Internal Medicine Clerkship 4th Year Lubbock

Location: Internal Medicine Clinic, TTUHSC

Duration: 4 weeks

Goals

To meet the objectives in increasing knowledge and skills and developing professional attitudes and behavior while caring for adult patients on Internal Medicine ambulatory service.

Objectives

• Knowledge
  The student should
  • Demonstrate ability to evaluate and manage patients with the following chronic conditions such as
  • DM type I & II, HTN, CAD, CHF, Thyroid disorders, OSA, COPD, HIV etc.
  • And with acute conditions such as respiratory illnesses, pain, common skin infections, drug side effects etc.
  • Learn and master the screening guidelines for colon/ cervical/ prostate/ breast cancers, osteoporosis, hyperlipidemia, hypothyroidism, and adult vaccination schedule.
  • Recognize alcohol and tobacco dependence problems with appropriate management and referral.
  • Learn to order labs in an appropriate manner.
• Skills
  The student should
  • Develop skills in performing an accurate history and physical with differential diagnosis and management plan with proper time management in a clinic setting.
  • Participate in procedures like I/D of abscess, joint injections, skin biopsies etc.
  • Develop the ability to interpret labs and ECGs.
  • Determine the clinical stability of the patient for appropriate disposition.
• Behaviour
  The student should
  • Establish trust with patient by effective communication skills (as referring patients by their names) and maintaining patient privacy and confidentiality.
  • Be sensitive to diverse factors affecting patients and their health care needs as race, culture, income and ethnicity.
• Attitude
  The student should
  • Learn care coordination with nursing staff and other ancillary services.
  • Discuss ethical issues, including end of life care where appropriate.

Educational Methods and Resources

The student will be rotating through general internal medicine and some subspeciality (Endocrine/ Infectious disease/ Pulmonary/ Nephrology) clinics as follows:

The student should

• Care for approx. 3-4 adult patients per day with above described disease mix.
• Present cases to the supervising attending with accurate history and physical and with a  differential diagnosis, assessment and plan.
• Present a case at morning report once during the rotation.
• Maintain patient log.
• Attend morning reports, journal clubs and noon conferences.
• Read core ambulatory articles.

Evaluation Methods

End of rotation evaluation forms to be filled by faculty attending based on the presentations, patient care and literature review.

Student progress and satisfaction will be assessed weekly.

Responsibility and Supervision

The student should

• Manage patients under the supervision of senior resident or attending.
• Demonstrate high standards of professionalism during patient care.

Evaluation of the Rotation

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation form.

Location: Inpatient Infectious Disease Consult Service – University Medical Center

Duration: 2 or 4 weeks

Goals

To meet the objectives while learning how to approach and care for patients with acute and chronic infectious diseases including HIV/AIDS.

Objectives

Knowledge

• The student should be able to evaluate patients with acute and chronic infectious diseases (e.g. bloodstream infections, endocarditis, osteomyelitis, post-operative infection, etc.) and identify the informational pieces necessary to make informed treatment decisions
• The student should be able to compose a thoughtful rationale regarding antimicrobial selection for individual patients.
• The student should be able to analyze clinical microbiologic data and apply this data to individual patients
• The student should be able to evaluate HIV and AIDS patients in an ambulatory setting and formulate a treatment plan

Skills

• The student should be able to perform a comprehensive history and physical exam on new infectious disease consultation patients with emphasis on an accurate and meticulous history including eliciting epidemiologic risk factors (e.g. food, animal or other exposures) and appreciating exam findings (e.g. skin lesions, lymphadenopathy, murmurs, etc.) that provide clues for appropriate diagnosis and management of infectious diseases.
• The should be able to perform and interpret a Gram’s stain of a clinical specimen.

Behavior and Attitude

• The student should be able to employ the American Board of Internal Medicine elements of professionalism in his or her practice of medicine (altruism, accountability, excellence, duty, honor and integrity, and respect for others).
• The student should be able to recognize factors that impact patients and their health care needs (e.g. cultural background, socioeconomic standing, etc.)

