MEDU-4092 - Internal Medicine Ambulatory Elective - Austin

MEDU-4092 - Internal Medicine Ambulatory Elective - Austin

Elective Title: Internal Medicine Ambulatory Elective - Austin
Course Number: MEDU-4092
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: C-form required, please contact Brian Sullivan @
Responsible Faculty Director: Roxana Rhodes, MD Periods Offered: 1, 3-4, 6, 9-10, 12-13 excluding holiday period 8 
Coordinator: Brian Sullivan Other Faculty:
Location to Report on First Day:
631 West 38th St, #5,Austin, Texas 78705

The student will encounter patients with a wide variety of medical complaints in an outpatient setting. The student will learn the methods of investigation for diagnosis of these complaints and the treatment options. They will also participate in planning the extensive screening and counseling for prevention. They will learn to integrate pharmacogenomics and genetics into the treatment of medical problems.

The student should be able to outline the initial work-up of common medical complaints and explain the rationale used in determining the diagnosis. The student should also begin to become independent in assessing and developing patient plan. The student will learn more advanced lab tests used to predict disease.

Description of course activities
1. The student will be assigned to work in the outpatient Concierge Internal Medicine solo practice on Monday through Friday. They will be under the supervision of Dr. Roxana Rhodes. 2. The student will directly participate in obtaining historical information and performing physical exams on patients.
3. The student will develop better understanding of integrating pharmacogenomics and genetics into medical practice.
4. The student will be responsible for creating notes in the EMR.

Type of students who would benefit from the course
Students who are planning careers in specialties in which they will be providing primary care such as Internal Medicine and Family Medicine. Students who are planning on going into Psychiatry will also benefit from the pharmacogenomics that is integrated into the practice. Students who are interested in a smaller solo practice will also benefit from the course.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8:00 5:00
Tuesday 8:00 5:00
Wednesday 8:00 5:00
Thursday 8:00 5:00
Friday 8:00 12:00

 Average number of patients seen per week: 40
 Call Schedule: None

Research / Other Course 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?
    The student is observed daily with each patient.
  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?
    The student will present to Dr. Roxana Rhodes.
  B. Frequency / Duration of Presentation(s)?
    The student will present daily with every patient encounter.
  C. Format - What guidelines are set for the student's presentation?
    The student will be expected to present in the standard SOAP note format.
  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)?
    The student will do daily written H&P with each patient encounter.
  B. Format - What guidelines are set for the student's written work?
    Written assignments will be the student''s 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.?
    Method of content selection will relate to cases seen in practice
  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)?
    Extra course activities will include thoughtful questions, providing resources on topics seen in clinic, and review of journal articles that pertain to cases.

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.
    Evaluation is also based on the student's attendance, enthusiasm, initiative, evidence of outside reading, and the quality of presentations.

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.