Integrated Clinical Experience Core (ICE)

The purpose of ICE is to expose students to clinical issues early in their medical education and to provide a clinical context for their training in the basic sciences. In ICE, students receive instruction on the history and physical examination, communication skills, behavioral sciences, ethics, humanistic aspects of medical practice, preventive medicine, and health care services research. ICE employs a biopsychosocial framework. In addition, students see patients in the office of primary care physicians in the Omaha area five times a semester. In the summer between the first and second years of medical school, students spend three weeks in a primary care preceptorship in sites throughout the state of Nebraska. Two afternoons a week are dedicated to ICE in the first and second years.

ICE Subjects First Year:
	Semester 1 * Professionalism and student ethical responsibilities * The physician-patient relationship * Clinical communication and interviewing skills * Human growth and development over the life-span
	Semester 2 * The family system in health and illness * Human sexuality * Ethical principles of practice * "Survival skills" for the Summer Preceptorship Experience Instruction * Common problems in primary care medicine
ICE Subjects Second Year:
	Semester 1 * Occupational and environmental medicine * Public health * Patient education * Clinical preventive medicine * Social and cultural issues in medical practice * Health care systems and medical mistakes
	Semester 2 * Clinical decision-making * Epidemiology * Biostatistics and principles of clinical research * Evidence-based medicine * Challenging issues (e.g. drug abuse, bad news delivery, domestic abuse) * Geriatrics
ICE Learning Format
A variety of teaching and learning modalities are employed in ICE. The entire class convenes once or twice a week for lectures, panel discussions, training videos, and/or demonstrations. Frequently, these didactic sessions are followed by small group learning. Composition of these groups is stable throughout two years. The purpose of the small group is to give students opportunities practicing behavioral skills (e.g., interviewing patients, physical examination maneuvers) and to discuss challenging interpersonal and ethical issues in medical education and practice. Frequent use is made of patient simulators. Self-directed and cooperative learning is facilitated through individual and small group projects that are required periodically throughout the year.
Faculty Responsibility
ICE small group facilitators create a safe and trusting atmosphere where challenging issues can be openly discussed and emotions freely expressed. Reticent students may need prompting and assistance to participate, while aggressive students may need help becoming sensitive to the needs of others. Faculty provide verbal and/or written feedback to the students at scheduled times throughout the two years. Small group is Pass/Fail and is based on attendance and participation. Absences - unexcused or frequent absences (even excused) and nonparticipation may result in a grade of fail for the small group.
Faculty Development
ICE faculty will be provided opportunities to learn small group facilitation skills through the faculty development program in the College of Medicine. These sessions are offered in the summer and early fall and typically occur in two to four hour blocks. Faculty development sessions are held before each small group session to help orient faculty to the specific subjects addressed that week, and to assist in identifying and solving learners' difficulties as they arise in small group discussions.
FOR FURTHER INFORMATION, CONTACT: M1 - Devin Nickol, M.D. Internal Medicine 559-7299 M2 - Jim Medder, M.D., M.P.H., Family Medicine 559-6271
History and Physical (H & P)
The History and Physical Diagnosis portion of ICE will provide instruction in the proper method of obtaining a pertinent medical history. It will also demonstrate techniques in performing a physical examination by focusing on normal findings (during the first year course) and abnormal findings (during the second year course). This is the foundation upon which the students will build as they continue to develop their history taking and physical diagnosis skills in the future. First year student sessions are covered in an organ system format. Students receive a one hour introductory lecture followed by a one hour small group session facilitated by a fourth year teaching assistant and supervised by physician faculty. Facilitators will regularly be provided with a handout stating objectives to be covered. Second year students receive a series of lectures on physical diagnosis. Topics include an Introduction to Patient Presentation and the Medical Record, Evidence Based Medicine, and organ-system targeted physical diagnosis. Small groups following the lecture sessions give the students the opportunity to practice patient presentation, note-writing and physical diagnosis techniques, while also learning to gather information from the medical literature and objectively assess the value of the physical exam in diagnosing a wide variety of conditions. The second year experience also includes formal H& P write-ups, based on patients the students see in conjunction with their Longitudinal Preceptors.
FOR FURTHER INFORMATION, CONTACT: Devin Nickol, M.D., Family Practice 559-6204
Longitudinal Clinic
The Longitudinal Clinical Experience meets five times a semester in the office of an Omaha primary care physician. This experience allows students early patient contact and an opportunity to practice examination and interviewing skills learned in other segments of ICE.
FOR FURTHER INFORMATION, CONTACT: Paul Paulman, M.D., Family Practice 559-6818
page last modified Tuesday June 22, 2004