Educational Methods and Resources

Clinical Exposure

1. Daily rounds on the Infectious Disease Inpatient Consultation Service at University Medical Center
2. HIV/AIDS clinic once/twice during the rotation

Teaching

1. Daily teaching rounds on ID Consultation Service at UMC
2. Teaching faculty in HIV/AIDS clinic

Self-Directed

1. Reading
   1. Manual of Clinical Problems in Infectious Disease, 5th ed., Gantz et al.
   2. TTUHSC Medical Student Guide to the HIV Clinic
   3. Infectious Diseases section of Harrison’s Principles of Internal Medicine
   4. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Dis.
2. Presentation – One to 4 times over the course of the rotation, at the discretion of the faculty physician, the student will be expected to research a topic that arises on rounds and provide a 5-7 minute oral presentation the following day on rounds.

Evaluation Methods

Oral

1. Feedback as necessary regarding performance throughout the rotation
2. Comprehensive review of performance, strengths, weaknesses at conclusion of rotation

Written

1. Summative evaluation form to be filled out at the conclusion of the rotation

Responsibility and Supervision

• The student will be expected to:
  1. Attend ID consultation rounds daily (Monday to Friday) and attend the Wednesday morning HIV/AIDS clinic once or twice depending upon the length of your rotation
  2. Evaluate and perform History and Physicals on new inpatient ID Consultations. This includes a written consult H&P and oral presentation of the patient on rounds.
  3. Follow from 1-5 (dependent on service census) patients daily without housestaff assistance (i.e. your “own” patients). This includes daily patient evaluation and acquisition of clinical data and oral presentation of such.
  4. Present a diagnostic and therapeutic impression on each of your patients daily. (You don’t have to be right, but you do have to exercise some neurons.)
  5. Evaluate HIV/AIDS patients presenting to the clinic, perform written H&P or progress note as indicated and orally present patient to faculty including your thoughts about a therapeutic plan.
• All student activities will be supervised by ID faculty physicians

Evaluation of the Rotation

The student should meet with the 4th year director at the end of the rotation to discuss and fill out an evaluation forms for rotation and faculty.

Location: MICU and General Floors

Duration: 2 - 4 weeks

Goals

To meet the objectives in strengthening knowledge, skills, attitude and behavior while managing patients on cardiology consult service.

Objectives

Knowledge

• he student should demonstrate ability to evaluate and manage patients with the following conditions:
  • Stable coronary syndromes
  • Cardiac dysrrhythmias
  • Congestive heart failure
  • Hypertension
• Understand the pathology, diagnosis and treatment of the conditions being managed while reading necessary texts and articles simultaneously making evidence based care decisions.
• The student should become competent in performing and accurately recording complete history and physical with assessment, differential diagnosis and plan independently.

Skills

The student:

• Should be able to accurately perform and record history and physicals with assessment, differential diagnosis and plan independently.
• Should develop skills to interpret EKGs.
• Should learn to interpret exercise/ adenosine/ dobutamine stress testing studies.
• Should learn the basics of echocardiography.
• Should be able to learn effective communication skills with patients and families using appropriate language and avoiding jargon and medical terminology.

Behavior

The student should be:

• Able to provide compassionate and empathic patient care in acute and chronic care settings.
• Sensitive to the diverse factors affecting patients and their health care beliefs and needs including race, culture, income and ethnicity.
• Develop effective communication skills with the staff including other physicians, nurses, respiratory therapists and social workers for better patient care delivery. 

Attitudes

The student should be able to:

• Practice and respect patient privacy and confidentiality while maintaining highest standards of professionalism.
• Discuss ethical issues including end of life care

Educational Methods and Resources

• Adult patient care with above described disease mix aiming at 3-4 patients per day.
• Case presentation during rounds with complete assessment, differential diagnosis and plan.
• Maintain patient log seen by the student to assess meeting the above mentioned objectives.
• Read core articles in cardiology handbook.
• Presentation and attendance in morning reports and journal clubs.
• Mandatory attendance in noon conferences.
• Dictate/ write discharge and/or transfer summaries.

Evaluation Methods

Review of student’s case presentations, documentation, professionalism and counseling skills during management rounds and conferences.

End of rotation evaluation forms.

Student satisfaction assessment once every two weeks with appropriate feedback to assure individual needs are met.

Responsibility and Supervision

The student will be  

• Responsible for patient managed by him/her under the guidance of senior resident.
• Responsible for communication with the primary team as well as consultants wherever indicated.
• Demonstrating highest standards of professionalism with patients and colleagues.

