IMHU-4008 - Law & Ethics in Clinical Practice

IMHU-4008 - Law & Ethics in Clinical Practice

Elective Title: Law & Ethics in Clinical Practice
Course Number: IMHU-4008
Elective Type: career Duration/Weeks: 4 Max Enrollment: 4
Prerequisites: Successful completion of Year 2
Additional Requirements: C-Form required & needs to be signed by the Course Director must be completed and submitted to Beverly Claussen at
Responsible Faculty Director: William J. Winslade, PhD, JD Periods Offered: 4, 5, 9,10 excluding holiday period 8 
Coordinator: Other Faculty: n/a
Location to Report on First Day:
UTMB Ewing Hall 3.102 or email

Students will learn how to organize, present and analyze clinical cases that pose ethical and legal issues such as patient competence, termination of treatment, truth telling, costs of care, therapeutic research, confidentiality, no code orders, interprofessional conflicts, etc.

Students should be able to:
1. Distinguish between ethical and legal aspects of a clinical situation.
2. Formulate legal and ethical issues in a manner relevant to clinical practice.
3. Assess alternative clinical decisions and recommend preferred courses of conduct.

Description of course activities
Each session will be devoted to case presentations drawn from hospital experiences of the students (or others such as faculty or existing case literature).

Type of students who would benefit from the course
All students curricular content is adapted to compliment each student's professional goals. Please contact Dr. Winslade for Galveston scheduling information. Non-UTMB students register for this elective by submitting a Visiting Student Application available online at:

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM

 Average number of patients seen per week:
 Call Schedule:

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time 5
Self-Directed Study 20
Data-Collection/Analysis 15

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty and other students
  B. Frequency / Duration of Presentation(s)?
    Preliminary and final presentation
  C. Format - What guidelines are set for the student's presentation?
    Using the framework of the book entitled Clinical Ethics
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    One major case analysis
  B. Format - What guidelines are set for the student's written work?
    Ten to twelve page written paper
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    They are selected by the student as needed.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student selected with guidance from the faculty.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Participate in relevant IMH activities and events during the elective period to include lectures, seminars, conferences, ad hoc case conferences, relevant ethics committees, designated interviews with selected clinicians, medical humanists, or other scholars.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Students will be evaluated on their verbal case presentations and will be required to write one case presentation and analysis.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.