MEDU-4099 - Inpatient Infectious Diseases in Immunocompromised Hosts

MEDU-4099 - Inpatient Infectious Diseases in Immunocompromised Hosts

Elective Title: Inpatient Infectious Diseases in Immunocompromised Hosts
Course Number: MEDU-4099
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: Joseph Patrik Hornak, MD Periods Offered: 1-13 excluding holiday period 8 
Coordinator: Destiny Willis; Backup: Victoria Garcia Other Faculty: Lucas Blanton, Miguel Cabada, Hemil Gonzalez, A. Scott Lea, Susan McLellan, April McDougal, David Reynoso, Juan Sarria, Daniel Stanton, Melinda Tanabe
Location to Report on First Day:
Jennie Sealy Hospital 8.402 at 8:00am

Goals
1. Learn to evaluate and treat patients with suspected bacterial, fungal, parasitic and viral infections in the immunocompromised host.
2. Learn to properly utilize the microbiology laboratory to diagnose pathogenic microorganisms and their sequelae.
3. Become familiar with the pathogenesis and natural history of the major infectious disease syndrome and the various microbial pathogens but with a refined focus on the immunocompromised patient population.
4. Understand the proper use and stewardship of antimicrobial agents.
5. Develop and practice good infection control habits for patient and personal protection and safety.
6. Become acquainted with the pre-transplant infectious diseases evaluation.

Objectives
By the end of the rotation the student should have developed the ability to properly evaluate, diagnose and treat an immunocompromised patient with an infectious disease. They should be able to recount the major syndromes as well as the major classes of therapeutic antimicrobial agents and adjuncts to the care of those patients afflicted by pathogenic microorganisms. The student will also be introduced to the concepts of infection control while practicing proper utilization of personal protective equipment as well as personal hygiene in the hospital environment.

Description of course activities
1. Daily evaluation of new and follow-up patients and daily rounds within the hospital as part of the dedicated immunocompromised infectious diseases consultation team. This includes the collection and analysis of pathologic and radiologic tests as well as working with other primary and consultative services during the hospital stay of assigned patients.
2. Didactic lectures and teaching conferences designed to teach the student different infectious disease concepts, antimicrobial agents, and healthcare epidemiology.
3. Students will be working as a member of a specialized team of clinicians involved in the care of complicated, adult patients hospitalized at UTMB affiliated facilities on a daily basis.

Type of students who would benefit from the course
This course is designed to introduce all students taking the elective to the evaluation and care of immunocompromised adult patients with a proven or suspected infectious disease. We expect this rotation to be highly beneficial to those students pursuing internal medicine, infectious diseases, hematology/oncology, nephrology, hepatology, cardiology, or surgery. Any student who intends to care for adult patients will find subjects of interest on this elective. Students who feel they need to enhance their skills in the areas of antimicrobial usage, pharmacokinetics, and stewardship will be helped by this elective. Similarly, students who want to enhance their skills in microbiology and epidemiology will be interested in this elective. Finally, the elective will introduce all students to the role of the specialty consultant in modern medical practice.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8:00 AM (see new and old consultations) 1:00 PM (round with attending and fellow)
Tuesday 8:00 AM (see new and old consultations) 1:00 PM (round with attending and fellow)
Wednesday 8:00 AM (see new and old consultations) ID Academic Half Day didactics
Thursday 8:00 AM (see new and old consultations) 1:00 PM (round with attending and fellow)
Friday 8:00 AM (see new and old consultations) 1:00 PM (round with attending and fellow)
Saturday
Sunday

 Average number of patients seen per week: 40
 Call Schedule: No

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study 4
Data-Collection/Analysis
Other


Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Checkbox pixInpatient Service   Checkbox pixAmbulatory   Checkbox pixSurgery   Checkbox pixStandardized patients
Checkbox pixPatients simulators   Checkbox pixOther
  B. Frequency - How often are students observed clinically?
    Daily
  C. Format - What method(s) are used to document the student's clinical performance?
    Checkbox pixDaily oral feedback   Checkbox pixEnd of period oral feedback   Checkbox pixWritten feedback
Checkbox pixOther

2.  Oral Presentation
  A. Audience - To whom does the student present?
    ID faculty, ID fellows
  B. Frequency / Duration of Presentation(s)?
    Daily
  C. Format - What guidelines are set for the student's presentation?
    Bedside rounds, table discussions
  D. Assessment - Who assesses the student's presentation performance?
    Checkbox pixSelf-assessment   Checkbox pixPeer assessment   Checkbox pixFaculty assessment
  E. Method of content selection
    Checkbox pixCurrent cases  Checkbox pixStudent-selected topic   Checkbox pixAssigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Daily
  B. Format - What guidelines are set for the student's written work?
    Students will submit daily consultation notes (initial and follow-up) with faculty guidance and supervision plus input from ID fellows.
  C. Length of written assignment(s)?
    Checkbox pixAbstract   Checkbox pixAnnotated bibliography   Checkbox pix1 - 2 page paper   Checkbox pix3+ 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?
    Checkbox pixPeer Assessment     Checkbox pixFaculty Assessment     Checkbox pixOther

4.  Examination
  Format
    Checkbox pixOral   Checkbox pixWritten multiple choice   Checkbox pixWritten essay / short answer   Checkbox pixOSCE
Checkbox pixOther

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)?
    1. Infectious Diseases Academic Half Day (Wednesday 12 noon - 2:30pm) - students will actively participate in didactic lecture, board review, clinical case discussions, journal club, and weekly seminar 2. Infectious Diseases Research-in-Progress (Friday 12 noon - 1:00pm) - students will actively participate in weekly presentations given by faculty and fellows regarding their active scholarly pursuits

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.
   

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.