Doctor of Medicine: Clinical Applications Fourth-year Required Courses

ANES 9210 Anesthesia Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

ANES 9220 Selected Topics in Anesthesiology
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

ANES 9410 Anesthesiology
Credits:
2,4
Directors:
George, Uggeri
Grading:
Pass/Fail
Description:

This is a comprehensive overview of anesthesia to include pre-, intra- and post-operative care and evaluation of surgical patients. Students will spend equal time in the pre-operative evaluation area; providing anesthesia during a case; and also post-operative evaluation. Student will develop familiarity with intubation techniques, the difficult airway, operative monitoring, regional anesthesia, and risk stratification.

Offered:  All weeks

Objectives:

Upon completion of this course, each student will be able to:

  • Describe the role and duties of an anesthesiologist.
  • Discuss the pharmacology of common anesthetic agents.
  • Manage the airway of an uncomplicated, unconscious apneic patient.
  • Describe the risks and benefits of regional, general and sedation anesthesia.
  • Understand and recognize the challenges in anesthetizing patients with difficult airways or other pre-existing conditions.
  • Preform a directed pre-anesthetic medical history and exam.
ANES 9420 Pain Management
Credits:
2
Directors:
Chafty
Grading:
Pass/Fail
Description:

Pain is prevalent in treatment of patients. The students will receive primarily acute pain management training while doing their anesthesia elective in the hospital. The pain management program is in an outpatient program done through the Kalamazoo Anesthesiology Pain Consultants. The student will be part of a team that includes physicians, physician's assistants, psychologists, nurses, occupational therapists, and physical therapists. There may be the occasional inpatient pain consult that the student will attend with the physician, but the vast majority of the training is done in an outpatient pain center and primarily deal with chronic, nonmalignant pain. By the end, the student should understand some common chronic pain issues and develop a considerate and thoughtful approach to management of these pain problems.

Offered: Only open to one student per block. Prior approval required.

Objectives:
  • Obtain an accurate and comprehensive history from the patient.
  • Perform a rational and thorough physical examination.
  • Try to focus as appropriate the history and physical to the patient's active pain issue.
  • Use the information gathered from the history and physical, as well as appropriate radiologic studies and labs, to create a problem list.
  • Try to generate a differential diagnosis from the active problem list.
  • Begin to develop a plan based on the problem list.
  • Present that problem list and differential diagnosis to the pain team.
  • Integrate learning based upon reading and experiences in the pain clinic to broaden the student's understanding of chronic pain management.
  • Begin to learn some block techniques that the student will apply as a resident and physician.
  • Understand the use of the multi-disciplinary approach to pain management.
AWAY 9110 Away elective at a non-LCME-accredited site
Credits:
2,3,4,5,6,7,8
Directors:
Gibson
Grading:
Pass/Fail
Description:

Medical student participation in electives for credit away from the medical school is a privilege that is optional and not required for advancement or graduation. Students in Foundations of Medicine may not register for an elective away from the medical school if they have failed the initial summative examination in a course during the current or previous term.

The prefix abbreviation “AWAY” designates a curriculum elective for credit with content approved by the medical school even though the medical school faculty do not directly deliver the curriculum and supervise the students. Different numbers are used for away electives in Foundations of Medicine and Clinical Applications, and for away electives at a Non-LCME accredited site and at a LCME accredited site:

AWAY 7110     Away elective at a non-LCME-accredited site (taken after completing four Foundations of Medicine electives but prior to completing the first third-year clerkship)

AWAY 7120     Away elective at an LCME-accredited site (taken after completing four Foundations of Medicine electives but prior to completing the first third-year clerkship)

AWAY 9110     Away elective at a non-LCME-accredited site (taken after completing the first third-year clerkship)

AWAY 9120     Away elective at an LCME accredited site (taken after completing the first third-year clerkship)

Medical school approval is required of all medical student curriculum experiences away from the medical school to assess the awarding of academic credit, assure that it does not adversely affect the student’s academic progress, and address concerns of student safety, risk, liability, and potential impact on the financial aid status of the student. Electives that are away are graded as Pass/Fail.

A maximum of one of the four required one-week electives in Foundations of Medicine designated by the prefix, AWAY) may be performed at a site that is not affiliated with the medical school and for which the medical school faculty do not directly deliver the curriculum and supervise the students, with prior approval of the associate dean for Educational Affairs.

A maximum of 12 weeks of fourth-year elective clerkships or experiences (designated by the prefix, AWAY) may be performed at sites that are not affiliated with the medical school and for which the medical school faculty do not directly deliver the curriculum and supervise the students (eg, approved electives at other LCME-accredited medical schools), including a maximum of 6 weeks at non-LCME-accredited sites, with prior approval of the associate dean for Educational Affairs.

 

Objectives:

You will be required to identify four self-directed learning objectives. Upon completion of this elective, you will be asked to reflect on the following two questions:

  1. How did you identify, analyze, and synthesize relevant information to achieve your two objectives?
  2. How did you appraise the credibility of your information sources?

 

AWAY 9120 Away elective at an LCME-accredited site
Credits:
2,3,4,5,6,7,8
Directors:
Gibson
Description:

Medical student participation in electives for credit away from the medical school is a privilege that is optional and not required for advancement or graduation. Students in Foundations of Medicine may not register for an elective away from the medical school if they have failed the initial summative examination in a course during the current or previous term.

The prefix abbreviation “AWAY” designates a curriculum elective for credit with content approved by the medical school even though the medical school faculty do not directly deliver the curriculum and supervise the students. Different numbers are used for away electives in Foundations of Medicine and Clinical Applications, and for away electives at a Non-LCME accredited site and at a LCME accredited site:

AWAY 7110     Away elective at a non-LCME-accredited site (taken after completing four Foundations of Medicine electives but prior to completing the first third-year clerkship)

AWAY 7120     Away elective at an LCME-accredited site (taken after completing four Foundations of Medicine electives but prior to completing the first third-year clerkship)

AWAY 9110     Away elective at a non-LCME-accredited site (taken after completing the first third-year clerkship)

AWAY 9120     Away elective at an LCME accredited site (taken after completing the first third-year clerkship)

Medical school approval is required of all medical student curriculum experiences away from the medical school to assess the awarding of academic credit, assure that it does not adversely affect the student’s academic progress, and address concerns of student safety, risk, liability, and potential impact on the financial aid status of the student. Electives that are away are graded as Pass/Fail.

A maximum of one of the four required one-week electives in Foundations of Medicine designated by the prefix, AWAY) may be performed at a site that is not affiliated with the medical school and for which the medical school faculty do not directly deliver the curriculum and supervise the students, with prior approval of the associate dean for Educational Affairs.

A maximum of 12 weeks of fourth-year elective clerkships or experiences (designated by the prefix, AWAY) may be performed at sites that are not affiliated with the medical school and for which the medical school faculty do not directly deliver the curriculum and supervise the students (eg, approved electives at other LCME-accredited medical schools), including a maximum of 6 weeks at non-LCME-accredited sites, with prior approval of the associate dean for Educational Affairs.

 

Objectives:

You will be required to identify four self-directed learning objectives. Upon completion of this elective, you will be asked to reflect on the following two questions:

  1. How did you identify, analyze, and synthesize relevant information to achieve your two objectives?
  2. How did you appraise the credibility of your information sources?
BINF 9210 Biomedical Informatics Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

BINF 9220 Selected Topics in Biomedical Informatics
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

BIOM 9210 Biomedical Sciences Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

BIOM 9220 Selected Topics in Biomedical Sciences
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

BIOM 9220 Selected Topics in Biomedical Sciences - Section 2 Expanding WikiProject Medicine
Credits:
4
Directors:
Joe Costello
Grading:
Pass/Fail
Description:

Students will contribute to the Wikipedia based WikiProject Medicine by selecting and enhancing one currently existing medical Wikipedia article using peer-reviewed medical evidence. This project is designed to improve the clinically-relevant and therapeutic information available on Wikipedia.  This elective will reinforce longitudinal strategies for locating and evaluating source material quality coupled with critical appraisal skills taught in the evidence-based medicine thread of the Professions of Medicine.  Students will gain a further understanding of the ways information from sources like Wikipedia influences their patients. Their involvement in WikiProject Medicine will contribute to the ongoing conversation surrounding available electronic medical information as well as improve the quality of information available through WikiProject Medicine.  The student can be offsite to complete the elective. However, the medical librarians will provide intermittent correspondence via e-mail, hold weekly office hours, and schedule consultation as needed.

The course will be designed, delivered, and evaluated in partnership with clinical faculty (employed, community and emeritus) and the WMed and hospital medical librarians.

Offered: June 2018 - May 2019 10 students max

Objectives:
  • Evaluate medical information written for consumers for readability and bias
  • Create and revise written medical information at a consumer reading level while maintaining accuracy
  • Analyze the role freely available online medical information plays in the decision making of consumers
  • Apply techniques to locate, synthesize, and cite high-level secondary sources of medical information
EMER 9210 Emergency Medicine Research
Credits:
4,5,6,7,8
Directors:
Overton
Grading:
Pass/Fail
Description:

This elective focuses on the planning, development, and/or execution of a research project as a means of understanding the entire research process in depth. The course stresses the integration of research into medical practice. Appropriate readings and periodic discussions will be used to augment the guided project development effort. The ultimate goal of this elective is to complete and publish one paper in a peer-reviewed journal, or present the student’s work in an appropriate research forum.

Students also attend all regular weekly Emergency Medicine resident and student conferences during the elective. Students’ duty schedules are adjusted to accommodate these educational sessions.

Offered:  Must have 3 month notice.

Objectives:
  • Search the research literature efficiently.
  • Use the literature to frame a research project.
  • Describe the process of experimental design.
  • Recognize the importance of research design in the success of a project.
  • Determine appropriate statistical analysis techniques for the most widely used experimental designs.
  • Plan a research project from concept development through data analysis and report writing.
  • Execute a research project from concept development through data analysis and report writing.
  • Describe the complexities of cost-benefits in research.
  • Describe the complexities of ethical issues in research.
  • Produces a peer-reviewed quality paper following appropriate research methodology.
EMER 9220 Selected Topics in Emergency Medicine
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

EMER 9410 Emergency Medical Services
Credits:
2,4
Directors:
Mastenbrook
Grading:
Pass/Fail
Description:

This elective offers students the opportunity to learn about and experience pre-hospital and disaster medicine through a series of structured didactic sessions and hands-on field experiences. This elective is made possible by several partnerships: WMed Department of Emergency Medicine Division of EMS, Kalamazoo County Medical Control Authority, Kalamazoo Department of Public Safety, Oshtemo Township Fire Department, Kalamazoo County 911 Dispatch, Life EMS, and PrideCare.

EMS is a relatively new specialty in the house of medicine, becoming an ABEM Boarded subspecialty in September 2010 with the first certification exam being administered in 2013. The Kalamazoo County EMS system is a high-performance single tier ALS system with countywide BLS first responders. Serving a population of a quarter million, the EMS system is made up of four ambulance services covering designated areas of the county and sixteen first responder agencies – fire departments and public safety.

The four-week curriculum is broken into 4 topic blocks, including history of ems, introduction to medical direction and system design, quality improvement and finance, and special ops. The NAEMSP textbook and online FEMA resources will be utilized. Students will ride along with our physician-staffed medical support unit twice a week, spend a day with a fire department/public safety agency, and observe emergency call taking and dispatching at a 911 and ems dispatch center. Additionally, students will participate in monthly local and regional meetings, weekly fellow didactics and emergency medicine grand rounds, monthly SIM lab, and monthly EMS case review. The course concludes with a written exam based on the 4 topic blocks and a written course evaluation. The course readings, exam, and evaluation will be available through an online learning platform, Moodle. Students may work ahead on assignments. Course faculty include WMed EMS Fellowship faculty/fellows and WMed EM senior residents.

Offered:  October-January 2019 - end of June

Objectives:
  • Discuss key historical events and legislation in the development of the modern US EMS system
  • Describe a difference between the American and Franco-German model of ems delivery
  • Discuss key features of six different EMS agency design types
  • Provide examples of direct and indirect medical direction
  • Describe three different ambulance deployment strategies
  • Define PSAP, EMD, Primary/Secondary/Tertiary caller
  • Discuss the differences among certification, licensing, and credentialing
  • List several examples of high risk ems calls
  • Discuss the purpose of quality improvement and give an example of how a fishbone diagram can be used in QI
  • Describe several components of an ems agency budget
  • Calculate unit hour utilization
  • Define the terms Disaster and MCI
  • Draw and label a basic ICS diagram: command and section chiefs
  • Describe and utilize SALT triage
  • Discuss several considerations for mass gatherings
EMER 9610 Advanced Emergency Medicine
Credits:
2,4
Directors:
R. Kothari
Grading:
Honors/Pass/Fail
Description:

Advanced Emergency Medicine Selective provides experiences with a diverse set of patients spanning all ages and experiencing many pathological conditions that present to the emergency department. Students are expected to perform the initial patient assessment, formulate a differential diagnosis and problem list, present the patient to a senior resident or attending physician, write orders, interpret diagnostic studies, discuss patients with consultants, perform or assist with procedures under supervision, write discharge instructions, and facilitate admissions and transfers.

Offered:  Not offered in July

Objectives:
  • Obtain a medical history and perform a physical examination appropriate to the patient’s presentation.
  • Develop a thorough differential diagnosis based on the patients’ complaint, and the history & physical exam.
  • Develop an appropriate management plan to evaluate & treat the patient’s condition.
FMED 9210 Family and Community Medicine Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

FMED 9220 Selected Topics in Family and Community Medicine
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

FMED 9420 Sports Medicine
Credits:
2,4
Directors:
Baker
Grading:
Pass/Fail
Description:

“Sports Medicine is a body of knowledge and broad area of health care which includes (1) exercise as an essential component of health throughout life, (2) medical management and supervision of recreational and competitive athletes and all other who exercise, and (3) exercise for the prevention and treatment of disease”. 

A physician with significant specialized training in both the treatment and prevention of illness and injury, the Sports Medicine Specialist helps patients maximize function and minimize disability and time away from sports, work, or school and is a leader of the Sports Medicine team, which also may include specialty physicians and surgeons, athletic trainers, physical therapists, coaches, other personnel, and the athlete. Students have the opportunity to see patients in the outpatient setting as well as accompany attending and fellow during training room visits. Students will be expected to attend sporting events and write up appropriate cases with the assistance of the attending.

Offered:  Not offered February thru August

Objectives:
  • Identify a chief complaint for any patient presenting to the Sports Medicine Clinic
  • Obtain an adequate history and physical exam for common Sports Medicine complaints
  • Synthesize history, physical exam findings and other patient data to complete an assessment of the Athlete’s condition in a variety of sports medicine settings (ie. Office, training room, sidelines, ultrasound suite, etc.)
  • Propose a plan for each problem identified in the visit
  • Present patients with common Sports Medicine conditions in a complete and concise manner, including the assessment and plan
  • Integrate evidence-based medicine and preventive care into the Sports Medicine visit
  • Be familiar with the examination of major joints in sports related injuries
  • Be familiar with the approach to the management of the most common sports related injuries
  • Gain exposure to the role/use of exercise and modalities physical therapy in the management of sports related injuries
  • Be familiar with prevention of athletic injuries
  • Be aware of medical issues related to mass participation in sports
FMED 9710 Advanced Hospital Family Medicine
Credits:
2,4
Directors:
VanDerKolk
Grading:
Pass/Fail
Description:

Advanced hospital clerkships provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

Advanced Hospital Family Medicine is an opportunity for students to participate in a busy, family medicine oriented, academic inpatient service at Bronson Methodist Hospital. Students will act as a sub-intern on the Family Medicine Service (FMS), comprised of and supervised by residents and attendings from the Department of Family and Community Medicine.

Participants will have the opportunity to work both days and nights on the service. While on days, students can expect to be responsible for the review, evaluation and management of 1-2 admitted patients under direct supervision. They will participate in regular daily rounds, presenting each patient under their care to the attending physician with their plan for the day. Students will be expected to present regularly on medical topics pertinent to the patients under their care. On nights, students will review and evaluate admitted patients and have the opportunity to admit patients from the emergency department.

This course can be taken as a required clerkship or an elective.

Offered:  All weeks

Objectives:
  • Identify patients requiring hospitalization for management of their conditions.
  • Obtain a complete History and Physical for a patient being admitted to the hospital.
  • Synthesize information from various sources to develop an assessment of the patient’s condition, culminating in a complete problem list with differential diagnoses.
  • Propose an initial management plan for each of the patients’ diagnoses.
  • Document adequately and completely the history, physical, and assessment and plan for the hospitalized patient.
  • Describe the presentation and initial management of several common inpatient conditions including COPD exacerbations, cellulitis, pancreatitis and others.

Advanced Clerkship Goals:

  1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
  2. Demonstrate patient-centered interview skills
  3. Demonstrate patient-centered examination techniques.
  4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
  5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
  6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
  7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
  8. Articulate the risks and benefits of what you are ordering (e.g., drugs, tests).
  9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
  10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
  11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
  12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
  13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
  14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
  15. Provide key aspects of the ideal handover to the recipient, including verbalizing the patient's illness severity and/or providing action planning and/or contingency planning.
  16. Demonstrates awareness of known threats to handover communication (e.g., interruptions and distractions) by paying attention to the timing and location of the handover communication.
  17. Acts as an active and integrate member of the team who in most situations prioritizes team goals over one's own professional goals.
  18. Understands the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
  19. Interpret common test results to anticipate and respond to early clinical deterioration.
  20. Adhere to institutional procedures and protocols regarding escalation of patient care.
  21. Understand the importance of informed consent to rapport building and shared decision making.
  22. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
  23. Demonstrate patient-centered skills in performing procedures:
    • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
    • Participate in shared decision making with patients about procedures
    • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
    • Simultaneously pay attention to both the procedure and the patient's emotional response.
  24. Identify real potential errors.
  25. Perform common safety behaviors (e.g., universal precautions, hand washing).
  26. Understand the importance of error prevention both to individual patients and to systems.
FMED 9720 Advanced Ambulatory Family Medicine
Credits:
2,4
Directors:
VanDerKolk
Grading:
Pass/Fail
Description:

Advanced ambulatory clerkships provide the opportunity for students to assume initial responsibility for the evaluation of patients in the ambulatory setting. Supervision will be provided by faculty preceptors in the academic setting as well as community private practices. Students expand upon competencies they developed during the third year as they team with residents and/or preceptors to provide preventive health services as well as acute and chronic illness management. The faster pace of ambulatory care provides an environment that strengthens patient and family communication skills, rapport development, and oral presentations. The use of evidence to inform treatment and counseling of patients and their caregivers are additional competencies that are highlighted in the outpatient setting.

Advanced Ambulatory Family Medicine is an opportunity for students to participate in a busy, resident-based family medicine outpatient clinic at the Family Health Center, a Federally Qualified Health Center. Students will act as entry level residents with direct supervision by senior Family and Community Medicine residents or attending physicians. Participants will perform the initial evaluation of patients, review patient records, and assimilate the information they have gathered into a complete assessment of the patient’s presenting problems. Finally, students will be expected to develop a plan for each problem identified.  Patients will be regularly presented to supervising physicians to finalize plans and follow-up. This course can be taken as a required ambulatory clerkship or an elective.

Offered:  All weeks

Objectives:
  • Identify a chief complaint for any patient presenting to the office.
  • Obtain an adequate history and physical exam for common outpatient complaints.
  • Synthesize history, physical exam findings and other patient data to complete an assessment of the patient’s condition.
  • Propose a plan for each problem identified in the visit.
  • Present patients with common outpatient conditions in a complete and concise manner, including the assessment and plan.
  • Integrate evidence-based medicine and preventive care into acute outpatient visits.
  • Begin to reconcile differences between preventive care guidelines from various organizations.

Advanced Clerkship Goals:

  1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
  2. Demonstrate patient-centered interview skills.
  3. Demonstrate patient-centered examination techniques.
  4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
  5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
  6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
  7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
  8. Articulate the risks and benefits of what you are ordering (e.g., drugs tests).
  9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
  10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
  11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
  12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
  13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
  14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
  15. Act as an active and integrated member of the team who in most situations prioritizes team goals over one's own professional goals.
  16. understand the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
  17. Maintains a professional demeanor in all but the most trying of circumstances.
  18. Interpret common test results to anticipate and respond to early clinical deterioration.
  19. Understand the importance of informed consent to rapport building and shared decision making.
  20. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
  21. Provides complete information to patients and families.
  22. Avoids medical jargon in communicating with patients and families.
  23. Demonstrate patient-centered skills in performing procedures:
    • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
    • Participate in shared decision making with patients about procedures.
    • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
    • Simultaneously pay attention to both the procedure and the patient's emotional response.
  24. Identify real and potential errors.
  25. Perform common safety behaviors (e.g., universal precautions, handwashing).
  26. Understand the importance of error prevention both to individual patients and to systems.
INTL 9110 Tropical Medicine Rotation to Madagascar
Credits:
2,3,4,5,6,7,8
Grading:
Pass/Fail
Description:

Application process: Application should be made with the Internal Medicine Department of Western Michigan University, Homer Stryker, MD, School of Medicine.

