MEDU-4166 - Palliative Care Consult Service

MEDU-4166 - Palliative Care Consult Service

Elective Title: Palliative Care Consult Service
Course Number: MEDU-4166
Elective Type: clinical • Direct Patient Care Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: N/A
Responsible Faculty Director: Brianna Probasco, MD, MSBS Periods Offered: 1-13 including holiday period 8 
Coordinator: Victoria Garcia Other Faculty: Melissa Andrade, MD; Sean O'Mahony, MB BCh BAO; Moustafa El Sayed, MD
Location to Report on First Day:
Clinical Sciences Building 4.104

Goals
Students should become familiar with basics of palliative care, including the difference between palliative care and hospice, the importance of interdisciplinary approach, and how to provide primary palliative care and when it is appropriate to ask for expert help. Identifying the most common, routing palliative diagnoses and how to approach patients care for respiratory disease (COPD & PF), heart disease, cancer, dementia, renal failure, neuromuscular disease (MG, MS, ALS, etc.), stroke and liver disease.

Objectives
1. The student will be able to obtain thorough history from chart review or patient/family, then attempt to narrow in on key factors influencing patient’s increased mortality/morbidity or decreased quality of life. 2. Communication is key above all else. Student will be exposed to symptom management, but focus will be on how to elicit patient’s values and how to translate this into an appropriate medical plan or recommendation.

Description of course activities
1. Students will evaluate patients at Galveston campus for palliative consults. Patients will be seen and discussed with palliative faculty or fellows, not rotating residents.
2. Students are expected to attend monthly palliative education sessions, wellness seminars, and twice monthly ethics discussions.
3. Students are invited to observe in palliative clinic if schedule and location permits and they have interest in doing so on a case by case basis.

Type of students who would benefit from the course
Palliative care is a subspecialty which spans all specialties and stages of life from conception to old age. A palliative care rotation would be useful to any student interested in any field of medicine, particularly for those who already have an interest in palliative care or who struggle delivering bad news and would like to have a guide to improve their communications skills.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8:30 4:30
Tuesday 8:30 4:30
Wednesday 8:30 4:30
Thursday 8:30 4:30
Friday 8:30 4:30
Saturday
Sunday

 Average number of patients seen per week: 3-4
 Call Schedule: None

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
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?
   
  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?
    peers and faculty
  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)?
   
  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
  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)?
    To be punctual and attentive, thoughtful questions, providing resources, patient engagement, case research to understand patient's condition from palliative perspective

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.
    The attending staff evaluates with advice from the palliative IDT, fellows, residents (as appropriate), nurses, and primary teams that interact on cases with student.

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.