International Health

INTERNATIONAL

HEALTH

11

190.0 International Health Elective

Instructor: Warren Hershman, M.D., M.P.H.

Location: The Hebrew University-Hadassah Medical School, Jerusalem, Israel
Contact information: Dr. Warren Hershman, Warren.Hershman@bmc.org, and Britt Simonson, brisimo@bu.edu, Evans 122, 638-7230
Number of Students: 6-8. Limited travel funds available for BUSM students
Period to be Offered: One to two months

Description of Elective:

This clinical clerkship is part of The Louis and Charlotte Kaitz BUSM/The Hebrew University-Hadassah Medical School Exchange Program. It is available to all fourth year students interested in the Israeli health system or whose professional career would be enhanced by a unique experience in Middle East medicine at a world renowned medical, educational and research institution. A conversational knowledge of Hebrew is a prerequisite for electives in general medicine and general surgery, but not for the other clinical electives.

190.00 Medical Care in Armenia

 

Instructors:
Hovaness Sarkavagyan, M.D., Chief, Thoracic Surgery, Grigor Lusavoric Medical Center
Gagig Manookyan, M.D., Chief, Intensive Care Department, GLMC
Voskan Pahlavyan, M.D., Chief, Cardiology, GLMC
Nikolai Dallakyan, Chief, Emergency Children’s Hospital and Chief, Yerevan Emergency Ambulance Service

Location: Grigor Lusavorich Medical Center and affiliated institutions in Yerevan, Republic of Armenia c/o Ara Minasyan, M.D., Chairman, Grigor Lusavoric Medical Center
10 Gurdjian Street, Yerevan, 375056
Tel/Fax: 374-1-15-13-90
Email: aihaemer@arminco.com

Students generally lodge at a local hotel in Yerevan or in the dormitories of the Armenian National Institute of Health, 49/4 Komitas Avenue, Yerevan, tel: 374-1-235-171

Number of Students: Up to six per rotation
Period to be offered: One four-week period throughout the year, by arrangement

Application Process:

Contact Armenia Partnership Program-Attn: Caroline Apovian, M.D.
Boston University School of Medicine

Email: Caroline.Apovian@bmc.org

Description of Elective:

Boston University School of Medicine has established a medical elective for fourth-year medical students at the Grigor Lusavoric Medical Center, in Yerevan, Republic of Armenia. The elective is open to medical students from accredited medical schools. The Grigor Lusavoric Medical Center is a leading trauma center for Yerevan, the capital city, and is the base of the municipal ambulance service. The four-week elective includes short rotations in the thoracic surgery, emergency medicine, intensive care, and cardiology services of GLMC. In addition, students may elect to rotate at a maternity and pediatric hospital or pediatric and adult polyclinics. They can also have experience on ambulance service calls during evening hours, depending upon service volume.during evening hours depending upon service volume.

The intensive care and thoracic surgery departments at GLMC have residency programs. Students will be expected to shadow the house officers during their daily rounds of these services. In daily conferences, morning rounds, practical studies and discussions with the preceptor, students will gain an understanding of the practice of medicine in a non-western environment. They will see a strong demonstration of the importance of taking a patient history without benefit of extensive diagnostic testing. Medical education differences will be apparent to the student as well as international efforts to upgrade health care through the transfer of technology to Armenian hospitals.

Written evaluation of student performance will be obtained from preceptors. The elective organizers will see that all student evaluation forms are completed and mailed back to the student’s school. Written evaluations of the elective are required of students within one month of completion of the elective. Dr. Ara Minasyan will assume direct responsibility throughout the student’s stay in Armenia; individual department or section heads will be responsible for general direction and content of the elective.

Student Comments

“…The doctors are excellent. They will discuss their approach to patient management and contrast how it may differ in America.”

“…I felt that physicians at the Emergency Hospital were very knowledgeable in making proper diagnoses and treatments considering the lack of resources in the hospital.”

“…they respected my ideas”

“…It allows an American student to have hands-on experience with diseases that one reads about only in textbooks, such as botulism, brucellosis and echinococcal infection.”

“…We discussed the infrastructure of the health care delivery system of Armenia and its future outlook.”

“…Their approach to adapt in situations when equipment is not available is unique.”

“…We were treated like we were family.”

“…The doctors are very enthusiastic about teaching foreign students.”

