Swiss Catalogue of Learning Objectives for Undergraduate Medical Training

Under a mandate of the Joint Commission of the Swiss Medical Schools

5. General Skills

for definition of Levels see Chapter 2

... history taking

Objective ID Level

S 1   clarifying the patient’s expectations and requests for the encounter 2

S 2   taking detailed, systematic history of somatic and psychological aspects of symptoms and complaints, the patient’s situation, his/her understanding and concerns, social and cultural background and illness experience 2

S 3   taking targeted, hypothesis-directed history 2

S 4   taking history from third party 2

S 5   noting and reacting to nonverbal cues 2

S 6   taking psychiatric history 1

S 7   communicating with and taking history from severely ill or dying patients 1

S 8   taking history in patients with special communication needs, e.g. language or speech problems 1

S 9   drawing a family tree (pedigree) 1

S 10   taking history in travel-related medical problem 1

S 11   taking occupational and workplace history 2

S 12   identifying hazardous behavior and dangerous lifestyle 1

S 13   taking psychoactive substance history 2

... information / management

Objective ID Level

S 14   elaborating a clinical question and searching for its solution in the literature 1

S 15   informing patient and family, colleagues and other professionals on findings and checking understanding 2

S 16   handling phone call from or to patient or third person 1

S 17   breaking bad news to patients and family 1

S 18   giving main information elements necessary to get informed consent 1

S 19   recording findings in patient file 2

S 20   writing letters for transfer or discharge of patient 1

S 21   counseling patients related to lifestyle (diet, physical activity, nutrition, smoking, alcohol, illicit drugs) 1

S 22   prescribing measures in treatment of pain, palliative and end-of-life care 1

S 23   filling-in prescription forms 2

S 24   filling-in a death certificate 1

S 25   summarizing the main points of diagnoses, active problems and management plans of a patient 2

S 26   diagnostic coding 1

S 27   clarifying with nursing staff monitoring and calling criteria concerning patients 1

S 28   retrieving patient-specific information from clinical data system 1

S 29   working with local / national guidelines and protocols 1

S 30   giving teaching presentations to students and other health professionals 1

S 31   conservative management of self-limiting disease ("wait and see") 1

S 32   perform house call and assess psycho-social, economic and hygienic situation, including risk factors for fall 1

S 33   giving advice about contraception and post-coital interception 1

... examination

Objective ID Level

S 34   assessment of general condition (habitus and posture, symmetry and mobility of body, nutritional state, mood and mental status) 2

S 35   assessment of vital functions (body temperature, respiration, pulse rate, blood pressure, venous pressure) 2

S 36   assessment of patients with medical emergencies and after trauma 1

S 37   recording of anthropometric data (height, weight, body mass index [BMI], skull circumference, waist and hip circumference) 2

S 38   assessment of skin and mucous membranes (signs of anemia, cyanosis, jaundice, edema, dehydration) 2

S 39   assessment of basic and instrumental activities of daily living 1

S 40   assessing indication and contraindications for surgical intervention 1

S 41   assessment of attention, thought (form and content), perception, affect and psychomotor behavior 1

S 42   evaluating decision-making capacity in cognitively impaired person 1

S 43   (forensic) examination of persons under the influence of alcohol and/or drugs 1

S 44   clinical diagnosis of death 1

S 45   estimation of time of death (livores, rigor mortis, rectal temperature) 1

S 46   examination of peripheral and central arterial pulses, detection of arterial bruits 2

S 47   examination of lymph node areas 2

S 48   detailed description of skin lesions 2

S 49   description of nails, scalp and visible mucous membranes 2

S 50   testing for dermographism 2

S 51   skin inspection with magnifying glass 1

S 52   description of eyelids and of eyelashes 2

S 53   description of upper eyelid after eversion 1

S 54   description of width of palpebral fissure 1

S 55   description of conjunctivae, including fornix 2

S 56   description of sclerae and corneae, including with fluorescein 1

S 57   determination of sensation to touch of cornea 1

S 58   description of pupil, direct reaction to light and convergence 2

S 59   description of iris 1

S 60   recognition and description of nystagmus 1

S 61   description of position and movement of eyes (corneal reflex images, cover test) 1

