Medicine

MEDICINE

10

100.1 Subinternship in Medicine

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

Contact: Britt Simonson

Location: Boston Medical Center
Telephone: 638-7230

Number of Students: 8
Period to be Offered: 4 week block

Description of Elective:

The Subinternship in Medicine is designed to challenge and enhance the capacity of the student to work as an increasingly independent, highly competent and compassionate caregiver and contributing team member. To achieve this goal, the subintern will work as an advanced care provider under the direct supervision of the ward resident and assume increasing responsibility for the initial evaluation and integration of the total care of assigned patients. The student is expected to integrate medical knowledge with clinical and interpersonal skills in order to demonstrate independent thought and develop a plan of action. The student is expected to develop a balance between acting independently and acknowledging his/her limitations and seeking help as appropriate. Clinical work will be supplemented by conferences offered by the Department of Medicine.

The subintern will play a crucial role in patient care and must commit to working the complete four-week block. Late night call in the hospital should be expected.

Responsibilities include:

admitting patients to the team

following a core of patients (on average 3-6 patients)

taking “long call” approximately every 4th night

providing overnight cross-coverage for other houseofficers’ or students’ patients during “call” nights

providing patient care through the last Sunday of the rotation

100.11 Advanced Acting Internship in Medicine

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

Contact: Britt Simonson

Location: Boston Medical Center
Telephone: 638-7230

Number of Students: 4 (available to Boston University School of Medicine students only)
Period to be Offered: 4 week block, through Block 14

Description of Elective:

The Advanced Acting Internship (AAI) builds upon and is a more intensive version of the version of the traditional subinternship. Two AAI students are paired on a ward team that has one fewer intern than the traditional ward team, and together, are expected to fulfill the role of one intern. Advanced acting interns work under the direct supervision of the ward resident and assume care of assigned patients. The student is expected to integrate book knowledge with clinical and interpersonal skills in order to demonstrate independent thought and develop a plan of action. The student is expected to develop a balance between acting independently and acknowledging his/her limitations and seeking help as appropriate. Clinical work will be supplemented by conferences offered by the Department of Medicine.

The Advanced Acting Intern will play a crucial role in patient care and must commit to working the complete 4 week block. Late night call in the hospital should be expected.

By providing this in-depth experience, we believe that you will have a unique opportunity to develop the attributes of an increasingly independent clinician and better prepare yourself for your internship. Your work as an Advanced Acting Intern will be recognized in your course evaluation and letters of recommendation.

Because of space limitations, we cannot guarantee that everyone who is interested can be an AAI. Students will be selected by lottery weighted by your clinical performance during the third year.

Responsibilities include:

admitting patients to the team

following a core of patients (on average 4-10 patients)

taking “long call” approximately every 4th night

providing overnight cross-coverage for other houseofficers’ or students’ patients during “call” nights

providing patient care through the last Sunday of the rotation

100.33 Advanced Medicine Elective – Medical Care of the Surgical Patient

Instructors: Daniel Cottrell, M.D., Asst. Professor of Medicine
Contact Person: Sarah Brunt  email: sarah.brunt@bmc.org

Location: Department of  General Internal Medicine, Crosstown, 801 Massachusetts Ave., 2nd Floor
Telephone: (617) 414-6927  Fax: (617) 414-4676

Number of Students: One
Period to be Offered: One month, between June and May inclusive

Description of Elective:

The elective is designed to provide an opportunity for the student interested in a surgical or medical career to gain experience in the management of medical problems in the surgical patient. Students spend one month on the Medical Consult Service and work under the direct supervision of two senior medical residents and the medical attending. He/she will actively participate in completing inpatient consultations including generation of management plans, daily work rounds and twice a week didactic sessions. The student is expected to work Monday through Friday, 8 am to 6 pm. There is no overnight call. The student will also participate in two half-day sessions per week in the Pre-Procedure Clinic, located in Shapiro Lower Level, where patients scheduled for elective surgery are assessed by providers from both Surgery and Anesthesia departments.  Students considering surgery including orthopedics, anesthesia, or internal medicine careers have found this elective valuable.

The interactions of medical and surgical illness are complex and may complicate management in the perioperative period. Many questions commonly arise. What are the risks of surgery and general anesthesia in patients with a given set of medical illnesses? What are the predictors of these risks? Can they be reduced by preoperative measures? How should medical problems be managed before and after surgery? What complications might be expected? It is hoped at the conclusion of this elective, the student will have an appreciation of how medical problems in the perioperative period should be approached diagnostically and therapeutically.  The Medicine Consult service is also the primary care team for patients admitted to Boston Medical Center with acute hip fractures, as the patients have many medical comorbidities that make their preoperative and postoperative management challenging.