Prerequisite: Russian and/or Armenian fluency

190.11 Adult Medicine/Geriatrics at Department of Medicine, University of Crete, Greece

Course Director(s): D T Boumpas, G Samonis
Coordinators: S Panagiotakis, MD
Location: Heraklion, Greece

Contact Information: Dr. Vassilis Zannis, vzannis@bu.edu, 700 Albany Street (W509), 617-638-5085

SHORT SUMMARY OF ELECTIVE:
This is an elective designed to develop skills in history taking, physical examination and differential diagnosis appropriate for the evaluation of adult and geriatric patients. Knowledge goals include the physiology of normal adult subjects and the impact of aging on disease development and treatment. The elective takes place in the island of Greece (Department of Medicine) where adult and geriatric patients are cared for on general medical service. Daily rounds take place there with the residents and the attending physicians. There are three nursing homes in the Heraklion area, one public and two private ones. The geriatric rotation includes regular visits to them. Crete is the third largest island within the Mediterranean basin with strong family ties. Emphasis is placed on understanding adult and geriatric care within the cultural enviroment of the island. As such the rotation contributes to multicultural awareness and delivery of care to populations with different cultural backgrounds and societal values. Of interest the island has served over the years as the prototype for the Mediterranean diet and students should be able to gain first hand-experience experience in its natural setting.

DESCRIPTION OF ELECTIVE:
The elective takes care at the University of Crete teaching hospital (PAGNH), a tertiary care University consisting of 820 beds. It is located in the scenic area of Voutes, 7 km from the center of Heraklion in Crete.

GOAL:
Develop skills in history taking, physical examination and differential diagnosis appropriate for the evaluation of the adult and the geriatric patients.

OBJECTIVES:
• Discuss the physiology of normal aging
• Review the impact of aging and the pathogenesis of disease in the elderly and treatment modalities
• Participate in geriatric care adjusted to the cultural experience, needs and expectation of the elders of Crete
• Develop competence in delivery of health care in adult and aged subjects in diverse cultural environments

FACULTY
The Department of Medicine was one of the first established in the University Hospital. The staff consists of 4 physicians appointed by the Faculty of the Medical School (Professor and past-Chair DT Boumpas, Professor and Chair G Samonis, Professor A Gikas, Associate Professor E Ganotakis Assistant Professor DP Kofteridis), Ass Professor P Sidiropoulos Director Division of Rheumatology) and 7 physicians appointed by the National Health System (JA Papadakis, GN Fanti, G Vrentzos, E Barbounakis, S Panagiotakis and G Hamilos).

The main Faculty members have interests and/or are certified on
Rheumatology, Obesity and Metabolic Disorders, Infectious Diseases and Geriatrics Dr Panagiotakis is an internist with a masters in Gerontology and specialization in Geriatrics and serves as a the coordinator.

PRINCIPAL TEACHING METHODS
The Geriatric patients are cared for on general medical service; daily rounds take place there with the residents and the attending physicians. There are lectures on different topics of contemporary medicine, including geriatrics, during the noon conferences. There are three nursing homes in the Heraklion area, one public and two private ones. The geriatric rotation includes regular visits to them.

CORE CURRICULUM AND BASIC SKILLS

1. Dementia and delirium and other altered mental states; the ability to distinguish between all of these
2. Approach the patient with falls
3. Approach the patient with syncope
4. Approach to urinary and fecal incontinence
5. Prevention and treatment of pressure sores
6. Osteoporosis
7. Pharmacology in the adult and the elderly
8. The nursing home environment and problems with the nursing home patient
9. Medical ethics as it relates to the treatment of elderly patients
10. Elder abuse

PATIENT CHARACTERISTICS/CLINICAL ENCOUNTERS
While didactics are conducted in English, be aware that the majority of patient encounters are conducted in Greek. You will be paired with a Greek student who will do their best to act in part as your translator during encounters, as well as have their own responsibilities for their own rotation. The attending physicians will also help translate as needed. Adult and Geriatric patients are seen throughout the general medical inpatient and outpatient services and the emergency room admissions. There is also a dedicated Geriatric Clinic for comprehensive geriatric assessment of older people. A significant portion of the Emergency Room evaluation of patients involves the elderly, their safety and their home environment. Visits to nursing homes with faculty are available elective options. Following the morning reports, each visiting student will be assigned to follow the status and the treatment of 1 to 2 cases of patients, along with a Greek medical student. Emphasis will be placed on the geriatric patients. Both the visiting and the Greek students will be under the supervision of the attending physician. See the attached weekly calendar to understand the responsibilities and opportunities while on service. Below are descriptions of different key elements of the rotation.