Contact:  Richard R. Roach, MD, FACP, Internal Medicine Faculty, Western Michigan University School of Medicine. Three orientations are required. The first relates to culture and geography [supper is provided to make sure you enjoy Malagasy food]. The second relates to schedule and expectations [a review of the daily schedule and check on completion of reading assignments]. The third has to do with packing and preparation [did you get all your vaccinations? Leave your hair dryer at home, etc.]. The rotation is offered during Block IV [Septermber-October]. Tel: 337-6396   

 

Goals:

  1. Develop confidence in physical exam, assessment of clinical course and relate to patients with different cultural values from the physician.
  2. Develop confidence in assessing tropical diseases recognizing the regional specificity of tropical diseases.
  3. Develop an understanding of Travel Medicine and competence to provide instructions to patients traveling to third world countries.
  4. Develop a comfort level of understanding a patient with different cultural values and expectations
Objectives:

Objectives: This rotation will familiarize the resident with common tropical diseases, public health issues in developing countries, poverty related disease and research being done in tropical medicine.  It will provide an opportunity to work in a cross-cultural environment, with patients who do not speak English.

INTL 9110 Section 2 - Amazon Region of Northern Peru
Credits:
4
Directors:
Thomas Melgar, MD
Grading:
Pass/Fail
Description:

This four-week rotation during block 9 (Mid February - Mid March).  Participants will travel to Iquitos, Peru.  The first two weeks will be spent in Iquitos at local hospitals and health care centers working with local physicians on inpatient and outpatient services.  At least one day will be spent in the lab working with local technicians on diagnostic testing of tropical diseases.  At least one day in Iquitos will be spent doing outreach clinics to the underserved population of the city.  After completion of the first week the team will move to a remote location up the Amazon river to a tributary of the Yarapa river which will serve as our base.  From there the team will visit 15-20 villages providing primary and urgent care to patients of all ages.  Students will have an opportunity to work in our mobile lab and to work with portable ultrasonography.  The team will be conducting multiple research projects and students will be able to participate in the development and implementation of those projects.

Offered: Block 9 only (Mid February – Mid March)

Objectives:

After completion of this elective, each student will be able to:

  1. Obtain a medical history and perform a physical examination appropriate to the patient’s presentation
  2. Construct a logically thought out, prioritized, differential diagnosis for problems typically seen in this tropical environment
  3. Construct a diagnostic and management plan appropriate to a resource poor environment
  4. Draw upon a strong foundation of knowledge of disorders seen in this region of the tropics
  5. Draw upon clinical experience with disorders seen in this region of the tropics
  6. Understand and order appropriate testing for tropical diseases
  7. Draw upon cultural competency from working with the native populations of the region
  8. Construct a problem list for public health in remote communities

B. Conditions typically encountered

1.     Presenting Problems

a.     Fever

b.     Rash

c.      Diarrhea

d.     Headache

e.     Dizziness

2.     Diseases/syndromes

a.     Parasitic infections of the gastrointestinal tract

b.     Skin disorders

c.      Upper respiratory infections

d.     Musculoskeletal problems

e.     Pterygium and refractive errors

f.      Malaria

g.     Dengue

h.     Zika

i.       Yellow fever

j.       Scarlet fever

k.     Rheumatic fever

l.       Leptospirosis

m.   Leishmaniasis

n.     Tuberculosis

o.     Malnutrition

p.     Dehydration

 

C. Typical schedule, activities, and events:  Schedule varies by location. In each location there will be at least one day off each week.  In Iquitos days typically are from 8 am until 4 pm.  In the jungle typically days begin at 7 am heading out by boat for 30-120 minutes to villages.  Approximately 4-5 hours of clinical time is spent working in the villages with a one hour lunch break and returning to the lodge between 3 and 5 pm. Management of clinic data and research project data can be done on the boats or at the lodge after the clinic day. Educational lectures will be provided by participants in the morning or evening. Late afternoon and evening is free time.  Participants may relax, read, swim, canoe or go on guided nature hikes. Each night an attending physician, a resident physician and student is on call for patients brought to us at the lodge after hours.  Students may ask to participate in the care of these patients but are not required.

 

D. Assigned reading/educational references:  Will be provided to the team once selected in the months prior to the trip

 

E. Assessment plan, criteria, and standards:  All participants will receive verbal feedback throughout the rotation and a direct one on one midpoint verbal evaluation. A complete written evaluation will be provided at the end of the rotation.

 

F. Evaluation of the elective:  All participants are expected to provide written feedback of the rotation.

 

G.  Other: 

1.     The Amazon Rainforest is a beautiful but harsch environment and accommodations in the lodge are rustic and not handicapped accessable. Think rustic camping. Applicants should be comfortable with this.

2.     Participants will need to provide proof of proper immunizations and prophylaxis based on the CDC international travel recommendations.

3.     Participants must have a valid passport and must be able to re-enter the USA.

4.     The cost of the elective varies but will be approximately $3,700

a.     Including:

                                                                 i.     Airfare to Iquitos

                                                                ii.     Lodging in Iquitos and in the Jungle

                                                               iii.     Food and water for all meals in the jungle

                                                               iv.     Daily breakfast in Iquitos

                                                                v.     Transportation to and from the jungle lodge and to the villages

                                                               vi.     Evacuation insurance

b.     Not included:

                                                                 i.     Transportation in Iquitos (approximately $1-2/day)

                                                                ii.     Food and water in Iquitos other than breakfast ($10-$15/day)

                                                               iii.     Immunizations and prophylactic medications

                                                               iv.     Personal expenses

5.     Spanish fluency is not required but is very helpful.  Translators are available.

6.     Optional one on one Spanish language instruction is available at an additional cost.

7.     Ultrasonography training and skill is beneficial.

8.     Each member of the team is expected to help transport up to 50 pounds of medical supplies by using one of their two free checked bags for this purpose.

9.     Space is limited: Students and residents must apply and be selected.  The application can be found at the following link:  https://www.surveymonkey.com/r/WMed2019

10.  The application is due by June 1st 2018 and decisions will be announced by June 30th 2018.

 

MED 9210 Medicine Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

MED 9220 Selected Topics in Medicine
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

MED 9220 Selected Topics in Medicine - Section 1 Student Chief
Credits:
4
Directors:
Vicki McKinney
Grading:
Pass/Fail
Description:

The purpose of this elective is to provide support to M3 students transitioning into the Internal Medicine clerkship. Student Chiefs will orient M3 students to expectations of the Medicine clerkship and student roles. The chiefs are expected to be available to the M3 students on the Medicine rotation for support with knowledge and skills required in the clerkship.  Students interested in being a Student Chief need to apply and will be selected by the faculty. This elective is available for Rotation 1 and 2 only.

 

Offered: Rotation 1: April 30 - May 11 May 21 - June 1

Rotation 2: June 25 - July 20

Objectives:
  • Orient M3 students to the Internal Medicine clerkship
  • Answer M3 student questions about the Internal Medicine clerkship
  • Provide help to M3 students on knowledge and skills required in the Internal Medicine clerkship
  • Assist the Internal Medicine clerkship director with meeting student needs during the clerkship rotation
MED 9410 Allergy and Asthma
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

The prevalence of allergic disease and asthma have increased over the past two decades, particularly in developed countries. This can vary with age, disease and geographic location. Allergy and immunology involves the management of disorders related to hypersensitivity or altered reactivity caused by release of immunologic mediators or by activation of inflammatory mechanisms. Understanding the pathophysiology for allergic inflammation is crucial to best assess patients and make recommendations regarding testing and treatment. This rotation will expose students to a variety of diseases involving altered immunity or hypersensitivity. For these diseases, the student will learn how to initiate diagnostic evaluation and therapy, and learn to recognize other diseases in which altered immunity plays an important role. The student will be assigned to an outpatient allergy setting with an assigned schedule for the month. He/she will see new and established patients with the allergist. On occasion, an inpatient consultation may be required. The student will attend weekly Grand Rounds and Internal Medicine block conference. 

Offered: All weeks, contingent upon Resident scheduling

Objectives:

The student will be able to describe and define the following conditions frequently encountered in the adult allergist’s outpatient setting. The student will be able to take the appropriate history, perform an appropriate physical exam and formulate a differential diagnosis for the symptoms and signs that bring the patient to seek specialist evaluation. Basic management for the most likely diagnosis should be proposed and discussed with the preceptor, if appropriate for the nature of the patient encounter.

  • Allergic rhinitis and conjunctivitis
  • Atopic dermatitis
  • Delayed hypersensitivity reactions
  • Urticaria
  • Diagnostic Testing
    • Skin tests (intracutaneous)
    • IgE-ELISA assays
    • Review pulmonary function testing  
MED 9420 Cardiology
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Cardiac disease impacts morbidity and mortality in adults, with coronary artery disease the leading cause of death in Americans. Patients in both the inpatient and outpatient setting may have concomitant cardiovascular disease such as coronary artery disease, cardiomyopathies, congestive heart failure, arrhythmias, and valvular heart disease. 

Offered: All weeks

Objectives:

The student will be able to describe and define the following conditions frequently encountered in adult cardiology patients. This includes familiarity with the evaluation and evidence-based management of these conditions:

  1. Coronary artery occlusive disease
  2. Cardiomyopathies: ischemic, non-ischemic, restrictive, infiltrative
  3. Specific nomenclature for congestive heart failture (CHF) syndrom (e.g. chronic systolic left ventricular CHF, acute on chronic systolic LV CHF, chronic distolic left sided dysfunction/CHF, acute on chronic diastolic left sided CHF, cor pulmonale or right ventricular heart failure - acute or chronic, etc)
  4. Atrial fibrillation
  5. Syncope evaluation (see various algorithms)
MED 9440 Endocrinology
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

The most common endocrine disorder managed by internists is diabetes. Endocrinologists also diagnose and manage other endocrine and metabolic disorders. In this rotation, students will have the opportunity to enhance their skills and strategies for glycemic control, as well as have exposure to other problems seen in an endocrine practice.

Offered: All weeks

Objectives:
  • Perform a complete history and physical exam eliciting the common historical and physical findings suggestive of metabolic or endocrine disorders.
  • Identify patients with symptoms suggestive of Diabetes Mellitus (DM).
  • Proficiently monitor and manage metabolic or endocrine disorders with available therapeutics.
  • Know the competent management of endocrine emergencies such as:
  1. DKA
  2. Hyperosmolar coma
  3. Thyroid storm
  4. Myxedema coma
  5. Severe fluid
  6. Electrolyte abnormalities
  7. Addisonian crisis
  • Coordinate care of patients with multidisciplinary teams as appropriate.
  • Describe and define the following conditions:
  1. Diabetes mellitus, types 1 and 2
  2. Hypothyroidism
  3. Hyperthyroidism
  4. Primary and secondary hyperparathyroidism
  5. Primary hyperaldosteronism
  6. Cushing syndrome
  7. Adrenal insufficiency
  8. Pituitary adenomas
MED 9450 Gastroenterology
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Gastrointestinal diseases, both acute and chronic, are common complaints of the adult patient. Students will become more familiar with the evaluation and management of those GI conditions that have not been able to be managed by patient’s primary care physician.

Offered: All weeks

Objectives:

The student will be able to describe and define the following conditions frequently encountered in the adult patient with GI complaints. This includes familiarity with the appropriate history features and physical exam findings seen in specific GI conditions, the differential diagnosis for patients with specific symptoms (but no diagnosis yet) and evidence-based management strategies.

  • Gastroesophageal reflux
  • Common causes of GI bleeding, upper (ulcers, varices) and lower (diverticulitis, various colitis conditions, cancer)
  • Diarrhea
  • Nausea and vomiting
  • Cirrhosis (due to any cause)
  • Colon polyps and cancer
MED 9460 Geriatric Medicine
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

According to the Centers for Disease Control, the population of the United States is aging at an unprecedented rate; by 2030, approximately 72 million members of the population, or nearly 20%, will be age 65 or older. Along with the aging of the population will come a great need for physicians and providers trained in the special needs of the older population, from the physical and medical changes that accompany aging to the unique psychosocial needs of older adults.

Older people over age 65 also account for more than half of the nation’s hospital usage and a significant share of other medical services as well.  An older patient may see an average of ~15 physician visits across various specialties and sites each year. In order to care for the unique needs of this rapidly growing audience, graduating medical students must have the knowledge and understanding of geriatric medicine. Providing effective and compassionate care in various settings and restoring health and function of older patients through various therapies is essential. Goals of care and care plans must be based on each individual patient, with an understanding that function and quality are usually the most important aspects (calling for palliative care vs. aggressive treatment).

The geriatrics elective offers students an opportunity to evaluate geriatric patients with a variety of medical problems.  Students will have the opportunity to provide comprehensive and team-based care to older adults, as well as have more focused problem-based encounters. Through this unique experience, the medical students will be equipped with a body of knowledge and experiences to carry forward into future professional endeavors (e.g. residency).

Offered: All weeks

Objectives:

After completion of this elective, each student will be able to:

  1. Describe and define common conditions frequently encountered in geriatric patients in an outpatient, long-term care setting.
  2. Perform an appropriate history and physical exam (focused or complete, as applicable). 
  3. Initiate a diagnostic evaluation of typical clinical presentations for common co-morbidities (e.g., congestive heart failure, chronic obstructive pulmonary disease, renal failure, unmanaged diabetes, wounds/pressure ulcers, cognitive changes). 
  4. Improve skill level in assessing base-line in patients with multiple co-morbidities. 
  5. Understand the unique physical/medical challenges and social needs that accompany aging in older adults and why an interdisciplinary model of care is most effective.
  6. Describe the preventive health guidelines (i.e., vaccinations, screening tests) for geriatric patients and considerations in counseling patients for preventive health in the context of their age, functional status, and other co-mordidities.
  7. Describe and understand how to support various care paths for geriatric patients (e.g., longevity, functional, palliative, hospice).
MED 9470 Hematology and Oncology
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Hematologic and oncologic diseases cover a wide array of conditions in adult patients. In this rotation, the student is exposed to the types of patients referred to these specialists for further evaluation and management.

Offered: All weeks

Objectives:

After completion of this elective, each student will be able to:

  • Describe and define the following adult conditions frequently seen by hematologists and oncologists:
    • Algorithm for the evaluation of anemias
    • Leukemias (CLL, AML, APL)
    • Lymphoma, Hodgekins and non-Hodgekins
    • Multiple myeloma
    • Sickle cell disease
    • Lung cancer
    • Colon cancer
    • Prostate cancer
    • Melanoma
  • Demonstrate competent clinical exam skills for detection of abnormal physical findings relating to the lymphohematopoietic system and underlying benign or malignant neoplasms.
  • Develop the initial diagnostic evaluation and management of the hemostatic and clotting system.
  • Appropriately assess the indications and procedure for:
    •  Transfusion of blood and its components.
    •  Therapeutic and prophylactic anticoagulation.
  • Recognize the indications for bone marrow aspirate and biopsy and lymph node biopsy.
  • Discuss the general approach to specific malignancies with patients, including breast, GI, lung, prostate, and thyroid cancers, including further evaluations, prognosis and treatment options.
  • Familiarity with the administration, side effects, and drug interactions of common chemotherapies, immunobiologic agents, and immunosuppressives used in the treatment of hematologic and solid malignancies.
MED 9480 Infectious Diseases
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Infectious diseases is a broad field that encompasses the evaluation and management of acute infectious processes as well as the management of patients with chronic infectious processes such as human immunodeficiency virus.  Infectious disease specialists play a role in public health, hospital infection control programs/policies and are the champions of antibiotic stewardship.

Offered: All weeks

Objectives:

After completion of this elective, each student will be able to:

  • Be familiar with the following conditions frequently encountered in the adult infectious disease inpatient or outpatient setting.
    • Fever
    • Endocarditis
    • Osteomyelitis
    • Sexually transmitted infections (STIs)
    • Human immunodeficiency virus
    • Tuberculosis
  • Perform a comprehensive exam with emphasis on potential common and uncommon manifestations as well as potential sites of occult infections.
  • Understand the microbiology, prevention and management of infectious diseases.
  • Understand basic principles of epidemiology and transmission of infection including environmental, occupational and host factors that predispose to infection.
  • Demonstrate competent use of antimicrobial therapy, including choice of agent, dosing, and monitoring of therapy.
  • Provide appropriate preventive care, including optimal use of immunizations and chemoprophylaxis.
  • Develop a rational diagnostic and evaluation plan for the most common clinical presentations of infectious diseases.
  • Describe and interpret tests commonly used in evaluation and treatment of possible infectious problems.
  • Understand how to properly collect culture specimens from throat, cervix, vagina, rectum, urethra and blood.
  • Provide appropriate patient counseling for patients with HIV, substance abuse, and high risk behaviors for contraction and spread of infectious diseases.
MED 9510 Nephrology
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Nephrologists play a vital role in the hospital setting as they see patients with renal issues on the critical care, medicine and surgery services. They also oversee inpatient hemodialysis. In the outpatient setting, they diagnose and manage patients with a variety of renal diseases and oversee outpatient chronic dialysis therapy. 

Objectives:

After completion of this elective, each student will be able to:

  1. Perform a comprehensive physical examination relevant to underlying systemic disease and manifestations of acute and chronic kidney disease. 
  2. Describe, differentiate, and manage the stages of:
    • Chronic Kidney Disease 
    • Acute Kidney Injury (AKI) 
    • Nephrolithiasis
    • Polycystic kidney disease
    • Nephrotoxicity of medications
  3. Identify the indications for dialysis, including criteria for emergent hemodialysis 
  4. Consistently recognize and manage simple and complex fluid, electrolyte and acid-base disorders. 
  5. Competently use protein/creatinine ratios, CrCl, FENa, and GFR in evaluation and management of patients. 
MED 9520 Neurology
Credits:
2
Directors:
Olken/Crooks
Grading:
Pass/Fail
Description:

Neurological problems are common in the adult patient. In the hospital setting, neurologists play a pivotal consultative role in the evaluation and management of stroke, seizure disorders, brain masses, and altered mental status. There are numerous chronic neurologic problems that are cared for in the outpatient setting, as well as outpatient consultative evaluations from primary care physicians.

Offered: All weeks

Objectives:

The student will be familiar with the following conditions frequenty encoutered in the adult with a neurological problem, in either the inpatient or outpatient setting:

  • Recognize, evaluate and manage patients with common neurologic presentations, including development of differential diagnosis and diagnostic and therapeutic plans.
  • Recognize the presenting features of common neurologic disorders:
    • Altered mental status evaluation
    • Seizure disorder
    • Dementias
    • Movement disorders
    • Demyelenating diseases
    • Neuromuscular diseases
    • Spinal cord diseases
    • Neurocutaneous syndromes
    • Headache
MED 9530 Physical Medicine and Rehabilitation
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Physical medicine and rehabilitation is a medical specialty where clinicians may have both an inpatient and outpatient practice. Their focus is on enhancing and restoring functional ability and quality of life to patients with various impairments or disabilities. Many patients who are cared for by a PM&R physician (aka physiatrist) have neurological disabilities such as brain injury (non-traumatic and traumatic), spinal cord, stroke, multiple sclerosis, polio, and other musculoskeletal problems. On this rotation, students will have the opportunity to care for patients in an inpatient setting. These settings are also referred to as “high intensity” rehabilitation settings in that a patient can expect to spend at least 3 hours per day participating in their rehabilitation. Physiatrists work as part of a multidisciplinary team to meet the needs of the “whole” patient in achieving maximal recovery.

Offered:  All weeks

Objectives:

After completion of this elective, each student will be able to:

  • Obtain a thorough pertinent history and perform a complete relevant exam on new patients admitted to a high intensity rehabilitation unit.
  • Develop a working problem list and goals of care for an individual patient.
  • Follow patients through their rehabilitation process and reflect on the emotional, cognitive, and physical challenges patients and clinicians face in achieving the goals of care.
  • Spend time with various therapists (e.g., physical, occupational, recreational, speech) to learn and understand their role in patient rehabilitation.
MED 9540 Pulmonary Medicine
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Pulmonary medicine focuses on the evaluation and management of acute and chronic lung disease.  Many pulmonologists have additional expertise in critical care medicine and sleep medicine. The student will gain familiarity with understanding with disorders of the lungs, upper airways, thoracic cavity, and chest wall seen in either the inpatient or outpatient setting, depending on their elective site and preceptor.

