MEDU-4016 - Infectious Diseases Consult Service for Adults

MEDU-4016 - Infectious Diseases Consult Service for Adults

Elective Title: Infectious Diseases Consult Service for Adults
Course Number: MEDU-4016
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Internal Medicine Clerkship is advised, but not required.
Responsible Faculty Director: A. Scott Lea, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Kiki Baldwin Other Faculty: Joseph Hornak, Juan Carlos Sarria, A. Clinton White, Lucas Blanton, Miguel Cabada,
Location to Report on First Day:
11A Jennie Sealy Faculty Workroom at 8:00am

1. Learn to evaluate and treat patients with suspected bacterial, fungal, parasitic and viral (HIV, HCV) infections.
2. Learn to properly utilize the microbiology laboratory to diagnose pathogenic microorganisms and their sequelae.
3. Become familiar with the pathogenesis and natural history of the major infectious disease syndrome and the various microbial pathogens.
4. Understand the proper use and stewardship of antimicrobial agents.
5. Develop and practice good infection control habits for patient and personal protection and safety.

By the end of the rotation the student should have developed the ability to properly evaluate, diagnose and treat a patient with an infectious disease. He/she should be able to recount the major syndromes as well as the major classes of therapeutic antimicrobial agents and adjuncts to the care of those patients afflicted by pathogenic microorganisms. The student will also be introduced to the concepts of infection control while practicing proper utilization of personal protective equipment as well as personal hygiene in the hospital environment.

Description of course activities
1. Daily evaluation of new infectious disease consultations and daily rounds within the hospital. This includes the collection and analysis of pathologic and radiologic tests as well as working with other primary and consultative services during the hospital stay of assigned patients.
2. Didactic lectures and teaching conferences designed to teach the student different infectious disease concepts, antimicrobial agents, and healthcare epidemiology.
3. Students will be working as a member of a specialized team of clinicians involved in the care of complicated, adult patients hospitalized at UTMB affiliated facilities on a daily basis.

Type of students who would benefit from the course
This course is designed to introduce all students taking the elective to the evaluation and care of adult patients with an infectious disease. Any student who intends to care for adult patients will find subjects of interest on this elective. Students who feel they need to enhance their skills in the areas of antimicrobial usage, pharmacokinetics, and stewardship will be helped by this elective. Similarly, students who want to enhance their skills in microbiology and epidemiology will be interested in this elective. Students going forward with specialized training in Global Health Issues, HIV, HCV, and Tropical Medicine will benefit from this elective. Finally the elective will introduce all students to the role of the specialty consultant in modern medical practice.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 0800 see consult and follow-up old patients 1300 Round with Attending
Tuesday 0800 see consult and follow-up old patients 1300 Round with Attending
Wednesday 0800 see consult and follow-up old patients 1300 Round with Attending
Thursday 0800 see consult and follow-up old patients 1300 Round with Attending
Friday 0800 see consult and follow-up old patients 1300 Round with Attending
Saturday - -
Sunday - -

 Average number of patients seen per week: 4-5 per student
 Call Schedule: students do not take call

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?
    Daily (Five times a week on Rounds)
  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?
    Attending physicians, assigned house staff, and students on the team
  B. Frequency / Duration of Presentation(s)?
    Daily on rounds; Students are encouraged to make a presentation at the weekly ID patient care conference.
  C. Format - What guidelines are set for the student's presentation?
    Students present their patients' initial evaluation and then their patients' progress on daily rounds. Patient Care Conference presentations are made in concert with the ID fellows assigned to that conference.
  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)?
    Students are not required to turn in evaluations but their daily notes are part of the record and are scrutinzed by the attending physician and fellows for content and appropriateness.
  B. Format - What guidelines are set for the student's written work?
    Students can compose progress notes in the electronic record and get appropriate constructive feedback from both house staff and faculty as needed.
  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?
    We encourage investigation of outcomes-based treatment using PICO technique, as well as utilization of the literature to help answer difficult and unknown questions regarding the students patients.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Students are encouraged to research questions and problems identified on daily rounds.
  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)?
    Students are required to attend all infectious disease conferences and Mdical Grand Rounds. This includes a weekly journal club and patient care conference. Students who become interested in a particular research project, or who encounter an interesting subject which they wish to present in a variety of professional forums are encouraged to do so and can sign up for additional electives designed to enhance their professional development in an area of special interest.

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 the student's ability to evaluate patients and learn and apply the basic principles of Infectious Diseases.

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.