MEDU-4078 - Multidisciplinary Clinical Skills Experience

MEDU-4078 - Multidisciplinary Clinical Skills Experience

Elective Title: Multidisciplinary Clinical Skills Experience
Course Number: MEDU-4078
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: This elective is a clinical refresher course designed for special circumstances only; C-form required, contact Shaine LeGrand ( at least 4 wks prior to start of elective.
Responsible Faculty Director: Dr. Anita Mercado Periods Offered: 1-7; 9-13 excluding holiday period 8 
Coordinator: Victoria Garcia Other Faculty:
Location to Report on First Day:
Assigned ward at 6:45am on the first day of the rotation.

Students will reinforce and enhance their knowledge of several fundamental clinical skills including history taking, physical examination, and conductance of simple clinical procedures.

By the end of this elective, students will improve their knowledge and skills to:
1) Perform a comprehensive and focused History and Physical Examination,
2) Present a succinct, well organized, and accurate patient presentation including diagnosis and differential diagnosis with treatment plan,
3) Identify pertinent physical exam findings, interpret pertinent laboratory and radiographic studies and become familiar with common bedside clinical procedures (e.g., paracentesis and/or central line placement)

Description of course activities
During this elective, the students will:
1) Perform and refine history and physical exam skills with daily assessment of assigned patients
2) Review medical records in EPIC
3) Present admit H&P to faculty on newly admitted patients to faculty/team and discuss diagnosis/differential diagnosis with intended assessment and plan of care
4) Interview and examine patients, review medical records (EPIC) and write daily SOAP notes for inpatients
5) Attend daily rounds with the inpatient team
6) Attend house staff morning report, Internal Medicine (IM) grand rounds and other scheduled conferences determined by their faculty, resident and chief residents
7) Days off will be scheduled by the student with the house staff (number of days off will be similar to MS 3 days off determined by the IM Clerkship)

Type of students who would benefit from the course
Any student who would like extra practice to reinforce clinical skills. May be of particular benefit to students who have been away from clinical practice for some time such as MD/PhD students.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 7 5
Tuesday 7 5
Wednesday 7 5
Thursday 7 5
Friday 7 5
Saturday 7 5
Sunday 7 5

 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

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

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty, Resident, and/or team
  B. Frequency / Duration of Presentation(s)?
    Students will be expected to present daily
  C. Format - What guidelines are set for the student's presentation?
    Students will be given precise instructions regarding how to present patients
  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)?
    Daily notes on all patients seen and 1 H&P to be reviewed by upper level resident or faculty.
  B. Format - What guidelines are set for the student's written work?
    Students will be given guidelines for comprehensive and focused history and physical exam
  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
    Oral   Written multiple choice   Written essay / short answer   OSCE

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)?

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".

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.

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.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

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)?

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?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

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.