INTERNAL MEDICINE SYLLABUS

FOURTH YEAR MEDICINEREQUIREMENT

Marc Heincelman, M.D., Clerkship DirectorMary Ann Snell, Student Education Coordinator

Medical University of South CarolinaCharleston, South Carolina

2017 - 2018

Senior Core Checklist

Activity Requirements Due?Syllabi Review syllabi and objectives

Sign attestationTo Mary Ann w/in 48 hrs of beginning of the course

□

Consult Lecture

Watch Consult tegrity, Read consult article 1st 48 hoursSee schedule

□□

Pain Lectures

Watch Tegrity Before OSCE □□

Pt. Handoff Workshop

Attend the workshop See schedule □

Pall. Care Workshop

Attend workshop & review 5 sessions below

See schedule □

Pall. Care Palliative Care Reflective Writing By the end of the course □Palliative Care Modules

+Comp. Assessment+Cancer Pain Mgmt*Loss, Grief, Bereavmnt+Last Hours of Living*Communicating Effectively*Clarifying Dx & Px*Neg. Goals of Care*Conflict Resolution

* Must be done before Palliative Care Workshop

+ Must be done by the end of the course

□□□□□□□□

Simple Cases

□  □  □  □  □  □  □  □   Choose 8 and complete by the end of the course. Do NOT choose #16

EPA Do a consult3 consult cards  □    □    □  Complete 1 card/week. 1must be attending

@  end of Clerkship □

Evaluations Need to get course grade At end of rotation □

1

SENIOR MEDICINE REQUIREMENT

OVERVIEWThis month-long rotation is an opportunity for you to develop your clinical skills on an Internal Medicine consultative clinical service. You will experience the daily work schedule and practice of the subspecialty division to which you are assigned.

GOALSDuring the Senior Medicine Requirement, you will acquire patient care skills, professional behaviors, medical knowledge, interpersonal and communication skills, practice-based lifelong learning and system-based practice skills that are necessary to evaluate and deliver safe, quality and evidence-based care for adult patients in the role of a consultant with supervision by residents, fellows, and attending physicians.

OBJECTIVESEntrustable Professional Activity: With significant supervision, perform and present an initial and follow-up Internal Medicine consultation on patients the inpatient and outpatient setting.

Milestone Competency Assessment ToolCorrectly identify and articulate the question the primary team is asking of the consultative team. CS4

Direct observation

Team rounds

Review of students’ notes

Demonstrate proper techniques for interviewing a patient to obtain a medical history in the consultative setting. PC1

Perform an accurate physical examination and identify pertinent abnormalities using common maneuvers. PC1

Independently gather patient data in the consultative setting PC1Analyze, synthesize, and integrate pertinent patient data in the consultative setting. PC2

Formulate an appropriate, justified, and prioritized differential diagnosis. PC2

Build a positive, healing relationship with patients. CS2Demonstrate professional demeanor and ethical behavior. PR1Apply knowledge of the pathophysiology, epidemiology, and natural history of diseases to the diagnosis and management of patient conditions in Internal Medicine (see individual courses below).

MK4

Present patient data gathered from patient interviews, physical examinations, and laboratory sources, including progress notes on patients, in standardized format.

CS1

Develop rational diagnostic and therapeutic plans to evaluate and treat patients’ clinical issues in the consultative setting. PC3

Document patient data gathered from patient interviews, physical examinations, and laboratory sources, including progress notes on patients, in standardized format.

CS5

Use evidence-based medicine and medical knowledge resources to answer the consult question. PL3

Use technologic resources (including electronic medical records) to optimize personal learning and engage in effective patient care. PL2

Develop a respectful and collaborative working relationship with members of the primary medical team, including direct verbal communication initially and in follow up.

IP4

2

Physicianship Objectives1. Adhere to the formal policies for the Senior Medicine Requirement2. Accept personal errors and honestly acknowledge them3. Demonstrate empathy and compassion to all patients4. Demonstrate a commitment to learn how to relieve pain and suffering5. Demonstrate an appreciation for patient dignity and autonomy6. Engage in timely interactions with colleagues and patients 7. Maintain patient confidentiality8. Be well groomed and dress professionally

