MEDU-4029 - Clinical Oncology and Hematology

MEDU-4029 - Clinical Oncology and Hematology

Elective Title: Clinical Oncology and Hematology
Course Number: MEDU-4029
Elective Type: clinical • Direct Patient Care Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Internal Medicine clerkship.
Responsible Faculty Director: Krishna Suthar, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Victoria Garcia Other Faculty: Dr. Maurice Willis; Dr. Avi Markowitz; Dr. Hesham Abowali; Dr. Sahba Nadeem; Dr. Ajay Mitter
Location to Report on First Day:
4.164 John Sealy Hospital at 8:30am

Goals
1. Expose students to the inpatient evaluation and management of common hematologic and oncologic conditions including acute & chronic leukemia, myeloproliferative neoplasms, solid tumor malignancies, cytopenias, thrombosis, and hemostasis.
2. Review the diagnostic work up of these common conditions through direct patient care and laboratory/imaging/pathology review.
3. Understand the psychosocial factors that arise in the care of patients with oncologic conditions.
4. Introduce the principles of evidence-based cancer management as it relates to the role of clinical trials.

Objectives
At the completion of the elective in Clinical Oncology and Hematology, medical students should:
1. Perform a comprehensive medical history and physical exam with emphasis on malignant disease
2. Appreciate the clinical approach to diagnosis, management, and monitoring of patients with oncologic conditions (i.e. features of the medical history, clinical exam, and commonly used diagnostic tests and procedures)
3. Identify common complications of systemic anti-cancer therapy
4. Understand etiology, pathophysiology, epidemiology, and screening (when indicated) of various hematologic and oncologic processes
5. Recognize common hematologic and oncologic emergencies such as Tumor Lysis Syndrome, Thrombotic Thrombocytopenic Purpura, etc
6. Begin to develop an approach to difficult conversations including goals of care discussions with oncologic patients
7. Review common supportive and palliative care measures in oncologic patients such as cancer-related cachexia, insomnia, cancer-related pain, etc
8. Learn the indications for blood product transfusions and potential complications of adverse effects related to transfusions

Description of course activities
This course will allow students to gain inpatient consult service exposure to Hematology and Medical Oncology. They will observe and participate in the diagnosis, management, and treatment of those with malignant disease or acute hematologic conditions.
If there are no conflicts with SOM oblications, we encourage students to attend available hematologic/oncologic meetings including case conference and interdisciplinary tumor boards (schedule below). They are also welcome to attend fellow didactics on Mondays from 12-1.
Students will have 30-40 hours of clinical exposure inpatient or with self-directed study time.

Type of students who would benefit from the course
The Introduction to Clinical Oncology and Hematology course is beneficial to all students of medicine given the interdisciplinary needs in the care of oncologic patients and frequency of hematologic complications such as thrombosis or anemia in the inpatient setting. The rotation hopes to provide insight into the approach taken by Medical Oncologists & Hematologist in the care of these often-complex conditions. The rotation is suitable for students who wish to learn, identify, and manage various general internal medicine conditions as they occur in cancer patients.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8AM-noon 1PM-5PM
Tuesday 8AM-noon 1PM-5PM
Wednesday 8AM-noon 1PM-5PM
Thursday 8AM-noon 1PM-5PM
Friday 8AM-noon 1PM-5PM
Saturday optional AM rounds none
Sunday optional AM rounds none

 Average number of patients seen per week: 3-6
 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?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Daily
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Attending, house staff, Oncology fellow, Tumor Boards
  B. Frequency / Duration of Presentation(s)?
    Daily
  C. Format - What guidelines are set for the student's presentation?
    Oral and written presentation of cases seen by the student
  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)?
    Minimum of two new consult notes per week and 3-5 follow up notes per week
  B. Format - What guidelines are set for the student's written work?
    Standard H&P 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.?
    Related to cases
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

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)?
    Mandatory daily inpatient consult rounds (usually starts around 9:30 AM but exact time per Attending Physician). Attendance at the following conferences is strongly encouraged except when SOM obligations are required or rounds are occurring. These include: Lymphoma/Leukemia Tumor Board – Monday, 11AM-12PM (varies) Urology Tumor Board – Monday, 12PM – 1PM Fellows’ Didactic Conference – Monday, 12PM – 1PM Head and Neck Tumor Board – Monday, 4PM-5PM Breast Tumor Board – Tuesday, 8AM – 9AM Neuro-Oncology Tumor Board – Tuesday, 8AM-9AM (varies) Thoracic Tumor Board – Wednesday, 12PM-1PM GI & Hepatobiliary Tumor Board – Wednesday, 4PM-5PM Internal Medicine Grand Rounds – Thursday, 12PM-1PM Care Conference – Friday, 7:30AM – 8:30AM

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.
    Students will be evaluated based on the following component:
1. Written and oral patient case presentations
2. Participation in the diagnosis and management of patients with cancer or with hematologic conditions
3. Presentation of faculty or fellow assigned clinical topics
4. Participation in rounds and the various conferences/Tumor Boards

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.