FAMU-4059 - Public Health Interdisciplinary Ambulatory Community Elective - St. Vincent''s Clinic

FAMU-4059 - Public Health Interdisciplinary Ambulatory Community Elective - St. Vincent''s Clinic

Elective Title: Public Health Interdisciplinary Ambulatory Community Elective - St. Vincent''s Clinic
Course Number: FAMU-4059
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: N/A
Responsible Faculty Director: Samuel Mathis, MD Periods Offered: 1-7, 9-12 excluding holiday period 8 
Coordinator: Jessica Prescott & Christopher Pleasant Other Faculty:
Location to Report on First Day:
contact the Family Medicine Course Coordinator Chris Pleasant (chpleasa@utmb.edu) or Jessica Prescott (jlpresco@utmb.edu)

(1) Enhance competency in diagnosing and treating health care problems in an ambulatory community setting. (2) Describe roles of the physician and other team members within an interdisciplinary team practice (practice must include an advance practice provider, i.e., nurse practitioner and/or physician assistant). (3) Describe the role of the community physician in fostering the health of the community with special emphasis on public health.

1. Medical Knowledge and Skills Objective: (1) Demonstrate proficiency in the diagnosis and management of at least 10 of the most frequently encountered medical problems in the selected community practice. (2) Describe the role of advanced practice providers, i.e. nurse practitioners and physician assistants, in a community practice.
2. Career Development objective: (1) Discuss with community faculty the challenges and rewards of practicing in the selected community. (2) Discuss with community faculty advantages and disadvantages of developing a community practice with an interdisciplinary team including advance practice providers, i.e., nurse practitioners and physician assistants.
3. Advocacy Objective: (1) Identify a community health issue affecting this community and the potential advocacy role for a physician. (2) Explore how the community physician may collaborate with other disciplines in the advocacy role.
4. Health Care Systems/Practice Management Objective: To review, examine and discuss healthcare systems: the use, costs, quality, knowledge and understanding of the structure, process and effects of health services for individuals and populations.
5. Service Learning Objective: During week 1 identify a service project that meets the needs of the clinic, patients, and/or community. Project is to be completed by the end of the rotation
6. CAM Objective: Discuss with the community faculty complementary and alternative health professionals roles in the community and how there relate to the community physician.
7. Other Objectives: (1) Identify the local chief public health official and medical examiner. (2) Describe how the community physician relates to public health surveillance needs and responses to public health risks. (3) Identify Homeland Security issues as relates to a community physician.

Description of course activities
Students and community faculty, primary care or specialty, will jointly develop a schedule for the four weeks that includes the following elements: 1) at least 20 half-day sessions in direct patient care activities in an interdisciplinary team environment (specialty or primary care medicine which includes advance practice providers, i.e., nurse practitioners or physician assistants) including at least 5 half days (8:00am - 4:00pm, Monday - Friday) collaborating with a nurse practitioner or physician assistant and other interdisciplinary team members. 2) at least 2 half-day sessions with the practice management staff. 3) recommended minimum of 8 half-days learning about community agencies and participating in community/public health advocacy/service learning activities with one or more agencies. 4) other 10 half days allocated by student and community faculty to best accomplish course objectives. Students and community faculty are encouraged to jointly agree to spend some evening and weekend time learning the lifestyle of the community faculty (e.g. hospital rounds, community activities, and family-time).

Type of students who would benefit from the course
This course will be of value to patient-centered physicians interested in community-based care in a primary care setting. Emphasis placed on future physicians learning and understanding social and other contextual factors influence on health.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday (NP) 8:00am-4:00pm
Tuesday (NP) 8:00am-4:00pm (Clinic) 3:00pm - 8:00pm
Wednesday (NP) 8:00am-4:00pm
Thursday (NP) 8:00am-4:00pm (Clinic) 3:00pm - 8:00pm
Friday (NP) 8:00am-4:00pm
Saturday (4th Saturday Clinic) 9:30am 2:00pm

 Average number of patients seen per week: 20
 Call Schedule: no

Research 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?
    At least 2 1/2 days per week.
  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?
    To the community faculty.
  B. Frequency / Duration of Presentation(s)?
    As determined by the community faculty.
  C. Format - What guidelines are set for the student's presentation?
    As determined by the community faculty.
  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?
    (1) Students will complete at least 2 clinic notes per half day session to be reviewed by community faculty (2) Healthcare Systems & Policy: Healthcare has become a major issue in American public life as evidenced by its growing attention in electoral politics, increasing share of societal resources, compromised access for sectors of the population and healthcare's critical role on the quality of life, morbidity and mortality. This assignment is designed as a review and examination of health care systems: the use, costs, quality, knowledge and understanding of the structure, process and effects of health services for individuals and populations. As this is a broad topic, requirements to fulfill this assignment are left up to you. Two choices are offered as examples (these examples will be offered during orientation to the selective during orientation. Assignment due week 3 of the course. (3) Public Health Services List: Develop a list of standard/typical public health services and identify the provider of each of those services in your selected community. If the services are not provided in the community, identify where those services may be accessed. This list should include the chief public health officer and medical examiner. Due week 3 of the course. (4) Service Learning/Advocacy Experience: Summarize your service learning and/or advocacy experiences in this community and list at least three concepts or skills you learned. Due week 4 of the course.
  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.?
    student selected
  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)?
    Students have to complete both components listed above to pass the elective. A grade of satisfactory or fail will be assigned.

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.
    to be determined by the preceptor

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.