INTL-4004 - International Field Epidemiology

INTL-4004 - International Field Epidemiology

Elective Title: International Field Epidemiology
Course Number: INTL-4004
Elective Type: career Duration/Weeks: 4 Max Enrollment: 15
Prerequisites: Successful completion of Year 2
Additional Requirements: C-Form required, send to Bradley Brock. Some Spanish ability preferred, but not required
Responsible Faculty Director: Melinda Tanabe, MD, MS Periods Offered: 1 excluding holiday period 8 
Coordinator: Bradley Brock Other Faculty: Maureen Laroche, PhD Robert Rodriguez, PhD, MPH (program manager)
Location to Report on First Day:
Site locations in Lima and Tumbes, Peru

This course is designed to provide hands-on training for field studies in South America, using a One Health approach. The course focuses on investigation of a mock outbreak of febrile illness. The course includes in training in the design, conduct and publication of epidemiological field investigations. The fieldwork component includes specific abilities, such as GPS mapping, household interviews, collection of biological specimens from humans and household animals, trapping small mammals, vector collection, and basic parasitology, bacteriology and virological techniques in BSL 2/3 laboratories. This course is directed at professionals who have some basic knowledge of both public health/epidemiology as well as basic-intermediate Spanish language skills.

Over this four-week course, including two weeks in northern Peru, students will develop and strengthen basic applied skills to conduct epidemiological field investigations using a One Health approach. By the end of the course the participants should be able to do the following: - Identify the occurrence of a potential epidemic outbreak and understand the importance outbreak investigations - Design, conduct and analyze household interviews in the field - Collect biological specimens from humans and household animals - Learn about the main techniques for the trapping of small mammals, necropsy and tissue sampling - Become familiar with the fundamentals of arthropod vector collection and speciation - Prepare a scientific manuscript of a field investigation

Description of course activities
Students will spend the first week engaging in preparatory activities for the two-week field experience. Subsequently, they will participate in a mock outbreak investigation that takes place in real time in northern Peru. They will learn how to apply epidemiological methods such as case definitions and data gathering, public health communications, community surveys, and surveillance techniques. Field activities will include environmental assessment, household surveys, small animal and arthropod trapping/identification, and geospatial mapping. Students will learn and practice laboratory techniques used in the field for pathogen identification, including sample collection/analysis, molecular/virologic techniques, storage/transportation, and field biosafety. Finally, over the final week they will synthesize results into an outbreak report that will include applied biostatistics, data modeling, and predictive analysis. These findings will be prepared for both communication with the media as well as for scientific publication. All work will be done in interprofessional teams to build skills in leadership, management, communications, and systems thinking.

Type of students who would benefit from the course
Students interested in global health, public health, field epidemiology, outbreak investigation, pandemic preparedness and response

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8 5
Tuesday 8 5
Wednesday 8 5
Thursday 8 5
Friday 8 5
Saturday 8 12

 Average number of patients seen per week:
 Call Schedule:

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?
    Faculty and peers
  B. Frequency / Duration of Presentation(s)?
    Once per week for 10 minutes
  C. Format - What guidelines are set for the student's presentation?
    10 minute oral presentation on current cases
  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 Manuscript at conclusion of rotation
  B. Format - What guidelines are set for the student's written work?
    Manuscript with current references over cases observed during field 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?
    Related to cases
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Related to cases
  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)?
    Student will participate in small group activities, seminars, journal club and read background materials.

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".
    Students must cover airfare. Please keep this in mind while enrolling and give yourself enough time to secure your airfare.

7.  Other Modes of Evaluation
  Please explain below.
    Grading components: Post Test 30%, Quizzes/Reading/Discussion 30%, Participation 30%, and Attendance 10%.  Will complete an evaluation form specific to the elective, to be reviewed with the responsible UTMB faculty member.

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.