Evaluation of the Rotation

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation forms for rotation and faculty.

Location: CICU

Duration: 4 weeks

Goals

To meet the objectives in strengthening knowledge, skills, attitude and behavior while managing patients in CICU.

Objectives

Knowledge

• The student should demonstrate ability to evaluate and manage patients with the following conditions:
  • Acute myocardial infarction Acute coronary syndrome Hemodynamic instability Hypertensive emergency
  • Acute rhythm disturbances: ventricular and atrial
  • Congestive heart failure: systolic and diastolic
• Understand the etiology, diagnosis and treatment of the conditions being managed while reading necessary texts and articles simultaneously making evidence based care decisions.
• The student should become competent in performing and accurately recording complete history and physical with assessment, differential diagnosis and plan independently.

Skills

• The student should participate in procedures such as ECG performance, central line placement, endotracneal intubation.
• Develop skills in ECG, CXR and echocardiogram interpretation.
• Should be able to accurately perform and record history and physicals with assessment, differential diagnosis and plan independently.
• Interpretation of lab tests.
• The student should be able to learn effective communication skills with patients and familieslising appropriate language and avoiding jargon and medical terminology.

Behavior

The student should be:

• Able to provide compassionate and empathic patient care in acute care settings.
• Sensitive to the diverse factors affecting patients and their health care beliefs and needs including race, culture, income and ethnicity.
• Develop effective communication skills with the team including other physicians, nurses, respiratory therapists, case managers and social workers for better patient care delivery.

Attitude

The student should be able to:

• Practice and respect patient privacy and confidentiality while maintaining highest standards of professionalism.
• Discuss ethical issues including end of life care.

Educational Methods and Resources

• Adult patient care with above described disease mix aiming at two new patients per day.
• Case presentation during rounds with complete assessment, differential diagnosis and plan.
• Case presentation in CICU conference once a week with literature search on evidence based patient care.
• Maintain patient log seen by the student to assess meeting the above mentioned objectives.
• Read core articles in CICU rotation handbook.
• Presentation and attendance in daily conferences.
• Dictate/ write discharge and/or transfer summaries.

Evaluation Methods

Review of student's case presentations, documentation, professionalism and counseling skills during management rounds and conferences.

End of rotation evaluation forms.

Student satisfaction assessment once every two weeks with appropriate feedback to ensure individual needs are met.

Responsibility and Supervision

The student will be

• Responsible for patient managed by him/her under the guidance of senior resident.
• Responsible for transfer summaries and communication with the receiving team.
• Demonstrating highest standards of professionalism with patients and colleagues.

Evaluation of the Rotation

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation forms for rotation and faculty

Location: Critical Care Units and General Floors

Duration: 4 weeks

Goals

To meet the objectives in strengthening knowledge, skills, attitude and behavior while managing patients on GI consult service.

Objectives

Knowledge:

• The student should demonstrate ability to evaluate and manage patients with the following conditions:
  • GI Bleeding (upper and lower)
  • Jaundice (hemolytic vs. hepatocellular vs. cholestatic)
  • Abdominal pain (parietal vs. visceral)
  • Hepatic encephalopathy
  • Diarrhea (acute and chronic)
  • Colon cancer
  • Liver cirrhosis and portal hypertension.
• Understand the pathology, diagnosis and treatment of the conditions being managed while reading necessary texts and articles simultaneously making evidence based care decisions.
• The student should become competent in performing and accurately recording complete history and physical with assessment, differential diagnosis and plan independently.

Skills:

The student

• Should be able to accurately perform and record history and physicals with assessment, differential diagnosis and plan independently.
• Should be able to interpret liver function tests and pancreatic enzymes.
• Should develop skills to interpret abdominal CTs with the help of the attending physician.
• Should learn colon cancer screening guidelines.
• Should be able to recognize acute abdomen.
• Should know the indications and contraindications of upper GI endoscopy, ERCP and colonoscopy.
• Should be able to learn effective communication skills with patients and families using appropriate language and avoiding jargon and medical terminology.

