgan 6 Case Study 5: Joe 7 Case Study 6: Amy 8 Module Evaluation and Review 8.1 Student Assessments 8.2 Consultant Review

Meet Your Patients: Case Challenges

Project Framework

Description

(Steve draft) Now that the talk has been talked, it is time for the physician to walk the walk!

When educating and treating for alcohol use, care must be individualized. Race, gender, and social groupings may impact the effects of alcohol use. It is important for medical students, when becoming healthcare providers, to be aware of these differences in order to deliver the specialized treatment necessary.

URL

Meet Your Patients: Case Challenges

Need

Patient interviews about alcohol use need to be individualized.

Needs Analysis

In the spring of 2008, we conducted a focus group with 13 medical school faculty and addiction consultants. The results

Brief Summary: The focus group shaped our module outline and content. With a rating scale of 1-5, the importance of the Special Populations/Meet Your Patients module was rated 4.33. Faculty determined, with a 3.85 rating, that the average medical student would benefit from additional instruction in this topic and giving a 3.67 rating to the belief that this topic aligned with recommended physician competencies in the area of substance abuse. Faculty said that the module would easily fit into their institution's current curriculum, giving this a rating of 3.50, and that they would include it in their own current teachings, rating this 3.69. The respondents said they would also encourage their students to learn more about this topic, rating the statement 3.85. The most respondents (4) were evenly split between devoting 1 or 2 hours of lecture time to the topic. They also gave suggestions in which areas of the topic to focus on, which we took under consideration when developing the course content.

Vision

Physicians-in-training develop individualized treatment plans based on each patient they see.

Mission

The CTI Solution.

The mission of this course is to provide medical students with the knowledge and skills to effectively treat alcohol abuse and dependence in patients where patient genetic/social background affects assessment, diagnosis, or treatment.

Goal

The goal of this course is to teach medical students how to administer individualized alcohol use treatment.

Learning Objectives

1. Recognize that alcohol misuse affects each individual differently, and awareness of variations on how alcohol affects different individuals will help when assessing and treating patients.
2. Interview and assess alcohol use in a variety of patients with different medical, social, or family histories.
3. Tailor specific treatment regimens based on individual life factors to present the most appropriate treatment plan for each patient.

Case Study 1: John

Case Focus: John is a 6 page case study highlighting alcohol use with adolescents and how the physician-in-training can approach John about his illegal alcohol use since he is underage.

Case Goal: The goal of this case is to present a case involving an adolescent who misuses alcohol and guide the physician-in-training through appropriate conversations with the patient regarding underage alcohol consumption.

Course Objectives Met: 1, 2, 3

Patient: John - 17YOWM

• Chief Complaint: Leg muscle strain sustained a day earlier while fooling around with his buddies
• Narrative: John is a 17-year-old high school student who is the lead quarterback on his football team. He comes to your office with complaints of a muscle strain he sustained yesterday. Through conversation of how John pulled his muscle, it is revealed he was drinking at the time while celebrating his team's success.
• Alcohol Use: Drinks six packs with friends on occasion(underage)
• AUD Diagnosis: At risk for alcohol use. John is underage.
• Relevant Past Medical, Psychosocial, Family History: Friends are fellow drinkers
• Take Home Message: John's muscle strain occurred while he was drinking with his friends. You treat John's muscle strain but also counsel him on the ramifications (both medical and legal) of his continued alcohol use.
• Practice Tip: Adapt your discussions on alcohol misuse to the patient's identity. In this case, John is underage, and so discussions of alcohol misuse should take this into consideration.
• URL's: John's Case

Case Study 2: Sarah

Case Focus: Sarah is a 6 page case study highlighting the effect prenatal alcohol use has not only on the mother, but the baby. This case contains a brief discussion of FASD and examples of assessment and brief interventions for prenatal alcohol use.

Case Goal: The goal of the Sarah case is to present physicians-in-training with a case on prenatal alcohol use and demonstrate appropriate assessment and brief intervention techniques with this population.

Course Objectives Met: 1, 2, 3

Patient: Sarah - 27YOBF

• Chief Complaint: Sarah is at your office for her first prenatal visit. She is currently 10 weeks pregnant with her first child.
• Narrative: This is Sarah's first prenatal visit at 10 weeks. Through regular prenatal discussions, Sarah admits to occasional alcohol use but insists it is "not a big deal".
• Alcohol Use: 3-4 glasses of wine -4 times a month, exceeded that once in the past month
• AUD Diagnosis: At risk for alcohol use disorder. However, because Sarah is pregnant, she should be counselled to abstain from alcohol use for the duration of the pregnancy.
• Relevant Past Medical, Psychosocial, Family History: Unplanned pregnancy with live-in boyfriend.
• Take Home Message: Physicians-in-training should be familiar with the detrimental causes of alcohol use during pregnancy, especially during the first trimester. Sarah should be assessed for alcohol use and counselled to abstain for the health of the fetus.
• Practice Tip: Prenatal treatment should emphasize the dangers of alcohol use during pregnancy
• URL's: Sarah's Case

Case Study 3: Len

Case Focus: The case study of Len features 6 pages devoted to alcohol misuse in older adults. In addition, Len is of Native American decent, and special considerations with this population are targeted.