Geriatrics Clinic
Attendance of the Geriatrics Clinic under the supervision of Dr Panagiotakis Older people with problems such as falls, unsteadiness, cognitive disorders and depression are assessed there. The assessment is comprehensive and multidisciplinary. There is a cooperation with the Psychiatry and the Neurology Clinics for referrals of more complex cases and the Social Service Department for older people with special needs in the community. Emphasis is given on the maintenance of functional autonomy of the patients and the relief of the burden of their families.

Geriatric rounds
Geriatric rounds are held once a week. The rounds are either sitting and/or by the bed of the patient. Special issues of care and discharge plan on complex geriatric cases are discussed. The rounds run by a multidisciplinary team composed by Dr Panagiotakis, a senior resident on Neurology, the physiotherapist and the social worker of the ward and a nurse.

Didactic lectures/ Teaching sessions/Appraisal presentations
These are detailed in the attached weekly calendar. Of note, morning report is held daily. The new admissions and the interesting follow-ups are discussed.
When there are students rotating in Geriatrics, Journal Clubs and noon conferences are devoted to geriatric issues. Students from Boston University do also their appraisal presentations on geriatric topics in these meetings.

Nursing Home rounds/Open Care Centers for Older people visits
Kalokairinou Nursing Home is a Charity of the Philanthropistic Institutions of A & M Kalokairinou in Heraklion city with almost 120 residents. Dr Panagiotakis visit the Institution with the students for rounds. Rounds involve the social worker of the Institution and a nurse. Matters regarding the well being of the residents, drug prescriptions, and referrals to subspecialties in the university hospital are discussed. In addition, Dr Panagiotakis and the students may visit the Open Care Centers of the Municipality of Heraklion and the Alzheimer Association, depending on the timing of their rotation. In these visits the students have the opportunity to meet and discuss with ambulatory older Cretan people in the community or even visit bed ridden people in their homes and understand the type of existing services and modes of care are offered in the community.

EVALUATION
Use of standard BU evaluation forms will be performed. Mid-clerkship evaluations and final evaluations will be provided by Drs Boumpas and Panagiotakis. Students will be required to complete a patient log describing the disease entities they encounter and learn.

NUMBER OF STUDENTS
-Up to six 3rd/4th year medical students during the months of March, April, May (a total of 12-18 students can be accommodated during the spring semester). No students will rotate during times of national or regional holidays, including Easter.

LENGTH OF ELECTIVE
4 weeks

AVAILABLE BLOCKS/semesters
Spring Semester

ER (Emergency Room) Rotation is held either on Monday or Tuesday
Professor Rounds are held either on Wednesday or Thursday, the same day with the Firm Chief Rounds
Firm Chief Rounds are held either Wednesday or Thursday
Nursing Home Rounds are held twice a week in the afternoon (Monday or Tuesday on the day that there is no ER rotation and on Thursday)

 

191    Cardiology-Medical Student Rotation (will not be offered 2014-2015)

Location: Schneider Regional Medical Center/ Virgin Islands Heart, LLC

St. Thomas, USVI

Preceptor: Roy Flood, MD, FACC

Application Process:
Student Sign-Up Instructions

Contact: Ana Bediako, Boston University School of Medicine, Office of Enrichment
Location: A-3
Telephone: 638-4167

Brief Course Summary:

This elective will involve both outpatient and inpatient clinical cardiology. The student experience will take place at Schneider Regional Medical Center.  This is a 200-bed hospital serving St. Thomas, St John, and surrounding areas. Hospital services include nuclear medicine, transthoracic and transesophageal echocardiography, exercise stress testing, and invasive/interventional cardiology.

 

Elective Summary:

The rotation will provide strong clinical experience with emphasis on practical everyday management of common inpatient cardiovascular entities such as coronary artery disease, cardiac dysrhythmias, congestive heart failure, and hypertension. In addition, it will provide a venue for outpatient consultative cardiology with an emphasis on preventive cardiology, preoperative screening, and basic outpatient diagnostic skills.

