FAMU-4001 - Acting Internship in Family Medicine

FAMU-4001 - Acting Internship in Family Medicine

Elective Title: Acting Internship in Family Medicine
Course Number: FAMU-4001
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 3
Prerequisites: Successful completion of Year 3
Additional Requirements: Course Coordinator: Chris Pleasant (chpleasa@utmb.edu) or Jessica Prescott (jlpresco@utmb.edu)
Responsible Faculty Director: Juliet McKee, MD Periods Offered: 1-13 excluding holiday period 8 
Coordinator: Jessica Prescott & Christopher Pleasant Other Faculty:
Location to Report on First Day:
Refer to the schedule that will be sent to you via email the week before the rotation begins.

Goals
1. Enhance student competencies in diagnosing and managing routine and complicated problems of patients in the inpatient settings. 2. Understand the role of the family physician in coordinating consultants and community health resources. 3. Develop a basic understanding of family dynamics and family-centered care, particularly in relation to complex and difficult patient problems. 4. Recognize the importance of the interdisciplinary approach to patient care. 5. Function fully as an intern on the hospital service.

Objectives
1. Evaluate and propose management plans for problems of Family Medicine patients in both inpatient and outpatient settings. 2. Provide daily comprehensive hospital management of patients, under the supervision of the supervising resident and Family Medicine faculty. 3. Integrate appropriate screening and interventions in all age groups of patients. 4. Identify and discuss common barriers/social determinants of health leading to patient compliance or non-compliance. 5. Identify medical, family, and community resources to assist in the care of patients.

Description of course activities
The Acting Intern (AI) will have the opportunity to gain experience as a Family Medicine intern in the hospital setting. While on the inpatient service the AI will undertake primary responsibility for patients assigned to his/her care under the supervision of the upper level resident and/or attending faculty. The Acting Intern (AI) will follow discharged patients in an outpatient setting to access follow-up care. Students enrolled in the AI will have 3 weeks of inpatient service and 1-week of outpatient experiences.

Type of students who would benefit from the course
This course is particularly valuable to students interested in Family Medicine or those students interested in the practice of comprehensive care in a primary care setting.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 7-12 (inpatient) 1-5 patient rounds
Tuesday 7-12 (inpatient) 1-5 patient rounds
Wednesday 7-12 (inpatient) 1-5 patient rounds
Thursday 7-12 (inpatient) 1-5 patient rounds
Friday 7-12 (inpatient) 1-5 patient rounds
Saturday OFF
Sunday OFF

 Average number of patients seen per week: 7-10
 Call Schedule: Scheduled twice while on inpatient service

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other (estimated schedule) Students enrolled in the AI will have 3 weeks of inpatient service and 1-week of outpatient experiences. The outpatient experiences will vary based on faculty availability and will be geared toward students experiencing some of the unique aspects of our department.


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 - Students are observes on the inpatient service and on 1-week of outpatient experiences.
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Family Medicine supervising faculty or resident
  B. Frequency / Duration of Presentation(s)?
    Daily; duration will vary based on complexity of patient
  C. Format - What guidelines are set for the student's presentation?
    AI should follow the Oral Case Presentation guidelines from the Assistant Dean of Educational Affairs
  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
  B. Format - What guidelines are set for the student's written work?
    History and physical exam reports, inpatient progress notes, clinic SOAP 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?
    No, but AI is expected to use current resources
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
   
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

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)?
    Prepare and make presentations to attending faculty and residents; preparation includes researching recent journal articles related to the topics. Ask thoughtful questions and contribute to discussions. Complete, by the end of the course, the assigned on-line modules from Environmental Health: An Integrative Approach, from The University of Arizona. Attend weekly resident Didactics.

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".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Individual critique and feedback on patient interactions, case presentations, special topics presentations, and review of medical record documentation. AI is graded on clinical performance, including professionalism, and on successful completion of the online IMR modules. An end-of-rotation evaluation form will be completed by the lead faculty.

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.
    Students receive on-going formal feedback throughout the elective from the attending the student is working with. At the end of the elective, the student receives a summative evaluation.
 
B.
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.
    History taking and physical exam skills
Interpretation of results and imaging
Management of routine and complex medical conditions in the hospitalized patient
Management of both acute and chronic conditions in the hospitalized patient
Admissions and Discharges
Placing orders
Communication and coordination with other clinical services (pharmacy, care management, nursing, PT/OT, etc.)
Communication and coordination with other specialties
Performance of some inpatient procedures
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Interpretation of results and imaging
Management of routine and complex medical conditions in the hospitalized patient
Management of both acute and chronic conditions in the hospitalized patient
Admissions and Discharges
Placing orders
Communication and coordination with other clinical services (pharmacy, care management, nursing, PT/OT, etc.)
Communication and coordination with other specialties.
Performance of some inpatient procedures
 
D.
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)?
    The AI will be assigned patients to follow by the supervising resident. The AI will be responsible for the patient from admission to discharge. The AI is expected to see the patient everyday, generate an assessment plan, place orders, write a progress note, and follow up/interpret on all test results and procedures. The AI is responsible for communicating with consulted services in regards to their patient and evaluating their recommendations. The AI will also be involved in the discharge planning for their patient and necessary follow up items. There will be opportunities for I&D, paracentesis, pulling lines or joining/observing procedures performed by other specialties. Upon the AI's initiative, a case report can be written for a patient that the AI was primary for. Students enrolled in the AI will also have 1-week of outpatient experiences. The outpatient experiences will vary based on faculty availability and will be geared toward students experiencing some of the unique aspects of our department. Responsibilities and tasks will be determined by the assigned preceptor.
 
E.
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?
    The course will help the student experience the work load and level of knowledge required for an intern in this field. It will also give the student a chance to answer any questions or concerns he/she has in regards to the field of training.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Midpoint evaluation will be provided by the attending physician after the first 2 weeks of the course. the student and the attending physician will discuss any deficiencies and formulate a plan to remediate them at this meeting.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    The student will have the opportunity to work with 6-10 faculty members during the course. The student will work 1-14 days with each faculty member. Attending faculty provides complete one on one supervision to all the students taking the course throughout the course. Students will work with different residents depending on schedules and availability. Deficiency remediation will be achieved as a collaboration between the attending faculty and the student with appropriate evaluation and goal setting.
 
H.
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.
    AIs will be under direct supervision of faculty during rounds and clinical activities with some supervision by senior residents only (PGY-2, PGY-3). At least 50% of the day is directly observed by attending faculty with the remainder being observed by the supervising resident who will also provide feedback to the attending faculty. It is recommended that an AI make their intention for a LOR known at the beginning of the rotation so the faculty may ensure that they observe enough skills and have enough time spent with the AI to appropriately write a strong LOR.