MEDU-4091 - Obesity, Prediabetes and Diabetes

MEDU-4091 - Obesity, Prediabetes and Diabetes

Elective Type: career
    
Title
Obesity, Prediabetes and Diabetes
Course Number
MEDU-4091
Duration/Weeks
2
Prerequisites: Successful completion of Year 2 
      Additional Requirements:
C-form Required
Responsible Faculty Director:
Hanaa Sallam, MD, PhD
Other Faculty:
Nastassia de Souza, MD; Rizwana Sultana, MD; Yusra Imtiaz, RD, DCES; Michelle Sierpina, PhD; Kevin McKinney, MD
Location to Report on First Day
Mary Moody Northern (Rm # TBD)
Periods Offered
2,3,7,8
excluding holiday periods 9 & 10
Maximum Enrollment
20

Goals
To strengthen the knowledge and skills of medical students in the areas of diagnosis, management and addressing disparities in pre-diabetes and diabetes, and to enhance their clinical decision through: 1) better understanding of the pre-diabetes-diabetes continuum; and 2) acquiring skills to screen for pre-diabetes to prevent Type II diabetes (T2).

Objectives
1. Review key hormones in glucose homeostasis.
2. Define insulin resistance, pre-diabetes, obesity, metabolic syndrome and T2.
3. List laboratory values of various blood glucose tests.
4. Describe the pathophysiological basis of T2.
5. Describe the pathophysiology of the metabolic syndrome and identify its parameters.
6. Discuss adipose tissue function vs. mass in the pathophysiology of T2.
7. Discuss obesity-related cardio-metabolic complications.
8. List and/or review complications of T2.
9. Identify population at risk for T2.
10. Compare the incidence of T2 in various ethnic groups and discuss the determinants of such disparities.
11. Compare outcomes of various interventions on glucose control in patients with pre-diabetes.
12. Identify approaches to the self-management of obesity.
13. Identify and manage pre-diabetes in our community.

Description of course activities
T2 has been always linked to obesity. However, this course helps student understand the role of adipose tissue function vs. mass in the development of T2. Ethnic and environmental factors play a significant role in the development of T2. The course helps tease out any confusion about the definitions of a spectrum of health conditions related to alterations in glucose homeostasis. In addition, students learn how to screen for pre-diabetes in their community to prevention T2. The course is offered over 30 hours a week of contact divided to apply various pedagogical methods. This approach is to ensure better student engagement and understanding.
1. Lectures: The lectures will be designed to introduce definitions and pathophysiological concepts.
2. PBL cases: PBL cases will be designed to engage student’s brain-storming and problem-solving skills.
3. Reading material: mandatory and elective readings will include book chapters, publications and or videos to enhance student understanding of the subject matter.
A. Community Engagement. During the course, students will be required to spend 2 mornings at Osher Lifelong Learning Institute (OLLI) to attend PreventT2 classes.
(Transportation can be arranged with colleagues and/or the instructor, if needed).

The students will have 15 hours of faculty time, 4 hours of self-directed time, 5 hours of data collection, 6 hours of community engagement, along with the clinic hours listed below.

Type of students who would benefit from the course
Medical Students who are interested to know more about preventative medicine.

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday 1-3
  Tuesday 9-12
  Wednesday
  Thursday
  Friday 9-12 1-3
  Saturday
  Sunday
   Average number of patients seen per week: 20  
   Call Schedule:   N/A  

Research 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?
    Twice/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
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Elective peers - Program Director - Faculty
  B. Frequency / Duration of Presentation(s)?
    Once at the end of the course / 15 minutes
  C. Format - What guidelines are set for the student's presentation?
    10 minutes presentation - 5 minutes Discussion Presentation guidelines include: 1. Introduction to provide background to the topic and discuss its importance 2. Use systematic way while answering the selected questions; organize your arguments in a logic sequence, support these arguments with demonstrative examples from available literature, and provide a list of references. 3. Provide a concise conclusion.
  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)?
    Once at the end of the elective, students will be asked to cite at least five recent references in their essay. They can use references from the readings that faculty will offer them during the elective. In addition, the course director will have one to one discussion to guide students on selecting the references.
  B. Format - What guidelines are set for the student's written work?
    Short essay of no more 750 words
  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?
    Students will be asked to cite at least five recent references in their essay. They can use references from the readings that faculty will offer them during the elective. In addition, the course director will have one to one discussion to guide students on selecting the references. Listed references will be in AMA style.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student chooses one of the proposed essay topics to write on: 1. What are the risk factors of type 2 diabetes and how to address them? Focus on 3 major risk factors. 2. "Let food be thy medicine and medicine be thy food". Discuss how food choices are key for management of patients with pre-diabetes or diabetes. 3. Park Rx is a program that encourages physical activity in the community at a low cost. Discuss the importance of and guidelines for physical activity in patients with pre-diabetes or diabetes. 4. Our body keeps our blood glucose level tightly regulated. Discuss the role of hormones regulating blood glucose levels (Focus on the major 2 hormones). 5. Based on the Diabetes Prevention Group research, lifestyle was more effective in reducing diabetes risk than Metformin. Yet, metformin remains used as a treatment for patients with pre-diabetes. Do you believe that there is still a benefit from using metformin in this patient population? Use evidence-based research to support your opinion.
  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)?
    The course will consist of four general components: 1. Lectures: The lectures will be designed to introduce definitions and pathophysiology of obesity, metabolic syndrome, pre-diabetes and diabetes. 2. Problem-based learning: through well-designed exercises to enhance students’ analytical and problem-solving capacities. 3. Readings/videos/online material: Recently published and milestone literature will be given as reading materials. We will classify them into mandatory and elective readings. 4. Community Engagement: During the course, students will be required to spend time in Osher Lifelong Learning Institute (OLLI) - 4700 Broadway, Galveston. These engagements will be discussed during the first-class orientation. During the course, students will be asked to take a brief medical history from patients with T2 or pre-diabetes.

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.
    Students will interact and meet with faculty from Endocrinology, Stark Diabetes Center, Health policies and Legislative Affairs, School of Nursing and Sleep Medicine.
They will meet the course director every day during the course who will provide hands on training and one on one mentoring, interaction and feedback.
Students will be evaluated with respect to the following items:
­ Knowledge acquisition,
­ Knowledge application / problem-solving skills,
­ Group interaction, and
­ Professional behavior
Students will be also given the chance to evaluate their benefits from the course. This will be through an evaluation form to help students to document the usefulness of the course in terms of specific knowledge and skills.
In order to pass this course (expected performance) students will have to complete the following:
­ Attend all required in-class sessions.
­ Complete at least one community organization site visit.
­ Complete writing assignments.

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.