INTL-4002 - Indian Health Service

INTL-4002 - Indian Health Service

Elective Type: clinical
Indian Health Service
Course Number
Prerequisites: Successful completion of Year 2 
      Additional Requirements:
Completion of one primary care clerkship. Contact Dr. Matt Dacso ( at least 6 months in advance. C-Form is required, send forms to Bradley Brock (
Responsible Faculty Director:
Matthew Dacso, MD, Msc
Other Faculty:
Location to Report on First Day
TBD by Indian Health Service, various locations in North America
Periods Offered
including holiday period 8
Maximum Enrollment

1) Clinical competency in diagnosis and management of primary care diseases with emphasis on diabetes, cardiovascular disease and syndrome X. 2) Basic knowledge of community-based health education and promotion programs. 3) Cultural sensitivity in respect of maximizing healthcare.

1) Student will spend significant clinical time dealing with primary care patients in respect of diagnosing and treating prevalent diseases such as diabetes, hypertension, cardiovascular disease and hyperlipidemia. 2) Student will participate in a community-based health education and promotion program emphasizing pre-clinical management and prevention of primary care diseases. 3) Student will spend significant time immersed in a Native American community developing cultural humility skills deployed in respect of healthcare.

Description of course activities
1) Students will spend at least three days a week seeing patients in a community clinic or hospital setting under an MD preceptor; clinic time will emphasize diagnosis and treatment of prevalent primary care diseases in the context of community- and public health clinical care enhanced by instruction in public health policy and the public healthcare system. 2) Site-dependent activities include opportunities for the student to participate in a community health education and promotion program assisting an MD preceptor and nurse-educators in developing and teaching health classes, assisting lay health educators in community health promotion activities including conducting home visits to reinforce lifestyle and pharmacological interventions, participation in community assessments focused on facilities in support of lifestyle changes, e.g. recreational facilities, support groups and diet-compliant foods, and helping to lead lifestyle modification programs such as cooking and exercise classes. 3) Student will work closely with educators and lay community health promoters in the course of participating in health education classes and health promotion activities and conducting home visits in order to develop cultural competence in the context of optimizing health care delivery.

Type of students who would benefit from the course
Students interested in community-based healthcare education and promotion, students interested in acquiring cultural humility, students interested in primary care, students interested in Native American health, students interested in public health

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday 8:00 - 12:00 1:00 - 5:00
  Tuesday 8:00 - 12:00 1:00 - 5:00
  Wednesday 8:00 - 12:00 1:00 - 5:00
  Thursday 8:00 - 12:00 1:00 - 5:00
  Friday 8:00 - 12:00 1:00 - 5:00
   Average number of patients seen per week: 25  
   Call Schedule:   N/A  

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?
    30 hours per week by an MD preceptor
  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?
    MD preceptor
  B. Frequency / Duration of Presentation(s)?
    To be determined by preceptor based on student’s performance/development
  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)?
    Note for selected patient contacts (10/week); lesson plan for health education and promotion classes (1/week).
  B. Format - What guidelines are set for the student's written work?
    Patient notes will follow SOAP format; lesson plans will consist of outline of teaching points and objectives
  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.
    Depending on clinic site, participants will receive 360 degree evaluations from clinical preceptor, director of health education and promotion program, lay health educator and selected patients.

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.