FAMU-4061 - Acting Internship in Family Medicine - Tyler

FAMU-4061 - Acting Internship in Family Medicine - Tyler

Elective Title: Acting Internship in Family Medicine - Tyler
Course Number: FAMU-4061
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: C Form required to register, send to Tyler Coordinator, Megan Pazos, megan.pazos@uthct.edu
Responsible Faculty Director: Philip Pippin, MD Periods Offered: 1-7, 11-13 excluding holiday period 8 
Coordinator: Jessica Prescott & Christopher Pleasant Other Faculty: Patti Olusola, MD
Location to Report on First Day:

1. Enhance student competencies in diagnosing and treating routine and complicated primary care problems of patients in both inpatient and outpatient settings. 2. Understand the role of the family physician working with consultants, the interdisciplinary inpatient care team, and community health resources. 3. Develop a basic understanding of family dynamics and family-centered care, particularly in relation to complex and difficult patient problems. 4. Prepare to function as an intern.

1. Evaluate and propose management plans for problems of Family Medicine patients in both inpatient and outpatient settings. 2. Provide daily comprehensive hospital management of patients, under the supervision of the supervising resident and Family Medicine faculty. 3. Identify and discuss common factors leading to patient compliance or non-compliance. 4. Identify medical, family, and community resources to assist in the care of patients.

Description of course activities
The Acting Intern (AI) will have the opportunity to gain experience as an intern in the hospital setting. While on the inpatient service the AI will undertake primary responsibility for patients assigned to his/her care under the supervision of the upper-level resident and/or attending faculty. The AI will attend weekly resident Didactics, as well as other conferences in the Department of Family Medicine that may be available. The AI will accompany the upper- level resident to clinic one afternoon each week.

Type of students who would benefit from the course
This course is particularly valuable to students interested in Family Medicine or those students interested in the practice of comprehensive care in a mix of outpatient and inpatient settings.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 7-12 1-5
Tuesday 7-12 1-5
Wednesday 7-12 1-5
Thursday 7-12 1-5
Friday 7-12 1-5
Saturday As needed
Sunday As needed

 Average number of patients seen per week: 7-10
 Call Schedule: Round one weekend, no overnight duty

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?
  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?
    Family Medicine inpatient team (faculty, residents, pharmacy, psychology, case manager)
  B. Frequency / Duration of Presentation(s)?
    Daily, 5-15 minutes per patient, 2-3 patients per day.
  C. Format - What guidelines are set for the student's presentation?
    AI should follow the Oral Case Presentation guidelines from the Assistant Dean of Educational Affairs
  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?
    One typed or handwritten complete H&P per week of the rotation, inpatient progress notes, clinic SOAP 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.?
    Current cases only
  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)?
    Prepare for daily rounds and presentations to the inpatient team (including attending faculty) as an intern would in the Tyler Family Medicine Residency. This includes starting with morning report and patient handoff, reviewing the patients medical record, interviewing and examining the patient, discussing the patient with other residents on the team, and addressing learning issues by referencing point of care resources or targeted literature searches for immediate application to the patient.

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.
    Individual critique and feedback on patient interactions, case presentations, special topics presentations, and review of medical record documentation. AI is graded on clinical performance in the same way an intern is evaluated with respect to the core competencies of medical knowledge, patient care/procedural skills, systems-based practice, practice-based learning and improvement, communication, and professionalism that will be used to evaluate during residency. An end-of-rotation evaluation form will be completed by the lead faculty.

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 receive on-going formal feedback throughout the elective from the attending the student is working with. At the end of the elective, the student receives a summative evaluation.

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.
    History taking and physical exam skills, communication with other clinical services, documentation of assessment and plan, inpatient orders (written on paper as practice and for feedback).

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Cardiac Stress Testing, Bedside Incision and Drainage, Lumbar puncture, Thoracentesis, Paracentesis, Intubation

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)?
    The student will be assigned patients to follow. The student will be responsible for the patient from admission to discharge. The student is expected to see the patient every day, write a progress note, and follow up on all test results and procedures. The student is responsible to communicate with consultants as well. The student will also be involved in the discharge planning for their patient.

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?
    The course will help the student experience the work load and level of knowledge required for an intern in this field. It will also give the student a chance to answer any questions or concerns he/she has in regards to the field of training.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Midpoint formative feedback will be provided by the attending physician after the first 2 weeks of the course. the student and the attending physician will discuss any deficiencies and formulate a plan to remediate them at this meeting.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    The student will have the opportunity to work directly with 3-4 faculty members during the 4-week elective. The student will work 5-12 days with each faculty member. Attending faculty provides complete one on one supervision to the AI. Students will work with residents assigned to the family medicine inpatient team.

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.
    The students will work directly with the attending faculty member on the inpatient team each week, totaling 3-4 unique faculty members through-out the rotation. Dedicated time with faculty is available and encouraged for students that choose to follow and assist the faculty member after rounds.