Case Goal: The goal of this case is to present alcohol use disorders in the context of older adults, emphasizing how age and social situations (loss of friends, spouses, family as they age/pass away) can affect alcohol consumption.

Course Objectives Met: 1, 2, 3

Patient: Len - 67YONAM

• Chief Complaint: Restless sleep, stomach pain. Pain and loss of sleep affecting his work as an artist.
• Narrative: Len is a 67-year-old sculptor who lives in town. He has a brother and niece who reside on the reservation outside of town. He is widowed, having lost his wife to cancer about a year ago. Len is well-known for his art and has many customers in town who frequent his shop.
• Alcohol Use: AUDIT score of 9. At risk for abuse.
• AUD Diagnosis: At risk for abuse.
• Relevant Past Medical, Psychosocial, Family History: Len is 67 years old and recently (past year) widowed. His brother and niece live on the Indian reservation outside of town. Len is an artist, but lately his stomach and restless sleep have disrupted his work.
• Take Home Message:Physicians-in-training should become familiar with assessing alcohol use in older adults and intervening when appropriate.
• Practice Tip: As a widower, Len is drinking more to cope. Len's drinking has resulted in physical problems, as well as sleep problems.
• URL's: Len's Case

Case Study 4: Morgan

Case Focus: Morgan is a 21 year old college student who is a member of the LGBT community. This case focuses on two important issues: 1) college-age drinking and 2) drinking within the LBGT community.

Case Goal: The goal of this case is to present challenges associated with alcohol misuse among college students and the LBGT community. Physicians-in-training will become aware of social issues that may impact interventions for alcohol use within these populations.

Course Objectives Met: 1, 2, 3

Patient: Morgan - 21YOBF

• Chief Complaint: Morgan comes into Student Health complaining of feeling sluggish, having an increased need for sleep, constant headaches, and frequent bouts of colds. These symptoms are affecting her college coursework.
• Narrative: Morgan is a 21-year-old college student. She is currently a junior at the university and is active in many social causes. Morgan describes herself as an activist who is constantly on the go. However, lately she has been feeling badly and the situation hasn't improved.
• Alcohol Use: Goes to the bar in the next town twice a week with friends
• AUD Diagnosis: At risk for alcohol abuse
• Relevant Past Medical, Psychosocial, Family History: Single, College-aged, Member of the LGBT community
• Take Home Message: Morgan's drinking is cause for concern, and you should counsel and provide a brief intervention so that her alcohol use does not escalate any further.
• Practice Tip: It is important to remember a patient's social/age history when counseling about alcohol misuse.
• URL's: Morgan's Case

Case Study 5: Joe

Case Focus: The focus of Joe is to present, in 6 pages, the case study of a homeless man who uses alcohol as a coping mechanism.

Case Goal: The goal of this course is to present alcohol misuse through the eyes of a homeless man. The physician-in-training should learn how to interview homeless patients and attempt to develop a treatment plan for Joe.

Course Objectives Met: 1, 2, 3

Patient: Joe - 52YOHM

• Chief Complaint: Joe has come into the walk-in clinic because he has been nauseated for an extended period of time and has stomach cramps.
• Narrative: Joe is a 52-year-old homeless Hispanic man who lost his wife six years ago, his only remaining family. Over the course of the next year he went into deep depression and his work ethic suffered. After losing his job he began living on the streets and has been living there for the last five years. Joe often frequents the soup kitchen in town for a meal, as he has little money to support himself otherwise.
• Alcohol Use: Joe scores a 5 on the AUDIT-12 exam. He is found to be consuming mouthwash as well.
• AUD Diagnosis: At risk for abuse
• Relevant Past Medical, Psychosocial, Family History: Widower and homeless
• Take Home Message: Outreach may be the best first step in reaching the homeless population who are in need of substance abuse treatment.
• Practice Tip: Attention needs to be paid towards contributing factors to long-term success. It is possible that the homeless population's treatment needs are not met for several reasons: Providers are wary of their high-risk medical problems, Their extensive list of demands/needs, Their unpredictable behavior
• URL's: Joe's Case

Case Study 6: Amy

Case Focus: The focus of Amy (5 pages long) is to present alcohol misuse among medical students and professionals.

Case Goal: The goal of this case study is to present physicians-in-training with a discussion of how their own peers could be at risk for alcohol abuse.

Course Objectives Met: 1, 2, 3

Patient: Amy - 24YOAF

• Chief Complaint: Amy comes to the university's Student Health Center because she has been experiencing frequent headaches and intermittent blurry vision.
• Narrative: Amy is a 24-year-old medical student. She is continuing a family history of entering the medical profession, as both her parents are physicians and her grandparents were involved in medicine. Amy has been commended often for her excellent grades and work ethic.
• Alcohol Use: She usually drinks an entire bottle of wine a few nights a week in order to relax
• AUD Diagnosis: At risk for abuse
• Relevant Past Medical, Psychosocial, Family History: Comes from a family of doctors, so she has alot of pressure to succeed
• Take Home Message: Amy's pressures to achieve has pushed her to partake in unhealthy choices, which in turn is negatively affecting her health.
• Practice Tip: It is important that the doctor-in-training abide by the same healthy behaviors they are taught to promote.
• URL's: Amy's Case

Module Evaluation and Review

Student Assessments

• Knowledge questions

• ASEIB questions

Consultant Review