S 62   description of lens, anterior chamber, media of the eyes (transillumination) 1

S 63   fundoscopy, bringing the fundus into focus 2

S 64   description of optic disc and retinal vessels (discrimination normal-abnormal) 1

S 65   estimation of intra-ocular pressure by palpation 1

S 66   assessment of visual acuity and of visual fields (with Donders confrontation test) 2

S 67   assessment of color vision with Ishihara tables 1

S 68   inspection and palpation of auricle and adjacent region (mastoid) 2

S 69   inspection of external auditory canal and tympanic membrane with otoscope 2

S 70   test of tubal function (motility of ear drum) 1

S 71   hearing tests with whispering, conversational voice and tuning fork 2

S 72   inspection and palpation of nose and face 2

S 73   assessment of nasal obstruction and anterior rhinoscopy 1

S 74   inspection of lips, oral cavity and oral pharynx including teeth, tongue, base of tongue, pharyngeal arches, tonsils, and inspection of excretory ducts of parotid glands (Stenon's duct) and submandubular glands (Warthon's duct) 2

S 75   palpation of floor of the mouth, cheeks, tonsils and base of tongue 1

S 76   inspection and (bimanual) palpation of parotid and submandibular glands 1

S 77   assessment of voice and speech including recognition of aphasia 2

S 78   external inspection and palpation of larynx 2

S 79   inspection, palpation and auscultation of cervical structures, thyroid, carotid arteries and lymph nodes 2

S 80   palpation of head and cervical spine, testing for mobility, tenderness and neck stiffness 1

S 81   inspection of shape and movement of chest and testing for tenderness on compression and/or percussion 2

S 82   examination of bones, joints and muscles of shoulder girdle 1

S 83   assessment of respiratory chest expansion by inspection, palpation and measurement of chest circumference 2

S 84   palpation of tactile fremitus 2

S 85   palpation of apex beat (heart) 2

S 86   percussion of lungs including respiratory shifting of diaphragm 2

S 87   auscultation of lungs 2

S 88   auscultation of heart 2

S 89   inspection and palpation of breasts including regional lymph nodes 2

S 90   inspection of abdomen 2

S 91   auscultation of abdomen (bowel sounds, bruits) 2

S 92   percussion of abdomen (liver, Traube's area, bladder dullness) 2

S 93   palpation of abdomen (abdominal wall, colon, liver, spleen, aorta, abdominal masses) 2

S 94   eliciting abdominal tenderness, rebound tenderness and guarding 2

S 95   eliciting shifting abdominal dullness 2

S 96   eliciting abdominal fluid thrill 1

S 97   eliciting renal tenderness 2

S 98   testing for inguinal hernia by inspection and palpation (also during increased abdominal pressure) of groin / hernial orifices 1

S 99   external inspection and palpation of (peri)anal area 1

S 100   rectal examination in male (anus, rectum, prostate gland, sacrum) and subsequent inspection of glove 1

S 101   inspection and palpation of penis and scrotum (testes, epidydimis, spermatic cord) including transillumination of scrotum 1

S 102   inspection and palpation of female external genitalia (vulva, perineum) 1

S 103   examination of spine, spine mobility and paravertrebral muscles standing and supine (kyphosis, scoliosis, lateral tilt, Schober procedure, position-dependent pain) 2

S 104   palpation, percussion and axial compression of spine for tenderness and pain 1

S 105   examination of iliosacral joints and pelvis including muscles (mobility, pain, atrophies) 1

S 106   assessing shape, function, motility and tenderness of upper extremities (elbow, wrist, finger joints and relevant structures and muscles) 1

