MEDU-4029 - Clinical Oncology

MEDU-4029 - Clinical Oncology

Elective Title: Clinical Oncology
Course Number: MEDU-4029
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Internal Medicine clerkship.
Responsible Faculty Director: Rohit Venkatesan M.D. Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Kiki Baldwin Other Faculty:
Location to Report on First Day:
4.164 John Sealy Hospital at 8:30am

1. Expose students to the common malignancies encountered in clinical practice: acute/chronic leukemias, lymphoma, and cancers of the breast, lung, colon or rectum, and prostate.
2. Instruct students regarding the proper diagnostic approach to these common malignancies.
3. Expose students to the complexity associated with management of these common malignancies.
4. Introduce students to the psychosocial issues for patients with malignancy.
5. Expose students to the financial issues associated with the care and management of patients with malignancy.
6. Introduce the concept of evidence based management of cancer, especially as it relates to clinical trials in cancer.

At the completion of the elective in Clinical Oncology, medical students should:
1. Be able to take a medical history and perform a physical examination with emphasis on malignant disease.
2. Have a good understanding of the clinical approach to a patient with a malignant disease (i.e., medical history, physical examination, and commonly used diagnostic tests and procedures.
3. Have a good understanding of the expected complications associated with the use of common cancer chemotherapeutic agents; including metabolic complications.
4. Understand basic information related to the etiology, pathogenesis, epidemiology and screening of common malignancies.
5. Have an understanding of common malignant diseases such as carcinoma of the prostate, breast, lung, and colon, malignant lymphoma (Hodgkin and non-Hodgkin) and leukemia.
6. Recognize and understand the management of the common complications and general internal medicine problems associated with cancer (e.g.; neutropenic fevers, cachexia, cancer-associated pain, and issues of palliative care of the terminally ill patient, etc.).
7. Learn the proper use of blood product transfusion and be able to recognize and manage transfusion related toxicities.

Description of course activities
This course is currently being offered only for inpatient ward and consult exposure. Students will observe and participate in the diagnosis, management, and treatment of inpatients with malignant diseases. There are multiple conferences (see below) each week that students are required to attend except when SOM obligations require otherwise. Conferences include multidisciplinary case conferences/Tumor Boards involving participation from radiology, pathology, medical oncology, radiation oncology and surgery, in addition to a divisional lecture series.
Students will have at least 32+hours a weeks either in clinic or self-directed time.

Type of students who would benefit from the course
This Introduction to Clinical Oncology would benefit all students of medicine because it provides considerable insight into the medical and psychosocial aspects of malignant diseases. Suitable for students who wish to learn, identify and manage numerous general internal medicine problems 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 AM rounds (inpatient) none
Sunday AM rounds (inpatient) none

 Average number of patients seen per week: 3-6
 Call Schedule: none/inpatient with ward team

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?
    Attending, house staff, Oncology fellow, Tumor Boards
  B. Frequency / Duration of Presentation(s)?
  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 one H&P each 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
    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)?
    Attendance at conferences is mandatory except when SOM obligations are required. Otherwise, whenever possible. These include: Daily Inpatient Ward Rounds (time per Attending MD) Inpatient Consult Rounds (time per Attending MD) Monday Lymphoma/Leukemia Tumor Board 11AM-noon Head and Neck Tumor Board 4PM-5PM Tuesday Patient Management Rounds 12PM-1PM Wednesday Neuro-Oncology Tumor Conference 8AM-9AM Thoracic Tumor Conference noon-1PM GI & Hepatobiliary Tumor Conference 4PM-6PM Thursday IM Grand Rounds noon-1PM Urology Tumor Conference 4:30PM-5:30PM (twice monthly) Friday Breast Tumor Conference 8AM-9AM Palliative Care Conference noon-1PM (monthly) Medical Oncology Fellow's Conference noon-1PM

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.
    Students will be evaluated on the basis of:
1. Case presentation written and oral
2. Participation in the diagnosis and management of patients with cancer
3. Presentation of any assigned reading material
4. Participation in rounds and 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.

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.