PEDU-4001 - Acting Internship in Pediatrics - Inpatient

PEDU-4001 - Acting Internship in Pediatrics - Inpatient

Elective Title: Acting Internship in Pediatrics - Inpatient
Course Number: PEDU-4001
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 4
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Pediatric clerkship. C-form is required to enroll, please contact Tiffany Swain (trswain@utmb.edu) and note location preferences.
Responsible Faculty Director: Amy Gonzalez, M.D. Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Tiffany Swain Other Faculty: Lemuel Aigbivbalu, M.D.; Marie Dawlett, M.D.; Geetha Radhakrishnan, MD; Bridget Sweeney-Gotsch, MD; Samantha Spears, MD
Location to Report on First Day:
Galveston or CLC team room

Goals
The student will develop skills in the care of hospitalized children and will learn an approach to the management of complex illnesses. The key concept to this elective is that the student will be facing many of the same challenges as an intern.

Objectives
The student is strongly encouraged to review the national sub-internship curriculum drafted by clerkship directors and residency program directors; choose those objectives most applicable to your own development as a clinician. The curriculum is available at this link: http://www.comsep.org/Curriculum/pdfs/COMSEP-APPDF.pdf

At the completion of this course the student should:
1. Feel comfortable obtaining a complete history and a physical examination on a pediatric patient.
2. Formulate a problem list and a pertinent differential diagnosis and develop a therapeutic plan for common pediatric problems.
3. Establish priorities in formulating plans.
4. Identify rationale for diagnoses and plans.
5. Utilize appropriately a consultants opinion.

Description of course activities
The student will have the opportunity to function as a pediatric intern on the ward team. The student will be responsible for patients assigned to his/her care and will make daily rounds with residents and attending physicians.

- Weekly Resident board review sessions on Tuesdays at Noon and didactics every other Thursday afternoon.

- Morning Report: Present overnight admissions daily and participate in the Tuesday morning Inpatient MR presentation.

- Grand Rounds attendance on Fridays.

- Orientation and guidance of clerkship students.

Type of students who would benefit from the course
Those interested in Pediatrics, Family Medicine, Pedi Psychiatry, Pediatric Surgery.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 5 AM 5:30 PM
Tuesday 5 AM 5:30 PM
Wednesday 5 AM 5:30 PM
Thursday 5 AM 5:30 PM
Friday 5 AM 5:30 PM
Saturday Weekend Schedule TBD prior to start of rotation.
Sunday Will have minimum of 4 days off during the month.

 Average number of patients seen per week: 15
 Call Schedule: One week of night float.

Research 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?
    To team on rounds
  B. Frequency / Duration of Presentation(s)?
    Daily presentation of assigned patients. Weekly presentation of learning issues. Presentation of a case at morning report at least once.
  C. Format - What guidelines are set for the student's presentation?
    Standard patient presentations (e.g. "SOAP" 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)?
    Daily patient notes; H&P's on all new admissions
  B. Format - What guidelines are set for the student's written work?
    SOAP notes / Standard H&Ps
  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.?
    Notes & H&Ps related to patients
  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)?
    Student should demonstrate understanding of their patients problems and the plan of care. They should function as a member of the team, carrying an appropriate number of patients and helping with team functions. Should demonstrate growing skills in patient care and self-directed learning, by reading about cases at hand and sharing information with the team.

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 by the Pediatric Attending Physician.

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.
    Students will receive real-time feedback on presentations and critical thinking.
 
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.
    Thorough history and physical exam; Systems based practice; Critical thinking and clinical decision making; Occasionally, procedures.
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    As above
 
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)?
    Acting Intern will be assigned patients and will be expected to know the patients very well, make accurate assessments and sound plans, delegate to and teach other learners.
 
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?
    This course will help students gain skills, knowledge, and familiarity with the workings of the inpatient service and thus be prepared to care for children in the inpatient setting.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Midpoint feedback will be given verbally. Remediation will be offered on a case by case basis. Some students may need to spend time with various faculty members to develop solid knowledge, skills, and confidence.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Students may encounter 2-3 faculty members. They may expect 5-10 working days each. Faculty members generally spend 6-7 hours of the working day with the team.
 
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.
    Students will work directly with 2-3 faculty members as part of the inpatient team and receive feedback directly from the faculty. Students often ask one (or more) faculty for recommendation letters at the completion of the rotation. Students may receive a combined letter written by the course director, as deemed appropriate.