MEDU-4048 - Outpatient Gastroenterology/Hepatology-Year 3

MEDU-4048 - Outpatient Gastroenterology/Hepatology-Year 3

Elective Title: Outpatient Gastroenterology/Hepatology-Year 3
Course Number: MEDU-4048
Elective Type: clinical Duration/Weeks: 2 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Gabriel Reep, MD Periods Offered: 1AB-7AB, 9AB-13AB excluding holiday period 8 
Coordinator: Victoria Garcia & Kiki Baldwin Other Faculty: Dr. G. Luthra; Dr. S. Cohn; Dr. K. Khan; Dr. Brooke Corning
Location to Report on First Day:
UTMB League City Campus GI Clinic 2240 Gulf Freeway S, League City, TX 77573 The GI clinic is on the second floor of the outpatient clinic building, the last clinic near the end of the hall on the right

The Gastroenterology rotation will give the student the opportunity to increase their knowledge of common diseases affecting the gastrointestinal tract, the liver, the biliary tract, and the pancreas. These include but are not limited to reflux esophagitis, peptic ulcer disease, inflammatory bowel disease, malabsorption syndromes, colon polyps and cancer, viral hepatitis, liver cirrhosis, portal hypertension, alcoholic hepatitis, acute pancreatitis, and chronic pancreatitis. The student skills will be improved by participation in outpatient clinic as well as observation of endoscopy procedures. This experience will be augmented by attending dedicated GI/Hepatology conferences during the rotation.

1. The student will learn how to elicit the history and perform a focused GI examination and interpret basic laboratory data on patients with common gastroenterological disorders.
2. The student will learn the clinical course and basic principles of treatment of common gastrointestinal, liver, biliary, and pancreatic disorders.
3. The student will become familiar with the indications, contraindications, and techniques used in gastrointestinal endoscopy including esophagogastroduodenoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound.

Description of course activities
1. The student will accompany faculty/fellows to outpatient clinic where they will see patients, present their cases in verbal and/or written form, and participate in discussion of their management.
2. The student will observe outpatient endoscopy procedures two half-days per week.
3. The student will be expected to read about their patients disease processes and any assigned learning issues when not actively involved in the above clinical duties.
4. The student will attend the regular conferences of the GI/Hepatology division.
5. There is driving involved to off-island clinic/endoscopy unit locations at the League City Campus for this course.

Type of students who would benefit from the course
The Gastroenterology elective should be useful to any student entering internal medicine or one of its specialties, family practice, general surgery, gynecology, or radiology.

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

 Average number of patients seen per week: 20-25
 Call Schedule: None

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?
  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?
    GI Fellow & Faculty
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Clinical Rounds and Conferences
  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)?
  B. Format - What guidelines are set for the student's written work?
  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.?
  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)?
    During the rotation student will be encouraged to organize a clinical vignette for presentation in the teaching setting, either informally during clinic teaching or formally during our GI Case Conference Meeting. The case material will be drawn from patients that the student has seen during the rotation. These will be short presentations (10-15 minutes) which highlight a specific learning opportunity that occurred during patient care. Students will be mentored in the preparation of these vignettes.

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 are evaluated by the attending GI faculty with input from GI division fellows.

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.