APPENDIX:

*Core Scientific Knowledge (from: AAMC-HHMI Scientific Foundations for Future Physicians, 2009)

• Apply knowledge of molecular, biochemical, cellular, and systems-level mechanisms that maintain homeostasis, and of the dysregulation of these mechanisms, to the prevention, diagnosis, and management of disease.
  
  
• Apply major principles of physics and chemistry to explain normal biology, pathobiology of significant diseases, and the mechanisms of action of major technologies used in the prevention, diagnosis, and treatment of disease.
  
  
• Use the principles of genetic transmission, molecular biology of the human genome, and population genetics to infer and calculate risk of disease, to institute an action plan to mitigate this risk, to obtain and interpret family history and ancestry data, to order genetic tests, to guide therapeutic decision-making, and to assess patient risk. 
  
  
• Apply the principles of the cellular and molecular basis of immune and nonimmune host defense mechanisms in health and disease to determine the etiology of disease, identify preventive measures, and predict response to therapies.
  
  
• Apply the mechanisms of general and disease-specific pathological processes in health and disease to the prevention, diagnosis, management, and prognosis of critical human disorders.
  
  
• Apply principles of the biology of microorganisms in normal physiology and disease to explain the etiology of disease, identify preventive measures, and predict response to therapies.
  
  
• Apply principles of pharmacology to evaluate options for safe, rational, and optimally beneficial drug therapy.
  
  
• Apply quantitative knowledge and reasoning – including integration of data, modeling, computation, and analysis – and informatics tools to diagnostic and therapeutic clinical decision-making.

 ^**Patient specific data: for example – demographics, patient history and physical exam, habits, lifestyle, culture, and genetics

^†Critical clinical decision-making cognitive functions and common problem solving skills to adopt and avoid

Heuristics:

• Recognizes acutely ill from sub-acutely ill
• Recognizes medical emergencies
• Utilizes differential diagnosis to develop care plan
• Utilizes evolution of physical exam findings to modify treatment course
• Anticipating disease course, recognizes when patient responds/fails to respond to treatment

Examples of common clinical problem solving skills: 

• Anticipates and responds to changes in patient acuity and evolution of clinical condition (see Heuristics)
• Able to exercise sound clinical judgment in both time-open and time-limited clinical encounters
• Utilizes algorithmic decision-making when appropriate
• Demonstrates ability to personalize clinical reasoning to construct and apply appropriate prototypes of disease

Cognitive errors

Context errors – limits possible consideration to only one set of diagnostic possibilities
Availability error – chooses a diagnosis that is familiar over the more rare diagnosis
Premature closure – once a decision is made, other possibilities are not considered

^††Examples of common core problem lists for the major specialties: 

Internal Medicine - antibiotics and infection (UTI, skin, pneumonia), abdominal pain, altered mental status, anemia, chest pain, cough, dyspnea, syncope, fluid and electrolyte imbalance, GI bleeding, acute renal failure, CHF, COPD/asthma, DVT/PE, diabetes mellitus, liver, life threatening illness

Ob/Gyn – labor and delivery, pregnancy complications, pregnancy and abdominal procedures, abnormal pelvic masses and bleeding, abnormal pap, menopause, vaginitis

Pediatrics – exams for different age groups, asthma. croup, pneumonia, foreign body aspiration, abdominal pain, diarrhea, vomiting, rash, limp, seizure, headache, malignancy, congenital heart disease, sickle cell anemia, cerebral palsy, attention deficit hyperactivity disorder

Primary Care – alcohol or illicit drug use, anemia, arrhythmia, arthritis, asthma, back pain, bronchitis, COPD, delirium/dementia, diabetes, dizziness, fever, GERD, hyperlipidemia, hypertension, hypothyroidism, obesity, UTI

Psychiatry - depression, anxiety, social withdrawal, disruptive and agitated behavior, substance use, unexplained physical complaints, personality disorders, bipolar disorders, psychotic disorders, delirium, PTSD, panic disorders, dementia, autism

Surgery– abdominal pain, fluids, nutrition, shock, anesthesia, laparoscopy, plastic and burns, vascular colorectal, hernias, organ specific surgery