Doctor of Medicine: Clinical Applications Fourth-year Required Courses

MEDU 6804 Advances and Perspectives in Medicine (Year 4)
Credits:
1
Directors:
Vanden Heuvel
Grading:
Pass/Fail
Description:

Advances and Perspectives in Medicine and Health provides students in the professional health-related sciences both exposure to and an opportunity for involvement in current topics that influence the practice, quality, and delivery of health care. The course consists of a series of events that includes seminars, workshops, plays, demonstrations, simulations, and conferences that are distributed throughout the academic year. Topics covered in the series of events include ethics, professionalism, communication, health policy, health disparities, delivery of care, biomedical/translational/clinical/community-based research, bioengineering, business and legal aspects of health care, health informatics, and global health. For some events, there are opportunities to participate in interprofessional discussion groups that include students from other health profession programs, as well as health care professionals. Students develop critical thinking skills and raise awareness to cross-disciplinary aspects and integration of health care teams, through attendance and reflection of the events in this course.

Objectives:

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

  1. Students gain an understanding of complex issues relevant to the health care professions.
  2. Students gain awareness of cross-disciplinary aspects and integration of health care teams.
  3. Students express their individual attitudes, feelings, and beliefs related to issues relevant to the health care professions through reflective writing assignments.
PROF 9340 Profession of Medicine 7
Credits:
0.5
Directors:
Gibb, Redinger
Grading:
Pass/Fail
Description:

Profession of Medicine 7 is a one-week course during the spring of the fourth year of medical school, and serves as a capstone review of medical ethics. The course consists of a series of student-presented and faculty-supervised clinical pathological conferences. Each presentation addresses actual medical ethical dilemmas that students have encountered during their medical school courses and clerkships. Students and faculty then lead small group discussions outlining the various ethical principles and approaches to these ethical dilemma. 

Objectives:
  1. Define medical ethics and humanities and their relevance to the practice of medicine.
  2. Describe the historical context for the development of modern medical ethics.
  3. Analyze specific historical clinical scenarios that influenced the development of modern medical ethics, utilizing the recommended framework (4 Box Method) for addressing ethical conflict.
  4. Identify resources available for guidance in resolving ethical questions, including the AMA Code of Medical Ethics, and others.
  5. Apply the concepts taught throughout the curriculum to specific cases of ethical dilemma and conflict.
TRAN 9100 USMLE Preparation and Examination
Credits:
1
Directors:
Morris
Grading:
Pass/Fail
Description:

USMLE Preparation and Examination includes comprehensive preparation for USMLE Step 1, USMLE Step 2 CK, and USMLE Step 2 CS. Students participate in informal group activities, as well as customized reviews based on each student’s needs.  Students attend weekly interactive video conferences covering basic science topics. Students schedule, on their own, to take the USMLE Step 1 exam upon completion of this course.

Objectives:

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

  1. Student will identify learning needs to prepare for USMLE Step 1, Step 2 CK, and Step 2 CS.
  2. Student will work with faculty to identify a learning plan to address learning gaps.
TRAN 9100 Clinical Skills
Credits:
1
Directors:
Gibson
Grading:
Pass/Fail
Description:

USMLE Preparation and Examination includes comprehensive preparation for USMLE Step 2 CK and USMLE Step 2 CS examinations. Students participate in group activities as well as customized reviews based on each student’s needs. The review includes a formative examination that mirrors the USMLE Step 2 CS examination. Students schedule, on their own, to take the USMLE Step 2 and CK exam upon completion of this course.

Objectives:

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

  • Demonstrate communication skills and physical examination skills.
  • Demonstrate competency for communication skills and examination skills sufficient to pass USMLE Step 2 CS.
  • Demonstrate documentation skills in electronic medical records that meet standards of USMLE Step 2 CS.
TRAN 9900 Transition to Residency
Credits:
2
Directors:
Baker
Grading:
Pass/Fail
Description:

Transition to Residency Course provides a summation of the Clinical Applications phase of the curriculum, and is designed to ensure the preparation of graduating students for residency. The course is designed to help the medical student understand their new role as a resident in the specialty of their choice.   The course will include topics on professionalism, communication, risk management, life skills and using informational resources for evidenced-based clinical decisions, the students will also follow their specialty track with procedure training and clinical topics designed to introduce the student for their future patient population that they will be caring for in residency.   It includes classroom didactics, small group case discussions, interactive role play, and simulation for procedural skills. 

Objectives:

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

Professionalism

  • Managing Medical Error and Disclosure and Documentation
  • Professional Liability
  • Incident reports
  • Debriefing after difficult encounters
  • Interacting with impaired peers and attending physicians
  • Handling the inappropriate patient or family member
  • Social Media

Life Skills

  • Managing finances and debt
  • Time management and prioritizing of tasks
  • Coping with the stresses of residency -Self-care skills and life balance

Practice-based learning and improvement

  • Utilization of informational resources for evidenced-based clinical decisions

Systems-based Practice

  • Transitions of care with safe sign out and hand-offs
  • Proper use of EMR and creating daily notes

Communication

  •  Transitions of care and sign out
  •  Managing conflict with peers, nursing staff, patients and families
  •  Informed consent

Managing family meeting and discussing code status

  • Phone etiquette with the Emergency room, consultant and nursing staff

Medical Knowledge

  •       Management of patient calls at night and review of “don’t miss” diagnoses
  •       Management of medical emergencies