Students on the elective rotation will be expected to evaluate and present patients with common cardiology diseases and will be exposed to invasive and interventional cardiology procedures.

Students will be expected to participate in clinical rounds on inpatients and to actively participate in outpatient consultations. There will also be a brief didactic presentation on a pertinent area of cardiology ;( e.g. case presentation, diagnostic procedures, or pathophysiology of a disease). Course evaluations will be based on participation and knowledge base. The rotation is expected to provide a foundation for management of common cardiovascular issues encountered in postgraduate training.

Conferences:
Students will be expected to attend and participate in Department of Medicine teaching conferences such as Grand Rounds and Tumor Board and departmental case presentations. There will be ample dedicated time with the attending physician to discuss individual cases and topics in detail.

Daily Schedule: See attached

The Student Curriculum on the Cardiology Rotation will actively reflect the seven fundamental objectives of the Boston University School of Medicine, embodied by the acronym “BU CARES”

Objectives:

1)      Discuss the epidemiology, recognition, treatment and prognosis of acute coronary syndromes- (B,U,R)

2)      Review treatment, common medications, prognosis and complications in congestive heart failure- ( B,U,R)

3)      Discuss the management of hypertension, with emphasis on pharmacologic approaches to treatment ( B, U, R)

4)      Demonstrate the ability to perform basic ECG interpretation (U)

5)      Apply principles of diagnostic testing in cardiology, specifically indications and  applications of non-invasive screening, echocardiography, and cardiac catheterization ( U,E)

 

Skills to Acquire:

It is expected that the student on elective will enhance his or her skill set in preparation for postgraduate training.  Examples to include:

1)      Documentation (progress notes, procedure notes, etc.) (C,A)

2)      Review of pertinent literature (original articles, reviews, etc.) (R,E,S)

3)      Oral presentation skills (C)

4)      Interpersonal communication ( patients, peers, nursing personnel, referring physicians ( B,C,S,A)

 

Daily Schedule for Cardiology Students at Schneider Regional Medical Center:

Monday

8:00 am-11:00 am Cardiac Catheterization Laboratory

11:00 am-12:00 pm Inpatient work rounds

1:00 pm-4:00 pm Outpatient Clinic

4:00 pm-5:00 pm Teaching Rounds/Case Review

 

Tuesday

8:00 am-9:00 am Teaching Rounds

9:00 am – 12:00 pm Non-invasive Laboratory

1:00 pm- 4:00 pm Outpatient Clinic

4:00 pm-5:00 pm Case Review

 

Wednesday

8:00 am-9:00 am Teaching Rounds

9:00 am-12:00 am Non-invasive Laboratory

1:00 pm-4:00 pm Outpatient Clinic

4:00 pm-5:00 pm Echo Review

 

Thursday

8:00 am-11:00 am Cardiac catheterization Laboratory

11:00 am-12:00 pm Work Rounds

1:00 pm-4:00 pm Outpatient Clinic

4:00 pm-5:00 pm Case Review

 

Friday

7:30 am- 8:00 am Work Rounds

8:00 am-9:00 am Teaching Rounds

9:00 am-11:00am Non-invasive Laboratory

12:00 pm-3:00pm Outpatient Clinic

3:00pm-5:00 pm ECG Review/Case Presentations

 

Students will be required  to keep a log of  cases they have seen and procedures witnessed and/or performed.  This will help assess adequate student exposure to problems encountered in Cardiology.

 

Evaluation: Formative evaluation: a mid-clerkship evaluation will be done by the Course Director, Dr. Roy Flood.  A summative evaluation will be performed by Dr. Flood to assess the student’s performance on rotation.

 

Number of Students:

 

  • 2 BU fourth-year medical students

Length of Rotation:

 

  • 4 weeks

 

192 Emergency Medicine Medical Student Rotation  (will not be offered 2014-2015)

Schneider Regional Medical Center-St. Thomas, USVI

Application Process:
Student Sign-Up Instructions

Contact: Ana Bediako, Boston University School of Medicine, Office of Enrichment
Location: A-3
Telephone: 638-4167

Faculty Director: Clayton Wheatley, M.D., FACEP
Hospital: Schneider Regional Medical Center
First Day Contact Person: Clayton Wheatley M.D. – 340.244.7575
Meeting Place: Schneider Regional Emergency Department

Brief Course Description: The student will rotate through the Emergency Department (ED) at Schneider Regional Medical Center. They will assist the attending physician in evaluation, management, and disposition of patients presenting to the Emergency Department. There will be exposure to a vast array of cases, some particular to the tropics, that will provide a broad Emergency Medicine (EM) experience. Students will be under close supervision and will intimately communicate with the attending ED physician.

