Ambulatory Community Selectives (ACS)
 

Background and Rationale:

Beginning in 2004-05, all students are required to take a 4-week selective that takes place in a Texas community setting, not in an academic health center, and emphasizes non-hospital experiences.

Through the Ambulatory Community Selective (ACS), the student will have the following opportunities:

a. to develop an appreciation of the art and practice of medicine as it occurs in a community.

b. to enhance and further develop their diagnostic and therapeutic skills

c. to view individual patients and families as unique, but situated within a cultural socio-economic setting,

d. to identify roles that practicing physicians take in a community, including advocacy, attention to public or community health issues, and leadership for community issues

e. to learn about at least one Texas community’s needs for health care professionals

f. to learn about interprofessional healthcare experience (i.e. working with a variety of healthcare professionals.)

The ACS Selective will also provide opportunities for UTMB Community Faculty, UTMB alumni, and/or friends-of-UTMB (i.e. potential new Community Faculty) to contribute to medical student education and to develop networks that may affect clinical referral processes.

Departments will also have the opportunity to further expose students to their specialty (i.e. residency recruitment).

Objectives of the ACS Selective:

The ACS Selective will provide each student an opportunity to explore a variety of issues. Required ACS Objectives include the following:

Knowledge and Skills Objective: to learn about the practice of a chosen medical discipline and to practice that discipline’s diagnostic and therapeutic skills in a Texas community setting.

Career Development Objective: to identify characteristics of practice in the selected community; scope of practice in the selected community; potential lifestyle of a physician in the selected community.

Advocacy Objective: identify the roles practicing physicians play in a community, such as patient advocate, public or community health monitor, or community leader.

Healthcare Systems/ Practice Management Objective: to learn more about issues of practice management and health care systems in communities, such as billing issues, professional communication with therapists, telemedicine, rural medicine, and accessing systems of support for patients with special needs.

Optional ACS Objectives may include the following:

Service Learning Objective: to engage in service learning

Note: Service-learning means a method under which students learn, through thoughtfully-organized service that is a) conducted in a community, b) helps foster civic responsibility; c) is integrated into and enhances the academic curriculum of the students; and d) includes structured time for students to reflect on the service experience. There are three basic components to effective service-learning:

 

· sufficient preparation, which includes setting objectives and planning projects so they contribute to learning at the same time work gets done.

· performing service.

· the participant attempts to analyze the experience and draw lessons, through such means as discussion with others and reflection on the work.

CAM Objective: To identify complementary-alternative medicine approaches important in a given community

Guidelines for Developing an ACS Selective:

The following guidelines have been developed by the Ambulatory Community Selective Committee to assist Departments as they design and implement ACS Selectives:

Course requirements:

All UTMB student selectives, including the ACS Selective, have the following minimum requirements:

Selectives must be full-time experience.

At least 50% of the student’s time must be spent in clinical duties.

Students are expected to evaluate a minimum of 2 patients/day in the outpatient setting

Non-clinical experiences are optional, and may include, but are not limited to, didactic instruction, projects, or independent study. Any independent study should be accompanied by an explicit measure (e.g., assessment, student presentations or reports) to assure that the time has been used productively.

Assessment: evaluation of student performance must include a faculty evaluation and at least one formal written assignment, assessment and/or patient-based exam. Selective experiences must include assessment of students in addition to clinical evaluation. Examples include:

o written examination

o structured oral examination, or structured clinical examination (OSCE)

o reflective journaling

o creation of learning portfolio

o evidence-based assessment of practice guideline

o electronic communication with peer interaction

o virtual classroom

o completion of electronic module(s) with built-in evaluation

o formal oral presentation.

Grading: students will be assigned a grade of Satisfactory or Fail.

The ACS Selective has the following additional requirements:

The community setting must be in Texas.

Community experiences prior to 4th year cannot be substituted for this requirement.

The experience must be ambulatory, i.e., patient-oriented experiences involving primarily face-to-face interaction with patients not in a hospital bed.

While not limited to Primary Care specialties, ACS Selectives should emphasize disciplines which provide direct services to patients.

Course proposals will be reviewed by the ACS Committee for suitability and alignment with objectives.