Offered: All weeks

Objectives:

After completion of this elective, each student will be able to:

  • Obtain a thorough pertinent history and perform a complete relevant exam on patients presenting with possible pulmonary disorders.
  • Recognize relevant historical data and abnormal physical exam findings in order to develop a differential diagnosis and initiate a treatement plan or recommend further diagnositc testing.
  • Initiate a diagnostic evaluation of common clinical presentations of pulmonary diseases.
    • Asthma
    • Chronic Obstructive Pulmonary Disease and Emphysema
    • Pulmonary function testing (indications and interpretation)
    • Lung neoplasms
    • Interstitial lung diseases
    • Pulmonary hypertension
    • Pulmonary embolism
  • Recognize the indications and appropriately order tests to evaluate pulmonary diseases.
  • Understand the components of pulmonary function testing. 
  • Recognize the indications to order and be able to interpret pulmonary function tests. 
  • Assist in procedures used in the diagnosis and management of common pulmonary diseases (if opportunity arises).
  • Have the opportunity to attend in the sleep lab.
  • Improve skill level in reading chest x-rays and chest CT scans.
  • Recognize the indications for pulmonary consultation.
  • Provide appropriate patient education for primary and secondary prevention of pulmonary disorders (e.g., tobacco exposure, occupational hazzards).
MED 9570 Nutritional Sciences
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Nutritional sciences is a broad term encompassing the multi-disciplinary outreach of nutrition form the biological sciences to the social and physical sciences. Nutrients play a role in maintenance and disruption of normal biochemical and physiologic processes in a number of disease conditions, including the development of types of malnutrition. Nutrients may impact drug metabolism and drug-nutrient interactions, as well as nutrient-nutrient interactions. From a population/public health perspective, food availability and the composition of those foods can play a role in the overall health of a community.  Physicians are uniquely positions to incorporate nutritional sciences into their own scholarly activities and clinical practice.

This elective allows the student to design their own curriculum with potential applications to either basic medical and/or clinical sciences. The student will work closely with the course director or other faculty member to derive their program of study, identify specific objectives, attend relevant WMed lectures/conferences, and pre-determine the summative tasks to be accomplished to fulfill the objectives of the elective. In addition, general basic clinical nutrition readings will be assigned.

Offered: All weeks, students must be counseled and approved by Director.

Objectives:

After completion of this elective, students will be able to:

  • The student will be familiar with the components of nutritional assessment and use of malnutrition risk assessment tools used in the inpatient and outpatient setting. 
  • The student recognizes and is able to describe the key historical, physical examination, and diagnostic study results associated with the following conditions frequently encountered in the adult with a nutritional problem (or child, if student opts for a pediatric population setting).  
    • Protein malnutrition (kwashiorkor), calorie malnutrition (marasmus), and protein-calorie malnutrition
    • Common symptoms and signs of vitamin and mineral deficiencies and excesses
  • Creation of individual student curriculum to meet individual learning goals 
    • For example:
      • Nutritional management of glycemic control
      • Medical management of obesity
      • Medical culinary arts
      • Community health/food availability issues related to population health
MED 9580 Palliative Care
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Palliative care focuses on improving quality of life and providing comfort to people of all ages with serious, chronic and life-threatening illnesses. While many think of “hospice” as being synonymous with palliative care, it is not as hospice primarily serves the patient whose life expectancy is less than 6 months. During this elective, the student will observe the spectrum of palliative care, from helping families and the patient understand and cope with the diagnosis of a serious illness that may or may not be able to be cured, with end-of-life discussions including goal setting, with symptom relief management to offer comfort, and with the transition to hospice care when appropriate. A palliative care service is a multidisciplinary team consisting of the physician, advanced practice provider, and medical social worker. Chaplain services as well as rehabilitation and nutrition specialists may be consulted if needed to fulfill the overall care plan. At Bronson, their program is called “Advanced Illness Management”.

Offered: All weeks, except Block 7 (Holiday weeks)

Objectives:

After completion of this elective, each student will be able to:

  • Communication with the patient and family (e.g. goals of care, delivering bad news, code status).
  • Understand pain and symptom relief management.
  • Understand prognostication and hospice evaluation in various disease states.
  • Reflect on emotional and physical responses associated with various encounters on the elective, including, it is occurs, being with a dying patient. This can be shared with preceptor, M4 elective director, mentor, and/or someone the student feels safe with.
MED 9590 Sleep Medicine
Credits:
2
Directors:
Olken
Grading:
Pass/Fail
Description:

Sleep medicine is a subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. Disordered and disturbed sleep are associated with up to 1/3 of fatal motor vehicle fatalities as daytime sleepiness is a common symptom. Abnormal sleep can be associated as well as impact chronic medical conditions such as hypertension, obesity and mood disorders. Chronic obstructive sleep apnea, sleep deprivation, insomnias, narcolepsy, restless leg syndrome and hypersomnias may be treatable. Sleep Medicine is a multidisciplinary specialty and physicians who seek certification may be internists, pulmonologists, pediatricians, neurologists, or otolaryngologists.

Offered: All weeks 

Objectives:

After completion of this elective, the student will be able to:

  • Describe the stages of sleep, including respiratory, musculoskeletal and neurologic features during each stage
  • Obstructive sleep apnea
  • Insomnias
  • Narcolepsy
  • Sleep deprivation
MED 9610 Extended Care
Credits:
2
Directors:
Olken
Grading:
Pass/Fail
Description:

Extended care facilities or nursing homes provide short-term nursing care and rehabilitation for adult patients following illness, injury or hospitalization. Many facilities also offer long-term care to patients with progressive chronic conditions such as dementia and neuromuscular diseases who are unable to live independently.

Offered:  All weeks

Objectives:
  • Obtain a thorough pertinent history and perform a complete relevant exam on new patients admitted to an extended care facility
  • Develop a working problem list and goals of care for an individual patient
  • Follow patients through their rehabilitation process and reflect on the emotional, cognitive, and physical challenges patients and clinicians face in achieving the goals of care
  • Spend time with various therapists (e.g., physical, occupational, speech) to learn and understand their role in patient rehabilitation
MED 9710 Advanced Hospital Medicine
Credits:
2,4
Directors:
Olken
Grading:
Pass/Fail
Description:

Advanced hospital clerkships provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

Hospital medicine is a growing professional track for internal medicine physicians. The Society for Hospital Medicine defines a hospitalist as a physician “who engages in clinical care, teaching, research, or leadership in the field of general hospital medicine. In addition to their core expertise managing the clinical problems of acutely ill, hospitalized patients, hospital medicine practitioners work to enhance the performance of hospitals and healthcare systems.” The M4 clerkship in hospital medicine exposes the student to the medical problems commonly seen in hospitalized adult patients and permits the student to have a greater role in the evaluation and management of these patients than they had during the M3 clerkship.

Offered: All weeks

Objectives:
  • Recognize, evaluate and manage the presentations of common acute medical problems encountered in inpatient general internal medicine.
    • Abdominal pain
    • Acute gastrointestinal bleeding
    • Acute pulmonary edema
    • Acute renal failure/kidney injury
    • Altered mental status
    • Arrhythmias
    • Chest pain
    • Drug withdrawal
    • Electrolyte disorders
    • Fever
    • Glycemic control
    • Hypertensive emergencies
    • Nausea and vomiting
    • Pain management
    • Respiratory distress
    • Seizures
    • Sepsis
  • Obtain a complete history and physical appropriate to the patient’s presentation.
  • Develop complete problem lists with appropriate assessment and plan, including differential diagnosis and selection of appropriate diagnostic studies and management plans.
  • Develop professional and caring relationships with patients and families, including timely discussions regarding the patient’s illness, recommended testing, prognosis, and treatment options.
  • Use consultants when indicated.
  • Develop appropriate discharge planning and outpatient follow-up care, including communication with outpatient physicians, discharge planners, and community resources essential for transition home.
  • Accurately assess and make judgments regarding acuity of illness for determining necessity for hospital admission and for determining need for intensive care admission.
  • Determine appropriate patient monitoring, including cardiac monitoring, diabetic monitoring, fluid management, neurological assessments and vital signs.
  • Function as both a responsible referring physician and as a consultant in appropriate settings.
  • Know the indications and be able to interpret and act upon the results, in the context of individual patients, for common lab and imaging studies.
  • Use the electronic health record to review test results, physician and non-physician notes, document patient care and progress as well as beginning proficiency in writing admission, discharge orders, and daily orders.
MED 9720 Advanced Ambulatory Medicine
Credits:
4
Directors:
Olken
Grading:
Pass/Fail
Description:

Outpatient or ambulatory internal medicine immerses the learner into the evaluation and therapeutic management of adult outpatients.  Patients present to their physician with acute problems, visits for chronic problems, visits for monitoring and management of complex medical conditions, visits for age- and gender-appropriate preventive care, visits to discuss life transitions (e.g., moving to assisted living or nursing home, end-of-life discussions and counseling for shared decision making) and visits that may not be as much “medical” but related to a patient’s health and life function or quality.  Patients may be accompanied by family members, friends, or significant others.  Thus, the entire spectrum of adult patients, aged 18+ may be encountered. Medical care that 20 years ago might have had to be delivered in the hospital setting is now managed and coordinated by a patient’s primary internist. The relationship between the physician and patient can be decades long, or recent.  The privilege to be invited into this special relationship cannot be taken lightly.  Students are expected to develop a sense of responsibility for continuity of care and the unique characteristics of an internal medicine practice.  The highest level of professionalism, character, and integrity is expected. 

Offered: All weeks, except Block 7 (Holiday weeks)

Objectives:

Upon completion of this course, each student will be able to:

  • Evaluate the purpose of each patient visit, including a complete history and an appropriate expanded exam related to presenting problem
  • Manage patients with clinical problems common to the outpatient setting, including: URI, UTI, musculoskeletal complaints, headache, abdominal pain, anxiety and depression, sleep complaints, skin rashes/lesions, hypertension, diabetes, asthma/COPD, chronic pain, coronary artery disease, and congestive heart failure, dementia/cognitive impairment, upper and lower GI diseases, chronic kidney disease, polypharmacy
  • Reccomend appropriate preventive medicine services according to current guidelines to patients encountered
  • Arrange for appropriate monitoring and follow up of chronic illnesses
  • Prioritize patient care for functioning in an outpatient setting
  • Use consultants appropriately to provide patient information in referral letters to consultants
  • Use the electronic medical record to complete documentation of all patient encounters
  • Create and execute an individual patient care plan from indicators and information obtained
  • Communicate with patients, families, colleagues, and other health care professionals to facilitate optimal patient care
  • Exhibit conduct consistent with accepted standards of ethical and professional behavior
MED 9721 Advanced Ambulatory Medicine - Pediatrics
Credits:
2,4
Directors:
Jayne Barr
Grading:
Pass/Fail
Description:

Advanced ambulatory clerkships provide the opportunity for students to assume initial responsibility for the evaluation of patients in the ambulatory setting. Supervision will be provided by faculty preceptors in the academic setting as well as community private practices. Students expand upon competencies they developed during the third year as they team with residents and/or preceptors to provide preventive health services as well as acute and chronic illness management. The faster pace of ambulatory care provides an environment that strengthens patient and family communication skills, rapport development, and oral presentations. The use of evidence to inform treatment and counseling of patients and their caregivers are additional competencies that are highlighted in the outpatient setting.

This rotation is designed to provide individualized teaching in the management of outpatient medical problems for students interested in combined internal medicine and pediatrics practice experience.  The student will spend the majority of their outpatient clinical experience in a community combined internal medicine and pediatrics practice.  There may also be opportunities for other experiences such as sports medicine and transitions of care clinics.  The student will gain experience in the ambulatory setting including preventative medical services, assessment of growth and development in children and adolescents, diagnosis and treatment management of common adult and pediatric ambulatory problems, psychosocial issues affecting patient compliance, and the importance of multidisciplinary care.  There may also be opportunities for performing or observing procedures such as EKG, Pap, microscopic examination of wet mounts, throat cultures, and injections. Other activities include Internal Medicine grand rounds and block conference and Pediatrics grand rounds and block conference.  At the conclusion of the experience, the student will give a short presentation to the practice site of a topic of interest.

Objectives:

After completion of this elective, each student will be able to:

  1. EPAs
    • Obtain a medical history and perform a physical examination appropriate to the patients presentation 
    • Construct a logically thought out and prioritized differential diagnosis 
    • Provide oral presentation of a clinical encounter 
    • Collaborate as a member of an interprofessional team; Be responsive to whole patient and behave in a professional manner that embraces and respects diversity while exhibiting compassion, honesty, integrity, respect, and responsibility 
    • Recognize a patient requiring urgent/emergent care and discuss the appropriate evaluation and management 
  2. Competencies
  • Medical Knowledge
    • Awareness of evidence-based guidelines guiding the diagnosis, treatment, and management of common primary care internal medicine and pediatrics problems
      1. Examples of common internal medicine problems include COPD, type 2 diabetes, essential hypertension, coronary artery disease, chronic pain
      2. Examples of common pediatric problems include well child exams, viral illnesses, asthma, ear infections, abdominal pain
    • Self directed learning and reading
  • Patient Care
    • Basic clinical skills – obtain a patient history and physical exam in a logical, organized, and thorough manner while adapting to the urgency of the medical situation and time available.
    • Oral presentations
    • There may be opportunities to perform or observe procedures such as throat cultures, injections, PAP smears, wet mounts, dermatologic procedures (cryrosurgery, excision of skin lesions and moles), PFTs and EKGs.
    • Identify opportunity to improve health promotion through patient education such as smoking cessation
  • Systems Based Practice
    • Community resources
  • Practice Based Learning and Improvement
    • Self directed learning and reading
    • Presentation of common Med Ped disease
  • Interpersonal and Communication Skills
    • Effective communication – perform patient interviews and physical examinations, and enhance presentation skills.
  • Professionalism
    • The student demonstrates responsible, professional, and respectful behavior.
    • Accepts constructive criticism and receptive to receiving feedback

Advanced Clerkship Goals:

  1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
  2. Demonstrate patient-centered interview skills.
  3. Demonstrate patient-centered examination techniques.
  4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
  5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
  6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
  7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
  8. Articulate the risks and benefits of what you are ordering (e.g., drugs tests).
  9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
  10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
  11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
  12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
  13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
  14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
  15. Act as an active and integrated member of the team who in most situations prioritizes team goals over one's own professional goals.
  16. understand the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
  17. Maintains a professional demeanor in all but the most trying of circumstances.
  18. Interpret common test results to anticipate and respond to early clinical deterioration.
  19. Understand the importance of informed consent to rapport building and shared decision making.
  20. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
  21. Provides complete information to patients and families.
  22. Avoids medical jargon in communicating with patients and families.
  23. Demonstrate patient-centered skills in performing procedures:
    • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
    • Participate in shared decision making with patients about procedures.
    • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
    • Simultaneously pay attention to both the procedure and the patient's emotional response.
  24. Identify real and potential errors.
  25. Perform common safety behaviors (e.g., universal precautions, handwashing).
  26. Understand the importance of error prevention both to individual patients and to systems.
MED 9810 Advanced Medicine Critical Care
Credits:
4
Directors:
Wilt, Nichols
Grading:
Pass/Fail
Description:

This rotation offers students the opportunity to accelerate their learning by spending a four week block in the intensive care unit.  The rotation provides the student the opportunity to diagnose and treat of a wide range of clinical conditions common among critically ill patients. Students will enhance their knowledge and skill in caring for the sickest patients in the hospital.  The Clinical site utilized for the Pediatric Advanced Critical Care Clerkship is the pediatric ICU at Bronson Children’s Hospital.  Students will be paired with interns and residents, and will participate in the ICU in a dedicated fashion; the intent is for students to function as a “subintern” and will result in a high level learning experience. 

Students will be expected to participate on rounds, will continue to perfect the gathering and synthesis of data, and expand on their ability to make diagnoses and develop care plans.  The student will be expected to gather a history based upon interview of patients/families, evaluate laboratory and radiographic material, and generate differential diagnoses and management plans.  They will also be expected to improve their documentation skills by writing patient notes in the electronic medical record.

This is a 4 week block rotation, and will correspond to the calendar set forth by the Western Michigan University School of Medicine. This varies on the time of year and the rotation site. The medical ICU consists of patients with primarily medical diseases affecting the major organs.

Offered: All weeks

Objectives:

After completion of this elective, each student will be able to:

Hemodynamics/Cardiovascular System

  • Understand the diagnosis, pathophysiology, and treatment of shock
  • Understand the basics of hemodynamic monitoring and apply this to resuscitation medicine
  • Understand the basics of fluid resuscitation
  • Know indications for the use of vasoactive agents
  • Recognize and treat dysrhythmias
  • Understand the principles of managing cardiac arrest

Pulmonary System

  • Recognize basic patterns on chest radiograph evaluation (ie infiltrate, effusion, pneumothorax)
  • Understand basic pulmonary physiology (shunt, V/Q mismatch, dead space)
  • Interpret arterial blood gases, and apply A-a gradient, P/F ratio
  • Understand the indications for intubation and mechanical ventilation
  • Understand the basics of mechanical ventilation and management
  • Understand spontaneous awakening trials and spontaneous breathing trials and apply these to liberation from mechanical ventilation
  • Recognize and treat pulmonary complications including pneumothorax, ARDS (including permissive hypercapnea), pneumonia, atelectasis, pulmonary embolism

Gastrointestinal System

  • Diagnose and treat gastrointestinal hemorrhage
  • Diagnose and treat clostridium difficile colitis and its complications
  • Recognize and treat complication from congenital GI abnormalities
  • Evaluate and treat pancreatitis

Neurologic System

  • Understand Cerebral Perfusion Pressure and its management
  • Diagnosis and treat acute ischemic and hemorrhagic stroke
  • Diagnose and treat subarachnoid hemorrhage
  • Diagnose and treat seizures including status epilepticus
  • Be familiar with brain death and its determination
  • Be familiar with sedation and analgesia and its effect on the CNS in the ICU

Renal System

  • Understand, diagnose, and treat oliguria
  • Define and treat acute kidney injury
  • Know the indications for renal replacement therapy

Metabolic System

  • Be familiar with, understand, and treat electrolyte disturbances
  • Manage hyperglycemia in the ICU
  • Understand, diagnose, and treat acid base disorders

Hematologic System

  • Understand the indications for blood product transfusion in the ICU
  • Evaluate and treat anemia
  • Evaluate and treat abnormalities of coagulation
  • Understand principles of anticoagulation

Endocrine System

  • Evaluate and treat abnormalities of the thyroid axis as it relates to critical illness
  • Evaluate and treat abnormalities of the adrenal gland as it relates to critical illness
  • Understand the principles of steroid replacement in the ICU

Infectious Diseases and Sepsis

  • Understand source identification and control of infections
  • Understand the basics of antibiotic selection and subsequent stewardship
  • Define and treat sepsis and septic shock, including early goal-directed therapy, and resuscitation and support

Advanced Clerkship Goals:

  • Recognize the severity of illness in patients with a variety critical illness.
  • Provide an extensive and complete assessment of the patient, including a complete history and physical examination, evaluation of laboratory data and radiographic material, synthesis of patient information, and generation of a comprehensive care plan.
  • Develop a rational evaluation and management plan for the stabilization and treatment of organ system dysfunction while evaluating and treating underlying etiologies.
  • Demonstrate competent use of technologic procedures and devices in the intensive care setting for the purposes of evaluating, monitoring, and managing patients.
  • Integrate imaging and other diagnostic studies in assessing the critically ill.
  • Effectively engage consultants and other ancillary care services in a team approach to manage critically ill patients.
  • Perform procedures necessary for the assessment and treatment of critically ill patients.
  • When indicated, address end of life decision making and advanced directives, and provide counseling for patients and their families.
  • Provide appropriate documentation of all patient interactions.
MEDU 9210 Medical Education Research
Credits:
4,5,6,7,8
Directors:
McKinney
Grading:
Pass/Fail
Description:

Students will work with a medical educator to understand the research process. In addition to discussions with faculty members, students will read books and articles on a research topic of their choice and design a research plan.  The students will present their research to the Medical Education Department for approval. Once approved, the students will execute and complete the research.

Objectives:

After completion of this elective, each student will be able to:

  • Formulate an original, high-quality research question and hypothesis
  • Apply knowledge of research to answer an original research question
  • Employ appropriate research methods to gather and analyze data
MEDU 9220 Selected Topics in Medical Education
Credits:
1,2,3,4,5,6,7,8
Directors:
McKinney
Grading:
Pass/Fail
Description:

Student will propose and research a topic of their choice related to physicians as educators under the guidance of a medical educator. In addition to discussions with faculty members, students will read books and articles on their topic and design a teaching module on the subject of choice and medical education research. On completion of this elective, students will be able to design a teaching module from objectives to assessment.

