MEDU-4004 - Clinical Allergy-Immunology - Year 4

MEDU-4004 - Clinical Allergy-Immunology - Year 4

Elective Title: Clinical Allergy-Immunology - Year 4
Course Number: MEDU-4004
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: C-form is required. Email C-Form to Dr. McCracken ( in PDF format & Kiki Baldwin. Students should email Dr. McCracken at least 30 days in advance for scheduling issues before the offering of the course.
Responsible Faculty Director: Jennifer McCracken MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Kiki Baldwin Other Faculty: Dr. Julia Tripple Dr. Sarah Pham
Location to Report on First Day:
PCP Suite 100 Monday at 8:30 AM

The allergic diseases are the most prevalent chronic illnesses. Supervised by faculty and fellows, students will be exposed to the management of patients with a wide variety of illnesses. Emphasis is placed on learning the proper use of allergic tests for diagnosis. Also the principles for managing common allergic conditions as well as immunologic disorders are stressed through inpatient consultations, outpatient clinics and seminars.

The strengths of this course are exposure to wide variety of patients/clinical presentations, the opportunity to work with multiple faculty, strong teaching from faculty and fellows, exposure to inpatient consults, exposure to allergy testing, spirometry, and drug challenges.

At the completion of a four week elective, students should be able to:
1. Obtain a coherent history from patients with allergic and immunologic disorders; perform a comprehensive physical examination with awareness of characteristic findings in such diseases; concisely reduce this information into a brief but relevant verbal presentation.
2. Formulate a plan for laboratory investigation of asthma, allergic diseases and immunologic disorders.
3. Understand the pathophysiologic mechanisms and therapeutic approaches currently used in the more common allergic disorders. Learn the NIH and GINA guidelines of treatment of asthma.
4. Learn to distinguish asthma, chronic obstructive pulmonary disease, hypersensitivity lung disease, and allergic bronchopulmonary aspergillosis.
5. Become proficient in distinguishing allergic, non-allergic, vasomotor rhinitis, and the triad of aspirin sensitivity, rhino sinusitis and asthma.
6. Identify the common inhalant antigens causing human allergic sensitization.
7. Distinguish urticaria, eczema and angioedema, and recognize the allergic, physical and inherited causes.
8. Identify the common causes of anaphylaxis, the proper evaluation of management of this syndrome, and indications for desensitization.
9. Learn the approach to patients with insect sting allergies.
10. Observe and interpret immediate skin testing to evaluate aeroallergen sensitivity.
11. Observe and interpret simple lung function tests.
12. Relate the most common immunologic disorders leading to immunodeficiencies.

Description of course activities
The major activities may be divided into inpatient consultations, outpatient clinics (all day, Monday through Friday), seminars-journal clubs (Thursday afternoon), and exposure to laboratory procedures. Clinics are located both at the PCP in Galveston and in League City(Multispecialty Center next to Hobby Lobby at Victory Lakes Town Center). Reading assignments will be provided in reviews and specific articles from reprints of divisional faculty. Each student will attend 4 didactic seminars

Type of students who would benefit from the course
This rotation is especially useful for individuals who will do primary care in Internal Medicine, Pediatrics or Family Medicine. It will prove useful to people interested in Ophthalmology, Otolaryngology, Dermatology, and Pulmonary Medicine. Finally, it will be exceedingly important to people interested in specializing in Allergy/Immunology, Laboratory Medicine, and Academic Internal Medicine.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8 - 12 Clinic 1 - 5 Clinic
Tuesday 8 - 12 Clinic 1 - 5 Clinic
Wednesday 8 - 12 Clinic 1 - 5 Clinic
Thursday 8 - 12 Clinic 1 - 5 Seminar and Journal Club
Friday 8 - 12 Clinic 1 - 5 Clinic

 Average number of patients seen per week: 15-20
 Call Schedule: 8-5 only

Research / Other Course 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?
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  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)?
  B. Format - What guidelines are set for the student's written work?
    Student will write history and show to faculty
  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?
    Strongly encouraged and selected with faculty.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    patient notes and review interesting current literature on interesting patients
  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)?
    Journal club presentation and attending seminars

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.
    Attending faculty will complete standard evaluation forms based on direct contact with students during rounds, clinics and seminars. Students will be encouraged to do independent evaluation of complicated patients and to present their findings during these activities.

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.