PATU-4053 - Molecular Diagnostics

PATU-4053 - Molecular Diagnostics

Elective Title: Molecular Diagnostics
Course Number: PATU-4053
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 3
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Jianli Dong, MD, PhD Periods Offered: 1-13 including holiday period 8 
Coordinator: Tracy Wilkins Other Faculty:
Location to Report on First Day:
5.140 Clinical Services Wing (409) 772-4866

This elective would like to provide medical students who are interested in any specialties an opportunity to become familiar with molecular genetics and genomics assays to be better prepared for the age of molecular and genomic medicine.

At the completion of this elective, students should:
1. Become familiar with molecular genetics and genomics tests available at UTMB and their applications.
2. Be able to describe clinical indications, methods, and result interpretation of molecular tests.
3. Gain further understanding of genetics and genomics concepts and apply them in clinical cases.
4. Be able to recommend appropriate genetics and genomics tests and contribute to respective clinical teams by sharing their expertise.
5. Become familiar with various molecular techniques that are useful to students interested in benchtop, translational, or clinical research.

Description of course activities
The elective would be an in-depth exposure to molecular diagnostics. Student will 1. Observe various molecular methods including nucleic acid extraction and purification, gel/capillary electrophoresis, conventional and real-time PCR, Sanger/pyro/next generation sequencing, fluorescent in situ hybridization (FISH), whole genome microarray, and the application of these techniques in various tests. 2. Review pertinent patient charts to examine the clinical use of various molecular assays including genetics (fragile X, Huntington disease, alpha-thalassemia, CFTR, HFE, germline chromosome microarray), cancer (KRAS, NRAS, BRAF mutations, HER2 FISH, somatic chromosome microarray), and pharmacogenetics (CYP2C19, CYP2C9/VKORC1 to guide clinical use of Plavix and Warfarin). 3. Apply basic molecular and genetics principles to the interpretation of molecular assays (eg, types of DNA variations, inheritance patterns, penetrance vs expressivity, germline vs somatic mutations).

Type of students who would benefit from the course
With the growth of molecular and genomic medicine, all students who are interested in the clinical use of molecular diagnostics tests will benefit from this elective.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8:00am - 12:00pm 1:00pm - 5:00pm
Tuesday 8:00am - 12:00pm 1:00pm - 5:00pm
Wednesday 8:00am - 12:00pm 1:00pm - 5:00pm
Thursday 8:00am - 12:00pm 1:00pm - 5:00pm
Friday 8:00am - 12:00pm 1:00pm - 5:00pm
Saturday N/A N/A
Sunday N/A N/A

 Average number of patients seen per week: N/A
 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?
    Daily by faculty and staff in Molecular Diagnostics
  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 and staff in Molecular Diagnostics
  B. Frequency / Duration of Presentation(s)?
    One sometime during the rotation before it ends
  C. Format - What guidelines are set for the student's presentation?
    PowerPoint presentation
  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?
    Describe 2-3 molecular tests observed during the elective, including the clinical indications, methods, result interpretation, and assay limitations.
  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)?
    Student will participate in Molecular Conferences. Student is encouraged to discuss new advance in the clinical use of molecular assays.

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.
    Additional evaluation will be based on inputs from laboratory technologists involved in bench-level teaching of the 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.

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.