Behavior:

The student should be

• Able to provide compassionate and empathic patient care in acute and chronic care settings.
• Sensitive to the diverse factors affecting patients and their health care beliefs and needs including race, culture, income and ethnicity.
• Develop effective communication skills with the staff including other physicians, nurses, respiratory therapists and social workers for better patient care delivery. 

Attitudes:

The student should be able to

• Practice and respect patient privacy and confidentiality while maintaining highest standards of professionalism.
• Discuss procedure indications and risks.

Educational Methods and Resources

• Adult patient care with above described disease mix aiming at two inpatients per day.
• Case presentation during rounds with complete assessment, differential diagnosis and plan.
• Participate in procedures in the GI lab such as colonoscopy, UGI endoscopy as well as ERCP, abdominal paracentesis etc. 
• Evaluate patients in GI clinic with the help of the attending.
• Maintain patient log seen by the student to assess meeting the above mentioned objectives.
• Read core topics in Harrison’s Textbook Of Internal Medicine.
• Attendance in morning reports and journal clubs.
• Mandatory attendance in noon conferences.
• Write consultation notes with assessment and plan.

Evaluation Methods

Review of student’s case presentations, documentation, professionalism and counseling skills during management rounds and conferences.

End of rotation evaluation forms.

Student satisfaction assessment once every two weeks with appropriate feedback to assure individual needs are met.

Responsibility and Supervision

The student will be  

• Responsible for patient managed by him/her under the guidance of senior resident/attending.
• Responsible for communication with the primary team as well as consultants wherever indicated.
• Demonstrating highest standards of professionalism with patients and colleagues.

Evaluation of the Rotation

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation form.

Location: General Floors and MICU Step-down

Duration: 4 weeks

Goals

To meet the objectives in increasing knowledge and skills and developing professional attitudes and behavior while caring for adult patients on General Internal Medicine floor service.

Objectives

By participation in this rotation, the student will be able to…

• Formulate a plan for the cost-effective diagnosis of diseases commonly seen by general internists in the hospital setting (A2,3; B2,3,5)
• Formulate a plan for the cost-effective management of diseases commonly seen by general internists in the hospital setting (B3;C1)
• Communicate prognosis and plan of care with patients and families using lay terms (B1;C4)
• Initiate discussion of end-of –life issues and advanced directives in a culturally sensitive manner (C2)
• Formulate and clearly communicate clinical histories and the plan of care to members of the health care team both verbally and in the form of written orders and progress notes (B1)
• Develop a systematic approach to organizing and acting upon clinical information in a time efficient manner (B5)
• Evaluate their own fund of knowledge and utilize available resources to provide evidence based answers to clinical questions (D3)

Core Manual

Knowledge

The student should

• Demonstrate ability to evaluate and manage patients in a hospital setting with the following conditions and complaints:
  • Abdominal Pain
  • Acute Renal Failure
  • Chest pain
  • Congestive Heart Failure
  • Fever
  • Drug and alcohol withdrawal
  • Dyspnea  (Asthma/COPD Exacerbations, Pneumonia etc.)
  • GI bleeding
  • HTN
  • Seizures
• Learn and understand the diagnosis and treatment of conditions being managed while reading necessary texts and articles simultaneously making evidence based care decisions.
• Become competent in performing and accurately recording complete H/P with assessment, differential diagnosis and plan independently.
• Learn to order labs appropriately.

Skills

The student should

• Participate in procedures such as thoracentesis, abdominal paracentesis, lumbar puncture, central venous catheter placement etc., as and when appropriate.
• Interpret lab tests.
• Learn effective communication skills with patients and families using appropriate language and avoiding jargon and medical terminology.
• Learn to consult other specialties and/or nonmedical personnel in a timely and appropriate manner and communicate with them about patient care.
• Determine the clinical stability of the patient for proper disposition.

Behavior

The student should

• Provide compassionate and empathic patient care in hospital care setting.
• Be sensitive to the diverse factors affecting patients and their health care beliefs and needs including culture, income and ethnicity.
• Coordinate care with nursing staff and other ancillary services.

Attitude

The student should

• Practice patient privacy and confidentiality while maintaining highest standards of professionalism.
• Discuss ethical issues including end of life care.