Description of Elective: As stated above, the elective will take place in the Emergency Department at Schneider Regional Medical Center. The contact person will be Clayton Wheatley, M.D., the EM Director. The student will initiate the evaluation of patients presenting to the Emergency Department and in conjunction with the ED attending determine the breadth and scope of the workup and plan for disposition. It is anticipated that there will be eight (8) hours of teaching contact time five (5) days/week which may include weekends. The setting of the Emergency Department provides the opportunity to see a great diversity of common clinical illnesses ¬¬both of a minor and critical care nature. The curriculum includes on-line video clips, reading assignments, and one-on-one experience working with an attending physician, all of which contribute to the students’ evaluation. Students will be expected to complete all the assigned components of this module and evaluate the clinical literature regarding patients they see in the ED. They will also be required to prepare a case presentation of an interesting patient they saw in the Emergency Department during the course of their rotation.

The criteria listed above will serve as the basis for final evaluation which shall consist of Honors/Pass/Fail. During the rotation the student will learn how to obtain an emergent history to evaluate patients presenting with:
• Chest pain
• Respiratory distress, asthma
• Coma and other alterations of consciousness
• Shock and hemorrhage
• Cardiac Emergencies
• Abdominal pain
• Psychiatric illness and acute agitation
• Multisystem trauma
• Pediatric fever

Goal: The purpose of this Emergency Medicine elective is to provide the student with an ability to rapidly assess the emergent patient and formulate an appropriate differential diagnosis, enabling stabilization and efficient disposition. With appropriate guidance it is expected that students will show improvement in their problem solving and diagnostic skills during the course of the rotation.

Objectives: By the end of the Emergency Medicine elective the BUSM student will be able to:
A. Rapidly assess patient signs and symptoms, and perform a focused emergency physical exam, while prioritizing and applying that information to triage the patient and assess emergent needs.
The student will perform (B,U,A,R,E):
1. A rapid and accurate assessment of overall patient status (i.e. sick/not sick)
2. An accurate focused physical exam for each system as it relates to patients presenting symptom and specifically to the following emergencies:
a) Chest pain
b) Shortness of breath, respiratory distress
c) Coma, altered levels of consciousness
d) Shock and hemorrhage
e) Cardiac distress and arrest
f) Acute abdominal pain
g) Psychiatric emergencies

B. Describe the diagnosis and treatment of the Trauma patient including (B,U,C,A,R):
1. Perform a rapid, comprehensive exam on the acute trauma patient
2. Describe and utilize the ABCDE protocol of ACLS
3. Ensure patient comfort and privacy during the exam
C. Demonstrate under direct supervision the following Emergency Medicine Skills (U,R) :
1. Provide CPR and assist in ACLS
2. Assess for communicable disease
3. Rapidly and accurately provide patient assessment and triage
4. Suture minor trunk and extremity lacerations
5. Emergent EKG reading
6. Reading chest, spine, and extremity X-rays
7. Peripheral IV line placement
8. Foley catheter placement
9. Observation of endotracheal tube placement
10. Wound hemorrhage control
11. Control of epistaxis
12. Nasal foreign body removal observation and/or assistance
13. Incision and drainage of simple abscesses
14. Removal of simple foreign bodies from cornea
15. Fracture assessment and basic splinting techniques

D. Observe and assist ED attending after being able to describe indications and possible complications of the following procedures (B,U,A,R):
1. Laceration repair of the face, ear, eyelids
2. Chest tube placement
3. Interosseous line placement
4. Initiation of thrombolytics for MI or CVA
5. Central line placement
6. Reduction of joint dislocations

E. Document the breadth and scope of this experience by keeping a log of procedures they have performed (U,R).

F. Practice Emergency Medicine exhibiting a professional demeanor that provides assurance to the patient and their family. Care must be practiced with integrity and consideration of sensible legal and ethical issues. In that regard the student must (B,U,C,A):
1. Be dutiful in patient care, arriving on time, and staying until all patient duties are complete.
2. Complete reading assignments
3. Recognize and acknowledge the patient’s right to refuse care
4. Identify and interact with surrogate decision makers
5. Practice Risk Management
6. Follow the contractual nature of patient care
7. Abide by all HIPAA and Confidentiality rules

The student will be judged on his/her professionalism throughout the course of the rotation.

