SOM Elective Brochure
 

Electives Type:  Clinical

Elective Title
Medical Intensive Care Acting Internship at Austin
Course Number
MEDU-4151
Duration/Weeks
4
Prerequisites: Successful completion of Year 3 
      Additional Requirements:
n/a
Responsible Faculty Director:
Shailaja Hayden, MD
Other Faculty:
Location to Report on First Day
Contact Tricia M. McElligott at tmmcelligott@seton.org or 512-324-7860
Periods Offered
1-11
including Period 12 (June), including the holiday vacation Period 13 (Dec)
Maximum Enrollment
1

Goals
 To develop skills in the care of critically ill patients in an intensive care unit setting.

Objectives
 1. To be able to conduct a problem-oriented assessment of critically ill patients with multi-organ system problems. 2. To develop diagnostic and management plans appropriate for a wide range of disease entities. 3. To manage the physical and psychological issues faced by acutely ill patients and their families.

Description of course activities
 This elective is for students who have completed a previous medicine elective and would like experience in the ICU. Supervised by the ICU resident and attendings, the student will have the opportunity to participate in procedures and twice daily ICU rounds.

Type of students who would benefit from the course
 Students interested in Internal Medicine, Family Medicine, or Emergency Medicine would benefit from this elective. To enroll, UTMB students should submit a C-form to Tricia M. McElligott via e-mail at tmmcelligott@seton.org or fax to 512-324-7988 for approval. Visiting students should submit an application through VSAS: https://services.aamc.org/20/vsas/public/school/instID/174 Select UTMB at Galveston as the host institution and indicate you wish to take MEDU 4151 on the application.

Weekly Schedule
  Clinical Activities (please insert estimated schedule here)
   
  Day of Week AM PM
  Monday Clinical rounds and patient care Clinical rounds and patient care
  Tuesday Clinical rounds and patient care Clinical rounds and patient care
  Wednesday Clinical rounds and patient care Clinical rounds and patient care
  Thursday Clinical rounds and patient care Clinical rounds and patient care
  Friday Clinical rounds and patient care Clinical rounds and patient care
  Saturday No duty
  Sunday No duty
       
  Average number of patients seen per week: 10  
  Call Schedule:   No overnight call  

  Research Activities (please insert estimated schedule here)
   
  Activity Hours per Week
  Faculty contact time

  Self-directed study

  Data collection/analysis

  Other


Method of student evaluation
Check all that apply - complete appropriate section(s) only:
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Daily
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty and residents
  B. Frequency / duration of presentation(s)?
    Daily
  C. Format - What guidelines are set for the student's presentation?
    Clinical case presentations
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Daily
  B. Format - What guidelines are set for the student's written work?
    Clinical notes, although notes do not currently go in electronic medical record
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
   
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
   
  F. Audience - Who assesses the studentís written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
   

6.  Other Modes of Evaluation
  Please explain below.
    Students will be evaluated on their reliability and sense of responsibility for patient care. Special attention will be paid to knowledge acquired during the externship as well as communication and listening skills. Written consults, oral presentations, and feedback from residents on the team will be used by the attendings to evaluate the studentsí performance.
 
7.  If this course is an Acting Internship, please complete the following:
   
  A. Specify how the student will be given formative feedback on their clinical skills.
    The student will receive informal day-to-day feedback from the attending physician and senior resident on their performance and skills. There will be a more in-depth mid-rotation review with the attending physician, and finally a written evaluation by the attending physician at the end of the rotation.
B. List advanced clinical skills that a student will be assured an opportunity to practice.
    1. Evaluation and management of complex critically ill medical patients, including patients with acute respiratory failure, acid-base abnormalities, septic shock, renal failure, and brain injury, amongst other diagnoses. 2. Management of mechanical ventilation in a critically ill patient 3. Management of shock in a critically ill patient 4. Interpretation of hemodynamic data in a critically ill patient 5. Interpretation of arterial blood gas 6. Management of supportive care in a critically ill patient, including enteral nutrition and DVT and GI prophylaxis as appropriate 7. Participation in family conferences to discuss goals of care and end-of-life issues
C. List other advanced clinical skills that a student may be exposed to depending on clinical case availability.
    1. Evaluation and management of cardiogenic shock 2. Placement of arterial catheter 3. Thoracentesis 4. Paracentesis 5. Lumbar puncture 6. Placement of central venous catheter 7. Use of bedside ultrasound
  D. How will the acting intern student have responsibilities similar to a PGY1 resident? How will their responsibilities differ?
    The Acting Intern (AI) will round on at least 2 patients each day, but likely carry less patients than the interns. The AI will be expected to pre-round, present their patients during attending rounds, make appropriate phone calls/coordination of care for their patients, and of course read and learn about their patients' medical issues, similar to the intern. They will not, however, be allowed/able to write orders or to enter official notes into the electronic medical record. AI will not be expected to round on weekends and will have no overnight call responsibilities.
  E. How will this course help prepare a student enter an internship in this field or a related field?
    Evaluating and managing a complex critically ill patient will help the AI learn to: 1. cognitively process and synthesize large amounts of data, 2. be organized and methodical in their approach to patient care, 3. recognize situations that require emergency, urgent, or non-urgent action. These skills will be very valuable to an intern in internal medicine, emergency medicine, or general surgery.
  F. How will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    The AI will meet face to face with the attending physician mid-rotation to discuss strengths, weaknesses, and make plans to improve performance if needed.
  G. Acting Internship students often seek letters of recommendation following their experience. How many different faculty are they likely to encounter during this course? What is the usual number of working days they can expect to encounter the same individual faculty member? Describe the degree of supervision and interaction with faculty vs. residents or other providers.
    Attending physicians generally supervise a 14 day stretch in the ICU, so the AI will encounter 2-3 attendings in their 4 week rotation, and work with each for 7-14 days. They will round with the interns, residents, and attending every day of the week. The resident will also work with the AI during the rest of day, such as when admitting new patients.

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