MEDU-4022 - Clinical Pulmonary Medicine

MEDU-4022 - Clinical Pulmonary Medicine

Elective Title: Clinical Pulmonary Medicine
Course Number: MEDU-4022
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: None
Responsible Faculty Director: Mohammed Zaidan, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Victoria Garcia & Kiki Baldwin Other Faculty: Alexander Duarte, MD, Gulshan Sharma, MD, Victor Cardenas, MD; Shiwan Shah, MD
Location to Report on First Day:
5.140 John Sealy Annex at 9:00 am

Through participation in consultative patient evaluation the student will expand his knowledge of pulmonary medicine and improve his skills in the diagnosis and management of patients with respiratory disease.

At the end of the elective, the student should:
1. Be competent in eliciting a detailed pulmonary disease history including a history of occupational or industrial exposure and evaluating the obvious and subtle physical findings associated with respiratory disease.
2. Be able to recognize and interpret the most common chest roentgenographic abnormalities.
3. Develop higher clinical skills in the treatment of all the common and many of the more unusual forms of pulmonary disease.
4. Become familiar with the indications for the use of invasive and semi-invasive diagnostics procedures.
5. Develop reasonable understanding of clinical ventilatory and gas exchange studies.
6. Observe diagnostic procedures such as bronchoscopies, transbronchial and percutaneous lung biopsies, pleural biopsies and thoracenteses.
7. Become familiar with interpretation of basic pulmonary function tests.

Description of course activities
Students evaluate new consults and present these at a daily staff conference. The patient's illness, x-rays and pulmonary function studies are discussed in detail at this conference. Additional diagnostic studies and management plans are reviewed after the patient is seen on staff rounds. Special diagnostic procedures, done by the staff, are usually scheduled at times when the student can participate. Clinical case conferences and a chest x-ray conference are held weekly. Small group, one-hour discussions are held with students four times a week.

Type of students who would benefit from the course
All medical students would derive some benefit from this elective. Students interested in a career in Internal Medicine, Anesthesiology or Thoracic Surgery will find this course particularly valuable.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8 -12 TDCJ Clinic 12-5 Consults
Tuesday 8-12 Consults 12-5 Consults
Wednesday 8-12 Consults 12-5 Consults
Thursday 8-12 Consults 12-5 Consults
Friday 8-12 Consults 12-5 Consults

 Average number of patients seen per week: 15-20
 Call Schedule: N/A

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?
    Attending, Pulmonary fellow
  B. Frequency / Duration of Presentation(s)?
    Daily, new patient or follow up patient presentations
  C. Format - What guidelines are set for the student's presentation?
    Formal oral presentation and written consultation note using H&P format for new consults and SOAP format for follow up presentations.
  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 notes on patients assigned to student.
  B. Format - What guidelines are set for the student's written work?
    Initial consult should be written/presented in H&P format. Follow up notes should be written/presented in SOAP format.
  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?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  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)?
    Participation in weekly Pulmonary Critical Care core conference.

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.
    The evaluation will be based on faculty observation of the student's ability to:
1. Perform a specialty specific history and physical examination of the patient with suspected respiratory disease.
2. To appropriately order and interpret laboratory tests.
3. To develop a reasonable differential diagnosis.
4. To explain the indications for bronchoscopy and pulmonary function testing.
5. To explain the pathophysiology and treatment of common respiratory disorders including asthma, COPD, chronic cough and lung cancer.

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.