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Contents 1 Course Details 1.1 MedStudentLearning.com URL 1.2 Description 1.3 Need 1.4 Needs Analysis 1.5 Vision 1.6 Mission 1.7 Goal 1.8 Learning Objectives 2 Case Studies 2.1 Case Study 1: John 2.1.1 Educational Objectives 2.1.2 Case Specifics 2.2 Case Study 2: Sarah 2.2.1 Educational Objectives 2.2.2 Case Specifics 2.3 Case Study 3: Len 2.3.1 Educational Objectives 2.3.2 Case Specifics 2.4 Case Study 4: Morgan 2.4.1 Educational Objectives 2.4.2 Case Specifics 2.5 Case Study 5: Joe 2.5.1 Educational Objectives 2.5.2 Case Specifics 2.6 Case Study 6: Amy 2.6.1 Educational Objectives 2.6.2 Case Specifics 3 Module Evaluation and Review 3.1 Student Assessments 3.2 Consultant Review

Course Details

MedStudentLearning.com URL

Meet Your Patients: Case Challenges

Description

Patient care for alcohol misuse is not generalizable; care must be individualized for each patient. This course presents six individual case studies. Each case study will illustrate how individual variation affects alcohol use, and how individual differences can impact assessment and treatment decisions.

Need

Patient interviews about alcohol use and subsequent treatment need to be individualized to each patient.

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 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 and/or socioeconomical background affects assessment, diagnosis, or treatment.

Goal

You will understand how to administer individualized alcohol use treatment.

Learning Objectives

1. Recognize that alcohol misuse affects each individual differently, and thus affects treatment choices
2. Interview patients 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 Studies

Case Study 1: John

Educational Objectives

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), and (3)

Expected Diagnosis: At risk for alcohol use. John is underage.

Take Home Message/Practice Tip: 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. 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.

Case Specifics

Patient: John - 17YOWM

Case Information: 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.

Chief Complaint: Leg muscle strain sustained a day earlier while fooling around with his buddies

Relevant Past Medical, Psychosocial, Family History: Friends are fellow drinkers. Drinks six packs with friends on occasion(underage)

Case Study 2: Sarah

Educational Objectives

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), and (3)

Expected Diagnosis: At risk for alcohol use disorder. However, because Sarah is pregnant, she should be counseled to abstain from alcohol use for the duration of the pregnancy.

Take Home Message/Practice Tip: 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 counseled to abstain for the health of the fetus. Prenatal treatment should emphasize the dangers of alcohol use during pregnancy

Case Specifics

Patient: Sarah - 27YOBF

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".

Chief Complaint: Sarah is at your office for her first prenatal visit. She is currently 10 weeks pregnant with her first child.

Relevant Past Medical, Psychosocial, Family History: Unplanned pregnancy with live-in boyfriend. 3-4 glasses of wine -4 times a month, exceeded that once in the past month

Case Study 3: Len

Educational Objectives

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), and (3)

Expected Diagnosis: At risk for abuse.

Take Home Message/Practice Tip: Physicians-in-training should become familiar with assessing alcohol use in older adults and intervening when appropriate. As a widower, Len is drinking more to cope. Len's drinking has resulted in physical problems, as well as sleep problems.

Case Specifics

Patient: Len - 67YONAM

Case Information: 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.

Chief Complaint: Restless sleep, stomach pain. Pain and loss of sleep affecting his work as an artist.

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. AUDIT score of 9. At risk for abuse.

Case Study 4: Morgan

Educational Objectives

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), and (3)

Expected Diagnosis: At risk for alcohol abuse

Take Home Message/Practice Tip: 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. It is important to remember a patient's social/age history when counseling about alcohol misuse.

Case Specifics

Patient: Morgan - 21YOBF

Case Information: 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.

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.

Relevant Past Medical, Psychosocial, Family History: Single, College-aged, Member of the LGBT community. Goes to the bar in the next town twice a week with friends

Case Study 5: Joe

Educational Objectives

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), and (3)

Expected Diagnosis: At risk for abuse

Take Home Message/Practice Tip: Outreach may be the best first step in reaching the homeless population who are in need of substance abuse treatment. 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

Case Specifics

Patient: Joe - 52YOHM

Case Information: 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.

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.

Relevant Past Medical, Psychosocial, Family History: Widower and homeless. Joe scores a 5 on the AUDIT-12 exam. He is found to be consuming mouthwash as well.

Case Study 6: Amy

Educational Objectives

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), and (3)

Expected Diagnosis: At risk for abuse

Take Home Message/Practice Tip: Amy's pressures to achieve has pushed her to partake in unhealthy choices, which in turn is negatively affecting her health. It is important that the doctor-in-training abide by the same healthy behaviors they are taught to promote.

Case Specifics

Patient: Amy - 24YOAF

Case Information: 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.

Chief Complaint: Amy comes to the university's Student Health Center because she has been experiencing frequent headaches and intermittent blurry vision.

Relevant Past Medical, Psychosocial, Family History: Comes from a family of doctors, so she has a lot of pressure to succeed. She usually drinks an entire bottle of wine a few nights a week in order to relax

Module Evaluation and Review

Student Assessments

• Knowledge questions

• ASEIB questions

Consultant Review