Objectives:

After completion of this elective, each student will be able to:

  1. Identify a health issue community members need information about
  2. Develop a teaching module to educate community members on the health issue
  3. Develop an appropriate method to assess change(s) in knowledge, skill or behavior by community members on a health issue
MEDU 9410 Medical Simulation
Credits:
2
Directors:
Lammers
Grading:
Pass/Fail
Description:

This elective is designed for medical students who are considering academic careers in medicine. Students will learn principles of experiential learning by developing simulation-based educational exercises. They will gain knowledge of and experience with simulation as an educational tool by reading selected textbook chapters and journal articles, assisting faculty in running simulation exercises, developing an immersive case simulation, observing and critiquing a debriefing session, and creating a procedure assessment tool. Students will observe simulations designed to teach or assess cognitive, technical, communication, and teamwork skills.

This two-week elective will be held primarily in the Simulation Centers at Western Michigan University School of Medicine and Borgess Medical Center. Students will work predominately with Dr. Lammers and the Simulation Center staff, but they will also interface with residents and faculty who are working on simulation projects.

Offered: July 16th - 29th 2018

 

Objectives:

After completion of this elective, students will be able to:

  1. List six assumptions about adult learners that should guide curriculum development.
  2. List five advantages of medical simulation over bedside clinical teaching in the education of medical students and resident physicians.
  3. Describe simulation exercises that use the artificial representation of a person, a situation, an environment, and an event to provide learning experiences.
  4. Develop a simple, simulation-based exercise that incorporates the four stages of Kolb’s experiential learning model.
  5. Develop, program, and pilot-test a 5-10 minute case-based simulation that teaches one or more of the following: clinical reasoning, medical decision-making, communication, or teamwork skills.
  6. Explain how to use reflective practice techniques in post-scenario debriefing sessions.
  7. Create a performance checklist to assess a procedural (technical) skill.
MEHL 9210 Medical Ethics Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

MEHL 9211 Medical Humanities Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

MEHL 9212 Health Law Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

MEHL 9220 Selected Topics in Medical Ethics
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

MEHL 9221 Selected Topics in Medical Humanities
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

MEHL 9221 Section 1: Skilled Observer in Art and Science
Credits:
2
Directors:
Mike Redinger/Paul Solomon
Grading:
Pass/Fail
Description:

The Skilled Observer in Art and Science demontrates how artists and scientists use intuition, cognitive processing, and skills in pattern recognition to reveal the connective tissue that makes complex systems work.  We live in time when science is distrusted, and art is mystified.  The Skilled Observer in Art and Science explains why acumen in these areas is essential.  It places emphasis on the neuroscience of human activity by looking at how art and science intersect in the biological sciences, physics, chemistry, mathematics, geoscience, medicine, and architecture.

Objectives:

- Apply techniques of skilled observation to physical examination and diagnsis procedures.

- Apply knowledge of embodied cognitive processing to physical examination and diagnosis procedures.

- Enhance doctor/patient relationships utlizing skilled observational techiniques, embodied cognitive proessing, and knowledge of how language determines identity.

- Place into context and discuss contemporary medical practice with the history of medicine.

MEHL 9221 Section 3: The Value of Art in Medicine
Credits:
2
Directors:
Dr. Tyler Gibb/KIA
Grading:
Pass/Fail
Description:

In the past several decades the arts have been  incorporated into many medical school curriculums as either a required longitudinal course, an elective course or as part of a humanities course. The visual arts are uniquely valuable in improving student's powers of observation and building their visual literacy. In combination with Visual Teaching Strategies (VTS), a program commonly used in art museums as a teaching tool, medical schools and medical residencies have reported improved communication and descriptive skills,  greater appreciation for ambiguity, diversity, compassion, empathy and greater respect for a variety of opinions by their students who participated in these programs. An additional benefit is student stress reduction by creating art or using the museum as a space of rejuvenation and inspiration.

Offered:

Block 5 (October 23-November 19, 2018)

Block 8 (January 15-February 11, 2019)

Objectives:
  • The student will learn the elements of art and principles of design
  • The student will be able to describe an unknown piece of art by understanding lines, shapes, form, space, color, and texture
  • The student will be able to describe a work of art in terms of mood and emotion.
  • The student will select a piece of art in the gallery and lead a discussion with their peers  The student will use art to discuss empathy, bias, ambiguity, compassion, and diversity  
MEHL 9222 Selected Topics in Health Law
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

MEHL 9410 Clinical Ethics Consultation and Committees
Credits:
2,4
Directors:
Gibb
Grading:
Pass/Fail
Description:

A theoretical understanding of ethical principles relating to health care is essential for all physicians. However, the application of these principles to actual situations of ethical conflict requires a different type of educational experience. In this course, the students will work closely with WMed clinical ethicists as they conduct ethics consultations, engage in ethical research and analysis, meet with patients and teams, and work with hospital ethics committees.

Objectives:
  1. Meaningfully and respectfully engage in discussions about ethically complex issues and cases in the practice of medicine.
  2. Understand the history of clinical ethics consultations and the various methods of ethics consultation.
  3. Discussion ethical conflicts that arise in the practice of medicine, including but are not limited to:
    • Informed Consent and Informed Refusal
    • Decision-Making Capacity
    • Surrogate Decision-Makers
    • Non-Beneficial Treatment (Medical Futility)
    • Organizational Ethics
    • Autonomy and Professional Duties
  4. Apply the “4-Topics Approach” of case analysis in ethical conflicts in the clinical setting.
  5. Discuss and appropriately utilize the AMA Principles of Medical Ethics with Annotations.
  6. Understand and strive to embody the ideals of a virtuous physician, including but not limited to: altruism, compassion, empathy, trustworthiness, honesty, integrity, solidarity, and devotion to their patients.
MEHL 9420 Psychiatry Ethics
Credits:
2
Directors:
Redinger
Grading:
Pass/Fail
Description:

This selective course is designed for students who are interested in psychiatric ethics.  This may be due to an interest in either advanced application of medical ethics or psychiatry as a medical specialty.  As a specialty, psychiatry frequently encounters ethical dilemmas.  Some of these are shared with other medical specialties while others are unique to psychiatric practice because of the nature of mental illness. Students interested in taking this selective should be prepared to respectfully engage in challenging discussions about the ethical care of psychiatric patients.

The course will consist of two components.  Part of the rotation will be spent observing the ways in which involuntary treatment proceedings occur throughout the community, including adult and juvenile drug and mental health courts and involuntary treatment hearings on the Borgess Inpatient Psychiatric Unit.  Additionally, there will be directed readings and small group discussion discussing ethical issues relevant to psychiatry and doing ethical case analysis.  Students will need to prepare before class by completing assigned readings and individual activities (or tasks) in order to participate in class.  The first day of the elective will discuss the mechanics of the course, expectations, and general overview of the topic.  Finally, the students will be expected to complete a capstone project on a topic relevant to psychiatric ethics.

Objectives:

After completion of this elective, each student will be able to:

  1. Meaningfully and respectfully engage in discussions about ethically complex issues and cases in the practice of psychiatry.
  2. Understand the history of psychiatry ethics.
  3. Discuss ethical conflicts that arise in the practice of psychiatry, including those common to other specialties as well as those unique to the practice of psychiatry.These include:
    • Boundary and Dual Relationship Issues
    • Confidentiality and Truth-Telling
    • Determination of Decision-Making Capacity and Informed Consent
    • Involuntary Treatment
    • Ethical Issues Relating to Special Psychiatric Populations
    • Ethical Issues Relating to the Practice of Psychiatric
    • Religion and Psychiatry
    • The History of the Relationship between Psychiatry and the Pharmaceutical Industry
    • The Involvement of Psychiatry in Human Rights Violations
  4. Apply the “4-Topics Approach” of case analysis in ethical conflicts in the psychiatric setting.
  5. Discuss and appropriately utilize the APA Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry and other sources of ethical guidance available to psychiatrists.
  6. Understand and strive to embody the ideals of a virtuous psychiatrist, including but not limited to: altruism, compassion, empathy, trustworthiness, honesty, integrity, solidarity, and devotion to their patients.
OBGY 9210 Obstetrics and Gynecology Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

OBGY 9220 Selected Topics in Obstetrics and Gynecology
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.Determined by the student and faculty member.

OBGY 9420 Reproductive Endocrinology and Infertility
Credits:
2,4
Directors:
Dodds, Young, Shavell
Grading:
Pass/Fail
Description:

This elective is designed for 4th year medical students interested in pursuing Obstetrics and Gynecology. It is particularly relevant for students who may wish to consider subspecialty training in Reproductive Endocrinology and Infertility (REI). This elective will allow the student to focus on REI problems exploring in depth the diagnostic evaluation and treatment approaches to those problems. The course will involve one-on-one patient care with our Reproductive Endocrinologists. In addition, the student will spend a brief time in the andrology, endocrine, and in vitro fertilization laboratories to provide a better understanding of laboratory contribution to diagnosis and treatment. Students will also participate in pelvic ultrasound and surgical care of patients. Didactic training from the Reproductive Endocrinologists will be given. Students will prepare a presentation on a clinical topic or an interesting case and present it at the end of the elective.

Offered:  Not offered week of Christmas

Objectives:

After completion of this elective, each student will be able to:

  • Knowledge of menstrual cycle physiology to understand the basis of ovulation, abnormal bleeding, polycystic ovary disease, and an ovulatory infertility issues.
  • Demonstrate an understanding of the common causes of infertility and how to use evidence based medicine to develop a plan for further evaluation and treatment.
  • Understand and discuss the risks and benefits of advanced reproductive technologies including in vitro fertilization, preimplantation genetic testing, donor oocyte, donor embryo, gestational carrier, and gamete and embryo cryopreservation for fertility preservation.
  • Improve patient history & physical presentation skills.
OBGY 9430 Gynecologic Oncology
Credits:
2,4
Directors:
Hoekstra, Mize
Grading:
Pass/Fail
Description:

This clerkship is designed for fourth-year medical students interested in pursuing Obstetrics and Gynecology residency training, and is particularly relevant for students considering subspecialty training in gynecologic oncology or minimally invasive surgery. This clerkship allows the student to focus on gynecologic oncology problems, with in-depth exploration of the diagnostic evaluation and treatment approaches through one-on-one patient care with our oncologists. Students participate in inpatient, ambulatory, and surgical care of patients through didactic and bedside teaching. Students prepare a presentation on a clinical topic or case, with the presentation at the end of the clerkship.

Objectives:

After completion of this clerkship, each student will be able to:

  1. List the current strategies and criteria for staging gynecologic cancer and the prognostic implications of staging.
  2. Describe the current standards for treatment of gynecologic cancers including surgical, chemotherapy, and radiation therapy. List the common adverse effects and limitations of common treatent regimens.
  3. Describe the standards of treatment for neoplastic and pre-malignant conditions that are treated by gynecologic oncologists (eg, molar pregnancy, endometrial hyperplasia with atypia, low malignant potential ovarian lesions)
  4. Prepare a specialty-focused history and physical examination for admission or new patient note, with appropriate attention to previous conditions. List the key aspects of a complete exam that would be performed by a gynecologic oncologist.
OBGY 9460 Labor and Delivery
Credits:
2,4
Directors:
McGhee
Grading:
Pass/Fail
Description:

This elective is designed for 4th year medical students interested in pursuing Obstetrics and Gynecology. This elective will allow the student to explore the ins and outs of labor and delivery and give them the opportunity to manage patients in labor. The course will involve one-on-one patient care with Certified Nurse midwives as well as OBGYN physicians. In addition, the student will spend time in triage. Students will also be part of the surgical team for patients who required surgery. Didactic training from the attending physicians in labor and delivery will be given. Students will prepare a presentation on a clinical topic or an interesting case and present it at the end of the elective.

Offered: All weeks

Objectives:

After completion of this elective, each student will be able to:

  1. Have knowledge of normal pregnancy, labor and management of labor, delivery and immediate postpartum complications.
  2. Demonstrate an understanding of the most common antepartum conditions: Diabetes (gestational and pre-gestational), hypertension (pre-existent and pregnancy induced hypertension).
  3. Have basic knowledge of multiple pregnancies specially twin pregnancies.
  4. Understand and discuss the risks and benefits of antepartum and intra-partum fetal monitoring.
  5. Improve patient history & physical presentation skills and perform accurate cervical exams.
ORTH 9210 Orthopaedic Surgery Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

ORTH 9220 Selected Topics in Orthopaedic Surgery
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

ORTH 9410 Non-operative Orthopaedics
Credits:
2,4
Directors:
Bovid
Grading:
Pass/Fail
Description:

Designed for the 4th year medical student that has a strong interest in the musculoskeletal system and is not pursuing a career in orthopaedic surgery.  This course will emphasize orthopaedic outpatient clinics.  Students will not be required but will have opportunities to be in the operating room and/or take evening call.  Students will work closely with assigned faculty members that are fellowship trained in different subspecialties of orthopaedic surgery.   Students will learn musculoskeletal history taking skills, the details of a musculoskeletal physical examination, interpretation of radiographs and advanced imaging techniques, treatment options with an emphasis of when to refer to an orthopaedic surgeon. There will be a lectureship series given by the faculty.

Offered:  All weeks

Objectives:

After completion of this elective, each student will be able to:

  • Apply advanced fundamental knowledge in musculoskeletal gross anatomy to physical examination techniques.
  • Demonstrate understanding in the basic science of soft tissue healing, fracture healing, tendinopathies, arthropathies, meniscal, ligament and tendon injury, and joint biomechanics and apply this knowledge to patient care.
  • Develop advanced knowledge of common musculoskeletal complaints and diseases that present to the orthopaedic surgeon and use critical thinking to apply this in patient care.
  • Gather essential and accurate information in a thorough musculoskeletal-focused history.
  • Perform an appropriate musculoskeletal physical examination to include the spine and extremities.
  • Interpret common plain film radiographs at a beginning level.
  • Demonstrate professionalism and effective communication skills in patient care and interactions with other members of the health care team.
ORTH 9420 Enhanced Musculoskeletal Anatomy
Credits:
4
Directors:
Lackey, Bovid
Grading:
Pass/Fail
Description:

Designed for the 4th year medical student with a potentially strong interest in pursuing orthopaedic surgery or other field focused on the musculoskeletal system as a career. This elective will allow students to revisit and delve deeper into extremity anatomy with a focus on surgical approaches and relevance to clinical practice. The course would be in the anatomy lab with guidance from both anatomy faculty and orthopaedic surgical faculty. The course will include dissection, hands on learning from the cadavers in the lab including practicing surgical approaches, didactics, and time for students to prepare a presentation on a clinically important anatomic topic to give at the end of the course.

Offered:  One four-week block per M4 Year

Objectives:

Upon completion of this elective, each student will be able to:

  • Apply advanced fundamental knowledge in musculoskeletal gross anatomy to physical examination, surgical approaches and techniques.
  • Demonstrate understanding in the basic science of soft tissue healing, fracture healing, tendinopathies, arthropathies, meniscal, ligament and tendon injury, and joint biomechanics and apply this knowledge to patient care.
  • Develop advanced knowledge of critical structures at risk during surgical treatment and use critical thinking to apply this in patient care.
  • Identify strengths and deficiencies in their own musculoskeletal anatomy knowledge and seek out and perform learning activities to address gaps in knowledge.
  • Communicate effectively and improve presentation skills.
PATH 9210 Pathology Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

PATH 9220 Selected Topics in Pathology
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

PATH 9410 Anatomic Pathology
Credits:
2
Directors:
DeJong
Grading:
Pass/Fail
Description:

The Anatomic Pathology elective is intended for medical students in their fourth year and provides broad experience in general diagnostic techniques. Students will have opportunities to participate in autopsy pathology, cytopathology and surgical pathology. A daily diagnostic conference is scheduled for students. In addition to direct responsibilities in autopsy and surgical pathology areas, the student will have the opportunities to participate in electron microscopy, immunohistochemistry, molecular diagnostics and flow cytometry techniques.

Offered:  All weeks

Objectives:
  • Gather the important information that is needed for the evaluation of specimens in anatomic pathology.
  • Complete a gross examination and dissection of at least 5-10 specimens per week. The student should demonstrate the ability to perform this gross dissection while being observed by at least one attending or resident.
  • Know about common pathologic conditions seen on the relevant subspecialty service (for example, GI pathology).
  • Perform Gross Dissection for the common specimens seen on the relevant subspecialty rotation.
  • Demonstrate professional responsibility in working as a team member with other members of the subspecialty service team, technical and support staff.
  • Career/context Know the training/career pathway for Anatomic Pathology.
PATH 9420 Forensic Pathology
Credits:
4
Directors:
DeJong
Grading:
Pass/Fail
Description:

By familiarizing the students with autopsies, to include clinical history, gross and microscopic findings, the forensic pathology rotation will enhance students' ability to establish clinicopathologic correlations. Emphasis will be placed on the student's development and use of observational and deductive skills, and on self-directed independent study. This elective will also provide an orientation to basic forensic medicine through observation of and active participation in forensic autopsies, death scene investigation, assigned readings, didactic instruction, observation of courtroom testimony and self-directed writing assignments. The student will receive focused instruction on Michigan Compiled Law as it pertains to physicians and the Medical Examiner’s Office in addition to training in proper death certification. The student will be exposed to the related and overlapping fields of anthropology, entomology, law enforcement, odontology and toxicology. The student’s mastery of the material will be assessed through daily teaching rounds and an open-book examination.

Offered: All weeks

Objectives:
  • Formulate a differential diagnosis based on a clinical history
  • Observe and describe gross findings in organs
  • Differentiate normal and abnormal gross findings at autopsy
  • Formulate a cause of death based on history, scene investigation and autopsy findings
  • Correlate clinical manifestations of the patient with morphologic findings at autopsy
  • Recognize the microscopic characteristics of frequent diseases
  • Describe the clinical and pathologic characteristics of common diseases and injuries
  • Outline the procedure of obtaining family consent for autopsy in hospital deaths
  • Define criteria for medical examiner’s case and apply the criteria to a variety of scenarios.
  • Exhibit conduct consistent with accepted standards of ethical and professional behavior.
PEDS 9210 Pediatric and Adolescent Medicine Research
Credits:
4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

PEDS 9220 Selected Topics in Pediatric and Adolescent Medicine
Credits:
1,2,3,4,5,6,7,8
Directors:
Approved faculty (Assistant Professor or higher)
Grading:
Pass/Fail
Description:

Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

Objectives:

Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

PEDS 9410 Pediatric Endocrinology
Credits:
2,4
Directors:
Draznin
Grading:
Pass/Fail
Description:

Pediatric Endocrinology is a primarily ambulatory 4th year elective based at the WMed Pediatric Subspecialty Clinic on Oakland Drive. Students will also have the opportunity to participate in consultations at the Bronson Children’s Hospital in downtown Kalamazoo, MI. Students may spend two or four weeks in our active academic pediatric endocrinology program. The site available is WMed Pediatric Subspecialty Clinic.

Offered: All weeks

Objectives:

After completion of this elective, each student will be able to:

  • Describe processes of growth and their differences in infants children and adolescents.
  • List common growth disorders in all pediatric age groups
  • Give a basic explanation of the evaluation and management of common growth disorders in pediatric patients.
  • Describe the pathophysiology, clinical manifestations, diagnostic evaluation, and basic management principles of diabetes mellitus (types 1 and 2) in children and adolescents.
  • Describe the Michigan Newborn Endocrine Screening Program, the treatment and long term care of infants identified to have congenital adrenal hyperplasia or congenital hypothyroidism in plain language that would inform parents and children.
  • Participate in a multidisciplinary diabetes clinic and be able to explain the need for the different disciplines involved.
PEDS 9420 Pediatric Hematology and Oncology
Credits:
2,4
Directors:
Elliott
Grading:
Pass/Fail
Description:

The student will join the Bronson Children’s Hospital Pediatric hematology-oncology unit that is the tertiary care center for blood disorders and cancer for children and adolescents in Southwest Michigan. As a member of the pediatric hematology-oncology team, the student participates in evaluating outpatients, rounding on the inpatient hematology-oncology service and performing inpatient consultations. Selected procedures may be performed (lumbar punctures and bone marrow aspirations). The pediatric hematology-oncology faculty will provide the student with a study outline and reading materials. Independent projects may be arranged. The sites available are WMed Pediatric Clinics.

