PMCU-4019 - Undersea and Hyperbaric Medicine

PMCU-4019 - Undersea and Hyperbaric Medicine

Elective Title: Undersea and Hyperbaric Medicine
Course Number: PMCU-4019
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 3
Prerequisites: Successful completion of Year 2
Additional Requirements: C-form Required, Email Dr. Phi-Nga Le (
Responsible Faculty Director: Phi-Nga Jeannie Le, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Amber Anthony Other Faculty:
Location to Report on First Day:
UTMB Health Undersea and Hyperbaric Medicine Clinic - Bay Colony (1804 FM 646 West, N, League City, TX 77573)

Introduction to the field and practice of Undersea and Hyperbaric Medicine subspecialty. Exposure and/or participation in research when conducted. For career consideration of specializing in Undersea and Hyperbaric Medicine.

1. Understand the changes in physiology when in the high-pressure environment.
2. Learn the application of the basic Gas Laws in high pressure environment.
3. Discern the physics and basic mechanics of how the hyperbaric chamber is employed as treatment modality tool.
4. Learn Diving physiology.
5. Participate in the scientific, commercial, recreational, and public safety diver physicals with Dr. Le.
6. Observe diving medical advisory being provided to diving programs. Dr. Le is the Diving Medical Advisor for Moody Gardens Diving Program.
7. Learn the physiological and mechanistic effects of hyperbaric oxygen (HBO2). Apply HBO2 as a therapy in specific indications.
8. Select the appropriate patients with certain pathophysiology for hyperbaric oxygen therapy.
9. Participate in the hyperbaric oxygen treatments of patients with specific indications, such as delayed radiation effects (osteoradionecrosis, soft tissue radionecrosis), chronic refractory osteomyelitis, failed/threatened flaps and grafts, Idiopathic Sudden Sensorineural Hearing Loss, ischemia-reperfusion injury in acute arterial ischemia (such as in frostbite), decompression sickness.
10. Assess the relative risks, contraindications, and side effects of hyperbaric oxygen (HBO2).
11. Understand how complications and side effects of hyperbaric oxygen therapy are managed.
12. Assist in the daily HBO2 treatments of patients. (Students will NOT be permitted to operate the hyperbaric chambers.)
13. Participate in the Consultation of new patients who are consulted to Hyperbaric Medicine.
14. Know that Hyperbaric Oxygen Therapy is NOT a form of wound care.

Description of course activities
The students will take part in the care of patients and divers as a member of the care team. This is an opportunity for a student to learn this career path and is not meant for the student to take the workload from the faculty. It should be an educational and fun elective rotation.

Type of students who would benefit from the course
Any student who is interested in diving medicine, hyperbaric oxygen therapy to treat disease states, high pressure physiology, and pathophysiology of the disease states that HBO2 addresses.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8:30 6:30
Tuesday 8:30 6:30
Wednesday 8:30 6:30
Thursday 8:30 6:30
Friday 8:30 6:30
Saturday Emergency Cases Only (3 hours)

 Average number of patients seen per week: 20
 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?
    Daily, by Dr. Phi-Nga Jeannie Le and the hyperbaric staff. Observation of inpatient consultation occurs occasionally but is not guaranteed.
  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 & Hyperbaric staff
  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?
    H&Ps and daily treatment 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.?
    related to cases
  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)?
    The monthly Undersea and Hyperbaric Medicine Diving Cases Conference hosted by Duke University. Dr. Le also gives lectures to outside entities. Student will be able to attend these lectures when given.

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.