MEDU-4119 - Advanced Diabetes Care in Clinical Practice

MEDU-4119 - Advanced Diabetes Care in Clinical Practice

Elective Title: Advanced Diabetes Care in Clinical Practice
Course Number: MEDU-4119
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Completion of IM clerkship. Email the C-Form directly to Dr. Belalcazar (lmbelalc@UTMB.EDU) in PDF format for course approval and copy the course coordinator, Victoria Garcia (vrgarcia@utmb.edu).
Responsible Faculty Director: Maria Belalcazar, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Victoria Garcia & Kiki Baldwin Other Faculty:
Location to Report on First Day:
Report to faculty via email at lmbelalc@utmb.edu

Goals
To advance diabetes management skills to the resident level and take leadership in efforts to raise awareness on existing diabetes care gaps among clinicians.

Objectives
1. To become familiar with diabetes care guidelines and apply them to patient care
2. To become comfortable in prescribing insulin and non-insulin therapy in the inpatient setting and in adjusting regimen for home after discharge
3. To identify and being to address a deficiency in care or a gap in diabetes care knowledge that may be shared with the medical community

Description of course activities
With faculty support:
1. Student will join as member of UTMB's Inpatient Diabetes team and participate in rounds three days a week and one day a week directly working with patients and the diabetes team as detailed in 3 below.
2. Student will fully manage at least three complex diabetes patients a day and participate in planning and counseling for discharge.
3. Identify and discuss with the medical team a deficiency in diabetes care or knowledge observed during the clinical elective and:
a) Spend one day a week working directly with patients and the diabetes team to better understand and address clinical care gap
b) Work one day a week in quality review/product based on elective clinical experience, under faculty guidance
c) Present work in brief by the end of the elective in a format that could be shared with the medical community

Type of students who would benefit from the course
1. Students interested in an adult medicine specialty
2. Students who would like to strengthen and improve the quality of care for people with diabetes
3. Students who would like to advance their medical career by strengthening skills in the care of a highly prevalent and complex medical condition
4. Students who enjoy team work and patient interaction

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 9:00 5:00
Tuesday 9:00 5:00
Wednesday 9:00 5:00
Thursday 9:00 5:00
Friday 9:00 5:00
Saturday
Sunday

 Average number of patients seen per week: 8-12
 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?
    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?
    Diabetes Team and faculty
  B. Frequency / Duration of Presentation(s)?
    4 days a week
  C. Format - What guidelines are set for the student's presentation?
    Diabetes-focused patient evaluation and presentation. Guide provided at start of elective. Interactive discussion during rounds and independently with faculty on work regarding deficiency in diabetes care or knowledge
  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)?
    Written consult and or progress note on EPIC 4 days/week. One abstract summary on observed knowledge or diabetes care deficiency with faculty input, due by the end of the elective
  B. Format - What guidelines are set for the student's written work?
    Standardized EPIC note documenting evaluation and plan for diabetes patient (guide given first day). Summary raising awareness of deficiency in knowledge gap should be limited to 300 words and should follow an abstract format that will be provided
  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?
    At least 2-3 pertinent references relating to the case
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Patient case/care issue seen during elective
  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)?
    If student is interested, they may use abstract relating to deficiency in knowledge or care for submission to a scientific meeting for presentation. Students interested in further advancing diabetes quality and safety efforts at the system level may sign up for research elective or work on their own time on an initiative of their choice

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.
    N/A

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.