Offered: All weeks

Objectives:

After completion of this elective, students will be able to:

  • Describe physiologic basis underlying age-specific hematologic and coagulation norms and be familiar with peripheral blood and bone marrow smears.
  • Describe the historical, physical and laboratory findings diagnostic of hematologic or oncologic abnormalities and recognize the hematologic findings in disorders of other organ systems.
  • List basic strategies of oncologic treatment, management of complications, and with toxicities associated with chemo radiotherapy.
  • List known chromosomal and molecular genetic abnormalities underlying hematologic/oncologic diseases, including the familial cancer syndrome.
  • Appreciate the hereditary, genetic, protein and laboratory abnormalities associated with congenital bleeding dyscrasias, and become familiar with long-term health issues in these patients.
  • Appreciate the psychological and emotional aspects of childhood cancer and chronic hematologic disorders, and be involved in family genetic counseling sessions.
PEDS 9440 Pediatric Pulmonary Medicine
Credits:
2,4
Directors:
Dr. Gregiore-Bottex
Grading:
Pass/Fail
Description:

Pediatric Pulmonary Medicine is primarily an outpatient experience, but student will participate in all Pediatric activities including Morning report and resident block conferences. The student will have ample opportunity to interview patients, perform physical examinations and discuss management of the most common pulmonary disorders. The student will participate in inpatient rounds and consults on patient admitted at Bronson hospital. They will have opportunity to observe a multidisciplinary team during the Cystic Fibrosis and Ventilation clinics. The student will observe bronchoscopy and spirometry or other pulmonary function testing. Emphasis is also placed on general pediatric issues: growth, immunization, risk of smoking or exposure to tobacco smoke, and infection control, patient education, safety and planning of care. The sites available are WMed Pediatric Subspecialty Clinics.

Offered: All weeks

Objectives:

After completion of this elective, all students will be able to:

  • Demonstrate progress in obtaining a pediatric pulmonary history.
  • Demonstrate age appropriate pediatric pulmonary examination.
  • Discuss the genetics, pathophysiology and management of cystic fibrosis, including most common complications and other impairment of airway clearance.
  • Describe two types of airway clearance techniques or devices in cystic fibrosis.
  • Discuss the pathophysiology and classify severity of asthma.
  • Explain the difference between controller and rescue medications for asthma. 
  • Discuss asthma management using the NIH / EPR guidelines based on asthma severity and degree of control.
  • Discuss the basic interpretation of spirometry and other test of pulmonary function.
  • Discuss the general approach to management of chronic cough and stridor.
  • Understand the care of a child with chronic lung disease: including prematurity, aspiration and immunodeficiency.
  • Understand the role of a multidisciplinary team in planning the care for a patient with chronic lung disease.
  • Participate in the quality improvement projects in the Clinic.
PEDS 9470 Developmental Behavioral Pediatrics
Credits:
2,4
Directors:
Dr. Soares
Grading:
Pass/Fail
Description:

The purpose of this course is to provide students with an overview of Developmental-Behavioral Pediatrics through their participation in several outpatient clinics as well as attendance at some of our community sites.  Students will learn skills specific to interviewing parents, caregivers, and children as well as the common developmental assessments used in general pediatric clinics and assessments used to evaluate for more complex developmental and behavioral concerns.

Offered:  All weeks 

Objectives:

After completion of this elective, each student will be able to:

  • Recognize normal and abnormal child development and behavior from infancy through young adulthood; including cognitive, language, motor, social and emotional components.
  • Differentiate between problem behavior and intrinsic and extrinsic factors that influence those behaviors that warrant referrals to other specialists.
  • Describe the impact of family structure, adoption and foster care on growth and development.
  • Interview parents, care providers, and youth.
  • Identify psychosocial and developmental screening techniques.
  • Identify components of psychological evaluations.
  • Identify management strategies for children with developmental disabilities or special needs.
  • Recognize needs of children at risk from psychosocial adversity.
  • Recognize abuse and neglect.
  • Discuss the impact of chronic illness, terminal conditions and death on children and their families.
  • Discuss the impact of trauma (domestic violence, bullying, physical and sexual abuse) on youth growth and development (domestic violence, bullying, physical and sexual abuse).
  • Recognize and manage common mental health conditions (anxiety, depression).
  • Recognize and manage common childhood behavioral concerns.
  • Recognize and coordinate childhood and adolescent mental health problems that require referral for diagnosis and treatment.
PEDS 9480 Prenatal Exposure and Childhood Trauma
Credits:
2,4
Directors:
Sloane
Grading:
Pass/Fail
Description:

Prenatal Exposure and childhood trauma is an ambulatory 4th year elective based at the WMU Unified Clinics on 1000 Oakland Drive. Students will also have the opportunity to participate in new patient interdisciplinary consultations and interdisciplinary follow-up visits at Elizabeth Upjohn Community Healing Center (2615 Stadium Drive in Kalamazoo) as well as integrated trauma screening and assessments at the Bronson Lakeview Family Care Pediatrics in Paw Paw. Students may spend two or four weeks in our active interdisciplinary elective.

Offered: All weeks

Objectives:

After completion of this elective, each student will be able to:

  • Describe multiple types of child trauma and maltreatment.
  • Understand the brain and developmental impact of traumatic stress including the significant impact on adult health (ACES model).
  • Understand the basic principles of Fetal Alcohol Spectrum Disorder, including University of Washington FASD Diagnostic Criteria.
  • Understand the deleterious impact of prenatal exposure to toxic stress.
  • Understand the deleterious impact of prenatal exposure to drugs (opiates, stimulants, cannabis, nicotine, et al).
  • Understand the concept of resiliency and the central place of importance for this when constructing trauma-informed case / treatment plans.
  • Understand the concept of secondary traumatic stress and learn the importance of processing trauma cases with a trusted supervisor as well as practical examples of self-care.
  • Understand the essential nature of intergenerational trauma and the practical impact of this in daily pediatric primary care practice.
  • Understand the importance of trauma screening in the primary care setting.
  • Understand the need for comprehensive interdisciplinary integrated trauma assessment in multiple settings.
  • Participate in interdisciplinary trauma assessments in multiple settings (BLFCP, EUCHC, and WMU CTAC) and be able to explain the need for tiered trauma assessment (based on trauma screening results) and the different disciplines involved in each tier.
  • Participate in follow-up visits for children involved in the Early Intervention Program (EIP) at EUCHC, and understand the unique regulatory roles of trauma-informed / sensory-focused occupational therapy, trauma-informed music therapy, and trauma-informed medication treatment in the overall management of complex young children exposed to toxic stress and complex prenatal exposure.
PEDS 9490 Pediatric Cardiology
Credits:
2,4
Directors:
Fountain
Grading:
Pass/Fail
Description:

The student will be working with the Bronson Children's Hospital Pediatric Cardiology Faculty in both the inpatient, consultative, and ambulatory clinic settings. Bronson Children's Hospital serves as the tertiary care referral center for Southwest Michigan.

 

 

 

Objectives:

Upon completion of this elective, students will be able to:

  • Demonstrate the ability to do a thorough history of patients with a cardiovascular complaint.
  • Demonstrate the ability to perform a thorough cardiovascular examination, including auscultation.
  • Discuss initial evaluation and management of common pediatric cardiovascular disorders.
  • Understand the rationale for using noninvasive/ invasive diagnostic techniques in the evaluation and treatment of pediatric patients with cardiovascular issues including: echocardiography, cardiac catheterization and electrophysiology, cardiothoracic surgery.
  • Understand the implications of congenital heart disease AND acquired heart disease on the long term growth and development of infants, children, and adolescents.
PEDS 9510 Newborn and Infant Nutrition
Credits:
2,4
Directors:
Gibson
Grading:
Pass/Fail
Description:

During this rotation, students will work clinically with Bronson Lactation Consultants, the Bronson NICU Dietitian and Bronson Pediatric Occupational Therapists. The focus of this clinical experience is to gain first hand experience in evaluating infants and counseling parents and caregivers regarding the normal nutritional needs of infants and troubleshooting feeding problems that may arise during infancy. 

Offered: May – August  

Objectives:

After completion of this elective, each student will be able to:

  • Demonstrate how to counsel parents and caregivers about normal nutritional needs of the newborn.
  • Evaluate mom/infant dyad regarding appropriate feeding techniques, whether bottle or breast fed.
  • Demonstrate the ability to support breast feeding when there isn’t adequate growth in the infant.
  • Recognize infant risk factors for poor feeding.
  • Recognize maternal factors that lead to breast feeding failure.
  • Describe the role of lactation consultant, dietitian and occupational therapist in supporting normal newborn/infant growth.
  • Describe community resources that help to support infant feeding.
PEDS 9520 Pediatric Allergy and Immunology
Credits:
2,4
Directors:
Barr
Grading:
Pass/Fail
Description:

This rotation is designed to provide individualized teaching in the management of outpatient medical problems for students interested in combined internal medicine and pediatrics practice experience.  The student will spend the majority of their outpatient clinical experience in a community combined internal medicine and pediatrics practice.  There may also be opportunities for other experiences such as sports medicine and transitions of care clinics.  The student will gain experience in the ambulatory setting including preventative medical services, assessment of growth and development in children and adolescents, diagnosis and treatment management of common adult and pediatric ambulatory problems, psychosocial issues affecting patient compliance, and the importance of multidisciplinary care.  There may also be opportunities for performing or observing procedures such as EKG, Pap, microscopic examination of wet mounts, throat cultures, and injections. Other activities include Internal Medicine grand rounds and block conference and Pediatrics grand rounds and block conference.  At the conclusion of the experience, the student will give a short presentation to the practice site of a topic of interest.

Objectives:

After completion of this elective, each student will be able to:

  1. EPAs
    • Obtain a medical history and perform a physical examination appropriate to the patients presentation (EPA 1a and EPA 1b)
    • Construct a logically thought out and prioritized differential diagnosis (EPA 2)
    • Provide oral presentation of a clinical encounter (EPA 6)
    • Collaborate as a member of an interprofessional team; Be responsive to whole patient and behave in a professional manner that embraces and respects diversity while exhibiting compassion, honesty, integrity, respect, and responsibility (EPA 9)
    • Recognize a patient requiring urgent/emergent care and discuss the appropriate evaluation and management (EPA 10)
  2. Competencies
  • Medical Knowledge
  • Awareness of evidence-based guidelines guiding the diagnosis, treatment, and management of common primary care internal medicine and pediatrics problems
    • Examples of common internal medicine problems include COPD, type 2 diabetes, essential hypertension, coronary artery disease, chronic pain
    • Examples of common pediatric problems include well child exams, viral illnesses, asthma, ear infections, abdominal pain
  • Self directed learning and reading
  • Patient Care
    • Basic clinical skills – obtain a patient history and physical exam in a logical, organized, and thorough manner while adapting to the urgency of the medical situation and time available.
    • Oral presentations
    • There may be opportunities to perform or observe procedures such as throat cultures, injections, PAP smears, wet mounts, dermatologic procedures (cryrosurgery, excision of skin lesions and moles), PFTs and EKGs.
    • Identify opportunity to improve health promotion through patient education such as smoking cessation
  • Systems Based Practice
    • Community resources
  • Practice Based Learning and Improvement
    • Self directed learning and reading
    • Presentation of common Med Ped disease
  • Interpersonal and Communication Skills
    • Effective communication – perform patient interviews and physical examinations, and enhance presentation skills.
  • Professionalism
    • The student demonstrates responsible, professional, and respectful behavior.
    • Accepts constructive criticism and receptive to receiving feedback
PEDS 9710 Advanced Hospital Pediatrics
Credits:
2,4
Directors:
Lane-Davies, Corpus
Grading:
Pass/Fail
Description:

Advanced hospital clerkships provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

Advanced Hospital Pediatrics is a hospital based pediatric rotation that utilizes Bronson Children’s Hospital as its clinical site. This center is the tertiary care referral center for pediatric disorders in Southwest Michigan. Fourth year students who have successfully completed all Year 3 required clerkships are eligible to register for this course.  During this rotation, students will focus on the development of patient management skills as they assume primary responsibility for patient care.

Faculty for this rotation are the Bronson Children's Hospital Pediatric Referral Service.

Offered:  All weeks

Objectives:
  • Take primary responsibility for their patients.
  • Perform focused histories, physicals, and communicate orally and in writing appropriately.
  • Share information effectively with patients and families.
  • Prioritize and organize work effectively.
  • Anticipate what patients will need during the course of hospitalization (i.e. when they need to be re-examined, when a lab needs to be repeated, when additional therapy is necessary, when additional history needs to be obtained, discharge criteria) and communicating this information effectively in hand-overs.
  • Re-evaluate patients when taking on their care (i.e. the assessment and plan, as well as the clinical status and looking further when the clinical picture is not consistent with the expected course).
  • Coping with uncertainty in patient care issues (i.e. knowing what you know and what you do not know, accessing best resources, and knowing when and how to get help).
  • Function as a "team player" with families, residents, attendings, nurses, ancillary staff and all others involved in the care of the patient.
  • Coordinate the care of patients during hospitalization and in planning for discharge.

Advanced Clerkship Goals:

  1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
  2. Demonstrate patient-centered interview skills
  3. Demonstrate patient-centered examination techniques.
  4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
  5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
  6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
  7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
  8. Articulate the risks and benefits of what you are ordering (e.g., drugs, tests).
  9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
  10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
  11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
  12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
  13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
  14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
  15. Provide key aspects of the ideal handover to the recipient, including verbalizing the patient's illness severity and/or providing action planning and/or contingency planning.
  16. Demonstrates awareness of known threats to handover communication (e.g., interruptions and distractions) by paying attention to the timing and location of the handover communication.
  17. Acts as an active and integrate member of the team who in most situations prioritizes team goals over one's own professional goals.
  18. Understands the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
  19. Interpret common test results to anticipate and respond to early clinical deterioration.
  20. Adhere to institutional procedures and protocols regarding escalation of patient care.
  21. Understand the importance of informed consent to rapport building and shared decision making.
  22. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
  23. Demonstrate patient-centered skills in performing procedures:
    • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
    • Participate in shared decision making with patients about procedures
    • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
    • Simultaneously pay attention to both the procedure and the patient's emotional response.
  24. Identify real potential errors.
  25. Perform common safety behaviors (e.g., universal precautions, hand washing).
  26. Understand the importance of error prevention both to individual patients and to systems.
PEDS 9712 Advanced Hospital Newborn
Credits:
4
Directors:
Marisha Agana
Grading:
Pass/Fail
Description:

Advanced Newborn Nursery is a hospital based pediatric rotation that utilizes Bronson Children’s Hospital Normal Newborn Nursery and Borgess Well Baby Nurery as its two clinical sites. These centers are the Level 1 Nursery referral centers in Southwest Michigan. Fourth year students who have successfully completed all Year 3 required clerkships are eligible to register for this course. During this rotation, students will focus on the development of patient management skills in the care of normal newborns as they assume primary responsibility for patient care.

Faculty for this rotation are the Bronson Children’s Hospital Pediatric Referral Service and the Borgess Hospital Normal Newborn Service.

1. Take primary responsibility for their newborn patients

2. Perform focused histories, physicals, and communicate orally and in writing appropriately.

3. Share information effectively with parents, families and care providers.

4. Prioritize and organize work effectively

5. Anticipate what newborns will need during the course of hospitalization (i.e. when they need to be re-examined, when a lab needs to be repeated, when additional therapy is necessary, when additional history needs to be obtained, discharge criteria) and communicating this information effectively in hand-overs

6. Re-evaluate newborns when taking on their care (i.e. the assessment and plan, as well as the clinical status and looking further when the clinical picture is not consistent with the expected course)

7. Coping with uncertainty in newborn care issues (i.e. knowing what you know and what you do not know, accessing best resources, and knowing when and how to get help)

8. Function as a "team player" with families, residents, attendings, nurses, ancillary staff and all others involved in the care of the newborn.

9. Coordinate the care of newborns during hospitalization and in planning for discharge

Offered: All blocks

Objectives:

Clinical competencies will be assessed utilizing the Medical Student Y4 Clinical Clerkship Assessment tool.  This form is EPA based, and comments on level of entrustability.  Cognitive objectives will be assessed utilizing case based patient discussions, presentations and assignments.

EPAs and Competencies evaluated during this rotation:

Engagement and Professionalism

  • Demonstrate personal accountability to newborn patients, colleagues and staff, in order to provide the best patient care
  • Demons0trate integrity, compassion, respect, altruism, and empathy when interacting with all members of the health care team, parents and their families
  • Demonstrate a family-centered approach to the care of the newborn
    • Identify the perspectives of newborns, families, self and other healthcare team members
    • Analyze how perspectives may conflict and converge
  • Provide culturally effective care
    • Identify the important role of culture in the care of each newborn
    • Recognize how one's own beliefs affect patient care
  • Demonstrate punctuality and ability to complete patient care tasks efficiently
  • Adhere to institutional guidelines, including those regarding attire, language, documentation, and confidentiality
  • Maintain appropriate professional boundaries with patients, families, and staff
  • Recognize the impact of stress, fatigue, and illness on learning and performance
  • Recognize and appropriately act on unprofessional behavior demonstrated by others
  • Identify one's own reactions to newborn patients and families, recognize when these reactions interfere with effective communication, and manage these reactions properly

 EPA 1. Gather a history and perform a physical examination.

  • Gather essential and accurate information about newborns and their conditions through history taking (maternal prenatal), physical examination, and the use of laboratory data, imaging, and other tests.
  • Demonstrate an investigatory and analytic approach to anticipated newborn clinical situations such as respiratory distress, lethargy, cyanosis, seizures, temperature instability, jaundice, etc.
  • Communicate effectively with parents, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.
  • Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions.
  • Demonstrate compassion, integrity, and respect for others.
  • Demonstrate respect for patient privacy and autonomy.
  • Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

EPA 2: Develop a prioritized differential diagnosis and select a working diagnosis following a patient encounter.

  • Gather essential and accurate information about newborns and their conditions through history taking, physical examination, and the use of laboratory data, imaging, and other tests.
  • Interpret laboratory data, imaging studies, and other tests required for the area of practice.
  • Apply established and emerging biophysical scientific principles fundamental to health care for newborns.
  • Apply established and emerging principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based health care.
  • Apply principles of epidemiological sciences to the identification of health problems, perinatal risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for newborns.
  • Identify strengths, deficiencies, and limits in one’s knowledge and expertise.
  • Communicate effectively with colleagues within one’s profession or specialty, other health professionals, and health related agencies
  • Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty

EPA 3: Recommend and interpret common diagnostic and screening tests.

  • Interpret laboratory data, imaging studies, and other tests required for the area of practice.
  • Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
  • Counsel and educate parents and their families to empower them to participate in the care of their newborns and enable shared decision-making.
  • Provide healthcare services to newborns, families, and communities aimed at preventing health problems or maintaining health.
  • Demonstrate an investigatory and analytic approach to clinical situations involved in newborns.
  • Apply principles of epidemiological sciences to the identification of health problems, perinatal risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for newborns.
  • Obtain and utilize information about individual newborn patients, populations of newborns, or communities from which patients are drawn to improve care.
  • Incorporate considerations of cost awareness and risk-benefit analysis in newborn and/or population-based care.

EPA 4: Enter and discuss patient orders/prescriptions.

  • Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
  • Develop and carry out newborn management plans.
  • Demonstrate an investigatory and analytic approach to newborn clinical situations.
  • Apply established and emerging biophysical scientific principles fundamental to health care for newborns.
  • Apply established and emerging principles of clinical sciences to diagnostic
  • and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based health care.
  • Apply principles of epidemiological sciences to the identification of health problems, perinatal risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for newborns.
  • Apply principles of social-behavioral sciences to provision of neonatal care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care.
  • Communicate effectively with parents, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds
  • Incorporate considerations of cost awareness and risk-benefit analysis in newborn and/or population-based care.

EPA 5: Provide documentation of a clinical encounter in written or electronic format.

  • Communicate effectively with parentss, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.
  • Communicate effectively with colleagues within one’s profession or specialty, other health professionals, and health related agencies Interpersonal and Communication Skills
  • Maintain comprehensive, timely, and legible medical records
  • Demonstrate accountability to patients, society, and the profession
  • Work effectively in various healthcare delivery settings and systems relevant to one’s clinical specialty.

EPA 6: Provide an oral presentation/summary of a patient encounter.

  • Gather essential and accurate information about newborns and their conditions through history taking, physical examination, and the use of laboratory data, imaging, and other tests.
  • Demonstrate an investigatory and analytic approach to newborn clinical situations
  • Identify strengths, deficiencies, and limits in one’s knowledge and expertise
  • Communicate effectively with parents, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.
  • Communicate effectively with colleagues within one’s profession or specialty, other health professionals, and health related
  • Practice flexibility and maturity in adjusting to change with the capacity to alter one’s behavior.
  • Demonstrate self-confidence that puts patients, families, and members of the healthcare team at ease.

EPA 7: Form clinical questions and retrieve evidence to advance patient care.

