CEEU-4007 - Student Chief of Service, Community Medicine and Medical Education

CEEU-4007 - Student Chief of Service, Community Medicine and Medical Education

Elective Title: Student Chief of Service, Community Medicine and Medical Education
Course Number: CEEU-4007
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: C-Form required to register, email CEE team at cee@utmb.edu
Responsible Faculty Director: Norman Miles Farr, MD, MPH Periods Offered: 3-7, 9-12 excluding holiday period 8 
Coordinator: CEE team at cee@utmb.edu Other Faculty: Nadia Ahmed, MD; Mary Suna Wilkerson, MD; Julian Quiceno, NP; Martha Diaz, RN
Location to Report on First Day:
St. Vincent's Hope Clinic, 2817 Post Office, Galveston, TX 77573

To learn and apply teaching and feedback skills in preparation to excel as a clinician-educator in residency and beyond while improving the learning environment and learning outcomes of students that are participating in clinical experiences at St. Vincent's and other community clinics serving the underserved in our community.

1. Describe and apply teaching strategies that can be used during the care of patients in a clinical setting.
2. Describe the characteristics of effective feedback and apply techniques that use the characteristics of effective feedback.
3. Describe the elements of the "RIME" method of evaluation.
4. Describe strategies to teach physical examination at the bedside without disrupting rounds.
5. Identify written and web-based resources for improving physical examination skills.
6. Describe and apply teaching pearls related to oral presentations.
7. Provide feedback on student progress notes.
8. Describe the basic premise of serving as a coach in a medical education setting.

Description of course activities
The student will serve as the "student chief of service" in the community clinics including St. Vincent's Hope Clinics, mobile community clinics affiliated with St. Vincent's Hope Clinic, FQHC Coastal Health and Wellness, and community engagement teaching sites. The student will act as a faculty liaison in a defined teaching role for students rotating through the clinics and in clinical operations. This will include facilitation of clinic flow, assisting students with administrative patient care tasks (referrals, pharmaceutical assistance, charity care), facilitating "bed-side" teaching opportunities, leading pre-developed workshops in clinical skills, and providing students with assistance in oral presentations and note writing. The students will complete an online and asynchronous medical education curriculum.

The students along with faculty preceptor will design a schedule that includes participating in teaching community clinics during the week including I-COPE clinics, Student-run clinics, and teaching opportunities in community engagement and education activities. The times listed in weekly clinical schedule includes the range of options for all the clinics, students and faculty will meet to discuss the rotation and assign clinics accordingly. Students should participate in a minimum of 5 clinical sessions weekly with the remainder of time dedicated to medical education curriculum and preparation of teaching activities.

Type of students who would benefit from the course
Students interested in enhancing their teaching skills in preparation for a residency at an academic program and working with junior students to improve their learning outcomes. Students interested in enhancing their teaching skills in preparation for a residency at an academic program and working with junior students to improve their learning outcomes.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 7:45 5:00 (depending on assigned clinics)
Tuesday 7:45 7:45 (depending on assigned clinics)
Wednesday 7:45 6:45 (depending on assigned clinics)
Thursday 7:45 7:45 (depending on assigned clinics)
Friday 7:45 3:00 (depending on assigned clinics)
Saturday 9:30 3:30 (not required)
Sunday N/A N/A

 Average number of patients seen per week: seen in teaching capacity;not as primary caregiver
 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?
    Observed in teaching and leadership capacity with preceptors and course leadership during the block.
  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?
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  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)?
    1 reflection - based on specified criteria, assignment by end of course
  B. Format - What guidelines are set for the student's written work?
    Reflection - based on specified criteria with detailed instructions, due by the end of the course; ~ 1 page single spaced or a representative project with approval of course director
  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.?
    Student choice, guidance provided on topic options.
  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)?
    As outlined above, no additional activities

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.

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.