G. Demonstrate an organized approach to clinical problem solving including differential diagnosis and systematic approach to the use of diagnostic tests (U,R).

Curriculum:

A. The curriculum will be composed of daily one-on-one student presentations of each patient to ED attending. Individual patient assessments, workups and care plans will be jointly reviewed and discussed.

B. Weekly lectures by an ED attending on a topic of interest

C. Online videos depicting procedures such as:
1. Central line placement
2. Lumber puncture
3. Management of multiple system trauma
4. Evaluation and management of GI bleed
5. Initial assessment and management of the poisoning overdose

D. Students will be required to keep a log of cases they have seen and procedures witnessed and/or performed. This will help assess adequate student exposure considering the episodic nature of patient illness presenting to the ED. This rotation intends to expose each student to the most common emergent conditions presenting to a community Emergency Department.

Evaluation: Formative evaluation: a mid-clerkship evaluation will be done by the Course Director, Dr. Clayton Wheatley. A summative evaluation will be performed by Dr. Wheatley to assess the student’s performance on rotation.

Number of Students:

• 2 BU fourth-year medical students

Length of Rotation:

• 4 weeks

193 Infectious Diseases Medical Student Rotation  (will not be offered 2014-2015)

Schneider Regional Medical Center/ Dept. of Infectious Diseases
St. Thomas, USVI

Application Process:
Student Sign-Up Instructions

Contact: Ana Bediako, Boston University School of Medicine, Office of Enrichment
Location: A-3
Telephone: 638-4167

Course Director: Tai Hunte, MD, MSPH

Brief Summary:
The Infectious Diseases elective will teach the student how to be an effective consultant and assist the student in improving their knowledge of infectious diseases. This rotation will provide the student with experience in the evaluation of patients with community-acquired and nosocomial infections, chronic HIV, sexually transmitted infections, as well as serious, non-infectious inflammatory disorders that mimic infectious disease. The student will be exposed to hospital based consultations and infection control, outpatient management in both the public health and private sector, and clinical microbiology. The student will gain a greater understanding of the range and appropriate use of antibiotics. This experience will improve the student’s understanding of the diagnosis and management of commonly encountered infectious diseases with attention to the use of the history and readily available laboratory tests.

Description of Elective:
The Infectious Diseases elective is an opportunity for the BUSM student to evaluate patients in the inpatient and outpatient setting, including the public health sectors. The student will see inpatient consults at Schneider Regional Medical Center (SRMC). They will also see patients at the HIV/STD/TB Clinic at the Department of Health (DOH).

The BUSM student will see patients Mondays through Friday with a work day beginning at 9AM ending no later than 5PM. The student will see patients at the DOH with the assistance of the nurses and case managers before presenting to the attending physician. The student will see new inpatient consultations at SRMC and present to the attending at daily rounds. The student will be expected to formulate an assessment and plan for each patient using relevant literature and recommended reading material prior to presenting to the attending. Students will follow their patients on the consult service throughout their admission and will write daily progress notes. Time will also be spent in the microbiology lab reviewing pertinent diagnostic tests.

This elective will provide exposure to the diagnosis and management of infections acquired in the community and the hospital, HIV and STDs, tropical medicine, and occasionally infections in travelers. It is well suited for an enthusiastic student interested in Infectious Diseases and Internal Medicine. The student will be exposed to the various healthcare settings in the private and public sector. They will be under the direct supervision of an attending physician but will also interact with other staff members including physicians from other specialties, nurses, case managers, and technicians.

The BUSM student will be evaluated on performance, presentation, and case write ups. They will be responsible for at least 3 case write ups per week. The attending physician will provide comments and feedback for improvement. The student should base their write ups on the listed objectives and core topics.

Administrative Contact: Tai Hunte, MD, MSPH
Email address: tchunte@cs.com
Office phone number: 340-774-1909
Cell number: 240-472-4466

Please email Dr. Tai Hunte one week prior to the rotation and report to the 5th floor of SRMC at the Infection Control office on their initial day at 9AM.