  • Apply established and emerging biophysical scientific principles fundamental to health care for newborns.
  • Apply established and emerging principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based health care.
  • Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for newborns.
  • Apply principles of social-behavioral sciences to provision of newborn care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care.
  • Identify strengths, deficiencies, and limits in one’s knowledge and expertise.
  • Identify and perform learning activities that address one’s gaps in knowledge, skills, and/or attitudes. Locate, appraise, and assimilate evidence from scientific studies related to newborn health problems.
  • Use information technology to optimize learning.
  • Obtain and utilize information about individual newborns, populations of patients, or communities from which patients are drawn to improve care.

EPA 8: Give or receive a patient handover to transition care responsibility to another healthcare provider or team.

  • Provide appropriate referral of newborns including ensuring continuity of care throughout transitions between providers or settings, and following up on newborn progress and outcomes.
  • Use information technology to optimize learning.
  • Communicate effectively with colleagues within one’s profession or specialty, other health professionals, and health related agencies
  • Work effectively with others as a member or leader of a healthcare team or other professional group
  • Demonstrate respect for patient privacy and autonomy.

EPA 9: Participate as a contributing and integrated member of an interprofessional team.

  • Communicate effectively with colleagues within one’s profession or specialty, other health professionals, and health related agencies.
  • Work effectively with others as a member or leader of a healthcare team or other professional group
  • Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions
  • Demonstrate compassion, integrity, and respect for others
  • Coordinate patient care within the healthcare system relevant to one’s clinical specialty.
  • Work with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust.
  • Use the knowledge of one’s own role and the roles of other health professionals to appropriately assess and address the healthcare needs of the newborn served.
  • Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the treatment of disease in individual newborns.

EPA 10: Recognize a patient requiring urgent or emergent care, initiate evaluation and treatment, and seek help.

  • Gather essential and accurate information about newborns and their conditions through history taking, physical examination, and the use of laboratory data, imaging, and other tests.
  • Interpret laboratory data, imaging studies, and other tests required for the area of practice
  • Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
  • Develop and carry out newborn management plans.
  • Communicate effectively with colleagues within one’s profession or specialty, other health professionals, and health related agencies
  • Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics.

EPA 11: Obtain informed consent for tests and/or procedures that the day 1 intern is expected to perform or order without supervision.

  • Organize and prioritize responsibilities to provide care that is safe, effective, and efficient.
  • Counsel and educate parents and their families to empower them to participate in the care of their newborns and enable shared decision-making.
  • Communicate effectively with parents, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.
  • Maintain comprehensive, timely, and legible medical records.
  • Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions.
  • Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care.
  • Demonstrate self-confidence that puts newborns, families, and members of the healthcare team at ease.

EPA 12: Perform general procedures of a physician.

  • Perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.
  • Counsel and educate parents and their families to empower them to participate in the care of their newborns and enable shared decision-making.
  • Maintain comprehensive, timely, and legible medical records.
  • Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations.
  • Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care.
  • Demonstrate self-confidence that puts patients, families, and members of the healthcare team at ease.

EPA 13: Identify system failures and contribute to a culture of safety and improvement.

  • Demonstrate an investigatory and analytic approach to newborn clinical situations.
  • Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.
  • Continually identify, analyze, and implement new knowledge, guidelines, standards, technologies, products, or services that have been demonstrated to improve outcomes
  • Communicate effectively with colleagues within one’s profession or specialty, other health professionals, and health related agencies
  • Demonstrate accountability to patients, society, and the profession.
  • Advocate for quality newborn care and optimal patient care systems.
  • Participate in identifying system errors and implementing potential systems solutions.

Conditions typically encountered

  1. Presenting Problems   
    • Newborn delivery and stabilization
    • Respiratory distress in thenewborn
    • Feeding difficulties and failure to thrive
    • Neonatal fever, neonatal sepsis
    • Pain management
    • Seizures
    • ABO Incompatibility and Jaundice
    • Congenital malformations
    • Breast feeding challenges
    • Fluids and electrolyte management and nutrition
    • Neonatal resuscitation

Diseases/syndromes

  • Hyaline Membrane Disease
  • Meconium Aspiration Syndrome
  • Congenital heart diseases
  • Central nervous system infections (TORCH)
  • Child abuse and neglect
  • Group B Beta Strep Infections
  • Skin and soft tissue infection
  • Urinary tract infection and kidney malformations
  • Inheritable chromosomal conditions like Trisomies, Di George, etc.
  • SGA, LGA
  • Eye infections
  • Constipation, Gastroenteritis and bloody diarrhea
  • Neonatal Abstinence syndrome

 

PEDS 9720 Advanced Ambulatory Pediatrics
Credits:
2,4
Directors:
Patel
Grading:
Pass/Fail
Description:

Advanced ambulatory clerkships provide the opportunity for students to assume initial responsibility for the evaluation of patients in the ambulatory setting. Supervision will be provided by faculty preceptors in the academic setting as well as community private practices. Students expand upon competencies they developed during the third year as they team with residents and/or preceptors to provide preventive health services as well as acute and chronic illness management. The faster pace of ambulatory care provides an environment that strengthens patient and family communication skills, rapport development, and oral presentations. The use of evidence to inform treatment and counseling of patients and their caregivers are additional competencies that are highlighted in the outpatient setting.

Advanced Ambulatory Pediatrics is a 4 week, outpatient pediatric rotation that utilizes the WMed Pediatric Clinic as well as a community pediatric office as potential clinical sites. Fourth year students who have successfully completed all Year 3 required clerkships are eligible to register for this course. During this rotation, students will focus on understanding the normal progression of growth and development from infancy through adolescence. Students will also develop their diagnostic and management skills of common acute pediatric complaints, with a focus on respiratory, abdominal and dermatologic problems, as well as common behavioral and mental health disorders. Faculty will all have appointments in the Department of Pediatric and Adolescent Medicine.

Offered:  All weeks

Objectives:
  • Assess normal and abnormal growth patterns in children and adolescents.
  • Understand Tanner staging in adolescents.
  • Recognize the normal developmental timeline from early infancy to adolescence with regard to the gross motor, fine motor, language, adaptive and personal-social domains.
  • Administer and interpret standardized developmental testing.
  • Discuss the referral patterns for children who present with concerns regarding growth and/or development.
  • Appreciate the importance of vision and hearing assessment.
  • Demonstrate an evaluation of the upper and lower respiratory system including but not limited to otologic examination with pneumatic otoscopy, and nasal passage examination.
  • Recognize, compare and contrast nasal obstruction, stridor, wheezing and alveolar congestion.
  • Demonstrate understanding of abdominal pain in children.Distinguish between benign abdominal pain and that requiring outside consultation.
  • Demonstrate knowledge of basic dermatologic problems in children, demonstrate the ability to describe skin lesions and develop a differential diagnosis based on history and physical findings.

Advanced Clerkship Goals:

  1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
  2. Demonstrate patient-centered interview skills.
  3. Demonstrate patient-centered examination techniques.
  4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
  5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
  6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
  7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
  8. Articulate the risks and benefits of what you are ordering (e.g., drugs tests).
  9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
  10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
  11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
  12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
  13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
  14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
  15. Act as an active and integrated member of the team who in most situations prioritizes team goals over one's own professional goals.
  16. understand the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
  17. Maintains a professional demeanor in all but the most trying of circumstances.
  18. Interpret common test results to anticipate and respond to early clinical deterioration.
  19. Understand the importance of informed consent to rapport building and shared decision making.
  20. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
  21. Provides complete information to patients and families.
  22. Avoids medical jargon in communicating with patients and families.
  23. Demonstrate patient-centered skills in performing procedures:
    • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
    • Participate in shared decision making with patients about procedures.
    • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
    • Simultaneously pay attention to both the procedure and the patient's emotional response.
  24. Identify real and potential errors.
  25. Perform common safety behaviors (e.g., universal precautions, handwashing).
  26. Understand the importance of error prevention both to individual patients and to systems.
PEDS 9810 Advanced Pediatric Critical Care
Credits:
4
Directors:
Robert Beck
Grading:
Pass/Fail
Description:

This rotation offers students the opportunity to accelerate their learning by spending a four week block in the intensive care unit.  The rotation provides the student the opportunity to diagnose and treat of a wide range of clinical conditions common among critically ill patients. Students will enhance their knowledge and skill in caring for the sickest patients in the hospital.  The Clinical site utilized for the Pediatric Advanced Critical Care Clerkship is the pediatric ICU at Bronson Children’s Hospital.  Students will be paired with interns and residents, and will participate in the ICU in a dedicated fashion; the intent is for students to function as a “subintern” and will result in a high level learning experience. 

Students will be expected to participate on rounds, will continue to perfect the gathering and synthesis of data, and expand on their ability to make diagnoses and develop care plans.  The student will be expected to gather a history based upon interview of patients/families, evaluate laboratory and radiographic material, and generate differential diagnoses and management plans.  They will also be expected to improve their documentation skills by writing patient notes in the electronic medical record.

This is a 4 week block rotation, and will correspond to the calendar set forth by the Western Michigan University School of Medicine. This varies on the time of year and the rotation site. The pediatric ICU consists of all aspects of pediatric critical care.

Offered: All weeks

Objectives:

After completion of this elective, each student will be able to:

    Hemodynamics/Cardiovascular System

    1. Understand the diagnosis, pathophysiology, and treatment of shock
    2. Understand the basics of hemodynamic monitoring and apply this to resuscitation medicine
    3. Understand the basics of fluid resuscitation
    4. Know indications for the use of vasoactive agents
    5. Recognize and treat dysrhythmias
    6. Understand the principles of managing cardiac arrest

    Pulmonary System

    1. Recognize basic patterns on chest radiograph evaluation (ie infiltrate, effusion, pneumothorax)
    2. Understand basic pulmonary physiology (shunt, V/Q mismatch, dead space)
    3. Interpret arterial blood gases, and apply A-a gradient, P/F ratio
    4. Understand the indications for intubation and mechanical ventilation
    5. Understand the basics of mechanical ventilation and management
    6. Understand spontaneous awakening trials and spontaneous breathing trials and apply these to liberation from mechanical ventilation
    7. Recognize and treat pulmonary complications including pneumothorax, ARDS (including permissive hypercapnea), pneumonia, atelectasis, pulmonary embolism

    Gastrointestinal System

    1. Diagnose and treat gastrointestinal hemorrhage
    2. Diagnose and treat clostridium difficile colitis and its complications
    3. Recognize and treat complication from congenital GI abnormalities
    4. Evaluate and treat pancreatitis

    Neurologic System

    1. Understand Cerebral Perfusion Pressure and its management
    2. Diagnosis and treat acute ischemic and hemorrhagic stroke
    3. Diagnose and treat subarachnoid hemorrhage
    4. Diagnose and treat seizures including status epilepticus
    5. Be familiar with brain death and its determination
    6. Be familiar with sedation and analgesia and its effect on the CNS in the ICU

    Renal System

    1. Understand, diagnose, and treat oliguria
    2. Define and treat acute kidney injury
    3. Know the indications for renal replacement therapy

    Metabolic System

    1. Be familiar with, understand, and treat electrolyte disturbances
    2. Manage hyperglycemia in the ICU
    3. Understand, diagnose, and treat acid base disorders

    Hematologic System

    1. Understand the indications for blood product transfusion in the ICU
    2. Evaluate and treat anemia
    3. Evaluate and treat abnormalities of coagulation
    4. Understand principles of anticoagulation

    Endocrine System

    1. Evaluate and treat abnormalities of the thyroid axis as it relates to critical illness
    2. Evaluate and treat abnormalities of the adrenal gland as it relates to critical illness
    3. Understand the principles of steroid replacement in the ICU

    Infectious Diseases and Sepsis

    1. Understand source identification and control of infections
    2. Understand the basics of antibiotic selection and subsequent stewardship
    3. Define and treat sepsis and septic shock, including early goal-directed therapy, and resuscitation and support

    Advanced Clerkship Goals:

    1. Recognize the severity of illness in patients with a variety critical illness.
    2. Provide an extensive and complete assessment of the patient, including a complete history and physical examination, evaluation of laboratory data and radiographic material, synthesis of patient information, and generation of a comprehensive care plan.
    3. Develop a rational evaluation and management plan for the stabilization and treatment of organ system dysfunction while evaluating and treating underlying etiologies.
    4. Demonstrate competent use of technologic procedures and devices in the intensive care setting for the purposes of evaluating, monitoring, and managing patients.
    5. Integrate imaging and other diagnostic studies in assessing the critically ill.
    6. Effectively engage consultants and other ancillary care services in a team approach to manage critically ill patients.
    7. Perform procedures necessary for the assessment and treatment of critically ill patients.
    8. When indicated, address end of life decision making and advanced directives, and provide counseling for patients and their families.
    9. Provide appropriate documentation of all patient interactions

     

    PSYC 9210 Psychiatry Research
    Credits:
    4,5,6,7,8
    Directors:
    Approved faculty (Assistant Professor or higher)
    Grading:
    Pass/Fail
    Description:

    Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

    Objectives:

    Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

    PSYC 9220 Selected Topics in Psychiatry
    Credits:
    1,2,3,4,5,6,7,8
    Directors:
    Approved faculty (Assistant Professor or higher)
    Grading:
    Pass/Fail
    Description:

    Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

    Objectives:

    Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

    PSYC 9710 Advanced Adult Psychiatry
    Credits:
    4
    Directors:
    Longstreet
    Grading:
    Pass/Fail
    Description:

    Advanced hospital clerkships provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

    Students work directly with a faculty psychiatrist, usually a psychiatry resident, and a multi-disciplinary team in an inpatient setting with older adult patients. Students perform initial evaluations and help manage patients throughout their hospitalization (if desired, the student may participate in the ECT Service). The site available is Borgess Medical Center.

    Not offered July and August

    Objectives:

    After completion of this elective, each student will be able to:

    • Demonstrate capacity to conduct comprehensive intake evaluations of inpatients
    • Discuss the diagnosis of a basic formulation, and provide a practical treatment plan for patients with a wide variety of psychopathologies.
    • Discuss basic pharmacology of psychotropic medications.
    • Manage their own inpatients with relative autonomy.
    • Provide supportive and or motivational therapies for inpatients when indicated.

    Advanced Clerkship Goals:

    1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
    2. Demonstrate patient-centered interview skills
    3. Demonstrate patient-centered examination techniques.
    4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
    5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
    6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
    7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
    8. Articulate the risks and benefits of what you are ordering (e.g., drugs, tests).
    9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
    10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
    11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
    12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
    13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
    14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
    15. Provide key aspects of the ideal handover to the recipient, including verbalizing the patient's illness severity and/or providing action planning and/or contingency planning.
    16. Demonstrates awareness of known threats to handover communication (e.g., interruptions and distractions) by paying attention to the timing and location of the handover communication.
    17. Acts as an active and integrate member of the team who in most situations prioritizes team goals over one's own professional goals.
    18. Understands the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
    19. Interpret common test results to anticipate and respond to early clinical deterioration.
    20. Adhere to institutional procedures and protocols regarding escalation of patient care.
    21. Understand the importance of informed consent to rapport building and shared decision making.
    22. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
    23. Demonstrate patient-centered skills in performing procedures:
      • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
      • Participate in shared decision making with patients about procedures
      • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
      • Simultaneously pay attention to both the procedure and the patient's emotional response.
    24. Identify real potential errors.
    25. Perform common safety behaviors (e.g., universal precautions, hand washing).
    26. Understand the importance of error prevention both to individual patients and to systems.
    PSYC 9712 Advanced Adolescent Psychiatry
    Credits:
    4
    Directors:
    Longstreet
    Grading:
    Pass/Fail
    Description:

    Advanced hospital clerkships provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

    Advanced Adolescent Psychiatry is an experience during which time students work as part of a treatment team including an attending psychiatrist, resident, social worker and therapists. Students will engage with faculty and staff in the process of psychological testing, group therapy, individual therapy, family therapy, and activities therapy. The site available is Borgess Medical Center.

    Not offered July and August

    Objectives:

    After completion of this elective, each student will be able to:

    • Demonstrate the capacity to perform a comprehensive intake evaluation on adolescents.
    • Assess and utilize family and community resources to better understand and manage patients.
    • Assess and manage the common psychiatric disorders in children and adolescents.
    • Utilize common psychotherapeutic and psycho-pharmacological treatment approaches.
    • Conduct observed individual and family therapy sessions.
    • Obtain collateral information from as well as provide comfort for the families and patients.

    Advanced Clerkship Goals:

    1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
    2. Demonstrate patient-centered interview skills
    3. Demonstrate patient-centered examination techniques.
    4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
    5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
    6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
    7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
    8. Articulate the risks and benefits of what you are ordering (e.g., drugs, tests).
    9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
    10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
    11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
    12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
    13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
    14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
    15. Provide key aspects of the ideal handover to the recipient, including verbalizing the patient's illness severity and/or providing action planning and/or contingency planning.
    16. Demonstrates awareness of known threats to handover communication (e.g., interruptions and distractions) by paying attention to the timing and location of the handover communication.
    17. Acts as an active and integrate member of the team who in most situations prioritizes team goals over one's own professional goals.
    18. Understands the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
    19. Interpret common test results to anticipate and respond to early clinical deterioration.
    20. Adhere to institutional procedures and protocols regarding escalation of patient care.
    21. Understand the importance of informed consent to rapport building and shared decision making.
    22. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
    23. Demonstrate patient-centered skills in performing procedures:
      • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
      • Participate in shared decision making with patients about procedures
      • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
      • Simultaneously pay attention to both the procedure and the patient's emotional response.
    24. Identify real potential errors.
    25. Perform common safety behaviors (e.g., universal precautions, hand washing).
    26. Understand the importance of error prevention both to individual patients and to systems.
    PSYC 9714 Advanced Geriatric Psychiatry
    Credits:
    4
    Directors:
    Longstreet
    Grading:
    Pass/Fail
    Description:

    Advanced hospital clerkships provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

    Students work directly with a faculty psychiatrist, usually a psychiatry resident, and a multi-disciplinary team in an inpatient setting with older adult patients. Students perform initial evaluations and help manage patients throughout their hospitalization (if desired, the student may participate in the ECT Service). The site available is Borgess Medical Center.

    Not offered July and August

    Objectives:

    After completion of this elective, each student will be able to:

    • Demonstrate the capacity to provide psychiatric evaluations on older adult patients.
    • Discuss the effects of medical illnesses and medications on the presentation of psychiatric illness.
    • Demonstrate the ability to appropriately use and interpret the results of various psychometric screening instruments.
    • Demonstrate the ability to assess and utilize family and community resources to better understand and manage patients.
    • Identify and assess common neuropsychiatric disorders.
    • Discuss pharmacologic and non-pharmacologic including treatment approaches to manage behavioral problems.
    • Explain the unique biomedical processes involved in the presentation of psychiatric symptoms in some medical conditions as well as the effect of medical illnesses on psychiatric disorders.

    Advanced Clerkship Goals:

    1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
    2. Demonstrate patient-centered interview skills
    3. Demonstrate patient-centered examination techniques.
    4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
    5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
    6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
    7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
    8. Articulate the risks and benefits of what you are ordering (e.g., drugs, tests).
    9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
    10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
    11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
    12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
    13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
    14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
    15. Provide key aspects of the ideal handover to the recipient, including verbalizing the patient's illness severity and/or providing action planning and/or contingency planning.
    16. Demonstrates awareness of known threats to handover communication (e.g., interruptions and distractions) by paying attention to the timing and location of the handover communication.
    17. Acts as an active and integrate member of the team who in most situations prioritizes team goals over one's own professional goals.
    18. Understands the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
    19. Interpret common test results to anticipate and respond to early clinical deterioration.
    20. Adhere to institutional procedures and protocols regarding escalation of patient care.
    21. Understand the importance of informed consent to rapport building and shared decision making.
    22. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
    23. Demonstrate patient-centered skills in performing procedures:
      • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
      • Participate in shared decision making with patients about procedures
      • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
      • Simultaneously pay attention to both the procedure and the patient's emotional response.
    24. Identify real potential errors.
    25. Perform common safety behaviors (e.g., universal precautions, hand washing).
    26. Understand the importance of error prevention both to individual patients and to systems.
    PSYC 9715 Advanced General Hospital Psychiatry
    Credits:
    4
    Directors:
    Peter Longstreet
    Grading:
    Pass/Fail
    Description:

     Discuss the role of drug interactions, adverse effects of medications, and poly-pharmacy in the patient's psychiatric presentation.
     Develop the capacity to perform cognitive assessments on these patients with delirium and or dementia.
     Demonstrate the ability to perform a neurological screening exam, and know when it is appropriate to order neurodiagnostic tests.
     Demonstrate the ability to provide supportive therapy for patients in the general hospital setting.

