MEDU-4002 - General Internal Medicine Consultation Service

MEDU-4002 - General Internal Medicine Consultation Service

Elective Title: General Internal Medicine Consultation Service
Course Number: MEDU-4002
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: Successful completion of Internal Medicine clerkship.
Responsible Faculty Director: Julian Gonzalez-Fraga, MD Periods Offered: 1-7; 9-13 excluding holiday period 8 
Coordinator: Other Faculty: n/a
Location to Report on First Day:
4.174 John Sealy Annex at 8:00 am

Students will gain expertise in inpatient consultation for patients requiring complex evaluation or seeking second opinions. The service provides insight into management of general medicine issues that arise in surgical and sub-specialty patients.
This rotation provides students with a chance to evaluate patient independent form residents, and also gives them a chance to review physical exam skills with attending.

Understanding pre-operative assessment; Understanding post-operative general medicine management; Understanding management of common medical problems in non medical patients; Improving medical student physical diagnosis skills at the bedside on a one to one basis.

Description of course activities
Students will see a diverse group of patients primarily located on the Surgery subspecialities (e.g. Orthopaedics, Neurosurgery and so forth) and Gynecology Services in John Sealy and Jennie Sealy Hospitals and TDCJ Hospital. Students will also see patients located in Day Surgery Holding Area as well as PACU. Students will be exposed to different medical problems, new or existing, experienced by these patients. The rotation provides an opportunity to work closely with the consult attending and house staff.
The students will see new patients as consultants and follow their hospital course as needed. Consults will be evaluated in conjunction with house staff and presented daily to the attending physician who will review all cases. Student experiences would include observations of bedside interviews, physical examination and interpretation of laboratory/imaging findings. Students will be exposed to evidence based discussions regarding different medical management topics.

Type of students who would benefit from the course
Students interested in hospital based Internal Medicine or Family Medicine.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8 5
Tuesday 8 5
Wednesday 8 5
Thursday 8 5
Friday 8 5

 Average number of patients seen per week: 10-12
 Call Schedule: None

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

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 Housestaff
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    For new consult patients, the initial presentation will be in H&P format. For follow up patients standard SOAP format will be expected.
  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)?
    Daily or as allowed by patient census
  B. Format - What guidelines are set for the student's written work?
    a. Presentation of the patient is usual SOAP format on a daily basis b. Presentation of a chosen topic on a weekly basis
  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?
    But Preferred
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student and Faculty Selection
  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)?
    Internal Medicine Morning Report 8:00 AM and Internal Medicine Noon Conference are mandatory.

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 ability to do an appropriate history and physical, integrate data and approach problems systematically. Evaluations will be based on the clarity of the thought process of the student through providing an up to the point assessment based on a complex H&P.
In other words, to have a clear thought process, students must have a good understanding of the pathophysiology of diseases and be able to integrate the pathophysiologic expectations with clinical findings.
Evaluation will be submitted by the attending physician.

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.