Goal:
The purpose of the Infectious Diseases elective is for the BUSM student to gain exposure and experience in the evaluation and management of patients with acute and chronic infections both community and hospital acquired.

Objectives:
By the end of the Infectious Diseases Elective, the BUSM student will be able to:
• Demonstrate the ability to perform initial and follow-up history and physical examination, including recent and current antibiotic usage history and presence of any indwelling catheters or hardware.
• Review how to take a thorough exposure history for infectious diseases.
• Develop a differential diagnosis for fever based on association with other symptoms, such as headache, altered mental status, cough, diarrhea, abdominal pain, dysuria, back pain, joint pain or swelling, rash, new neurological abnormality.
• Discuss the clinical presentation, pathophysiology, and initial evaluation of the following: fever in the hospitalized patient, bacteremia, infectious diarrhea, meningitis, pneumonia (community acquired, hospital acquired and aspiration), tuberculosis, opportunistic infections in HIV, sexually transmitted infections, urinary tract infections, skin and soft tissue infections, bone and joint infections, fever in a returning traveler
• Describe the approach to chronic outpatient management of HIV.
• Diagnose and manage common STDs, and describe an approach to a patient with genital symptoms.
• Interpret gram stains and to appropriately use the microbiology laboratory.
• Utilize the major classes of antibiotics appropriately and cost effectively.
• Recognize the role of the following in predisposing to or altering the presentation of infectious diseases: advanced age, diabetes mellitus, malnutrition, renal failure, COPD and cardiovascular disease, and congenital or acquired immunodeficiency (including HIV infection)
• Understand factors that may alter antibiotic choice or dose, including renal function and allergies.
• Understand the essential elements of a succinct consultation that focuses on the pertinent clinical issues.
• Demonstrate ability to communicate with microbiology personnel in regards to positive clinical cultures.
• Demonstrate respect for patients regardless of the circumstances of their illness

Faculty:
Tai Hunte, MD, MSPH
Director of the Department of Health HIV/STD/TB Clinic
Department of Infectious Diseases, SRMC
Chairman of Infection Control, SRMC
Email address: tchunte@cs.com
Office phone number: 340-774-1909
Cell number: 240-472-4466

Curriculum:
The curriculum includes:
• Daily HIV/STD/TB clinic patient exposure
• Daily rounds on inpatient consultations and follow ups
• Occasional office clinic patient exposure
• Participation in patient evaluations, write-ups, and patient presentations
• Weekly didactic discussions on various Infectious Diseases core topics

Evaluation:
The student will have a formative mid-clerkship evaluation with Dr. Tai Hunte. At the end of the rotation, the student will have a summative evaluation with Dr. Tai Hunte to gauge their achievement of the above stated objectives. The completed BU evaluation will be forwarded to the Office of the Registrar.

Number of Students:
• Two BU fourth-year medical students

Length of Rotation:
• 4 weeks

705.0 International Health Elective

Instructor: Suzanne Sarfaty, M.D., Director, International Health Program, BUSM
Contact: Ana Bediako
Location: A-3
Telephone: 638-4167
Website: International Health Program (provides expanded details in relation to information below)

Description of Elective:

This is a clinical clerkship or research opportunity for medical students interested in the field of International Health (IH). BUSM has a few established affiliations with hospitals and medical schools overseas, but students may seek alternative sites for their electives. They must be conversant with the language spoken in the host country for maximal learning benefit unless there is a provision for translators as part of the elective.

Any student wishing to undertake an IH elective must complete a formal application and submit it for approval to Dr. Sarfaty or the designated faculty contact (e.g. Warren Hershman, M.D. for the Israel elective and Vassilis Zannis, M.D. for the Greece elective). A letter of acceptance from the preceptor under which the student will work is also required.

It is strongly recommended that the student initiate plans for the IH elective six months in advance, as logistics for arranging overseas electives can be difficult. Evacuation/travel insurance will be provided to medical students if deemed necessary after discussion with Dr. Sarfaty or faculty contact.

Stipend:
All students are eligible to apply for a stipend to support the cost of the IH elective. Applications are accepted twice a year (July 15 and October 15) and are funded through a competitive process. Awards typically range from $400 to $1500, although awards of less or more are given. Funding is by reimbursement and is intended to help cover airfare and other expenses related to the elective. A completed post-elective report and original receipts must be submitted in order for reimbursement to be granted. In addition, students should consult the website for other potential sources of funding.