    Objectives:
    • Discuss the role of psychological and behavioral processes that impact patients' somatic presentations in the general medical setting.
    • Gain experience seeing patients with a variety of medical illnesses and psychiatric issues
    • Demonstrate the ability to clarify the reason(s) for a psychiatric consultation.
    • Demonstrate the capacity to effectively assess patients with common psychiatric referral problems.
    RAD 9210 Radiology Research
    Credits:
    4,5,6,7,8
    Directors:
    Approved faculty (Assistant Professor or higher)
    Grading:
    Pass/Fail
    Description:

    Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

    Objectives:

    Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

    RAD 9220 Selected Topics in Radiology
    Credits:
    1,2,3,4,5,6,7,8
    Directors:
    Approved faculty (Assistant Professor or higher)
    Grading:
    Pass/Fail
    Description:

    Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

    Objectives:

    Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

    RAD 9410 Diagnostic Radiology
    Credits:
    2,4
    Directors:
    Tominna, Smullens
    Grading:
    Pass/Fail
    Description:

    This is an overview of diagnostic radiology. Students will rotate through general radiology and the different subspecialties (gastrointestinal, neuroradiology, mammography, interventional radiology, musculoskeletal, and emergency radiology). Students will participate in the daily reading of images and in the performance of procedures. They will operate during the rotation as part of a team consisting of physicians, physician assistants, radiology physician assistants, nurses, and technologists.

    During the elective, the students will choose what rotations they would like to participate in. They will participate in interpretation of images and performing procedures with the staff radiologist. Students will be on the rotation for approximate ten hours per day, some of which may be night shifts. Students will be expected to present an interesting case at the end of the elective. Students will attend all departmental conferences.

    Offered: All weeks

    Objectives:

    After completion of this elective, each student will be able to:

    • Develop and demonstrate an understanding of the imaging modalities of radiology (X-ray, Ultrasound, CT, MRI, Fluoroscopy, Nuclear Medicine, and Interventional Radiology).
    • Develop and demonstrate an understanding of the indications for imaging.
    • Develop and demonstrate an understanding of the anatomy on imaging
    • Develop an understanding of the pathology seen on imaging.
    • Maintain a professional and positive relationship with the radiology staff and referring clinicians (professional, interpersonal and communication skills).
    • Develop an understanding of the limitations of imaging.
    • Develop an understanding of the risks of radiation and contrast.
    • Develop an understanding of the terminology used in radiology.
    RAD 9460 Interventional Radiology
    Credits:
    2,4
    Directors:
    Tominna, Smullens
    Grading:
    Pass/Fail
    Description:

    This is a 2 or 4-week elective in interventional radiology. Students will be expected to be involved in the initial work up of patients, participate in procedures, and in the follow-up care of patients. Students will be expected to understand the risks, benefits and alternatives to procedures. The will be expected to perform basic procedure (line placement, paracetesis and thoracetesis) by the end of the rotation. Students will also be expected to participate in ward rounds. They will operate during the rotation as part of a team consisting of physicians, physician assistants, radiology physician assistants, nurses, and technologists. Students will not be required to take call. Students will be expected to present an interesting case at the end of the elective. Students will attend all departmental conferences.

    Offered: All weeks

    Objectives:

    After completion of this elective, each student will be able to:

    • Develop and demonstrate an understanding of the different imaging modalities used in interventional radiology (X-ray, Ultrasound, CT, MRI, and Fluoroscopy).
    • Develop and demonstrate an understanding of the indications, alternatives, and risks for intervention.
    • Develop and demonstrate an understanding of the anatomy on imaging.
    • Develop the skill to be able to perform basic procedures (image guided line placement, paracentesis and thoracentesis).
    • Participate in more complex procedures and understand the equipment used.
    • Maintain professional and positive relationships with interventional radiology staff and referral clinicians (Professionalism, Interpersonal and Communication Skills).
    • Attend clinic once a week with the interventional radiologist.
    • Develop an understanding of the risks of radiation and contrast.
    • Develop an understanding of the terminology used in interventional radiology.
    SURG 9210 Surgery Research
    Credits:
    4,5,6,7,8
    Directors:
    Approved faculty (Assistant Professor or higher)
    Grading:
    Pass/Fail
    Description:

    Students may develop an individualized research plan of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

    Objectives:

    Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

    SURG 9220 Selected Topics in Surgery
    Credits:
    1,2,3,4,5,6,7,8
    Directors:
    Approved faculty (Assistant Professor or higher)
    Grading:
    Pass/Fail
    Description:

    Students may develop an individualized course on a topic of their choice under the direction of a faculty member. Students should work with a faculty member to submit the form Elective Proposal to Educational Affairs at least eight weeks prior to the projected start date. The elective must be approved by the Associate Dean for Educational Affairs.

    Objectives:

    Specific objectives are developed by the student and supervising faculty, and customized for each rotation.

    SURG 9220 Selected Topics in Medicine - Section 1 Student Chief
    Credits:
    4
    Directors:
    Vicki McKinney
    Grading:
    Pass/Fail
    Description:

    The purpose of this elective is to provide support to M3 students transitioning into the Surgery Clerkship. Student Chiefs will orient M3 students to expectations of the Surgery clerkship and student roles. The chiefs are expected to be available to the M3 students on the Surgery rotation for support with knowledge and skills required in the clerkship. Students interested in being a Student Chief need to apply and will be selected by the faculty. This elective is available for Rotation 1 and 2 only.

     Offered: Rotation 1: April 30 - May 11 May 21 - June 1

    Rotation 2: June 25 - July 20

    Objectives:
    • Orient M3 students to the Surgery clerkship
    • Answer M3 student questions about the surgery clerkship
    • Provide help to M3 students on knowledge and skills required in the Surgery clerkship
    • Assist the Surgery clerkship director with meeting student needs during the clerkship rotation
    SURG 9410 Cardiothoracic Surgery
    Credits:
    2,4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    The cardiothoracic surgery rotation is designed for students who are interested in a general surgery or primary care residency. They will manage patients as independently as possible with oversight from an attending surgeon. They will be assigned to the cardiothoracic surgery service at either Borgess or Bronson. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient and outpatient setting. They will be assigned a faculty mentor/preceptor at their assigned hospital.

    Offered: All weeks

    Objectives:

    After completion of this elective, each student will be able to:

    • Obtain a complete and accurate history in an organized fashion focused on a cardiothoracic patient
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills).
      • Identify pertinent history elements in common presenting situations (coronary artery disease, lung cancer).
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting.
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care.
    • Perform a complete and accurate physical exam in logical and fluid sequence.
      • Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of patient visit.
      • Identify, describe and document abnormal physical exam findings with specific focus on cardiothoracic examination.
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety.
    • Prioritize a differential diagnosis following a clinical encounter.
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations.
      • Integrate information as it emerges to continuously update differential diagnosis.
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis.
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan.
    • Recommend and interpret common diagnostic and screening tests for patients with suspected cardiothoracic disease.
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder.
      • Provide rationale for decision to order the test.
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values.
    • Enter and discuss orders and prescriptions for anticoagulation.
      • Demonstrate an understanding of the patient’s current condition and preferences that will underpin the orders being provided.
      • Demonstrate working knowledge of the protocol by which orders will be processed in the environment in which they are placing the orders.
      • Compose orders efficiently and effectively, such as by identifying the correct admission order set, selecting the correct fluid and electrolyte replacement orders, and recognizing the needs for deviations from standard order sets.
    • Document a clinical encounter in the patient record
      • Filter, organize, and prioritize information
      • Synthesize information into a cogent narrative
      • Record a problem list, working and differential diagnosis and plan
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting)
    • Provide an oral presentation of a clinical encounter
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty
      • Provide an accurate, concise, and well-organized oral presentation
    • Recognize a patient requiring urgent or emergent care and initiate evaluation and management
      • Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors
      • Recognize severity of a patient’s illness and indications for escalating care
      • Identify potential underlying etiologies of the patient’s decompensation
      • Communicate the situation to responding team members
    • Obtain informed consent for tests and/or procedures
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures including cardiac bypass, valve replacement, pulmonary resection
    • Perform basic procedures such as assisting in surgery, suturing, reading EKGs, CXRs and CT scans of the chest
      • Demonstrate the technical (motor) skills required for the procedure
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure
    SURG 9420 Plastic and Reconstructive Surgery
    Credits:
    2
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    The plastic surgery rotation is designed for students who are interested in a plastic, vascular, orthopedic or general surgery residency. They will manage patients as independently as possible with oversight from an attending surgeon. They will be assigned to the plastic surgery service at either Borgess or Bronson. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient and outpatient setting. They will be assigned a faculty mentor/preceptor at their assigned hospital.

    Offered: All weeks, 2 week duration

    Objectives:

    After completion of this elective, each student will be able to:

    • Obtain a complete and accurate history in an organized fashion focused on wound healing abilities such as cessation of tobacco and nutritional status.
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills).
      • Identify pertinent history elements in common presenting situations.
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting.
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care.
    • Perform a complete and accurate physical exam in logical and fluid sequence.
      • Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of patient visit.
      • Identify, describe and document abnormal physical exam findings.
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety.
    • Prioritize a differential diagnosis following a clinical encounter.
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations.
      • Integrate
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis.
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan.
    • Document a clinical encounter in the patient record.
      • Filter, organize, and prioritize information.
      • Synthesize information into a cogent narrative.
      • Record a problem list, working and differential diagnosis and plan.
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting).
    • Provide an oral presentation of a clinical encounter.
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty.
      • Provide an accurate, concise, and well-organized oral presentation.
    • Obtain informed consent for tests and/or procedures as appropriate.
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures.
    • Perform basic procedures such as assisting in surgery, suturing wounds, debridements, and wound VAC changes.
      • Demonstrate the technical (motor) skills required for the procedure.
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure.
    SURG 9430 Ophthalmology
    Credits:
    2,4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    The ophthalmology rotation is designed for students who are interested in an ophthalmology or primary care residency. They will manage patients as independently as possible with oversight from an attending surgeon. They will be assigned to the general surgery service at either Borgess or Bronson. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient and outpatient setting. They will be assigned a faculty mentor/preceptor at their assigned hospital.

    Offered: All weeks

    Objectives:
    • Obtain a complete and accurate history in an organized fashion focused on ophthalmologic problems
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills)
      • Identify pertinent history elements in common presenting situations
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care
    • Perform a complete and accurate physical exam in logical and fluid sequence
      • Perform a clinically relevant, focused ophthalmologic exam pertinent to the setting and purpose of patient visit
      • Identify, describe and document abnormal physical exam findings
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety
    • Prioritize a differential diagnosis following a clinical encounter
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations
      • Integrate information as it emerges to continuously update differential diagnosis
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan
    • Recommend and interpret common diagnostic and screening tests
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder
      • Provide rationale for decision to order the test
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values
    • Enter and discuss orders and prescriptions of eye drops
      • Demonstrate an understanding of the patient’s current condition and preferences that will underpin the orders being provided
      • Demonstrate working knowledge of the protocol by which orders will be processed in the environment in which they are placing the orders
      • Compose orders efficiently and effectively, such as by identifying the correct admission order set, selecting the correct fluid and electrolyte replacement orders, and recognizing the needs for deviations from standard order sets
    • Document a clinical encounter in the patient record
      • Filter, organize, and prioritize information
      • ynthesize information into a cogent narrative
      • Record a problem list, working and differential diagnosis and plan
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting)
    • Provide an oral presentation of a clinical encounter
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty
      • Provide an accurate, concise, and well-organized oral presentation
    • Recognize a patient requiring urgent or emergent care and initiate evaluation and management
      • Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors
      • Recognize severity of a patient’s illness and indications for escalating care
      • Identify potential underlying etiologies of the patient’s decompensation
      • Communicate the situation to responding team members
    • Obtain informed consent for tests and/or procedures such as cataract extraction,
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures
    • Perform basic procedures such as assisting in surgery and ophthalmologic examination
      • Demonstrate the technical (motor) skills required for the procedure
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure
    SURG 9440 Neurosurgery
    Credits:
    2,4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    The neurosurgery rotation is designed for students who are interested in a neurosurgery, general surgery, orthopedic surgery or primary care residency. They will manage patients as independently as possible with oversight from an attending surgeon. They will be assigned to a preceptor at either Borgess or Bronson. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient and outpatient setting.

    Offered: All weeks

    Objectives:

    After the completion of this elective, each student will be able to:

    • Obtain a complete and accurate history in an organized fashion focused on neurologic problems
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills)
      • Identify pertinent history elements in common presenting situations with specific focus on neurologic complaints
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care
    • Perform a complete and accurate physical exam in logical and fluid sequence
      • Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of patient visit
      • Identify, describe and document abnormal physical exam findings with specific focus on neurologic examination
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety
    • Prioritize a differential diagnosis following a clinical encounter
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations
      • Integrate information as it emerges to continuously update differential diagnosis
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan
    • Recommend and interpret common diagnostic and screening tests
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder
      • Provide rationale for decision to order the test
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values
    • Document a clinical encounter in the patient record
      • Filter, organize, and prioritize information
      • Synthesize information into a cogent narrative
      • Record a problem list, working and differential diagnosis and plan
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting)
    • Provide an oral presentation of a clinical encounter
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty
      • Provide an accurate, concise, and well-organized oral presentation
    • Recognize a patient requiring urgent or emergent care and initiate evaluation and management
      • Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors
      • Recognize severity of a patient’s illness and indications for escalating care
      • Identify potential underlying etiologies of the patient’s decompensation
      • Communicate the situation to responding team members
    • Obtain informed consent for tests and/or procedures
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures as appropriate
    • Perform basic procedures such as assisting in surgery, suturing wounds, reading films and obtaining a complete neurologic examination
      • Demonstrate the technical (motor) skills required for the procedure
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure
    SURG 9450 Otolaryngology
    Credits:
    2,4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    The otolaryngology rotation is designed for students who are interested in a general surgery, ENT or primary care residency. They will manage patients as independently as possible with oversight from an attending surgeon. They will be assigned to an otolaryngologist at either Borgess or Bronson. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient and outpatient setting. 

    Offered: All weeks

    Objectives:

    After completion of this elective, all students will be able to:

    • Obtain a complete and accurate history in an organized fashion focused on ear, nose and throat complaints
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills)
      • Identify pertinent history elements in common presenting situations (vertigo, ear pain, recurrent sinus infections, head and neck malignancies)
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care
    • Perform a complete and accurate physical exam in logical and fluid sequence
      • Perform a clinically relevant, focused physical exam of the head and neck pertinent to the setting and purpose of patient visit
      • Identify, describe and document abnormal physical exam findings
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety
    • Prioritize a differential diagnosis following a clinical encounter
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations
      • Integrate information as it emerges to continuously update differential diagnosis
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan
    • Recommend and interpret common diagnostic and screening tests
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder
      • Provide rationale for decision to order the test
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values
    • Document a clinical encounter in the patient record
      • Filter, organize, and prioritize information
      • Synthesize information into a cogent narrative
      • Record a problem list, working and differential diagnosis and plan
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting)
    • Provide an oral presentation of a clinical encounter
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty
      • Provide an accurate, concise, and well-organized oral presentation
    • Recognize a patient requiring urgent or emergent care and initiate evaluation and management
      • Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors
      • Recognize severity of a patient’s illness and indications for escalating care
      • Identify potential underlying etiologies of the patient’s decompensation
      • Communicate the situation to responding team members
    • Obtain informed consent for tests and/or procedures such as tonsillectomy and tympanostomy tubes
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures
    • Perform basic procedures such as assisting in surgery and suturing wounds
      • Demonstrate the technical (motor) skills required for the procedure
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure
    SURG 9460 Urologic Surgery
    Credits:
    2,4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    The urology rotation is designed for students who are interested in a urology, general surgery or primary care residency. They will manage patients as independently as possible with oversight from an attending surgeon. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient and outpatient setting. They will be assigned a faculty mentor/preceptor at their assigned hospital.

    Offered: All weeks

    Objectives:

    After completion of this elective, each student will be able to:

    • Obtain a complete and accurate history in an organized fashion focusing on urologic conditions
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills)
      • Identify pertinent history elements in common presenting situations
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care
    • Perform a complete and accurate physical exam in logical and fluid sequence focused on genitourinary examination
      • Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of patient visit with specific attention to the urologic examination
      • Identify, describe and document abnormal physical exam findings
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety
    • Prioritize a differential diagnosis following a clinical encounter
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations
      • Integrate information as it emerges to continuously update differential diagnosis
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan
    • Recommend and interpret common diagnostic and screening tests including interpreting urinalysis
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder
      • Provide rationale for decision to order the test
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values
    • Document a clinical encounter in the patient record
      • Filter, organize, and prioritize information
      • Synthesize information into a cogent narrative
      • Record a problem list, working and differential diagnosis and plan
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting)
    • Provide an oral presentation of a clinical encounter
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty
      • Provide an accurate, concise, and well-organized oral presentation
    • Recognize a patient requiring urgent or emergent care and initiate evaluation and management
      • Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors
      • Recognize severity of a patient’s illness and indications for escalating care
      • Identify potential underlying etiologies of the patient’s decompensation
      • Communicate the situation to responding team members
    • Obtain informed consent for tests and/or procedures as appropriate
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures
    • Perform basic procedures such as assisting in surgery and cystoscopy
      • Demonstrate the technical (motor) skills required for the procedure
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure
    SURG 9470 Vascular Surgery
    Credits:
    2,4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    The vascular surgery rotation is designed for students who are interested in orthopedic vascular, general surgery or primary care residency. They will learn to manage both arterial and venous disease under the supervision of a vascular surgeon. They will spend either two or four weeks assigned to the vascular surgery service. They will gain operative experience as well as learn to manage patients in the inpatient and outpatient setting. They will be assigned a faculty mentor/preceptor or group.

    Offered: All weeks

    Objectives:

    After competion of this elective, each student will be able to:

    • Obtain a complete and accurate history in an organized fashion
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills).
      • Identify pertinent history elements in common presenting situations with focus on vascular disease (arterial occlusive disease, aneurysmal disease, venous stasis and vascular access).
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting with focus on vascular disease (arterial occlusive disease, aneurysmal disease, venous stasis and vascular access).
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care.
    • Perform a complete and accurate physical exam in logical and fluid sequence
      • Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of patient visit with focus on vascular examination (pulses, skin changes, ABIs).
      • Identify, describe and document abnormal physical exam findings.
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety.
    • Prioritize a differential diagnosis following a clinical encounter
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations.
      • Integrate information as it emerges to continuously update differential diagnosis.
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis.
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan.
    • Recommend and interpret common diagnostic and screening tests by spending at least one day in the vascular ultrasound lab
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder.
      • Provide rationale for decision to order the test.
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values.
    • Enter and discuss orders and prescriptions with respect to anticoagulation
      • Demonstrate an understanding of the patient’s current condition and preferences that will underpin the orders being provided.
    • Document a clinical encounter in the patient record
      • Filter, organize, and prioritize information.
      • Synthesize information into a cogent narrative.
      • Record a problem list, working and differential diagnosis and plan.
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting).
    • Provide an oral presentation of a clinical encounter
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty
      • Provide an accurate, concise, and well-organized oral presentation
    • Recognize a patient requiring urgent or emergent care and initiate evaluation and management such as acute arterial thrombosis, ruptured or leaking aneurysm, venous thromboembolism
      • Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors
      • Recognize severity of a patient’s illness and indications for escalating care
      • Identify potential underlying etiologies of the patient’s decompensation
      • Communicate the situation to responding team members
    • Obtain informed consent for tests and/or procedures
      • Describe the indications, risks, benefits, alternatives and potential complications of basic procedures such as endovascular stenting or aneurysm repair, carotid endarterectomy
    • Perform basic procedures such as assisting in surgery, suturing, debridements, obtaining a thorough vascular exam, obtaining vascular access
      • Demonstrate the technical (motor) skills required for the procedure
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure
    SURG 9480 Breast Surgery
    Credits:
    2,4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    The breast surgery rotation is designed for students who are interested in a general surgery residency or primary care. They will learn to manage both benign and malignant breast disease under the supervision of a breast surgeon. They will spend either two or four weeks assigned to the breast surgery service. They will gain operative experience as well as learn to manage patients in the inpatient and outpatient setting. They will be assigned a faculty mentor/preceptor or group.