Educational Methods and Resources

The student should

• Care for approximately 3 adult patients per day with above described disease mix.
• Stay overnight during at least three- four nights on call and see at least two new patients per call night with their complete assessment and plan.
• Present cases during rounds with complete assessment, differential diagnosis and plan.
• Maintain patient log to assess meeting the above mentioned objectives.
• Attend morning reports and noon conferences.
• Write discharge/transfer summaries.
• Read texts relevant to their patient’s disease process.  Examples of resources may include Cecil’s Essentials, Washington Manual, or other resources suggested or supplied by the course director.

Evaluation Methods

End of rotation evaluation forms to be filled by the attending on the floor.

Review of student's case presentations, documentation, professionalism and counseling skills during management rounds and conferences.

Responsibility and Supervision

The student should

• Try to manage patients independently while remaining under the supervision of the senior resident.
• Demonstrate high standards of professionalism during patient care. 

Evaluation of the Rotation

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation form.

Location: Southwest Cancer Treatment and Research Center and University Medical Center

Duration: 4 weeks

Goals

To meet the objectives in increasing knowledge, skills, attitude, and behavior while evaluating and managing patients with hematologic diseases and malignancies.

Objectives

Knowledge:

• Students should acquire the core knowledge necessary to evaluate and manage patients with the following conditions:
  • Anemia, Thrombocytopenia, Polycythemia, Thrombocytosis
  • Neutropenia with Fever
• Supportive Management of the Cancer Patient
• The student should understand the pathophysiology, the diagnostic techniques, and the treatment approaches for these conditions and should read appropriate books and articles on these topics.  Cancer:  Principles and Practice of Oncology by DeVita, et. al. may also be used as a reference.

Skills:

• The student should be able to accurately perform and record a history and physical examination.
• The student should be able to develop a differential diagnosis and suggest diagnostic and therapeutic plans.
• The student should develop skills in the interpretation of CBC’s/differentials and blood smears.
• The student should improve communications skills with patients and families using appropriate language and avoiding jargon and medical terminology.  He/she should be sensitive to the physical, emotional, social, and spiritual difficulties facing patients with severe and sometimes terminal illnesses.
• The student may be able to participate in a variety of procedures such as bone marrow aspiration/biopsy, paracentesis, thoracentesis, and lumbar puncture.

Behavior:

The student should

• Provide compassionate and empathetic patient care in all clinical settings
• Be sensitive to the diverse factor affecting patients and their healthcare needs and beliefs including race, culture, income and ethnicity
• Develop effective communication skills with the staff, including other physicians, nurses, and social workers

Attitudes:

The student should be able to practice and respect patient privacy and confidentiality while maintaining the highest standards of professionalism.

Educational Methods and Resources

• The student should work and round with the Hematology/Oncology Service, and should follow at least two consults per day.
• The students should present in rounds with a complete assessment, analysis, and suggestions for plans.
• The students should expect to present at least one article during rounds every other week or present a patient to the Multidisciplinary Oncology Conference.
• The students should attend the Multidisciplinary Oncology Conference every Friday morning.
• The students should read articles related to the diseases of their patients.
• The students should attend Department of Internal Medicine noon conferences.
• The students may participate in clinics at the Southwest Cancer Treatment and Research Center as time allows.

Evaluation Methods

• Evaluation is based on the review of the student case presentations, case write-ups, professionalism, and patient interaction during rounds.
• Student rotation evaluation forms will be used.

Responsibility and Supervision

The student will be responsible for patients managed by him/her under the guidance of residents on the service and faculty. The faculty on the service will be responsible for student education and supervision.

Evaluation of the Rotation

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation forms for rotation and faculty.

Location: MICU

Duration: 4 weeks

Goals

To meet the objectives of increasing knowledge and skills and developing professional attitudes and behavior while caring for adult patients on MICU service.

Objectives

Knowledge:

• The student should demonstrate ability to evaluate and manage patients with the following conditions:
  • Acute Respiratory Failure
  • Hemodynamic Instability
  • Severe Metabolic Disorders
  • Acute Abdominal Condition as Pain etc
  • Acute Neurological Condition as seizures etc
  • Hypertensive Emergency
• Understand the etiology, diagnosis and treatment of the conditions being managed while reading necessary texts and articles simultaneously making evidence based care decisions.
• The student should become competent in performing and accurately recording complete history and physical with assessment, differential diagnosis and plan independently.

