MEDU-4162 - Evaluation, Diagnosis and Management -Hospitalized Patients in a UTMB Community-Based Hospital

MEDU-4162 - Evaluation, Diagnosis and Management -Hospitalized Patients in a UTMB Community-Based Hospital

Elective Title: Evaluation, Diagnosis and Management -Hospitalized Patients in a UTMB Community-Based Hospital
Course Number: MEDU-4162
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: N/A
Responsible Faculty Director: Michael Eisenberg, MD Periods Offered: 1-6, 9-13 excluding holiday period 8 
Coordinator: Tamika Thibodeaux Other Faculty:
Location to Report on First Day:
Clear Lake Hospital - Please contact Tamika Thibodeaux at trthibod@utmb.edu.

Goals
Enhance the independent evaluation, diagnosis and management of hospitalized patients in a UTMB community-based hospital.

Objectives
1. To improve and refine the ability to conduct an interview, perform a physical examination, compile a relevant problem list, formulate differential diagnosis, develop a thoughtful and thorough assessment, and prepare plans for the management of the patient.
2. To refine skills of the oral presentation of the new patient and follow up patients to the attending physician.
3. To practice and improve the interpersonal skills needed to address the social and psychological needs of the patient and the family.
4. To develop skills in creating and executing an appropriate management plan for common medical problems.
5. To become comfortable with an increased level of responsibility in the management of patients.
6. To coordinate care between different health professionals including care management, nursing staff and consultants.

Description of course activities
The student will function in a role analogous to that of an intern. Student will be able to enter orders into Epic EMR and will undertake primary clinical responsibilities for certain number of the patients on the team. Orders must be signed by the attending physician. The student will round daily (including weekends). Students will be paired up with an attending physician and will take days off depending on the physicians work schedule each month. Students will generally work a 60- hour week. The student will also attend multidisciplinary rounds (POCR), M&M conferences and other scheduled conferences within the Department of Internal Medicine as determined by their attending physician keeping in mind that patient care responsibilities take priority.

Type of students who would benefit from the course
Students who are pursuing a career in primary care or who are interested in a career in Internal Medicine.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 0800 1700
Tuesday 0800 1700
Wednesday 0800 1700
Thursday 0800 1700
Friday 0800 1700
Saturday
Sunday

 Average number of patients seen per week: 25
 Call Schedule: No

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time 32
Self-Directed Study 1
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?
    Daily to Faculty on rounds and in clinic in Internal Medicine.
  B. Frequency / Duration of Presentation(s)?
    Daily patient presentations.
  C. Format - What guidelines are set for the student's presentation?
    Formal oral presentations, written consultation notes and H&Ps.
  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)?
    N/A
  B. Format - What guidelines are set for the student's written work?
    N/A
  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.?
    N/A
  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)?
    Daily attendance, participation in progression of care rounds (POCR) and morbidity and mortality meetings (M&Ms), and thoughtful questions.

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.
    N/A

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.
   
 
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.
   
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
   
 
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)?
   
 
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?
   
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
 
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.