PMRU-4003 - Brain Injury at Moody Neurorehabilitation Institute

PMRU-4003 - Brain Injury at Moody Neurorehabilitation Institute

Elective Title: Brain Injury at Moody Neurorehabilitation Institute
Course Number: PMRU-4003
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: C-form required, send to Brian Sullivan at Successful completion of Neurology, Psychiatry & Internal Medicine Clerkships.
Responsible Faculty Director: Ana V. Durand-Sanchez, MD Periods Offered: 4, 9-12 excluding holiday period 8 
Coordinator: Brian Sullivan Other Faculty:
Location to Report on First Day:
1275 Space Park Dr., Nassau Bay, TX 77058

This elective will help students understand the importance of interprofessional care for people with Traumatic Brain Injury. Students will learn the importance of recovery and rehabilitation with aquatic therapy, assistive technology, cognitive rehabilitation, community integration, occupational therapy, neuropsychological services, physical therapy, speech/language therapy, therapeutic rehabilitation and rehabilitation nursing/direct care staff.

By the end of this course, students will be able to:

1. Explain the pathophysiology of traumatic brain injury, including how to apply Glascow Coma Scale with acute injury and typical signs and symptoms of mild, moderate, and severe injury.

2. Describe the goals of post-acute injury rehabilitation and the role of interdisciplinary care to achieve the most autonomous functioning.

3. Understand complex rehabilitative care delivery, including barriers to care.

Description of course activities
Students will spend their time primarily at the treatment program at Moody Neurorehabilitation Institute. They will learn from clients in the program, as well as their family and support people, about the impact of TBI and the process of recovery. They will work with treatment providers from various disciplines about goal setting and the therapy in that discipline, as well as rotating weekly (on Mondays and Thursdays) with Dr. Durand-Sanchez who is board-certified in PM&R and Brain Injury Medicine. They will get to work with the Neuropsychologist at least once during the rotation, in addition to the master and doctorate level neuro therapists who are on site each day.

Type of students who would benefit from the course
Particularly students interested in pursuing PM&R, Neurology, and Psychiatry. Any student who wants to learn more about inter-professional care.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:00 5:00
Tuesday 8:00 5:00
Wednesday 8:00 5:00
Thursday 8:00 5:00
Friday 8:00 5:00

 Average number of patients seen per week: 20+ at the main facility and 15+ at Encompass.
 Call Schedule: No

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?
    Inter-professional clinicians, including Dr. Durand-Sanchez
  B. Frequency / Duration of Presentation(s)?
    At least a weekly topic discussion plus an end of course presentation.
  C. Format - What guidelines are set for the student's presentation?
    Students will discuss orally with providers what they have learned about TBI and various forms of therapy.
  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)?
    Weekly patient note
  B. Format - What guidelines are set for the student's written work?
  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.?
    Dr. Durand-Sanchez will assign
  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)?
    Students will be provided a reading list to explore mechanism and trajectory of Traumatic Brain Injury. Students will follow at least the same three patients daily through the rotation. Students may visit the inpatient residential unit.

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.