S 107   assessing shape, motility, stability and tenderness of lower extremities and relevant structures and muscles (ankle and knee, meniscus signs, position of patella, patella function and relief) 1

S 108   assessing axes of legs on standing (genu valgum, genu varum) 1

S 109   assessing feet on standing (pes planus, pes valgus) 1

S 110   assessment of capillary pulse and refill 1

S 111   testing for arterial insufficiency (Ratschow-Test) 1

S 112   assessing varicose veins with Trendelenburg test and Perthes test 1

S 113   eliciting tendon reflexes (triceps, biceps, knee, ankle) and plantar response 2

S 114   assessment of function of cranial nerves 1

S 115   assessment of passive muscle stretch, inspection of muscle bulk, muscle tone, muscle strength and involuntary movements 2

S 116   eliciting complex reflexes: abdominal, anal, masseter, snout, grasp 1

S 117   inspection of gait (normal, on heels, hopping in one place) 2

S 118   testing of coordination (finger-to-nose, heel-to-shin, heel-to-toe, diadochokinesis) 2

S 119   Romberg's test, Unterberger's test 1

S 120   recovering of balance after push 1

S 121   assessment of sense of light touch and sense of pain 2

S 122   assessment of sense of temperature, sense of vibration and position sense 1

S 123   assessment of discriminative sensations (e.g.stereognosis) 1

S 124   testing for meningeal irritation 2

S 125   testing for cervical and lumbar radicular signs 1

S 126   assessment of level of consciousness by means of Glasgow coma scale 1

S 127   assessment of orientation in space and time 2

S 128   assessment of memory, Mini Mental Status, Clock test 1

S 129   speculum examination: inspection of vagina and cervix (with simulator) 1

S 130   bimanual examination: palpation of vagina, cervix, uterine corpus, ovaries (with simulator) 1

S 131   rectal examination in female: anus, rectum, palpation of pouch of Douglas and uterus (with simulator) 1

S 132   inspection of abdomen of pregnant woman 1

S 133   recording Apgar score 1

... procedures

Objective ID Level

S 134   basic life support for adults: assessment, breathing, circulation, defibrillation (Automatic External Defibrillation) until arrival of professional emergency medical personnel (simulator) 2

S 135   advanced cardiac life support (basic cardiac rhythm algorithms, with simulator) 1

S 136   assessment and initial care of external injuries (wounds, bleeding, burns, sprains, dislocations, fractures) 1

S 137   assessment of trauma patients according to the ABCDE (advanced trauma life support - ATLS) 1

S 138   transport of casualty 1

S 139   stopping hemorrhage (direct pressure, pressure point, pressure bandage, tourniquet) 1

S 140   using appropriate hand hygiene at workplace 2

S 141   intravenous injection and cannulation 1

S 142   subcutaneous and intramuscular injection 1

S 143   pre-operative preparation of operative field for minor surgery, asepsis and antisepsis 1

S 144   infiltration anesthesia 1

S 145   venepuncture 2

S 146   finger prick 2

S 147   patient instruction for mid-stream urine sample collection 1

S 148   performing and reading of urine stick test 2

S 149   preparation and examination of urinary sediment 1

S 150   taking an electrocardiogram at rest 1

S 151   spirometry 1

S 152   measurement of expiratory peak flow 2

S 153   using and giving instructions to use metered dose inhalers, spacers and nebulizers 1

S 154   removal of wound sutures 2

S 155   application of bandage 1

S 156   taking a throat swab 2

S 157   application of eye dressing 1

S 158   instillation of eye drops 2

S 159   application of eye ointment 2

S 160   flooding and rinsing ocular tissue 1

S 161   ear irrigation 1

S 162   wound cleaning 1

S 163   stitching of skin incisions and lacerations 1

S 164   application of a sling 1

S 165   preparation to watch / to assist in operating theatre (scrub-up, gown up, put on sterile gloves, etc.) 2

