Clinical Transaction Project

Over the past several years, medical educators throughout the world have increasingly embraced the concept that the development of clinical competence is the primary goal of medical education.  Much thought has gone into how to define it, how to analyze its components, and how to measure it.  At Vanderbilt, we have embraced this challenge with the creation of the Clinical Transaction Project (CTP), initially funded by the Josiah Macy Foundation, the AAMC and the New York Academy of Medicine. 

• The Clinical Transaction Project enhances development of the skills that comprise the clinical transaction — engaging the patient in a thorough, informative, and insightful interview; performing an accurate and nuanced physical examination; and synthesizing all relevant data using a sound clinical reasoning process.
• The foundational principle behind the CTP is that there are generic clinical skills that can be learned in the context of specific clinical problems. 

Over the past four years, the faculty involved in this project has selected 27 core clinical problems that are so common and so important that we feel all students should attain competence in managing them before leaving the undergraduate phase of their medical education.  These 27 problems have been distributed amongst the required clinical rotations, which have developed learning activities to assure that all students achieve basic competence in managing the assigned problems during the course of the rotation.  The Master Clinical Teachers are responsible for teaching the skills associated with many of the presenting problems.

Learning objectives have been developed for each of the presenting problems and are posted on KM Portfolio, Vanderbilt’s learning portfolio for the clinical years.  KM Portfolio interfaces with the hospital’s electronic medical record in a HIPAA compliant fashion, and every note a student writes automatically loads into that student’s individual portfolio, thus creating a patient panel.  These panels can be sorted by any diagnosis or complaint that might relate to a presenting problem, allowing students to easily compile logs of their experiences with each of the problems.  During meetings with the Master Clinical Teachers, students can use KM Portfolio to facilitate discussions of their progress in the Clinical Transaction Project.

The 27 presenting problems are listed below:     

Emergency Medicine
Chest pain
Shortness of breath

Medicine
Chest pain
Cough
Back pain
Dysuria
GI Bleeding
Murmur
Jaundice
Rash
Depression
Substance abuse

Neurology
Coma
Altered mental status

OB-GYN
Vaginal discharge
Abnormal bleeding
Pelvic pain

Pediatrics
Fever
Sore throat

Psychiatry
Mood disorders
Substance abuse
Anxiety disorders
Psychotic disorders
Eating disorders
Child psychiatry

Surgery
Breast lump
Shock
Trauma
Abdominal pain