PR4

PD1CS2, PR3

MK5, PR3, PC3PC4

CS1, CS2, PR3PR2PR4

Direct observation

Team rounds

Review of students’ notes

SPECIFIC COURSE OBJECTIVESCourse Title Specific Course ObjectivesNephrology LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should

be able to do the following:1. Complete an evaluation for Acute Kidney Injury (AKI), interpret lab, radiological studies and synthesize a differential diagnosis. (MK1, MK3, MK4, MK5, MK7, PC1, PC2, PC3, CS1)2. Describe the steps involved in urine microscopy and interpretation of urine microscopy in patients with AKI. (MK5, PC7)3. Define and describe the indications for dialysis therapy and the mechanics of different modes of dialysis. (MK5, MK6, PC3, PC5, PR2, PL2)4. Evaluate and treat hypo/hypernatremia, hypo/hyperkalemia, acidosis and alkalosis. (MK1, MK2, MK3, MK4, MK5, MK7, PC1, PC2, PC3, PC6, CS1, CS2, CS3, CS4)5. Define and describe the treatment and public health significance of Chronic Kidney Disease and hypertension. (MK1, MK2, MK3 MK4, MK5, MK6, PC1, PC2, PC3, PC4, PC5, PC6, PL6, SL1)

6. Write complete and succinct consult and follow up notes in EPIC (MK3, MK4, MK5, PC2, PC3, PC6, CS1, CS5, PR1, PR4, PR5).

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. Students will evaluate patients both in hospital and in clinic and present patients orally to the attending physician to attain feedback on presenting cohesively and on ability to synthesize information and provide a well thought out plan. Students will also write an initial consult note and follow up notes in the electronic medical record under the student tab (EPIC).2. Students are expected to continue independent scholarly activity by reading journal articles and/or books pertinent to their patients.3. The nephrology faculty and fellows on service will be actively involved in team based teaching during the rounds.4. The faculty and fellows on service dedicate time outside patient care activities to provide didactic sessions involving, but not restricted to, AKI, electrolyte and acid base problems, and dialysis.5. Students will complete modules and attend conferences, which cover physician handoffs, consultative medicine, and palliative care.

PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:1. Acute Kidney Injury and Acute Glomerulonephritis2. Electrolyte Disorders: hyponatremia, hypernatremia, hyperkalemia3. Proteinuria with and without nephrotic syndrome4. Acid Base Disturbances5. End stage renal disease: management of medical problems associated with ESRD.

3

Cardiology LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:1. Take a good cardiac history and demonstrate understanding of cardiac risk factors. (MK3, MK4, PC1, CS1)2. Perform and accurately document a complete cardiovascular examination. (PC1, CS5)3. Explain use of lab tests, EKGs, ECHO, stress testing and cardiac invasive procedures in working up cardiac disorders. (MK5, PC2)4. Describe basic cardiac, coronary and electrophysiological anatomy, and basic cardiac hemodynamics. (MK1, MK2, MK6, PC2)5. Present new cases confidently, follow-up cases assigned and work efficiently as a team member. (MK3, PC2, CS5, IP2)

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. When on the consult service students will practice reviewing charts, obtaining medical history, performing physical examination, reviewing laboratory data, discussing gathered material with fellow and attending, and writing up consult report.2. Students should attend all Cardiology conferences and didactic sessions that the division offers. (7:30-8:30 am, M, W-F)3. Students will complete online modules and attend conferences that cover physician handoffs, consultative medicine, and palliative care.

PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:1. Coronary artery disease2. Congestive heart failure3. Arrythmia4. Valvular heart disease5. Risk Factor Modification (EM, HTN, Hyperlipidemia, Smoking)

Gastroenterology Hepatology

LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:1. Assess patients with liver disease and develop appropriate differential diagnoses and clinical assessments and plans. (MK4, MK5, MK6, PC1, PC2, PC3)2. Define and describe pathophysiology and management of complications resulting from cirrhosis and portal hypertension. (MK1, MK2, MK3, PC2) 3. Define and describe when referral for liver transplant evaluation is appropriate by assessing severity of liver disease and short term prognosis in patients with cirrhosis. (MK4, MK5, PC1, PC3, PC4, PL3)4. Observe and actively participate in the comprehensive evaluation required for patients undergoing liver transplantation evaluation, and the selection process that occurs in determining a patient’s potential candidacy. (MK4, PC1, PC4, PC5, PC6, CS1, SL1, IP2)5. Describe the mechanism of action and common side effects, and toxicities of immunosuppressive agents used after liver transplant. (MK4, PC2, PC3)

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. In Hepatology clinic, students will be responsible creating a clinical plan for the patients.2. Students will round with the Liver Attending on the inpatient Liver Service and hospital Liver Consults.3. Students will observe outpatient endoscopy, to learn the management of patients with esophageal varices.4. Students will attend the following Hepatology (and Gastroenterology) didactic conferences: GI Fellows Conference, Liver Biopsy Conference, Liver Imaging and Tumor Board, and Liver Transplant Selection Committee.5. Students will complete modules and attend conferences that cover physician handoffs, consultative

4

medicine, and palliative care.

PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:1. Complications of cirrhosis/portal hypertension: ascites, varices, hepatic encephalopathy, and spontaneous bacterial peritonitis2. Complications that arise after liver transplant3. Chronic hepatitis C (outpatient management and treatment)4. Alcoholic liver disease (including patients with alcoholic hepatitis)5. Patients with chronic hepatitis of unclear etiology (outpatient evaluation including the role of liver biopsy)

Gastroenterology Luminal

LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:1. Identify typical clinical presentations of various etiologies of abdominal pain (peptic ulcer disease, cholecystitis, pancreatitis, bowel obstruction). (MK1, MK2, MK3, MK4)2. Define and describe the diagnosis and treatment of esophageal disorders such as GERD, dysphagia, Barrett’s esophagus. (MK4, MK5, PC2, PC3)3. Define and describe the basic causes of diarrhea and outline an appropriate diagnostic work-up for both acute and chronic diarrhea. (MK4, MK5, PC1, PC2)4. Define and describe the role of endoscopy for both screening and therapeutic purposes. (MK5, PC3, PC4, CS4)5. Demonstrate professional demeanor, ethical behavior, and effective communication skills in interactions with patients. (PC1, CS1, CS2, PR1, PR2)

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. Bedside teaching during daily team rounds (inpatient consultation service) or in clinic (outpatient service).2. Formal didactic GI Divisional conferences held on a weekly basis.3. Informal didactic sessions throughout the rotation focusing on topics/cases proposed by the student/housestaff.4. Observation of endoscopic procedures such as EGD, colonoscopy, ERCP, EUS, small bowel capsule study, and motility studies.5. Directed reading on general and selected topics in Gastroenterology.6. Students will complete online modules, attend conferences that cover physician handoffs, consultative medicine, & palliative care.

PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:1. Cholecystitis/Peptic ulcer disease/Pancreatitis2. Inflammatory bowel disease/Irritable bowel syndrome3. Diarrhea: acute vs chronic4. Dysphagia/GERD5. Bowel obstruction

Hematology - Oncology

LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:Hematology-specific:1. Discuss, diagnose, and treat common congenital and acquired bleeding disorders; and common thrombotic disorders including venous thromboembolism (VTE) and heparin-induced thrombocytopenia (HIT). (MK3, MK5, PC1, PC2, PC3)2. Provide safe and effective anti-thrombotic therapy using heparin, low molecular weight heparin, warfarin, direct thrombin inhibitors, and direct oral anticoagulants. (MK5, MK8, PC5, PC6)3. Interpret peripheral blood smears and clinical lab tests to diagnose common disorders of red blood cells, platelets, and white blood cells. (MK1, MK3, MK4, MK6, PC1, PC2, PC3)

Oncology-specific:

5

1. Apply knowledge of the pathophysiology, epidemiology, and natural history of neoplastic diseases to the diagnosis and staging of common patient conditions in oncology. (MK1, MK2, MK3, PC1, PC2)2. Assist in the development of treatment plans for patients with newly diagnosed malignancies. (MK5, MK6, PC3, PC4, PC6, CS4)3. Recognize and understand preliminary treatment of common complications of chemotherapy. (MK5, PC6)

Common to both:1. Demonstrate effective and professional interpersonal and communication skills, and model ethical behavior. (CS1, PR1, PR2)2. Demonstrate proper techniques to obtain medical history and perform physical exam in the consultative and outpatient setting. (PC1, CS1)3. Present and document patient data gathered from interviews, examinations, and records in standardized format. (CS1, CS5)

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. Attend 2 half-day clinics per week (subject to availability) and complete outpatient evaluation of one new patient and one follow-up patient in each clinic.2. Attend afternoon rounds with Oncology or Hematology Consult Service. Perform at least 3 new consult evaluations per week and follow-up evaluations of these patients.3. Review peripheral blood smears during the Hematology consult service rounds in the Hematology lab.4. Participation in formal division conferences, including core curriculum lectures, grand rounds, tumor boards, and Journal Club.

PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:Hematology: 1. Cytopenias (anemia, leukopenia and thrombocytopenia)

2. Acquired coagulation disorders (liver disease, chronic kidney disease)3. Congenital and acquired bleeding disorders, VTE, and HIT

Oncology: 1. Newly diagnosed solid tumors - commonly encountered in the inpatient and outpatient setting such as lung cancer, colon cancer, prostate cancer, etc.2. Common problems associated with chemotherapy (neutropenic fever, tumor lysis

syndrome, severe diarrhea, etc)

Infectious Diseases

LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:1. Diagnose and assess common community and hospital acquired infections and develop a timely evidenced based plan of care for the patient. (MK4, MK8, PC1, PC2, PC3)2. Describe the basic aspects of antimicrobial treatment and rational use of anti-infective therapeutic agents, as well as the negative patient and societal complications of antimicrobial overuse. (PC3, PC6, PL3, PL6)4. Develop a basic knowledge of HIV diagnosis, management, and health maintenance as well as an understanding of the role of appropriate HIV care in addressing population health through decreased transmission and in addressing racial and ethnic health disparities. (MK4, PC6, SL4, PL6)5. Provide non-judgmental and compassionate care to patients with stigmatizing infections and develop a therapeutic relationship built on trust and honesty. (PC3, PR1, PR2, CS3, CS3) 6. Provide appropriate consultative care and communicate with other members of the patient’s care team in a clear and effective manner. (PC5, CS4, IP3)

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. Students will participate in clinical care both for inpatient and outpatients which will involve assessment, diagnosis and management of patients with infectious diseases. A minimum of 2 weeks

6

of consultation rounds with the Infectious Disease attending and fellow at MUHA, ART, or VA will provide extensive exposure to the diagnosis and treatment of infectious diseases, with up to an additional two weeks spent in the Infectious Diseases clinics.2. Clinical experience is supplemented and extended by case conferences including both HIV and non-HIV conferences, grand rounds, and journal clubs. 3. Small group teaching sessions geared towards medical students in their clinical years will cover core infectious disease topics. 3. An infectious disease textbook is provided to each student during the rotation to supplement clinical and didactic teaching.

PATIENT ENCOUNTERS: Students will be expected to assess, diagnose and create a treatment plan for patients with these specified conditions: HIV/AIDS, post-surgical and traumatic wound infections, prosthetic joint infections, osteomyelitis, bacteremia, and complicated skin and soft tissue infections.

Endocrinology LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to:1. Define and describe pathophysiology of common endocrine disorders. (MK3, MK4)2. Evaluate, with supervision, endocrine disorders commonly seen in primary care. (MK5, MK8, PC1, PC2)3. Define and describe treatment strategies for these diseases. (MK6, PC3, PC4, PC5)4. Describe the importance of laboratory investigation in evaluations. (MK5, MK8, PC3)5. Discuss the importance of endocrine research in this field. (PL2, PL3, PL4, PL5)

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. Student will see patients in attending clinics.2. Student will work with inpatient consultation team and will see patients in inpatient setting.3. Student will participate in weekly grand rounds and journal club.4. Students will complete online modules and attend conferences which cover physician handoffs, consultative medicine, and palliative care.

PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:1. Diabetes Mellitus (Type I and II)2. Diseases of the Thyroid3. Diseases of the Adrenal Gland4. Osteoporosis

Pulmonary Medicine

LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:1. Demonstrate proper patient interview and physical examination techniques in the context of consultative medicine. (PC1, CS4) 2. Analyze, synthesize, and integrate pertinent patient data to formulate a comprehensive and logically ordered differential diagnosis when assessing patients on the Pulmonary Consult service. (MK4, MK6, PC1, PC2)3. Present and document data gathered from patient interviews, physical examinations, and laboratory sources, in standardized format in both initial consult notes and daily progress notes. (PC2, PC3, CS4, CS5)4. Perform diagnostic and laboratory test interpretation for common studies used in pulmonary medicine (e.g. chest x-rays and pulmonary function tests), and actively consider cost-effectiveness when ordering or recommending diagnostic studies. (MK4, MK5, PC2, PL4, SL2)5. Apply knowledge of the pathophysiology, epidemiology, and natural history of diseases to the diagnosis and management of common patient conditions in pulmonary medicine. (MK3, MK4, MK6, MK8, PC2, PC3)6. Demonstrate effective and professional interpersonal and communication skills in interactions with

7

patients and their families, including an awareness of psychosocial factors related to patients’ problems. (CS1, PR1, PR2)

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. Students will participate on the Pulmonary Consult service, and evaluate consult patients under attending and fellow supervision.2. Students will present and discuss patients with the consult attending, fellow, and team.3. Students will complete selected reading material on topics pertinent to the pulmonary medicine.4. Attendance at Pulmonary Core Clinical Conferences at noon on Mondays, Tuesdays, and Thursdays.5. Students will complete online modules, attend conferences that cover physician handoffs, consultative medicine, & palliative care.

PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:1. Chronic respiratory failure, including very severe COPD with hypoxemia and/or hypercarbia2. Obstructive lung diseases, including COPD (due to either emphysema and/or chronic bronchitis), asthma, and bronchiectasis3. Restrictive lung diseases, including interstitial lung disease, pleural effusion, pneumoconiosis, and collagen-vascular diseases4. Pulmonary malignancies, including non-small cell lung cancer, small cell lung cancer, metastases, and malignant effusions

Rheumatology &

Immunology

LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:1. Evaluate patients with joint pain and inflammatory arthritis. (MK3, MK4, PC1, PC2, CS1, CS4)2. Perform musculoskeletal exam techniques and describe procedures such as arthrocentesis and injections. (MK5, MK8, PC7, CS1)3. Perform a diagnostic evaluation of patients with suspected autoimmune disease. (MK5, MK6, PC3)4. Describe commonly utilized therapies in treating patients with a broad range of musculoskeletal diseases. (MK5, MK7, MK8, PC5)5. Demonstrate effective and professional interpersonal and communication skills, and model ethical behavior. (CS1, CS2, PR1, PR2)

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. The majority of time is spent in ambulatory clinics, where students will have intense one-on-one contact with faculty in the evaluation of ambulatory patients. 3. Instruction on indications and methodology for joint aspiration and injection, including hands on when applicable.4. Students will attend and participate in all conferences and teaching sessions.5. Students will learn pharmacotherapy related to rheumatology, including disease-modifying anti-rheumatic drugs (DMARDs), biologics, and other immunosuppressant and anti-inflammatory medications.6. Students will complete online modules, attend conferences that cover physician handoffs, consultative medicine, and palliative care.

PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:1. Inflammatory arthritis including rheumatoid arthritis (RA), psoriatic arthritis, and others 2. Connective tissue disorders including systemic lupus erythematosus (SLE), systemic sclerosis / scleroderma, Sjogren’s syndrome, and others3. Vasculitis including ANCA-associated vasculitis and giant cell arteritis (GCA)4. Crystalline arthritis including gout and pseudogout

Hospital LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:

8

Medicine Consults

1. Define and apply risk assessment and risk reduction strategies in patients with medical problems undergoing surgery. (MK4, MK7, PC3, PC5, PL3)2. Demonstrate fundamentals of perioperative cardiovascular, pulmonary, and diabetes management. (MK3, MK4, PC3)3. Demonstrate basics of perioperative venous thromboemolism prophylaxis, anticoagulation management, and antibiotic prophylaxis management. (MK4, PC3, SL2)4. Demonstrate understanding of diagnosis and treatment of basic nosocomial infections such as pneumonia and urinary tract infections. (MK3, MK4, PC3, SL2)

INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:1. Students will round with the general medicine/hospitalist consult team at MUSC.2. Students are expected to independently evaluate patients, follow and write daily notes on their patients, and present findings and plans to the hospitalist attending.3. The consult team at MUSC consists of an attending hospitalist and a medical resident who will work with and provide feedback to medical students during the rotation.4. Students are encouraged to come to the Department’s conferences such as morning report, noon conference and grand rounds.5. Students will complete modules and attend conferences that cover physician handoffs, consultative medicine, and palliative care.

PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:1. Sinus tachycardia2. Hypertension2. Pneumonia3. Urinary tract infections4. Pulmonary embolus5. Diabetes mellitus6. Anemia

STUDENT RESPONSIBILITIES

1. All Internal Medicine courses adhere to the “Medical Student Supervision and Teaching Policy” approved by the MUSC COM UCC on June 15, 2012.

2. Students are allowed to see and perform non-invasive exams on patients that have been assigned to them by their attendings or residents unsupervised. For invasive exams (breast, genital, rectal), a resident or attending physician must be present.

3. Students are allowed to participate in ANY procedure that is common to Internal Medicine with approval and supervision by the certified healthcare provider, including but not limited to nurse, respiratory therapist, resident or attending physician who is performing that procedure. Procedures include but are not limited to IV or central line placement, ABGs, lumbar punctures, arthrocentesis, thoracentesis, or paracentesis.

4. Students are expected to use EPIC in the inpatient setting and outpatient and consult setting to document notes for both new and follow-up patients. For instructions on how to use EPIC go to “EPIC instructions” on clerkship website.

5. Please see course specific instructions for a further delineation of expectations.

9

ACTIVITIES

Students’ exact schedule, including attending rounds, will be at the discretion of the division to which you have been assigned. The Department of Medicine has a full schedule of conferences, which you are strongly encouraged to attend, in addition to any assigned clinics and conferences mandated by each individual Division

OTHER ACTIVITIES

All Senior Medicine students are required to do 8 SIMPLE and all Palliative Care cases in their entirety. The course coordinator will periodically audit all online cases. If the cases and/or modules are not completed appropriately, students will be ineligible for honors in this course.