S 166   attendance in theatre at various operations 2

S 167   clamping of umbilical cord / separation of placenta from child 1

S 168   assessment of fetal heart rate during pregnancy 1

Objective ID		Level
S 1	clarifying the patient’s expectations and requests for the encounter	2
S 2	taking detailed, systematic history of somatic and psychological aspects of symptoms and complaints, the patient’s situation, his/her understanding and concerns, social and cultural background and illness experience	2
S 3	taking targeted, hypothesis-directed history	2
S 4	taking history from third party	2
S 5	noting and reacting to nonverbal cues	2
S 6	taking psychiatric history	1
S 7	communicating with and taking history from severely ill or dying patients	1
S 8	taking history in patients with special communication needs, e.g. language or speech problems	1
S 9	drawing a family tree (pedigree)	1
S 10	taking history in travel-related medical problem	1
S 11	taking occupational and workplace history	2
S 12	identifying hazardous behavior and dangerous lifestyle	1
S 13	taking psychoactive substance history	2

Objective ID		Level
S 14	elaborating a clinical question and searching for its solution in the literature	1
S 15	informing patient and family, colleagues and other professionals on findings and checking understanding	2
S 16	handling phone call from or to patient or third person	1
S 17	breaking bad news to patients and family	1
S 18	giving main information elements necessary to get informed consent	1
S 19	recording findings in patient file	2
S 20	writing letters for transfer or discharge of patient	1
S 21	counseling patients related to lifestyle (diet, physical activity, nutrition, smoking, alcohol, illicit drugs)	1
S 22	prescribing measures in treatment of pain, palliative and end-of-life care	1
S 23	filling-in prescription forms	2
S 24	filling-in a death certificate	1
S 25	summarizing the main points of diagnoses, active problems and management plans of a patient	2
S 26	diagnostic coding	1
S 27	clarifying with nursing staff monitoring and calling criteria concerning patients	1
S 28	retrieving patient-specific information from clinical data system	1
S 29	working with local / national guidelines and protocols	1
S 30	giving teaching presentations to students and other health professionals	1
S 31	conservative management of self-limiting disease ("wait and see")	1
S 32	perform house call and assess psycho-social, economic and hygienic situation, including risk factors for fall	1
S 33	giving advice about contraception and post-coital interception	1

