PATU-4023 - Forensic Pathology Ambulatory Community Elective

PATU-4023 - Forensic Pathology Ambulatory Community Elective

Elective Title: Forensic Pathology Ambulatory Community Elective
Course Number: PATU-4023
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: N/A
Responsible Faculty Director: Erin Barnhart, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Tracy Wilkins Other Faculty: Monica Patel, MD, Judtih Aronson, MD
Location to Report on First Day:
GCME (Galveston County Medical Examiner's Office, 1205 Oak St. La Marque, TX 77568

(1) To revisit basic concepts of general pathology and morphologic manifestations of disease and trauma on the human body. To review basic general pathology of all major organ systems. (2) To introduce students to the role of the Medical Examiner in documenting and monitoring threats to public health, such as toxic exposures, industrial and other workplace accidents, product failures, infectious diseases and illegal drug abuse. (3) To familiarize students with members of forensic medicine teams and their roles in determining cause and manner of death. (4). To acquaint students with the Medical Examiner system and interactions of the Medical Examiner's Office with legal, justice, and public health systems.

1. Medical Knowledge and Skills Objective: (1) Review and assess the circumstances of death (2) Participate in forensic examination (autopsy) of the deceased. (3) Recognize and interpret the pathologic findings associated with common natural diseases and traumatic or toxic injuries. (4) Communicate with families, physicians, government officals, and members of the criminal justice system concerning autopsy findings. (5) Understand and participate in the coordination of additional examinations from other forensic specialties (6) Identify the cause and manner of death for individual cases 2. Career Development objective: Describe ways in which physicians may be required to interact with forensic pathologists. 3. Advocacy Objective: (1) Describe the role the forensic pathologist plays in monitoring various threats to public health. (2) Observe communication skills needed for compassionate interactions with bereaved families. 4. Health Care Systems/Practice Management Objective: (1) Understand and describe the organization and coordination of death investigations in Texas and the U.S. (2) Describe interactions between the Medical Examiner's Office and local health departments, law enforcement, and social services organizations. (3) Explain how medical examiner's offices are funded. 5. Service Learning Objective: N/A 6. CAM Objective: N/A 7. Other Objectives: N/A

Description of course activities
Students will observe and participate in forensic autopsies, visit scenes of death, and accompany pathologists to court to observe testimony and pre-trial conferences. If available during the selective period, students will attend various county/community meetings, such a Child Death Review Team meetings. Students will engage in independent study of forensic pathology, prompted by cases observed during the elective. Students will spend approximately 2 hours per week in informal discussion about cases and forensic pathology concepts with the Chief ME or Deputy ME. As case load can vary unpredictably on any given day, a reading list and applicable textbooks will be provided for self-guided study opportunities.

Type of students who would benefit from the course
Any students interested in pathology, gross anatomy, occupational or environmental medicine, or legal medicine. Students with an interest in other disciplines/specialties may benefit from an enhanced understanding of forensic pathology as well.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:15 4:30
Tuesday 8:15 4:30
Wednesday 8:15 4:30
Thursday 8:15 4:30
Friday 8:15 4:30

 Average number of patients seen per week: 10-15
 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?
    Daily during autopsies
  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?
    One oral presentations will be made to GCME staff.
  B. Frequency / Duration of Presentation(s)?
    One oral presentations will be required during the selective. This should be a 30-45 minute power point presentation of a forensic pathology topic chosen by the student with faculty approval
  C. Format - What guidelines are set for the student's presentation?
    Relevant forensic pathology
  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)?
    Daily assistance with case documentation and evidence collection.
  B. Format - What guidelines are set for the student's written work?
    One written assignments is required; (1) Students will be responsible for one autopsy case write up. Details are found in the syllabus and a template will be provided by the supervising pathologist. (2) Students will also submit a one page report describing the role of individuals at a death investigation, and the role of members of the forensic sciences team encountered during the selective.
  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.?
    student selected with mentor approval
  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)?
    For a grade of satisfactory, students must show an acceptable level of performance on required assignments and participate in autopsy functions and other related activities as assigned. Students must also demonstrate appropriate professional behavior.

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.
    up to the mentor

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.