SIMPLE CASES: 1) Objectives for each case are embedded into the online cases (and are not repeated here.) 2) Instructions:

a. To log in go to:  http://www.med-u.orgb. For first time users:

i. Click on “Login to Cases” up in the right marginii. Choose First time user

c. Complete all the questionsd. Click the “Accept” buttone. Click “Send”

3) For returning users:a. Just login using the account you have already created on another rotation.b. Follow directions given on site.

4) You must complete EIGHT cases with the exception of #16.

PALLIATIVE CARE CURRICULUM (modules highlighted in red must be done before the palliative care workshop)This curriculum is a published curriculum that addresses many issues that students need to understand and be able to manage. Although the curriculum involves patients with cancer, the attitudes, knowledge and skills taught are applicable to patients with palliative care needs for any reason or for any underlying diagnosis. Objectives:1) After studying module 1 (Comprehensive Assessment) students will be able to:

a. Explain conceptions of suffering. b. Describe a framework to guide assessment of the multiple issues that frequently cause

patients and families to suffer. This framework will be used to develop the patient's care plan.

c. Use NEST, a validated screening tool, to facilitate an initial screening assessment. d. Carry out a detailed assessment of active issues.

2) After studying this module 2 (Cancer Pain Management), students will be able to: a. Compare and contrast nociceptive and neuropathic pain. b. Understand steps of analgesic management. c. Utilize alternative routes of delivery d. Convert between opioids while maintaining analgesia.

10

e. Utilize adjuvant analgesic agents. f. Understand adverse effects of analgesics and their management.g. Understand principle methods of interventional pain management. h. List barriers to pain management.

3) After studying module 4 (Loss, Grief and Bereavement), students will be able to: a. Define loss, grief, and bereavement. b. Facilitate creative adaptation to losses. c. Screen for and assess uncomplicated and complicated grief. d. Manage reactions to loss, including anxiety and depression. e. Follow through with bereaved family members after a patient's death.

4) After reviewing module 6 (Last Hours of Living), students will be able to:a. Assist families to prepare for the last hours of life. b. Assess and manage the pathophysiologic changes of dying. c. Pronounce a death and notify the family.

5) After studying module 7 (Communicating Effectively) students will be able to: a. Explain why the communication of information is a core clinical skill for physicians. b. Use a six-step protocol to deliver bad news. c. Use a translator effectively when language is a barrier.

6) After studying module 8 (Clarifying Diagnosis and Prognosis) students will be able to: a. Describe the difficulty inherent in prognostication. b. Contrast what is known with the limitations of current prognostic models. c. Apply the six-step protocol to communicate and clarify diagnosis and prognosis.

7) After studying module 9 (Negotiating Goals of Care) will be able to: a. Be honest, while identifying reasonable hope. b. Discuss potential goals of care and treatment priorities, and how they interrelate and

change. c. Use a seven-step protocol to negotiate goals of care and treatment priorities. d. Identify goals when patients lack capacity.

8) After studying module 12 (Conflict Resolution) students will be able to: a. Describe futility and factors that lead to conflict. b. Use a seven-step protocol to facilitate resolution of conflict c. Recognize when the oncologist or cancer care team is the source of conflict.

REFLECTIVE WRITINGEach student is expected to write ~3 paragraphs describing a meaningful patient encounter. One of the palliative care modules should be directly applied to the patient encounter, and the paragraph should include the following:1) A description of the patient (without violating HIPAA) and the encounter you and your team

had with the patient. This description should be concise, within one paragraph.2) Explain how the encounter is related to one of the palliative care modules you completed

(breaking bad news, a patient-team conflict, discussed goals of care, etc.) You must specifically cover topics i-iii, listed below. [1 POINT FOR THIS SECTION]

i. What went well? Did the team use any of the skills/concepts taught in the module?ii. What did not go well?

iii. How could the skills taught in the module have improved the encounter?3) How did the module and patient encounter change how you will practice or approach patient

care in the future? Or how did it solidify what you already do? [1 POINT FOR THIS SECTION]

11

4) Your paragraph must be emailed to Mary Ann in Microsoft Word as an attachment at the end of the rotation. Please be sure to add your name and what module you are referencing in the reflective writing essay.

The reflective writing essay is graded out of 2 points, and if a student’s score is less than 2 points, a final grade of Honors is not possible.

PALLIATIVE CARE WORKSHOP1) Recognize the importance and complexity of breaking bad news and leading a successful

family conference.2) Observe and practice the framework and skills necessary for the successful facilitation of a

family conference.3) Identify skills essential to successful communication.4) Identify pitfalls to avoid in leading a family conference and breaking bad news.

