CEEU-4008 - Interprofessional - Continuity of Practice Experience, I-COPE

CEEU-4008 - Interprofessional - Continuity of Practice Experience, I-COPE

Elective Title: Interprofessional - Continuity of Practice Experience, I-COPE
Course Number: CEEU-4008
Elective Type: clinical Duration/Weeks: Longitudinal Max Enrollment: varies
Prerequisites: Successful completion of Year 2
Additional Requirements: C-Form required, There is an application process for the elective that will be sent to all 2nd year students during the second half of second year with details of program eligibility and information. Contact cee@utmb.edu for details. (2 weeks of elective credit given upon satisfactory completion).
Responsible Faculty Director: Norman Miles Farr, MD, MPH Periods Offered: longitudinal over 3rd year 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:
Clinic information will be sent to student prior to 1st day.

1. Embed students in the practice of longitudinal holistic patient care in an interprofessional patient-centered medical home.
2. Provide a substantive interprofessional practice experience to achieve the 4 Interprofessional Education Collaborative Competencies.
3. Provide a continuity experience for students with interprofessional peers and preceptors resulting in meaningful relationships and quality feedback.
4. To establish relationships with faculty role models outside the student's profession.
5. Create a culture at UTMB where primary care is viewed as a positive, dynamic career choice by students.
6. Serve as an educational innovation hub and model for value-added education, students providing meaningful value-added contributions to the health care system.

1. Students will be able to identify and apply a patient-centered approach to their own panel of patients.
2. Students will be able to discuss the concept of structural social determinants of health (SSDOH), identify the impact of SSDOH on health outcomes and behavior and develop advocacy skills in advancing SSDOH.
3. Students will reflect on their personal leadership skills, learning strategies, wellness plans and role as future physicians.
4. Students will demonstrate competence in communication skills, e.g., patient presentations, notes.
5. Students will demonstrate competence in physical exam skills - with opportunity for direct observation and feedback.
6. Students will experience and reflect on the dimensions of continuity - continuity of patient care, including developing and sustaining a relationship with the patient; continuity of learning relationships; continuity of assessment; continuity of context; continuity of professional development.
7. Students will demonstrate a commitment to provide care to patients who are unable to pay and to advocate for access to health care for members of disadvantaged populations.
8. Students will recognize the role of the physician in patient advocacy and utilize available community resources required to provide comprehensive care and to address challenges specific to the care of a disadvantaged patient population.

Description of course activities
Student are selected to participate in the Interprofessional - Continuity of Practice Experience program (I-COPE), a voluntary longitudinal course over the course of third year with an overarching purpose to foster consistent, positive patient/provider relationships within an interprofessional collaborative practice. The I-COPE clinic serves as a patient-centered medical home and an education-centered medical home for students from multiple professions where they have continuity with patients and faculty. In this program, students care for a panel of complex, uninsured patients on a longitudinal basis over the course of the third year of medical school; in clinic every other week throughout third year with designated exceptions. Student-providers are expected to prepare for patient visits prior to clinic, to see them independently prior to presenting to a preceptor, place orders on patients, and to take a lead role in their ongoing follow-up care; truly engaging students in meaningful patient care. Additionally, students attend workshops on important topics to enhance their clinical and teamwork skills and have required reflections on their experiences. Students' engagement in this program is a testament to their dedication to become a more humanistic, effective provider.

Schedule is 1/2 day of clinic every other week, exact time given after student assignment.

Type of students who would benefit from the course
All students would benefit from the continuity experience offered in I-COPE. Since these clinics are offered for the uninsured, those interested in working with under-resources populations may be especially interested in participation.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM

 Average number of patients seen per week: See description of course activities
 Call Schedule:

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?
    Every other week during assigned clinics.
  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?
    Presents at clinic huddle to clinic team prior to clinic and presents patient directly to preceptor in clinic
  B. Frequency / Duration of Presentation(s)?
    Every assigned clinic session, every other week; 1 to 2 patient huddle and oral presentations
  C. Format - What guidelines are set for the student's presentation?
    Huddle presentation structure given to student; standard clinical oral presentations expectations.
  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 written on patients every other week during assigned clinics. - Reflections at mid-year and end of year.
  B. Format - What guidelines are set for the student's written work?
    - Standard medical H&P expectations, guided by faculty preceptors. - Reflections have a standard format and expectation provided to students
  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)?
    Lunch-time workshops, six total out of the year required. Offered twice each to provide flexibility. At least 10 different sessions offered during the year, of which six are required.

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.
    To successfully complete I-COPE and receive credit, in addition to completing the listed course requirements, students must also remain in good academic standing during their clerkship rotations. If any portion of any clerkship is unsatisfactorily completed, the student may be dropped from the course and will not receive credit, as per the discretion of the I-COPE director and/or the Assistant Dean for Clinical Education, regardless of how much of I-COPE requirements have been completed to that point.

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.