MEDU-4061 - Outpatient Infectious Diseases in the Community

MEDU-4061 - Outpatient Infectious Diseases in the Community

Elective Title: Outpatient Infectious Diseases in the Community
Course Number: MEDU-4061
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
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: Joseph Patrik Hornak Other Faculty: Dr. Daniel Stanton, April McDougal, Lucas Blanton, Eugene Harper, Ewa Tomczak, and Hemil Gonzalez
Location to Report on First Day:
Victory Lakes Town Center ID Clinic (1:00pm)

Goals
1. Learn to evaluate and treat patients with suspected bacterial, fungal, parasitic and viral (HIV, HCV) infections in the outpatient setting.
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.
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. Familiarize with good consultative medical principles.
7. Become acquainted with travel medicine.
8. Participate in creating two scholarly clinical abstracts worthy of submission to a scientific conference.

Objectives
By the end of the rotation, the student should have developed the ability to properly evaluate, diagnose and treat a patient with an infectious disease in the outpatient arena. He/she 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.

Description of course activities
This outpatient rotation will provide fourth-year medical students with a comprehensive experience in ambulatory infectious diseases subspecialty care with emphasis on HIV, sexually transmitted infections, viral hepatitis, outpatient antimicrobial therapy, orthopedic infections, travel medicine, and referrals from primary care physicians.

1. Daily evaluation of new and follow-up infectious disease consultations in our clinic. This includes detailed chart review, the collection and analysis of pathologic and radiologic tests plus other objective data.
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 adult patients seeking care at our UTMB Infectious Diseases clinics.
4. Independent self-study activities will complement the clinical exercises to augment understanding and application of infectious diseases principles.

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 adult patients with an infectious disease. 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. Students seeking further education in global health, HIV, HCV, and tropical & travel medicine will benefit from 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 Independent study Victory Lakes clinic
Tuesday Independent study UHC Galveston clinic
Wednesday UHC Galveston clinic Didactics
Thursday Independent study UHC Galveston clinic
Friday Independent study Didactics
Saturday
Sunday

 Average number of patients seen per week: 20
 Call Schedule: None

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study 13
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, IM residents, JSSOM students on clerkship or other ID elective(s)
  B. Frequency / Duration of Presentation(s)?
    Daily
  C. Format - What guidelines are set for the student's presentation?
    Patient cases seen in the clinic
  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)?
    In addition to daily clinic notes, students will write 2 case abstracts during the month rotation.
  B. Format - What guidelines are set for the student's written work?
    To assist with students' critical understanding of patient cases, they will be expected to write two 1-page clinical abstracts related to cases seen in the clinic. This will also serve them well if they are interested in submitting abstracts to regional/national meetings.
  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.?
    Current cases, with faculty input and oversight.
  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 to 2:30pm) - active participation in lecture, board review, journal club, case discussions, and weekly seminar 2.Infectious Diseases Research-in-Progress (Friday 12 noon to 1:00pm) - active participation in research conference with faculty and fellows presenting upon active scholarly projects 3.During the rotation student will be encouraged to organize a clinical vignette for presentation in the teaching setting, either informally during clinic teaching or formally during our ID Academic Half Day. The case material will be drawn from patients that the student has seen during the rotation. These will be medium-length presentations (25 minutes) which highlight a specific learning opportunity that occurred during patient care. Students will be appropriately mentored in the preparation of these vignettes.

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.