INTL-4006 - Advanced Senior Medical Field Experience in Global Health

INTL-4006 - Advanced Senior Medical Field Experience in Global Health

Elective Title: Advanced Senior Medical Field Experience in Global Health
Course Number: INTL-4006
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: Unlimited
Prerequisites: Successful completion of Year 3
Additional Requirements: Required: Course director approval on C-Form & Institution-level approval. Contact Dr. Naik-Mathuria (Bnaik@utmb.edu) at least 6 months prior to intended travel period for more information.
Responsible Faculty Director: Dr. Bindi Naik-Mathuria Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Bradley Brock Other Faculty:
Location to Report on First Day:
Field Location

Goals
1. Provide opportunity for students to work in a global environment, across international boundaries, in a different health care system and setting
2. Expose future U.S. physicians to tropical medicine and public health in low-resource settings.
3. Increase student competence, knowledge, and skills in tropical medicine and travel health.

Objectives
1. Refine clinical diagnostic skills related to infectious diseases in international settings
2. Learn about management of tropical diseases and other common medical conditions in resource poor settings
3. Learn different ways to diagnose and treat patients with a variety of medical conditions not commonly seen in the U.S.

Description of course activities
A clerkship in the international rotation's field must be completed before going (for example, if someone is going to do an adult tropical medicine elective, they should have done Internal Medicine before leaving; if completing an international ob/gyn rotation, the ob/gyn clerkship should be completed before travel). Planning and contact with faculty (Dr. Naik-Mathuria) and program manager should begin at least 6 months prior to the expected dates of the elective. Tasks during this time include: acquiring an understanding of priority issues in global health; selecting a foreign country for the elective experience; identifying a local (on-site) health professional willing to serve as preceptor/supervisor, with the help of UTMB faculty; making the necessary travel arrangements, including passport, visas, immunizations, etc., and planning for the financing of the elective. The student should, with the help of his/her advisor, define at least 3 personal objectives for the elective. Selection of specific locations and appropriate learning experiences will be the responsibility of the local preceptor and the Health/Medical School authorities in the host country. Each student will be expected to: (1) participate with host country staff in the delivery of patient/client care; (2) assess the effectiveness of functional components of the country's health system, and (3) delineate the impact of a variety of determinants on the health of the country's population, both nationally and regionally. On return to UTMB, each student will be required to submit an evaluation completed by the field site supervisor and complete a reflection assignment. Students will have the opportunity to debrief with a UTMB faculty member.

This course satisfies the Global Health Concentration, and provides an additional global clinical elective to INT-4015.

Students will be expected to complete registration with the US Department of State Smart Traveler Enrollment Program.

Type of students who would benefit from the course
This elective will be especially valuable to students interested in: global health; health and medical care systems of foreign countries; cross-cultural approaches to medical practice; the exploration of possible alternatives to meeting the health care needs of populations in the U.S.; students interested in community based primary care and public health; students in interested in tropical medicine.

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

 Average number of patients seen per week: Variable depending on site
 Call Schedule: Variable depending on site

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other


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
  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?
    N/A
  B. Frequency / Duration of Presentation(s)?
   
  C. Format - What guidelines are set for the student's 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)?
    One- Narrative reflection at end of elective
  B. Format - What guidelines are set for the student's written work?
    Include a description of the activity, how the student's objectives were met (or not met), and what they learned from it.
  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.?
    Students Selected
  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)?
    Will be highly dependent on site, but expect student to participate in teaching rounds, lectures, small group discussions, labs, and to do extra reading on selected topics. The on-site global faculty will provide an assessment. We will send him/her a form to complete for student and director to review and ensure an exit interview with the student.

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.
   

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.
   
 
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.
   
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
   
 
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)?
   
 
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?
   
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
 
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.