MEDU-4095 - Community Practice, Pulmonary, Critical Care and Sleep Medicine

MEDU-4095 - Community Practice, Pulmonary, Critical Care and Sleep Medicine

Elective Title: Community Practice, Pulmonary, Critical Care and Sleep Medicine
Course Number: MEDU-4095
Elective Type: clinical Duration/Weeks: 2 Max Enrollment: 1
Prerequisites: None
Additional Requirements: C-form required. Please contact Brian Sullivan at
Responsible Faculty Director: Radheshyam Bhatt, MD Periods Offered: 1A, 3B, 4AB-5AB, 6A, 9AB, 11AB-13AB excluding holiday period 8 
Coordinator: Brian Sullivan Other Faculty:
Location to Report on First Day:
UTMB CLC 4 A Nursing Station

1. Introduce basic disease concepts in pulmonary and sleep medicine. Disease states such as acute respiratory failure, asthma, COPD exacerbation, sleep apnea, pneumonia, pleural effusion and lung malignancy. Etc.
2. Understand therapeutic plan for disease states described.
3. Introduce interpretation of chest imaging, pulmonary function tests and sleep studies.
4. Introduce procedural aspects in pulmonary medicine
5. Undertake accurate history taking as it pertains to pulmonary and sleep medicine disease states.

1. Be able to define common disease states encountered in pulmonary and sleep medicine.
2. Analyze diagnostic and imaging chests in pulmonary and sleep medicine.
3. Formulate initial management plan and apply diagnostics.
4. Evaluate on going patient care and modify plan of care as needed.

Description of course activities
1. The medical student will round on patients on the pulmonary service at UTMB CLC, Kindred LTACH and well as see patients with the attending in the private practice clinic.
2. The medical student will present patients to faculty on rounds.
3. The medical student will be introduced to pulmonary procedures when the opportunity arises.

Students will be exposed to long term ventilated patients and critical care disease states in the Kindred ICU.

Procedures such as bronchioscopies, thoracentesis, endotracheal intubation, central lines and chest tube placement will be introduced to the student as permitted.

Diagnostics such as sleep studies, pulmonary function test and chest imaging will be reviewed with the rotating student.

Type of students who would benefit from the course
Medical students who are interested in pulmonary, critical care and sleep medicine.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 9AM-12PM UTMB CLC inpatient rounding Kindred LTACH/other
Tuesday 9AM-12PM UTMB CLC inpatient rounding 1PM-4PM clinic
Wednesday 9AM-12PM UTMB CLC inpatient rounding Kindred LTACH/other
Thursday 9AM-12PM UTMB CLC inpatient rounding 1PM-4PM clinic
Friday 9AM-12PM UTMB CLC inpatient rounding Kindred LTACH/other

 Average number of patients seen per week: 10
 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?
  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?
    Faculty or other. Oral presentation is not required.
  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)?
  B. Format - What guidelines are set for the student's written work?
    For daily progress notes, consults and H&P, pre-determined template will be used.
  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.?
    Assigned cases and student selected topics with input from attending.
  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)?
    Attendance and participating in daily clinical activities.

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.

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.