Objective ID		Level
S 34	assessment of general condition (habitus and posture, symmetry and mobility of body, nutritional state, mood and mental status)	2
S 35	assessment of vital functions (body temperature, respiration, pulse rate, blood pressure, venous pressure)	2
S 36	assessment of patients with medical emergencies and after trauma	1
S 37	recording of anthropometric data (height, weight, body mass index [BMI], skull circumference, waist and hip circumference)	2
S 38	assessment of skin and mucous membranes (signs of anemia, cyanosis, jaundice, edema, dehydration)	2
S 39	assessment of basic and instrumental activities of daily living	1
S 40	assessing indication and contraindications for surgical intervention	1
S 41	assessment of attention, thought (form and content), perception, affect and psychomotor behavior	1
S 42	evaluating decision-making capacity in cognitively impaired person	1
S 43	(forensic) examination of persons under the influence of alcohol and/or drugs	1
S 44	clinical diagnosis of death	1
S 45	estimation of time of death (livores, rigor mortis, rectal temperature)	1
S 46	examination of peripheral and central arterial pulses, detection of arterial bruits	2
S 47	examination of lymph node areas	2
S 48	detailed description of skin lesions	2
S 49	description of nails, scalp and visible mucous membranes	2
S 50	testing for dermographism	2
S 51	skin inspection with magnifying glass	1
S 52	description of eyelids and of eyelashes	2
S 53	description of upper eyelid after eversion	1
S 54	description of width of palpebral fissure	1
S 55	description of conjunctivae, including fornix	2
S 56	description of sclerae and corneae, including with fluorescein	1
S 57	determination of sensation to touch of cornea	1
S 58	description of pupil, direct reaction to light and convergence	2
S 59	description of iris	1
S 60	recognition and description of nystagmus	1
S 61	description of position and movement of eyes (corneal reflex images, cover test)	1
S 62	description of lens, anterior chamber, media of the eyes (transillumination)	1
S 63	fundoscopy, bringing the fundus into focus	2
S 64	description of optic disc and retinal vessels (discrimination normal-abnormal)	1
S 65	estimation of intra-ocular pressure by palpation	1
S 66	assessment of visual acuity and of visual fields (with Donders confrontation test)	2
S 67	assessment of color vision with Ishihara tables	1
S 68	inspection and palpation of auricle and adjacent region (mastoid)	2
S 69	inspection of external auditory canal and tympanic membrane with otoscope	2
S 70	test of tubal function (motility of ear drum)	1
S 71	hearing tests with whispering, conversational voice and tuning fork	2
S 72	inspection and palpation of nose and face	2
S 73	assessment of nasal obstruction and anterior rhinoscopy	1
S 74	inspection of lips, oral cavity and oral pharynx including teeth, tongue, base of tongue, pharyngeal arches, tonsils, and inspection of excretory ducts of parotid glands (Stenon's duct) and submandubular glands (Warthon's duct)	2
S 75	palpation of floor of the mouth, cheeks, tonsils and base of tongue	1
S 76	inspection and (bimanual) palpation of parotid and submandibular glands	1
S 77	assessment of voice and speech including recognition of aphasia	2
S 78	external inspection and palpation of larynx	2
S 79	inspection, palpation and auscultation of cervical structures, thyroid, carotid arteries and lymph nodes	2
S 80	palpation of head and cervical spine, testing for mobility, tenderness and neck stiffness	1
S 81	inspection of shape and movement of chest and testing for tenderness on compression and/or percussion	2
S 82	examination of bones, joints and muscles of shoulder girdle	1
S 83	assessment of respiratory chest expansion by inspection, palpation and measurement of chest circumference	2
S 84	palpation of tactile fremitus	2
S 85	palpation of apex beat (heart)	2
S 86	percussion of lungs including respiratory shifting of diaphragm	2
S 87	auscultation of lungs	2
S 88	auscultation of heart	2
S 89	inspection and palpation of breasts including regional lymph nodes	2
S 90	inspection of abdomen	2
S 91	auscultation of abdomen (bowel sounds, bruits)	2
S 92	percussion of abdomen (liver, Traube's area, bladder dullness)	2
S 93	palpation of abdomen (abdominal wall, colon, liver, spleen, aorta, abdominal masses)	2
S 94	eliciting abdominal tenderness, rebound tenderness and guarding	2
S 95	eliciting shifting abdominal dullness	2
S 96	eliciting abdominal fluid thrill	1
S 97	eliciting renal tenderness	2
S 98	testing for inguinal hernia by inspection and palpation (also during increased abdominal pressure) of groin / hernial orifices	1
S 99	external inspection and palpation of (peri)anal area	1
S 100	rectal examination in male (anus, rectum, prostate gland, sacrum) and subsequent inspection of glove	1
S 101	inspection and palpation of penis and scrotum (testes, epidydimis, spermatic cord) including transillumination of scrotum	1
S 102	inspection and palpation of female external genitalia (vulva, perineum)	1
S 103	examination of spine, spine mobility and paravertrebral muscles standing and supine (kyphosis, scoliosis, lateral tilt, Schober procedure, position-dependent pain)	2
S 104	palpation, percussion and axial compression of spine for tenderness and pain	1
S 105	examination of iliosacral joints and pelvis including muscles (mobility, pain, atrophies)	1
S 106	assessing shape, function, motility and tenderness of upper extremities (elbow, wrist, finger joints and relevant structures and muscles)	1
S 107	assessing shape, motility, stability and tenderness of lower extremities and relevant structures and muscles (ankle and knee, meniscus signs, position of patella, patella function and relief)	1
S 108	assessing axes of legs on standing (genu valgum, genu varum)	1
S 109	assessing feet on standing (pes planus, pes valgus)	1
S 110	assessment of capillary pulse and refill	1
S 111	testing for arterial insufficiency (Ratschow-Test)	1
S 112	assessing varicose veins with Trendelenburg test and Perthes test	1
S 113	eliciting tendon reflexes (triceps, biceps, knee, ankle) and plantar response	2
S 114	assessment of function of cranial nerves	1
S 115	assessment of passive muscle stretch, inspection of muscle bulk, muscle tone, muscle strength and involuntary movements	2
S 116	eliciting complex reflexes: abdominal, anal, masseter, snout, grasp	1
S 117	inspection of gait (normal, on heels, hopping in one place)	2
S 118	testing of coordination (finger-to-nose, heel-to-shin, heel-to-toe, diadochokinesis)	2
S 119	Romberg's test, Unterberger's test	1
S 120	recovering of balance after push	1
S 121	assessment of sense of light touch and sense of pain	2
S 122	assessment of sense of temperature, sense of vibration and position sense	1
S 123	assessment of discriminative sensations (e.g.stereognosis)	1
S 124	testing for meningeal irritation	2
S 125	testing for cervical and lumbar radicular signs	1
S 126	assessment of level of consciousness by means of Glasgow coma scale	1
S 127	assessment of orientation in space and time	2
S 128	assessment of memory, Mini Mental Status, Clock test	1
S 129	speculum examination: inspection of vagina and cervix (with simulator)	1
S 130	bimanual examination: palpation of vagina, cervix, uterine corpus, ovaries (with simulator)	1
S 131	rectal examination in female: anus, rectum, palpation of pouch of Douglas and uterus (with simulator)	1
S 132	inspection of abdomen of pregnant woman	1
S 133	recording Apgar score	1