Patient Care

  •       Review of BLS and ACLS protocols, PALS if appropriate
  •       Procedure simulations for emergency and critical care in addition to specialty
  •       specific procedural skills
  •       Review indications and contraindications of commonly performed procedures
  •       Setting the agenda in the outpatient encounter
  •       Interpretation of common laboratory and radiology results
  •       Writing Admission Orders

Teaching

  •       Transitioning into the role of teacher for medical students

EPA 2:  Prioritize a differential diagnosis following a clinical encounter

  • Integrate information as it emerges to continuously update differential diagnosis.
  • Explain and document the clinical reasoning that led to the working diagnosis in a manner that is transparent to all members of the health care team.
  • Manage ambiguity in a differential diagnosis for self and patient and respond openly to questions and challenges from patients and other members of the health care team.
  • Didactics include:  Role play session with opportunities to obtain history and critique history taking in a small group format.  Difficult patient cases and role play on discussing sensitive information with the patient.

EPA 3:  Recommend and interpret common diagnostic and screening tests

  • Recommend reliable and effective screening and diagnostic tests and apply to patient-specific guidelines
  • Explain how results of laboratory and diagnostic tests will influence diagnosis and management of the patient
  • Discern urgent from non-urgent results and how to respond correctly.
  • Education through role-play and small group sessions will each student participating in a case with presenting symptoms, history and physical exam results.  Through group discussion and role play the student will recommend the common diagnostic tests and explain how the results will aid in the determining the diagnosis. Interactive discussion on the top 10 calls from the floors and how to respond to them.

EPA 4:  Enter and discuss orders and prescriptions

  • 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.
  • Attend to patient-specific factors such as age, weight, allergies, pharmacogenetics, and co-morbid conditions when writing or entering prescriptions or orders.
  • Demonstrate working knowledge of admission orders
  • Didactics on composing admission orders and specialty specific breakout to review protocols common to their specialty.  Composition of common orders including IV fluids and electrolyte replacements in small group discussion.

 EPA 5:  Document a clinical encounter in the patient record

  • Choose the information that requires emphasis in the documentation based on its purpose (e.g., Emergency Department visit, clinic visit, admission History and Physical Examination).  *Comply with requirements and regulations regarding documentation in the medical record.  *Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting).
  • Record documentation so that it is timely and complete
  • Accurately document the reasoning supporting the decision making in the clinical encounter for any reader (e.g., consultants, other health care professionals, patients and families, auditors).
  • Document patient preferences to allow their incorporation into clinical decision making.
  • Educational sessions on proper use of EMR and documentation of encounters.  Specialty specific documentation breakout sessions for clinical encounters and procedures, if applicable.

EPA 6:  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.
  • Adjust the oral presentation to meet the needs of the receiver of the information.
  • Assure closed-loop communication between the presenter and receiver of the information to ensure that both parties have a shared understanding of the patient’s condition and needs.
  • In small group sessions, students will demonstrate how to give an oral summary of a case given to them.   Demonstration of consolidation of a clinical case into an oral presentation of the pertinent points.

EPA 8:  Give or receive a patient handover to transition of care responsibility

  • 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.
  • Follow a structured handover template for verbal communication.
  • *Provide succinct verbal communication that conveys, at a minimum, illness severity, situation awareness, action planning, and contingency planning.
  • Elicit feedback about the most recent handover communication when assuming primary responsibility of the patients.
  • Provide feedback to transmitter to ensure informational needs are met.
  • Ask clarifying questions.
  • Repeat back to ensure closed-loop communication.
  • Education on hand off using IPASS for transition of care and demonstration of understanding of it in small group exercises.   Phone etiquette will be practiced in role play sessions for encounters with patients’ families, nurses and consultants.

EPA 10:  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.
  • Apply basic and advanced life support as indicated.
  • Start initial care plan for the decompensating patient.
  • Understand how to initiate a code response and participate as a team member.
  • Communicate the situation to responding team members.
  • Document patient assessments and necessary interventions in the medical record.
  • Clarify patient’s goals of care upon recognition of deterioration (e.g., DNR, DNI, comfort care).
  • All students will participate in an ACLS-lite, BLS-lite and if specialty appropriate a PALS-lite in the simulation lab.   Demonstration of the skills needed in ACLS, BLS and PALS through evaluation of knowledge and procedure skills.  Through small group sessions the students will demonstrate the communication skills needed in a code response situation.   Through role-play small group session, the students will demonstrate how to clarify goals of care for a patient with discussion for code status with the family.   Students will be educated on when and how to document in the medical record for the emergency and rapid response calls on the floors.

EPA 11:  Obtain informed consent for tests and procedures

  • Describe the key elements of informed consent:  indications, contraindications, risks, benefits and potential complications of the intervention
  • understand how to give consent for blood products and the risks and benefits
  • understand cultural or religious objections for blood products and the alternatives available
  • In the simulation lab, the students will review the common hospital procedures required on call and the indications, risks, and benefits and what needs to be communicated to the patient to obtain consent.   Risk management office will review the proper documentation and necessary elements in obtaining consent.

EPA 12:  Perform general procedures of a physician

  • Demonstrate technical skills for basic procedures needed for the student and their anticipated residency. 
  • Understand the indication, contraindications, risks and benefits of the procedures needed in the residency program
  • Demonstrate effective communications and team dynamics in performing the procedures
  • Students will all participate in ACLS-lite, BLS-lite and for a small group PALS-lite during the course.  The students will participate in a procedure simulation day for review of basic procedures for floor coverage as a first-year resident.  The students will be placed into groups based on the specialties that they will be entering for procedural skills specific to the specialty.