Skills:

• The student should participate in procedures as central line placement, endotracheal intubation, ABGs, NG tube insertion, lumbar puncture.
• Develop skills in ventilator management and weaning protocols.
• Should be able to accurately perform and record history and physicals with assessment, differential diagnosis and plan independently.
• Interpretation of lab tests as ABGs, EKGs, CXR, Electrolytes etc.
• The student should be able to learn effective communication skills with patients and families using appropriate language and avoiding jargon and medical terminology.

Behavior:

The student should be

• Able to provide compassionate and empathic patient care in acute care settings.
• Sensitive to the diverse factors affecting patients and their health care beliefs and needs including race, culture, income and ethnicity.
• Develop effective communication skills with the staff including other physicians, nurses, respiratory therapists and social workers for better patient care delivery. 

Attitude:

The student should be able to

• Practice and respect patient privacy and confidentiality while maintaining highest standards of professionalism.
• Discuss ethical issues including end of life care.

Educational Methods and Resources

• Adult patient care with above described disease mix aiming at two patients per day.
• Case presentation during rounds with complete assessment, differential diagnosis and plan.
• Case presentation in MICU conference once a week with literature search on evidence based patient care.
• Maintain patient log seen by the student to assess meeting the above mentioned objectives.
• Read core articles in MICU handbook.
• Presentation and attendance in morning reports and journal clubs.
• Mandatory attendance in noon conferences.
• Dictate/write discharge and/or transfer summaries.

Evaluation Methods

Review of student’s case presentations, documentation, professionalism and counseling skills during management rounds and conferences.

End of rotation evaluation forms.

Review of mock ventilator management scenario.

Student satisfaction assessment on a weekly basis with appropriate feedback to assure individual needs are met.

Responsibility and Supervision

The student will be:

• Responsible for patient managed by him/her under the guidance of senior resident.
• On call at night at least 3-4 nights a month.
• Responsible for transfer summaries and communication with the receiving team.
• Demonstrating highest standards of professionalism with patients and colleagues.
• Student must meet with Dr. Jumper in her office once a week.  Please contact Debbie Schalles to set up this meeting.  Her number is 743-3107.

Evaluation of the Rotation

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation form on rotation and faculty.

Location: Critical care Units, General floors and Hemodialysis unit

Duration: 4 weeks

Goals

To meet the objectives in strengthening knowledge, skills, attitude and behavior while managing patients on nephrology consult service.

Objectives

Knowledge:

• The student should demonstrate ability to evaluate and manage patients with the following conditions, initiate management and know when to refer patients for appropriate subspecialty care:
  • Oliguria /Anuria
  • Pre renal azotemia
  • Acute kidney injury (AKI)
  • Acute kidney injury on chronic kidney disease
  • Medical management issued of patients with ESRD
  • Initial assessment and plans for patients diagnosed with advanced CKD
  • Adjustment of medications and avoidance of renal toxic agents in CKD
  • Fluid and electrolyte abnormalities
  • Acid base disorders
  • Hematuria, Proteinuria, Pyuria
  • Glomerular diseases
  • Hypertension- benign, accelerated, malignant, essential and secondary
  • Renal disease in pregnancy
• Understand the pathology, diagnosis and treatment of the conditions being managed while reading necessary texts and articles simultaneously making evidence based care decisions.
• The student should become competent in performing and accurately recording complete history and physical with assessment, differential diagnosis and plan independently.

Skills:

The student should be able to

• Accurately perform and record history and physicals with assessment, differential diagnosis and plan under the guidance of fellow.
• Develop skills to assess kidney function.
• Recognize limitations of different methods to assess GFR.
• Correctly interpret urinalysis, urine electrolytes and urine protein/ creatinine.
• Accurately classify patients with regard to stage of CKD.
• List appropriate interventions based on stage of CKD.
• Recognize when to refer patients for dialysis access placement.
• Make general recommendations regarding long term plans for ESRD         treatment.
• List the risks and benefits of erythropoeitic agents.
• Describe the principles related to the use of phosphate binders, vitamin D supplemnts and calcimetic drugs for treatment of bone disease and hyperparathyroidism.
• Recognize urgent and emergent indications for hemodialysis.
• Effectively communicate with patients and families using appropriate language and avoiding jargon and medical terminology.

