DERU-4006 - Acting Internship (AI) in Dermatology

DERU-4006 - Acting Internship (AI) in Dermatology

Elective Title: Acting Internship (AI) in Dermatology
Course Number: DERU-4006
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: This AI should only be taken by MS4s interested in a dermatology career. C-Form is required.
Responsible Faculty Director: Lindy Ross, MD Periods Offered: 1-8 including holiday period 8 
Coordinator: Other Faculty: Richard Wagner, MD; Erica Kelly, MD; Brent Kelly, MD; Michael Wilkerson, MD; Bernard Gibson, MD; Brandon Goodwin, MD; Janice Wilson, MD; Kathleen Kroger, MD; Sharon Raimer, MD
Location to Report on First Day:
4.112 McCullough Bldg.

Goals
The educational goals of the Acting Internship in Dermatology are to comprehensively introduce AI senior medical students to all of the clinical and educational aspects of a dermatology residency at a University Medical Center (UTMB).

Objectives
1. Familiarity with full scope of dermatology practice; 2. Diagnose and treat common dermatological entities; 3. Become familiar with the normal histological appearance of skin and common patterns in dermatopathology; 4. Be able to recognize and manage skin diseases in seriously ill and hospitalized patients on the dermatology consult service; 5. To gain experience in critically analyzing published, peer-reviewed dermatology articles and presenting them at our weekly journal club to faculty, residents and students; 6. To become familiar with performing and interpreting commonly performed diagnostic tests and surgical procedures for skin diseases.

Description of course activities
This course has been designed to expose the medical student to all aspects of a university dermatology practice. This four-week course requires exposure to general clinical dermatology, pediatric dermatology, procedural dermatology, Mohs surgery, cosmetic dermatology, dermato-pharmacology, dermatopathology, and phototherapy. The AI dermatology student will participate along with the dermatology residents and faculty in all of the department academic activities during the four-week period, including dermatology conferences such as general textbook, dermatopathology textbook, unknown clinical conference, unknown dermatopathology conference, grand rounds, special presentations and weekly journal conference (Archives of Dermatology, Journal of the American Academy of Dermatology, Dermatologic Surgery and others). The AI will be responsible for reading and presenting one preselected original article at each Friday journal club during the rotation. Students should be available on weekends to join the dermatology resident on call should a dermatology consultation be called. A detailed schedule of the weekly AI clinical assignments and departmental conferences will be provided weekly by the chief resident.

Type of students who would benefit from the course
Students interested in a dermatology career only.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday clinic 9-noon clinic or consults 1-5:30
Tuesday clinic/Mohs/dermopath 9-noon TDCJ clinic 1-5:30
Wednesday clinic/Mohs/dermopath 9-noon clinic/Mohs 1:530
Thursday clinic 9-noon clinic 1:5:30 or consults
Friday Academic Friday 7-1:30 TDCJ Procedures 1:30-5:30
Saturday call from home call from home
Sunday call from home call from home

 Average number of patients seen per week: 100
 Call Schedule: call from home

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time NA
Self-Directed Study NA
Data-Collection/Analysis Not applicable
Other Not applicable Not applicable

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-mainly in an outpatient setting
  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?
    Weekly dermatology journal club (Fridays) where the AI student presents one article to the dermatology faculty, residents and other students. Will present cases to faculty in clinic daily.
  B. Frequency / Duration of Presentation(s)?
    Weekly for Journal Club. Several times daily for case presentations.
  C. Format - What guidelines are set for the student's presentation?
    Standard dermatology journal club format. The student will also be expected to present patients to faculty and residents in the dermatology clinics.
  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)?
    Will be asked to write an H&P weekly for an interesting patient seen by the student. This write up will not be a part of the EMR.
  B. Format - What guidelines are set for the student's written work?
    Standard format for clinic notes.
  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.?
    Related to patients seen by the student in the clinic.
  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)?
    The AI student is expected to attend all of the departmental academic activities described previously and attend clinics as scheduled each day, unless excused. In addition, the AI student will be assigned an article from the dermatology journal scheduled for our weekly journal club for oral presentation and discussion with the attending faculty, residents and other students.

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.
    Not applicable

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.
    Students will receive feedback daily by faculty or upper-level residents regarding the accuracy of their description of skin findings of patients and on their differential diagnoses.
 
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.
    Skin biopsies, cryosurgery, suturing, dermoscopy, KOH examinations, reading of dermatopathology slides
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    AIs will be expected to manage, with supervision, complicated outpatient and hospital consult patients. Interesting patients worthy of case reports are frequently seen during the rotation.
 
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)?
    Most of the students completing this AI will do an internship in Internal Medicine. Following this elective, they should be able to recognize and often manage many of the skin findings seen frequently by internists such as drug eruptions, vasculitis, skin signs of internal disease, many infections etc.
 
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?
    Students will interview numerous patients daily and do PE of the skin, develop a differential diagnosis and management plan, then have the opportunity to present findings to faculty.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Clinical conclusions and management plans are an expected part of the presentation of patients to faculty.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Students will receive feedback midpoint from the course director.
Should any remediation be needed, a plan for such will be devised between the student and the director.
 
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.
    Students will generally work with all of the dermatology faculty during the rotation. This occurs directly in clinic, on rounds while seeing consults in the hospital or around the microscope while reading dermopathy slides.