PATIENT HANDOFF WORKSHOP1) Describe the importance of handoffs in the current medical environment2) Develop an accurate written handoff based on the medical record3) Practice writing handoffs4) Give verbal handoff from written example

GRADING POLICYFEEDBACK:

1. Consult cards : Student are given 3 “consult cards” that contain the milestones (steps) to doing a performing a consult. One card MUST be completed by an attending. The consult can be an inpatient or outpatient (clinic patient) consult. If you are not progressing appropriately, please let your Course Director know so that you can receive extra help. Also, please get extra cards if necessary for further feedback. Turn these cards in at the end of the rotation.

2. Midpoint cards : Students are given 2 of these cards to be completed by 1 attending and 1 resident or 2 attending physicians. These should be completed and turned in by the end of week 2 of the rotation.

EVALUATION: The Senior Medicine Requirement graded on an Honors-Pass-Fail basis. Your attending physician and the fellow assigned to your team will evaluate your clinical performance. We follow the COM Clinical Course Assessment and Grading Policy - “Policy: 4th Year Electives and Externship Failure (Approved on May 1st, 2015.) Each Elective, Externship, and required course, sets criteria for failure, pass, and honors for the course prior to the start of each academic year. These criteria will be made available to students at the beginning of each course in written form.”

All clinical faculty and rotations will assess the clinical performance of students using the standardized COM Clinical Performance Evaluation (CPE).

A student will FAIL the elective or externship if any one of the following conditions is met: A Clinical Performance Evaluation grade of 2.75 or lower (with the exception of

Internal Medicine which is a clinical grade of 2.80 or lower), or at the discretion of the Course Director if the following occurs, one (1) or more ratings of “rarely, if ever”, or two (2) or more ratings of “inconsistently”.

12

A failing grade on any secondary component (of the grade). Additionally, a student is eligible for failure at the discretion of the Course Director if the

student receives any comments of concern about the professional behavior of the student.

What if a student fails some component of the grade?If a student fails the clinical component of the grade, the student must repeat the course. If a student fails a secondary component of the grade (i.e., OSCE) the student will receive a grade of “Incomplete” (IN) and will have the opportunity to remediate that portion of the grade. The student will not receive honors for the course as a whole regardless of performance on the remediated portion of the grade. If the secondary component is failed a second time, the student must repeat the course.

Policy: 4th Year Electives and Externship Honors (Approved on May 1, 2015)A student will be eligible for honors at the discretion of the course director if the student achieves a Clinical Performance Evaluation clinical grade of 3.81 or higher with no ratings of “rarely, if ever” or “inconsistently”.”

1) Criteria for Honors :a) Clinical Evaluations: must obtain an average of 13 “Almost Always” with the rest of the

criteria being evaluated as “Consistently”. [Average of 61 out of 64 points on CPE form; GPA of 3.81].

b) Must receive 2 out of 2 points on the reflective writing eassy.c) Must PASS OSCEd) Any unexcused absences from workshops, or failure to complete online curriculum on

time makes the student ineligible for honorse) An honors grade may be reviewed and potentially withheld if the student obtains

any “Rarely, if ever” on any evaluation, has more than 4 “Inconsistently” marks on any evaluation, or has any professionalism issues raised by on their evaluations as indicated by a “Yes” being checked on questions 19-23.

2) Criteria for Passing :a) Clinical Evaluations: must obtain a minimum average of 13 “Consistently” marks and 3

“Inconsistently” marks. [Average of 45 out of 64 points on CPE form; GPA of 2.81].b) Must receive 1 out of 2 points on the reflective writing project.c) Must PASS OSCEd) A passing grade may be reviewed and potentially withheld if the student obtains any

“Rarely, if ever” on any evaluation, 2 or more marks of “Inconsistently” on any given evaluation or has any professionalism issues raised by on their evaluations as indicated by a “Yes” being checked on questions 19-23.

e) You must complete the palliative care curriculum, your reflective writing project (meeting passing standards for the project), and SIMPLE cases in their entirety.

3) OSCE : The OSCE will be held the last Monday morning of the rotation (see schedule for details.) The OSCE covers the content given in the online curriculum, online lectures and workshops given during the rotation.a) Passing the OSCE is a score of 45 out of 75 points.

4) Students may ask the Clerkship Director to have the Internal Medicine Education Committee review the grade, but this must be done within 30 days of the final grade posting (See Dean’s Office Grade Grievance Policy). The student must complete the IM Grade Grievance Form and turn in to Mary Ann Snell. If the grade is upheld, the student may appeal their grade to

13

the Clinical Sciences Planning and Evaluation Committee. If the matter is not resolved to the satisfaction of the student and the student continues to feel that a wrong has occurred, the student may petition in writing Dr. Donna Kern and Dr. Angela Dempsey for a final appeal.

