FAMU-4064 - Substance use in Primary Care

FAMU-4064 - Substance use in Primary Care

Elective Title: Substance use in Primary Care
Course Number: FAMU-4064
Elective Type: clinical Duration/Weeks: 2 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: C-form required, please send form to Jessica Prescott (jlpresco@utmb.edu)
Responsible Faculty Director: Ernst Nicanord, MD Periods Offered: 1AB-10AB, 11A, 12AB-13AB including holiday period 8 
Coordinator: Jessica Prescott Other Faculty:
Location to Report on First Day:
FM PCP and Dickinson Clinic

1. The student will learn the prevalence of substance use disorder in the primary care setting.
2. The student will learn to identify the patients with or who are at risk for substance use disorder.
3. The student will understand how untreated substance disorders contribute increased morbidity and mortality.

1. Develop a basic understanding of the science of addiction.
2. Evaluate evidence-based screening tools for substance use in primary care.
3. Evaluate the use of Brief Interventions to address substance use in primary care.
4. List the Medications used for nicotine use disorder in primary care.
5. List the Medications used for alcohol use disorder in primary care.
6. List the Medications used for opioid use disorder in primary care.

Description of course activities
The focus of this elective will be dedicated to the geriatric patients seen at the Family Medicine clinic that might be affected by substance use. Students will receive individual supervision as they assess selected patients at the PCP and Dickinson FM clinics. Student will be required to document patient encounters and to complete online reading assignments related to substance use. There will be no overnight call or weekend duties. Student will see patients alongside the residents and report to faculty on Monday and Tuesday. Student will see patients with faculty on Wednesday to Friday. Tuesday and Thursday afternoon are assigned to self-directed study time to complete online modules.

Type of students who would benefit from the course
Students interested in primary care, psychiatry, and geriatrics. Students who wants to further their understanding of substance use disorder.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:00am 5:00pm
Tuesday 8:00am 5:00pm
Wednesday 8:00am 5:00pm
Thursday 8:00am 5:00pm
Friday 8:00am 5:00pm

 Average number of patients seen per week: 24-30
 Call Schedule: No

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?
    4-6 half days a week
  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?
    Faculty, social worker, resident
  B. Frequency / Duration of Presentation(s)?
    24-30 times a week, 2-4 minutes each
  C. Format - What guidelines are set for the student's presentation?
    3rd year clerkship presentation format.
  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)?
    H&P on patients seen in clinic.
  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.?
    case related
  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)?
    Student is expected to participate in all the clinic sessions. To complete the online reading assignments. Discuss cases relating to the reading assignments.

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 present faculty with proof of completion of the completed online reading assignments on the last day of the rotation.

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.