MEDU-4160 - Clinical Cardiology - Ultrasound, Echo, and EKG

MEDU-4160 - Clinical Cardiology - Ultrasound, Echo, and EKG

Elective Title: Clinical Cardiology - Ultrasound, Echo, and EKG
Course Number: MEDU-4160
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 4
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of IM clerkship.
Responsible Faculty Director: Joseph Allencherril, M.D. Periods Offered: 1-13  including holiday period 8 
Coordinator: Victoria Garcia & Kiki Baldwin Other Faculty:
Location to Report on First Day:
UTMB Clear Lake Campus Clinic (4th floor)

To develop competency in cardiovascular disease management, with additional focus on EKG interpretation as well as point-of-care ultrasound (POCUS) and echocardiography acquisition and interpretation

1) Point of care ultrasound acquisition and interpretation, with a focus on lung, abdominal, and peripheral vascular (venous and arterial) windows
2) Basic echocardiography acquisition and interpretation
3) Structured EKG interpretation
4) Basic management of cardiovascular diseases in ambulatory and inpatient settings
5) Understand appropriateness of common cardiac procedures, including coronary angiography, left heart catheterization, right heart catheterization, and percutaneous coronary intervention
6) Understand appropriateness of common cardiac diagnostic testing, including rest and stress echocardiogram, transesophageal echocardiography (TEE), cardiac PET and SPECT stress testing, and cardiovascular CT.
7) Integrate interpretations of cardiovascular disease literature into disease management

Description of course activities
This integrated elective affords the unique opportunity for students to explore the full breadth of clinical cardiology in both the ambulatory and inpatient settings. Students will be able to gain competency in point-of-care ultrasound (POCUS) acquisition and interpretation, with a focus on cardiac, lung, and vascular windows and integrate this into the active management of patients. Additionally, there will be structured EKG interpretation didactics throughout the rotation. There will be additional exposure to transthoracic echocardiography (TTE nuclear cardiology (including PET and SPECT stress testing), transesophageal echocardiography (TEE), and cardiovascular CT. Finally, interested students will be able to participate in mentored clinical research in the domain of cardiovascular disease.

Type of students who would benefit from the course
Students with interests in internal medicine, cardiology, emergency medicine, family medicine, cardiothoracic surgery, vascular surgery, and cardiovascular disease in general will benefit from this elective.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8am 4pm
Tuesday 8am 4pm
Wednesday 8am 4pm
Thursday 8am 4pm
Friday 8am 4pm
Saturday OFF OFF
Sunday OFF OFF

 Average number of patients seen per week: 20
 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?
    On a daily basis. This is a unique opportunity to work one-on-one with faculty and understand the breadth of work as a clinical cardiologist.
  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?
    Cardiology Faculty and Fellows
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    UTMB Internal Medicine 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)?
  B. Format - What guidelines are set for the student's written work?
    UTMB Internal Medicine 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.?
    Students will participate in the management of cardiovascular disease patients as assigned by cardiology faculty and fellows.
  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)?
    While not required, motivated and interested students will have the opportunity to take part in clinical research under a faculty mentor with the goal of publication of an abstract and a peer-reviewed manuscript.

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.
    There will be daily, timely, and regular feedback with the faculty mentor with regards to clinical assessments, presentations and interpretations of EKGs and basic imaging findings.

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.