Behavior:

The student should be

• Able to provide compassionate and empathic patient care in acute and chronic care settings.
• Sensitive to the diverse factors affecting patients and their health care beliefs and needs including race, culture, income and ethnicity.
• Develop effective communication skills with the staff including other physicians, nurses, respiratory therapists and social workers for better patient care delivery.

Attitudes:

The student should be able to

• Practice and respect patient privacy and confidentiality while maintaining highest standards of professionalism.
• Discuss renal care issues with the patient and family.

Educational Methods and Resources

• Adult patient care with above described disease mix aiming at two inpatient consults per day.
• Case presentation during rounds with complete assessment, differential diagnosis and plan.
• Evaluate patients in nephrology clinics under the supervision of fellows.
• Maintain patient log seen by the student to assess meeting the above mentioned objectives.
• Read core topics in Harrison’s Textbook Of  Internal Medicine.
• Presentation and attendance in nephrology conferences on Tuesday and Wednesday.
• Mandatory attendance in noon conferences.
• Write consultation notes.
• The student can choose to be on transplant service for week if interest

Evaluation Methods

Review of student’s case presentations, documentation, professionalism and counseling skills during management rounds and conferences.

End of rotation evaluation forms.

Student satisfaction assessment once every two weeks with appropriate feedback to assure individual needs are met.

Responsibility and Supervision

The student will be  

• Responsible for patient managed by him/her under the guidance of senior resident/fellow.
• Responsible for communication with the primary team as well as consultants wherever indicated.
• Demonstrating highest standards of professionalism with patients and colleagues.

Evaluation of the Rotation

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation form.

Location: TTUHSC Clinics and University Medical Center

Duration: 4 weeks

Goals

To meet the objectives in increasing knowledge, skills, attitude, and behavior while evaluating and managing patients with acute and chronic respiratory diseases.

Objectives

Knowledge:

• Students should acquire the core knowledge necessary to evaluate and manage patients with the following conditions:
  • COPD
  • Asthma
  • Pulmonary fibrosis
  • Sleep apnea
  • Bronchogenic carcinoma
• The student should understand the pathophysiology, the diagnostic techniques, and the treatment approaches for these conditions and should read Cecil’s Essentials text and articles on these topics.

Skills

• The student should be able to accurately perform and record a history and physical examination.
• The student should be able to develop a differential diagnosis and suggest diagnostic and therapeutic plans.
• The student should develop skills in interpretation of pulmonary function tests, chest x-rays, and arterial blood gases.
• The student should improve communications skills with patients and families using appropriate language and avoiding jargon and medical terminology.

Behavior:

The student should:

• Provide compassionate and empathetic patient care in all clinical settings
• Be sensitive to the diverse factors affecting patients and their healthcare needs and beliefs including race, culture, income and ethnicity
• Develop effective communication skills with the staff, including other physicians, nurses, respiratory therapists, and social workers

Attitudes:

The student should be able to practice and respect patient privacy and confidentiality while maintaining the highest standards of professionalism.

Educational Methods and Resources

• The student should work with adult patients in both clinics and in the hospital. They should follow at least two consults per day.
• The students should present in rounds with a complete assessment, analysis, and suggestions for plans.
• The students should expect to present at least one article at the MICU Conference every other week.
• The students should maintain a patient log to document patient contact and experiences with various disease processes.
• The students should read the core articles in the Pulmonary Handbook for this rotation.
• The students should attend Department of Internal Medicine noon conferences.
• The students should participate in the interpretation of pulmonary function tests and observe procedures.

Evaluation Methods

Evaluation is based on the review of the student case presentations, case write-ups, professionalism, patient interaction during clinic and consult rounds.

1. The student rotation evaluation forms will be used.
2. The student will score at least 70 on a short pulmonary function test.
3. The student satisfaction will be assessed on a regular basis with appropriate feedback to assure that individual needs and goals are met.

Responsibility and Supervision

 The student will be responsible for patients managed by him/her under the guidance of residents on the service and faculty.  The faculty on the service will be responsible for student education and supervision.

Evaluation of the Rotation

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation form.