MEDU-4058 - Palliative Care

MEDU-4058 - Palliative Care

Elective Title: Palliative Care
Course Number: MEDU-4058
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Jose Mendoza, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Other Faculty: Rebecca V. Burke, MD
Location to Report on First Day:
John Sealy Annex, 4.160; (409) 772-4610; Kayla Shamburger (

This elective is designed to expose medical students to the specialty of Hospice and Palliative Care. Students will be introduced to the skills and knowledge needed to provide quality end-of-life care, advanced care planning, and symptom management to patients with advanced illnesses.

1. Learn techniques to facilitate difficult conversations with patients and their families. 2. Recognize physicians leadership role in initiating discussion of end-of-life topics early in the course of a serious disease 3. Assess pain and symptoms adequately and suggest appropriate symptom management treatment recommendations 4. Develop an appreciation for the prevalence of cross-cultural encounters and common barriers that arise in end-of-life issues 5. Demonstrate the skills necessary to recognize the need for de-escalation of care, code status designation, and care withdrawal in a compassionate manner 6. Familiarize themselves with the roles and responsibilities of each member of the Interdisciplinary Care Team

Description of course activities
Students will be involved in the assessment of hospitalized patients with a broad mix of advanced medical illnesses, specifically focused on pain and non-pain symptom management, complex medical decision making, advanced care planning, and end-of-life discussion and care. Patients will be seen both in the inpatient setting (including ICU, non-ICU, GIP), as well as outpatient clinic setting. The faculty and IDT staff will educate students on core topics in Palliative Medicine, with periodic informal topic presentations by the students.

Type of students who would benefit from the course
All medical students contemplating a career involving direct patient care.

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

 Average number of patients seen per week: 10-15
 Call Schedule: N/A

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?
  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?
    Attending, NPs, SW, Chaplain, other learners (e.g. fellows, residents, students)
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Patient Presentations on rounds; Occasional informal presentations of various topics related to Palliative Medicine
  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 notes written for patients assigned to student, including consult notes, H&Ps, and progress notes (~1-3 per day). One case report to be completed by the end of the course
  B. Format - What guidelines are set for the student's written work?
    Notes to be completed using the Palliative Care note template in Epic
  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?
    Yes, Via PubMed and Up to Date
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Selected from patients seen on the consult service
  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)?
    Lecture attendance, IDT meetings, Journal Club, Self-care sessions, Self-reflection

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.
    Surveyed feedback from IDT team and other preceptors

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.