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 • Direct Patient Care Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: C-form is required. Email C-Form to Dr. Christians (nachrist@utmb.edu) in PDF format & Destiny Willis. Students should email Dr. Christians at least 30 days in advance for scheduling issues before the offering of the course.
Responsible Faculty Director: Nicole Christians, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Destiny Willis; Backup:Victoria Garcia Other Faculty: Dr. Julia Tripple Dr. Jennifer McCracken
Location to Report on First Day:
PCP Suite 100 Monday at 8:00 AM

Goals
Allergic diseases are among the most prevalent chronic illnesses. Through participation in outpatient clinics under the supervision of faculty and fellows, students will gain experience evaluating and managing patients with a wide variety of allergic and immunologic conditions. Emphasis is placed on understanding the appropriate use and interpretation of allergy testing and spirometry.

Objectives
At the completion of a four week elective, students should be able to:
1. Obtain appropriate histories from patients with allergic and immunologic disorders; perform comprehensive physical examinations with awareness of characteristic findings in such diseases.
2. Understand the pathophysiologic mechanisms, diagnostic evaluation and current therapeutic approaches for common allergic disorders.
3. Learn to distinguish asthma, chronic obstructive pulmonary disease, hypersensitivity lung disease, and allergic bronchopulmonary aspergillosis.
4. Observe and interpret spirometry.
5. Learn the NIH and GINA guidelines for the treatment of asthma.
6. Become proficient in distinguishing and treating allergic and non-allergic rhinitis, including vasomotor rhinitis.
7. Observe and interpret skin prick testing for the evaluation of aeroallergen sensitization while identifying common aeroallergens contributing to allergic diseases.
8. Recognize urticaria and understand the allergic and physical causes.
9. Distinguish between histamine and bradykinin-mediated angioedema.
10. Identify eczema and understand its underlying allergic, environmental and genetic factors, as well as appropriate management strategies.
11. Recognize anaphylaxis, identify common causes and understand the appropriate management.
12. Distinguish between IgE-mediated food allergies and food intolerances/sensitivities and understand the indications for food allergy testing.
13. Understand the key elements of a comprehensive drug allergy history and the indications for drug challenges and desensitizations.
14. Learn the approach to patients with insect sting allergies.
15. Identify the most common immunologic disorders leading to immunodeficiencies.

Description of course activities
Participation in outpatient allergy clinics (Monday through Friday) and didactic sessions (Thursday afternoons). Allergy clinics are located at the Primary Care Pavilion in Galveston and at the Multispecialty Center in Victory Lakes Town Center (next to Hobby Lobby).

Type of students who would benefit from the course
This rotation is particularly beneficial for students interested in specializing in Allergy/Immunology, as well as primary care in Internal Medicine, Pediatrics or Family Medicine. It is also valuable for students considering Ophthalmology, Otolaryngology, Dermatology and Pulmonary 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
Saturday
Sunday

 Average number of patients seen per week: 20-30
 Call Schedule: none

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


Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Checkbox pixInpatient Service   Checkbox pixAmbulatory   Checkbox pixSurgery   Checkbox pixStandardized patients
Checkbox pixPatients simulators   Checkbox pixOther
  B. Frequency - How often are students observed clinically?
    Daily
  C. Format - What method(s) are used to document the student's clinical performance?
    Checkbox pixDaily oral feedback   Checkbox pixEnd of period oral feedback   Checkbox pixWritten feedback
Checkbox pixOther

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Students will present patients they have seen to the faculty.
  B. Frequency / Duration of Presentation(s)?
    Daily
  C. Format - What guidelines are set for the student's presentation?
    Standard SOAP format
  D. Assessment - Who assesses the student's presentation performance?
    Checkbox pixSelf-assessment   Checkbox pixPeer assessment   Checkbox pixFaculty assessment
  E. Method of content selection
    Checkbox pixCurrent cases  Checkbox pixStudent-selected topic   Checkbox pixAssigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Daily
  B. Format - What guidelines are set for the student's written work?
    Student will chart clinic notes.
  C. Length of written assignment(s)?
    Checkbox pixAbstract   Checkbox pixAnnotated bibliography   Checkbox pix1 - 2 page paper   Checkbox pix3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
   
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
   
  F. Audience - Who assesses the student's written performance?
    Checkbox pixPeer Assessment     Checkbox pixFaculty Assessment     Checkbox pixOther

4.  Examination
  Format
    Checkbox pixOral   Checkbox pixWritten multiple choice   Checkbox pixWritten essay / short answer   Checkbox pixOSCE
Checkbox pixOther

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".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Attending faculty will complete standard evaluation forms based on direct contact with students during 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.
   
 
B.
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.
   
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
   
 
D.
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)?
   
 
E.
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?
   
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
 
H.
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.