Objective ID		Level
S 134	basic life support for adults: assessment, breathing, circulation, defibrillation (Automatic External Defibrillation) until arrival of professional emergency medical personnel (simulator)	2
S 135	advanced cardiac life support (basic cardiac rhythm algorithms, with simulator)	1
S 136	assessment and initial care of external injuries (wounds, bleeding, burns, sprains, dislocations, fractures)	1
S 137	assessment of trauma patients according to the ABCDE (advanced trauma life support - ATLS)	1
S 138	transport of casualty	1
S 139	stopping hemorrhage (direct pressure, pressure point, pressure bandage, tourniquet)	1
S 140	using appropriate hand hygiene at workplace	2
S 141	intravenous injection and cannulation	1
S 142	subcutaneous and intramuscular injection	1
S 143	pre-operative preparation of operative field for minor surgery, asepsis and antisepsis	1
S 144	infiltration anesthesia	1
S 145	venepuncture	2
S 146	finger prick	2
S 147	patient instruction for mid-stream urine sample collection	1
S 148	performing and reading of urine stick test	2
S 149	preparation and examination of urinary sediment	1
S 150	taking an electrocardiogram at rest	1
S 151	spirometry	1
S 152	measurement of expiratory peak flow	2
S 153	using and giving instructions to use metered dose inhalers, spacers and nebulizers	1
S 154	removal of wound sutures	2
S 155	application of bandage	1
S 156	taking a throat swab	2
S 157	application of eye dressing	1
S 158	instillation of eye drops	2
S 159	application of eye ointment	2
S 160	flooding and rinsing ocular tissue	1
S 161	ear irrigation	1
S 162	wound cleaning	1
S 163	stitching of skin incisions and lacerations	1
S 164	application of a sling	1
S 165	preparation to watch / to assist in operating theatre (scrub-up, gown up, put on sterile gloves, etc.)	2
S 166	attendance in theatre at various operations	2
S 167	clamping of umbilical cord / separation of placenta from child	1
S 168	assessment of fetal heart rate during pregnancy	1