    Offered: All weeks

    Objectives:

    After competion of this elective, each student will be able to:

    • Obtain a complete and accurate history in an organized fashion with focused attention to benign and malignant breast diseases.
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills).
      • Identify pertinent history elements in common presenting situations with focus on breast disease (mastitis, abscesses, benign disease and maligancies).
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting with focus on breast disease (mastitis, abscesses, benign disease and maligancies).
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care.
    • Perform a complete and accurate physical exam in logical and fluid sequence.
      • Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of patient visit with focus on breast examination (masses, skin changes, lymphadenopathy).
      • Identify, describe and document abnormal physical exam findings.
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety.
    • Prioritize a differential diagnosis following a clinical encounter.
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations.
      • Integrate information as it emerges to continuously update differential diagnosis.
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis.
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan.
    • Recommend and interpret common diagnostic and screening tests by spending at least one day in the breast imaging suite/with radiologist.
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder.
      • Provide rationale for decision to order the test.
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values.
    • Enter and discuss orders and prescriptions with respect to hormonal and chemotherapy options for breast malignancies.
      • Demonstrate an understanding of the patient’s current condition and preferences that will underpin the orders being provided.
    • Document a clinical encounter in the patient record.
      • Filter, organize, and prioritize information.
      • Synthesize information into a cogent narrative.
      • Record a problem list, working and differential diagnosis and plan.
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting).
    • Provide an oral presentation of a clinical encounter.
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty.
      • Provide an accurate, concise, and well-organized oral presentation.
    • Obtain informed consent for tests and/or procedures.
      • Describe the indications, risks, benefits, alternatives and potential complications of basic procedures such as partial mastectomy, modified radical mastectomy, and sentinel lymph node biopsy.
      • Describe the indications, risks, benefits, alternatives and potential complications of hormonal therapy, chemotherapy and radiation therapy for breast malignancies with specific attention to estrogen, progesterone and Her-2 receptors.
    • Perform basic procedures such as assisting in surgery, suturing, ultrasound and breast biopsies.
      • Demonstrate the technical (motor) skills required for the procedure.
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure.
    SURG 9530 Surgical Skills
    Credits:
    2
    Directors:
    Lisa Miller
    Grading:
    Pass/Fail
    Description:

    The surgical skills rotation is designed for students who are interested in any type of surgical residency. They will participate in a number of skills sessions and group learning activities designed to prepare them for life as a surgical house officer.

     

    Offered:  TBD—March or April

    Objectives:

    A. Objectives

     

    1. Prioritize common patient scenarios encountered on the surgical floor and emergency department
      • Demonstrate triage skills for most critically ill patients to less critical requests from patients and staff
      • Identify common complaints that could represent life threatening emergencies
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care
      • Demonstrate clinical reasoning in work up of patient with urgent, emergent and consultative settings
    2. Demonstrate ability to manage common perioperative problems
      • Describe preoperative work up for patients undergoing elective and emergent procedures
      • Demonstrate ability to write postoperative orders for patients undergoing elective and emergent surgery
    3. Describe appropriate antimicrobial management
      • List appropriate prophylaxis for common operative procedures
      • Describe purpose of antimicrobial stewardship
    4. Radiology
      • Read CXR, CT and ultrasound images
    5. Clinical skills
      • Suturing/knot tying
      • Retractors
      • Laparoscopic access
      • Robot
      • Endoscopy
      • FAST exam and ultrasound
      • Central lines
      • Chest tubes
      • Sim man
    6. Wound care—led by wound care nurses
      • Ostomies
      • Wound VAC
      • Other dressing choices
    7. Mock paging
      • Respond to pages from nursing staff
    8. Dictation and procedures
    9. Obtain informed consent for tests and/or procedures
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures as appropriate
    10. Panel discussion about great surgical intern
      • Residents
      • Faculty

    B. Student expectations—Students are expected to be engaged and present for all sessions. Students are expected to conduct themselves in a professional manner at all times

    C. References to be determined

    D. Students will be evaluated on a pass/fail basis. Input will be sought from preceptor and other ancillary staff.

    E. Students will be asked to evaluate the clerkship at the end of the rotation.

    SURG 9710 Advanced General Surgery
    Credits:
    4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    Advanced hospital clerkships provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

    The advanced general surgery rotation is designed for students who are interested in a general surgery residency. They will manage patients as independently as possible with oversight from the general surgery chief resident and an attending surgeon. They will be assigned to the general surgery service at either Borgess or Bronson. Assistance with teaching 3rd year students will also be expected. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient and outpatient setting. They will be assigned a faculty mentor/preceptor at their assigned hospital.

    Offered:  Not offered in July

    Objectives:

    Upon completion of this course, each student will be able to:

    • Obtain a complete and accurate history in an organized fashion.
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills).
      • Identify pertinent history elements in common presenting situations.
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting.
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care.
    • Perform a complete and accurate physical exam in logical and fluid sequence.
      • Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of patient visit.
      • Identify, describe and document abnormal physical exam findings.
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety.
    • Prioritize a differential diagnosis following a clinical encounter.
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations.
      • Integrate information as it emerges to continuously update the differential diagnosis
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis.
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan.
    • Recommend and interpret common diagnostic and screening tests.
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder.
      • Provide rationale for decision to order the test.
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values.
    • Enter and discuss orders and prescriptions.
      • Demonstrate
      • Demonstrate working knowledge of the protocol by which orders will be processed in the environment in which they are placing the orders.
      • Compose orders efficiently and effectively, such as by identifying the correct admission order set, selecting the correct fluid and electrolyte replacement orders, and recognizing the needs for deviations from standard order sets.
    • Document a clinical encounter in the patient record.
      • Filter, organize, and prioritize information.
      • Synthesize information into a cogent narrative.
      • Record a problem list, working and differential diagnosis and plan.
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting).
    • Provide an oral presentation of a clinical encounter.
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty.
      • Provide an accurate, concise, and well-organized oral presentation.
    • Give or receive a patient handover to transition care responsibly.
      • Conduct handover communication that minimizes known threats to transitions of care (e.g., by ensuring you engage the listener, avoiding distractions).
      • Document—and update—an electronic handover tool.
      • Provide succinct verbal communication that conveys, at a minimum, illness severity, situation awareness, action planning, and contingency planning.
    • Recognize a patient requiring urgent or emergent care and initiate evaluation and management.
      • Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors.
      • Recognize severity of a patient’s illness and indications for escalating care.
      • Identify potential underlying etiologies of the patient’s decompensation.
      • Communicate the situation to responding team members.
    • Obtain informed consent for tests and/or procedures.
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures.
    • Perform basic procedures such as assisting in surgery, suturing wounds, debridements, wound VAC changes, incision and drainage of abscesses.
      • Demonstrate the technical (motor) skills required for the procedure.
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure.

    Advanced Clerkship Goals:

    1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
    2. Demonstrate patient-centered interview skills
    3. Demonstrate patient-centered examination techniques.
    4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
    5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
    6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
    7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
    8. Articulate the risks and benefits of what you are ordering (e.g., drugs, tests).
    9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
    10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
    11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
    12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
    13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
    14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
    15. Provide key aspects of the ideal handover to the recipient, including verbalizing the patient's illness severity and/or providing action planning and/or contingency planning.
    16. Demonstrates awareness of known threats to handover communication (e.g., interruptions and distractions) by paying attention to the timing and location of the handover communication.
    17. Acts as an active and integrate member of the team who in most situations prioritizes team goals over one's own professional goals.
    18. Understands the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
    19. Interpret common test results to anticipate and respond to early clinical deterioration.
    20. Adhere to institutional procedures and protocols regarding escalation of patient care.
    21. Understand the importance of informed consent to rapport building and shared decision making.
    22. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
    23. Demonstrate patient-centered skills in performing procedures:
      • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
      • Participate in shared decision making with patients about procedures
      • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
      • Simultaneously pay attention to both the procedure and the patient's emotional response.
    24. Identify real potential errors.
    25. Perform common safety behaviors (e.g., universal precautions, hand washing).
    26. Understand the importance of error prevention both to individual patients and to systems.
    SURG 9712 Advanced Pediatric Surgery
    Credits:
    4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    Advanced hospital clerkships provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

    The advanced pediatric surgery rotation is designed for students who are interested in a general surgery, pediatric or primary care residency. They will manage patients as independently as possible with oversight from an attending surgeon. They will be assigned to the pediatric surgery service at Bronson. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient and outpatient setting. They will be assigned a faculty mentor/preceptor but will work with everyone on the pediatric surgery team.

    Offered: Not offered in July

    Objectives:
    • Obtain a complete and accurate history in an organized fashion.
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills).
      • Identify pertinent history elements in common presenting situations.
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting.
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care.
    • Perform a complete and accurate physical exam in logical and fluid sequence.
      • Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of patient visit.
      • Identify, describe and document abnormal physical exam findings.
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety.
    • Prioritize a differential diagnosis following a clinical encounter.
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations.
      • Integrate information as it emerges to continuously update the differential diagnosis
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis.
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan.
    • Recommend and interpret common diagnostic and screening tests.
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder.
      • Provide rationale for decision to order the test.
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values.
    • Enter and discuss orders and prescriptions as appropriate.
      • Demonstrate
      • Demonstrate working knowledge of the protocol by which orders will be processed in the environment in which they are placing the orders.
      • Compose orders efficiently and effectively, such as by identifying the correct admission order set, selecting the correct fluid and electrolyte replacement orders, and recognizing the needs for deviations from standard order sets.
    • Document a clinical encounter in the patient record.
      • Filter, organize, and prioritize information.
      • ynthesize information into a cogent narrative.
      • Record a problem list, working and differential diagnosis and plan.
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting).
    • Provide an oral presentation of a clinical encounter.
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty.
      • Provide an accurate, concise, and well-organized oral presentation.
      • Situation awareness, action planning, and contingency planning.
    • Recognize a patient requiring urgent or emergent care and initiate evaluation and management.
      • Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors.
      • Recognize severity of a patient’s illness and indications for escalating care.
      • Identify potential underlying etiologies of the patient’s decompensation.
      • Communicate the situation to responding team members.
    • Obtain informed consent for tests and/or procedures as appropriate.
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures.
    • Perform basic procedures such as assisting in surgery, suturing wounds, debridements, wound VAC changes, incision and drainage of abscesses.
      • Demonstrate the technical (motor) skills required for the procedure.
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure.

    Advanced Clerkship Goals:

    1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
    2. Demonstrate patient-centered interview skills
    3. Demonstrate patient-centered examination techniques.
    4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
    5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
    6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
    7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
    8. Articulate the risks and benefits of what you are ordering (e.g., drugs, tests).
    9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
    10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
    11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
    12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
    13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
    14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
    15. Provide key aspects of the ideal handover to the recipient, including verbalizing the patient's illness severity and/or providing action planning and/or contingency planning.
    16. Demonstrates awareness of known threats to handover communication (e.g., interruptions and distractions) by paying attention to the timing and location of the handover communication.
    17. Acts as an active and integrate member of the team who in most situations prioritizes team goals over one's own professional goals.
    18. Understands the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
    19. Interpret common test results to anticipate and respond to early clinical deterioration.
    20. Adhere to institutional procedures and protocols regarding escalation of patient care.
    21. Understand the importance of informed consent to rapport building and shared decision making.
    22. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
    23. Demonstrate patient-centered skills in performing procedures:
      • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
      • Participate in shared decision making with patients about procedures
      • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
      • Simultaneously pay attention to both the procedure and the patient's emotional response.
    24. Identify real potential errors.
    25. Perform common safety behaviors (e.g., universal precautions, hand washing).
    26. Understand the importance of error prevention both to individual patients and to systems.
    SURG 9714 Advanced Surgical Oncology
    Credits:
    4
    Directors:
    Miller
    Grading:
    Pass/Fail
    Description:

    Advanced hospital clerkships provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

    The surgical oncology rotation is designed for students who are interested in a general surgery or primary care residency. They will manage patients as independently as possible with oversight from an attending surgeon. They will be assigned to the surgical oncology service through West Michigan Cancer Center. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient and outpatient setting.

    Objectives:
    1. Obtain a complete and accurate history in an organized fashion
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills)
      • Identify pertinent history elements in common presenting situations
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care
    2. Perform a complete and accurate physical exam in logical and fluid sequence
      • Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of patient visit
      • Identify, describe and document abnormal physical exam findings
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety
    3. Prioritize a differential diagnosis following a clinical encounter
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations
      • Integrate information as it emerges to continuously update differential diagnosis
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan
    4. Recommend and interpret common diagnostic and screening tests
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder
      • Provide rationale for decision to order the test
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values
    5. Enter and discuss orders and prescriptions
      • Demonstrate an understanding of the patient’s current condition and preferences that will underpin the orders being provided
      • Demonstrate working knowledge of the protocol by which orders will be processed in the environment in which they are placing the orders
      • Compose orders efficiently and effectively, such as by identifying the correct admission order set, selecting the correct fluid and electrolyte replacement orders, and recognizing the needs for deviations from standard order sets
    6. Document a clinical encounter in the patient record
      • Filter, organize, and prioritize information
      • Synthesize information into a cogent narrative
      • Record a problem list, working and differential diagnosis and plan
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting)
    7. Provide an oral presentation of a clinical encounter
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty
      • Provide an accurate, concise, and well-organized oral presentation
    8. Recognize a patient requiring urgent or emergent care and initiate evaluation and management
      • Recognize normal vital signs and variations that might be expected based on patient and disease-specific factors
      • Recognize severity of a patient’s illness and indications for escalating care
      • Identify potential underlying etiologies of the patient’s decompensation
      • Communicate the situation to responding team members
    9. Obtain informed consent for tests and/or procedures as appropriate
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures
    10. Perform basic procedures such as assisting in surgery
      • Demonstrate the technical (motor) skills required for the procedure
      • Understand and explain the anatomy, physiology, indications

    Advanced Clerkship Goals:

    1. Demonstrate clinical reasoning in gathering focused information relevant to a patient's care.
    2. Demonstrate patient-centered interview skills
    3. Demonstrate patient-centered examination techniques.
    4. Articulate a management plan based on the well-reasoned differential and working diagnoses.
    5. Provide complete and succinct documentation so that other providers have evidence of your clinical reasoning to ensure continuity of care and patient safety.
    6. Recommend reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions.
    7. Routinely reflect on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test.
    8. Articulate the risks and benefits of what you are ordering (e.g., drugs, tests).
    9. Consistently discuss diagnostic plans with the patient, and provide evidence that patient preferences have been solicited and factored into decision making.
    10. Distinguish common, insignificant abnormalities from clinically important abnormalities.
    11. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies.
    12. Filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation.
    13. Adjust oral presentations for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus stable).
    14. Routinely identify the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one's own knowledge gaps and patient needs.
    15. Provide key aspects of the ideal handover to the recipient, including verbalizing the patient's illness severity and/or providing action planning and/or contingency planning.
    16. Demonstrates awareness of known threats to handover communication (e.g., interruptions and distractions) by paying attention to the timing and location of the handover communication.
    17. Acts as an active and integrate member of the team who in most situations prioritizes team goals over one's own professional goals.
    18. Understands the roles of other team members, seek their counsel, actively listen to their recommendations, and incorporate them into practice.
    19. Interpret common test results to anticipate and respond to early clinical deterioration.
    20. Adhere to institutional procedures and protocols regarding escalation of patient care.
    21. Understand the importance of informed consent to rapport building and shared decision making.
    22. Demonstrate an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought.
    23. Demonstrate patient-centered skills in performing procedures:
      • Avoid medical jargon such that patients are able to verbalize understanding of the procedure.
      • Participate in shared decision making with patients about procedures
      • Have confidence commensurate with level of knowledge and skill that puts patients at ease.
      • Simultaneously pay attention to both the procedure and the patient's emotional response.
    24. Identify real potential errors.
    25. Perform common safety behaviors (e.g., universal precautions, hand washing).
    26. Understand the importance of error prevention both to individual patients and to systems.

     

    SURG 9810 Advanced Trauma and Surgery Critical Care
    Credits:
    4
    Directors:
    Curtiss, Maltz
    Grading:
    Pass/Fail
    Description:

    This rotation offers students the opportunity to accelerate their learning by spending a four week block in the intensive care unit.  The rotation provides the student the opportunity to diagnose and treat of a wide range of clinical conditions common among critically ill patients. Students will enhance their knowledge and skill in caring for the sickest patients in the hospital.  The Clinical site utilized for the Pediatric Advanced Critical Care Clerkship is the pediatric ICU at Bronson Children’s Hospital.  Students will be paired with interns and residents, and will participate in the ICU in a dedicated fashion; the intent is for students to function as a “subintern” and will result in a high level learning experience. 

    Students will be expected to participate on rounds, will continue to perfect the gathering and synthesis of data, and expand on their ability to make diagnoses and develop care plans.  The student will be expected to gather a history based upon interview of patients/families, evaluate laboratory and radiographic material, and generate differential diagnoses and management plans.  They will also be expected to improve their documentation skills by writing patient notes in the electronic medical record.

    The advanced trauma and critical care surgery rotation is designed for students who are interested in a general surgery or other surgery subspecialty residency. They will manage patients as independently as possible with oversight from the general surgery senior resident on service and an attending surgeon. They will be assigned to the trauma/critical care surgery service at either Borgess or Bronson. Assistance with teaching 3rd year students will also be expected. They will gain operative experience as well as have increased responsibilities managing patients in the inpatient critical care and trauma bay settings. They will be assigned a faculty mentor/preceptor at their assigned hospital.

    This is a 4 week block rotation, and will correspond to the calendar set forth by the Western Michigan University School of Medicine. This varies on the time of year and the rotation site. The trauma/surgical ICU consists of primarily surgical-related problems.

    Offered:  Not offered in July

    Objectives:

    Upon completion of this course, students will be able to:

    • Obtain a complete and accurate history in an organized fashion
      • Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, need for interpretive services, demonstrates active listening skills)
      • Identify pertinent history elements in common presenting situations
      • Obtain focused, pertinent histories in urgent, emergent and consultative setting
      • Demonstrate clinical reasoning in gathering focused information relevant to patient’s care
    • Perform a complete and accurate physical exam in logical and fluid sequence
      • Perform a clinically relevant, focused physical exam pertinent to the trauma or critically ill patient
      • Identify, describe and document abnormal physical exam findings with specific focus on the ABCs of trauma
      • Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort and safety
    • Prioritize a differential diagnosis following a clinical encounter
      • Synthesize essential information from the previous records, history, physical exam and initial diagnostic evaluations with specific focus on the ABCs of trauma
      • Integrate information as it emerges to continuously update differential diagnosis
      • Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis
      • Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan
    • Recommend and interpret common diagnostic and screening tests
      • Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder
      • Provide rationale for decision to order the test
      • Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values
    • Enter and discuss orders and prescriptions
      • Demonstrate an understanding of the patient’s current condition and preferences that will underpin the orders being provided
      • Demonstrate working knowledge of the protocol by which orders will be processed in the environment in which they are placing the orders
      • Compose orders efficiently and effectively, such as by identifying the correct admission order set, selecting the correct fluid and electrolyte replacement orders, and recognizing the needs for deviations from standard order sets
    • Document a clinical encounter in the patient record
      • Filter, organize, and prioritize information
      • Synthesize information into a cogent narrative
      • Record a problem list, working and differential diagnosis and plan
      • Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting)
    • Provide an oral presentation of a clinical encounter
      • Present information that has been personally gathered or verified, acknowledging any areas of uncertainty
      • Provide an accurate, concise, and well-organized oral presentation
    • Give or receive a patient handover to transition care responsibly
      • Conduct handover communication that minimizes known threats to transitions of care (e.g., by ensuring you engage the listener, avoiding distractions)
      • Document—and update—an electronic handover tool
      • Provide succinct verbal communication that conveys, at a minimum, illness severity, situation awareness, action planning, and contingency planning
    • Recognize a patient requiring urgent or emergent care and initiate evaluation and management
      • Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors
      • Recognize severity of a patient’s illness and indications for escalating care
      • Identify potential underlying etiologies of the patient’s decompensation
      • Communicate the situation to responding team members
    • Obtain informed consent for tests and/or procedures
      • Describes the indications, risks, benefits, alternatives and potential complications of basic procedures
    • Perform basic procedures such as assisting in surgery, suturing wounds, debridements, wound VAC changes, intubation, central venous and arterial line placement, chest tube placement, foley catheterization, C spine stabilization
      • Demonstrate the technical (motor) skills required for the procedure
      • Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure

    Advanced Clerkship Goals:

    1. Recognize the severity of illness in patients with a variety critical illness.
    2. Provide an extensive and complete assessment of the patient, including a complete history and physical examination, evaluation of laboratory data and radiographic material, synthesis of patient information, and generation of a comprehensive care plan.
    3. Develop a rational evaluation and management plan for the stabilization and treatment of organ system dysfunction while evaluating and treating underlying etiologies.
    4. Demonstrate competent use of technologic procedures and devices in the intensive care setting for the purposes of evaluating, monitoring, and managing patients.
    5. Integrate imaging and other diagnostic studies in assessing the critically ill.
    6. Effectively engage consultants and other ancillary care services in a team approach to manage critically ill patients.
    7. Perform procedures necessary for the assessment and treatment of critically ill patients.
    8. When indicated, address end of life decision making and advanced directives, and provide counseling for patients and their families.
    9. Provide appropriate documentation of all patient interactions.