STUDENT CONDUCT

Students should exhibit professional and ethical behavior at all times. Among other things, this includes appropriate dress, demeanor, attendance, promptness, and appropriate interactions with health care providers.

Code of ConductMUSC and the College of Medicine are invested in maintaining an academic and clinical environment in which students, faculty, fellows, residents, nurses and staff can work together freely without threat of mistreatment or bias with regard to their race, color, religion, sex, sexual orientation, national or ethnic origin, age, disability or any other factor irrelevant to participation in the activities of the College.  Students are responsible for reading and understanding the Code of Conduct Policy. https://www.musc.edu/medcenter/policy/stds_of_conduct.pdf

Attendance: You have a daily commitment to be on work rounds led by the team resident, fellow, and attending physician. You must receive prior approval from Dr. Heincelman in order to be absent. For absences that are requested in advance, an absence form must be completed in E-value. For emergency situations (illness, death in family etc), you must speak to someone from your team and an email needs to be sent to Dr. Heincelman (heincelm@musc.edu) and the coordinator (snellma@musc.edu). An absence form must then be completed in E-value within 24 hours. You are highly discouraged from attending residency interviews on this rotation . Once approval has been received it will then be your responsibility to let your team know you will be gone. A student schedule is included in this syllabus. We follow the MUSC College of Medicine Absence and Away Policy (please see website link for details).

Dress Code: You are expected to dress professionally. Patients will recognize you as a concerned member of the medical team, and will expect (and deserve) appropriate attire on your part. Attendings and residents reserve the right to comment on the appropriateness of dress. Name tags must be worn at all times.

Policies and Procedures: This clerkship follows all COM and MUSC policies and procedures regarding students. Please contact the Clerkship Director if any are violated so that the situation can be rectified. Links to pertinent policies can be found on our website. If you cannot find a particular policy please contact Mary Ann Snell.

EPIC INSTRUCTIONSInstructions for EPIC can be found on the Internal Medicine Student Website at the following link: http://clinicaldepartments.musc.edu/medicine/education/medstudents/EPIC

14

SENIOR MEDICINE REQUIREMENT CONTACTS

Most of the time you will meet with the division coordinator immediately following orientation. S/he will answer any questions you might have and may supply you with some additional information. At that time they will put you in touch with your team members.

Subspecialty: Contact: Phone: Location:

Cardiology: Paulette Okurowski 876-4807 2nd Floor Strom Thurmond

MED 855 MC Cardiology Consults Dr. Valerian Fernandes

Endocrinology: Beth Gunnells 792-4747 822 CSB

MED 862 MC Endocrine Consults/Clinics Dr. Beatrice Hull

Gastroenterology: Cynthia Peeples 876-0298 2nd Floor Strom Thurmond

MED 842 MC GI Hepatology Consults/Clinics Dr. David Koch

MED 858 MC GI Luminal Consults/Clinics Dr. Pooja Elias

Hem/Onc: Kris Banks-Smalls 792-1298 5th Fl Walton Bldg.

MED 859 MC Hem/Onc Consults/Clinics Dr. Todd Gourdin

Infectious Disease: Shawn Prioleau 792-4542 12th Fl. RT

MED 861 MC ID Consults/Clinics Dr. Lauren Richey

Nephrology: Tammy Hill 792-9188 822 CSB

MED 851 MC Nephrology Consults/Clinics Dr. Ruth Campbell

Pulmonary: Cameron Hay 792-7199 816 CSB

MED 865 MC Pulmonary Consults Dr. Lynn Schnapp

Rheumatology: Terri Hayes 792-3484 822 CSB

MED 891 MC Rheum Consults/Clinics Drs. Faye Hant & Diane Kamen

Hospitalists: Donna Gerke 792-1211 1213 RT

MED 891 MC Medicine Hospitalist Consults Dr. Marc Heincelman

15

COURSE EVALUATION

In order to identify areas for improvement for the Internal Medicine Senior Medicine Requirement, you are required to critique each portion of the course using the E*value. You will also be required to provide feedback for attendings, residents, and fellows with whom you worked. These comments are held in strict confidence, and are never seen by the attendings, residents, or fellows. Issues critically important to the function of the Department are shared with the Chairman. These evaluations need to be completed by the Monday following the completion of the rotation.

PROBLEMS

If you have any questions or problems during your rotation, please call the student coordinator at 792-7282 (807 E CSB). If you have any problems on the service during the rotation, please contact the student coordinator, or Clerkship Director. If you would like to meet with the Clerkship director during or after the rotation, you may schedule an appointment by contacting your student coordinator.

Course Director: Marc Heincelman, M.D., heincelm@musc.edu Pager #14327

16