OBGU-4033 - Interpersonal Violence: Practices to Help Patients Improve Health Outcomes

OBGU-4033 - Interpersonal Violence: Practices to Help Patients Improve Health Outcomes

Elective Title: Interpersonal Violence: Practices to Help Patients Improve Health Outcomes
Course Number: OBGU-4033
Elective Type: career Duration/Weeks: 1 Max Enrollment: 30
Prerequisites: Successful completion of Year 2
Additional Requirements: C-form Required. Please contact Brandie Denton @bldenton@utmb.edu
Responsible Faculty Director: Leila Wood, MD Periods Offered: 1A or 1B excluding holiday period 8 
Coordinator: Other Faculty: Jeff Temple, MD
Location to Report on First Day:
Classroom

Goals
Medical doctors, nurses, and other healthcare professionals are a critical lifeline to survivors of interpersonal violence, including domestic violence and sexual assault. The CDC estimates that 1 in 3 women and 1 in 10 men experience domestic violence and 1 in 5 women experience sexual assault in their lifetime. Interpersonal violence has significant health consequences, from immediate injury to chronic pain, diabetes, and poor mental health outcomes. Many violence survivors will present in medical settings for care, but may not disclose experiences of violence, limiting effective care options. This course is designed to prepare future physicians with the knowledge base for effective screening and intervention to help survivors of domestic violence and sexual assault, and ultimately promote improved health outcomes. This course will provide students with a foundational understanding of the causes, correlates, prevalence and impact of domestic violence and sexual assault, with a particular focus on adult populations. Students will explore trauma-informed interpersonal violence prevention and intervention models relevant to physicians, such as brief screening and assessment models to use in clinical practice to determine if abuse has occurred. Students will learn and apply patient education that goes beyond screening approaches to more effectively support patients who have experienced domestic violence and sexual assault. Referral and follow-up methods that support improving safety and health outcomes will be presented and applied. Evidence-based models for physicians and other health-care professionals will be presented that can be applied to future clinical cases. The goals of this course are to: 1) Engage future physicians with information about the causes, correlates, prevalence, and health impacts of domestic violence and sexual assault that will translate to clinical practice; 2) Disseminate and practice universal educational approaches to use in clinical practice; 3) Prepare medical students to effectively provide trauma-informed support to interpersonal violence survivors in clinical settings.

Objectives
1. Engage future physicians with information about the causes, correlates, prevalence, and health impacts of domestic violence and sexual assault in order to identify cases in clinical practice.
2. Increase understanding of impact of interpersonal violence on at-risk and diverse populations.
3. Disseminate and practice universal educational approaches to use in clinical practice.
4. Prepare medical students to effectively provide trauma-informed support to diverse interpersonal violence survivors in clinical settings.

Description of course activities
1. Brief daily readings
2. Brief daily lecture (in class)
3. Guest speakers from area domestic violence and sexual assault programs (in class)
4. Small group application of skills from lecture and readings (in class)
5. In-class simulation
6. Presentation in class
7. Case application (homework)
8. Safety planning (assignment)

Students will be in clinic for about 16 hours, 11 hours of self-directed time, & 3 hours of other (site visit) to make up 30 hours for the week.

Type of students who would benefit from the course
Students entering any field of medicine would benefit from this course, but students considering careers in emergency medicine, OB/GYN, physical therapy, and community/general practice may particularly benefit.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 9:00 5:00
Tuesday 9:00 1:00
Wednesday 9:00 1:00
Thursday
Friday
Saturday
Sunday

 Average number of patients seen per week: 0
 Call Schedule: N/A

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other


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
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    peers and faculty
  B. Frequency / Duration of Presentation(s)?
    once
  C. Format - What guidelines are set for the student's presentation?
    Students will present on a specific skill learned in the class to detect, screen, assess, provide education, or and how they would present in.
  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)?
    Twice- A safety planning assignment and a case application.
  B. Format - What guidelines are set for the student's written work?
    Students will present on a specific skill learned in the class to detect, screen, assess, provide education, or and how they would present in.
  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
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Related to composite cases of patients experiencing interpersonal violence and presenting in medical settings.
  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)?
   

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.
   

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.
   
 
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.
   
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
   
 
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)?
   
 
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?
   
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
 
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.