Students should contact the Medicine Consult service director, Dr. Daniel Cottrell, via email (daniel.cottrell@bmc.org) in the week prior to starting service for more information as well as link to educational supplemental materials.

 

 

 

A core syllabus of articles from the medical, surgical and obstetrical literature relevant to medical consultation is available and should be picked up from the coordinator one week prior to beginning the rotation.

101.1 Advanced Medicine Elective and Sub-Internship-Medical Intensive Care Unit: Menino and ENC Pavilions

Instructors: Arthur C. Theodore, M.D., Christine Reardon, M.D., Pulmonary/Critical Care Medicine Faculty

Location: Boston Medical Center, Menino Pavilion

Telephone: 617-638-4860 (Kathyann Adamson-R3)
Number of Students: Two (fourth year BU medical students only)
Period to be offered: One Month

Description of Elective:

The Advanced Medicine elective and the Sub-Internship in the Medical Intensive Care Unit (MICU) is designed to provide highly motivated students with an introduction to the diagnosis and management of critically ill patients with single and multi-system organ failure. The MICU is designed to provide state of the art care to seriously or critically ill patients in an environment that emphasizes learning, teaching and independence. Students are exposed to a large spectrum of clinical problems including, but not limited to, respiratory failure with or without mechanical ventilation, ARDS, shock, sepsis, gastrointestinal hemorrhage, diseases related to alcohol or drug excess, HIV-related conditions, pulmonary edema, pulmonary emboli, renal, hepatic or cardiac failure, DKA, fluid, electrolyte or thermic disturbances, CVA or complications of malignancies.

Care is provided in a team format which besides physicians, nurse practitioners and senior medical students, includes nurses, respiratory therapists, pharmacists, nutritionists, physical therapists and social workers. This multi-disciplinary approach provides excellent care to patients by capitalizing on the expertise of many services. Students are expected to participate on daily ventilator and work rounds, and to contribute to the management of patients by collecting and assimilating data for presentation to the attending, arranging consults and tests, and by placing orders and performing common procedures under direct supervision.

On the Menino Campus, patients are cared for by two teams, each consisting of 2 residents, 2 interns and a pulmonary/critical care attending; a pulmonary/critical care fellow is also dedicated to the unit. The PGY 2 or 3 admits and performs the initial management on all patients in the MICU with the supervision of the MICU Attending/Fellow during the day or the Special Care Unit Night Coverage (SCUNC) at night. Subsequent daily care is then assumed by a PGY 1 resident or a Medical Student on a sub-internship rotation. On ENC patients are cared for by a single team consisting of two PGY 2 or 3 residents, two nurse practitioners, a pulmonary/critical care attending and fellow. The Resident or the Nurse Practitioner admits the patient with the supervision of the MICU Attending/Fellow during days and the float PGY1 resident admits during the night under the supervision of the Anesthesia Attending. Subsequent management of the patient is then performed by one of the residents, nurse practitioners or the medical student.

Students are assigned to the Menino MICU preferentially. Students who take this course as a Sub-Internship are required to be present for 6 days of the week (weekdays and either Saturday or Sunday). Students who take this course as an elective are required to be present for only weekdays. There is no night call.

Restrictions:


1) Reception of Honors grade in third year medicine clerkship or in the medicine sub-internship.

2) These requirements may be waived if the student is approved by the Clerkship Selection

Committee, chaired by Dr. Warren Hershman.

102.1 Ambulatory Medicine

Contact: Cleon Ryland, Jr.

Location: Boston Medical Center, E122
Telephone: 638-7265

Description of Elective:

Advanced Internal Medicine, Medicine II Block: All Students will complete a required four week Ambulatory Medicine rotation in the fourth year. For the 4 week ambulatory medicine rotation, students will be assigned to one of the following sites:  Jamaica Plain/West Roxbury VA, Bedford VA, Roger Williams Medical Center, Neighborhood Health Centers, Private Practices or BMC.  BUSM is exploring additional possible clinical venues for training in Ambulatory Internal Medicine and may add new venues in the coming year.

Course restricted to 4th year BUSM students only.

 

105.1 Palliative Care

 

Course Director:  Sandhya Rao, MD  Sandhya.Rao@bmc.org

Location: Boston Medical Center

Telephone: (617) 414-6965

Number of Students: TBD

Period to be offered:  Please contact Dr. Rao regarding availability

 

DESCRIPTION OF ELECTIVE:

 

This elective is designed to give students with an interest in palliative care increased exposure to the role of the palliative care provider in the inpatient setting.  Students will participate as members of the palliative care team during which time they will staff palliative care consults, attend family meetings, and learn more about the role of the palliative care provider in the care of patients in the inpatient setting.

 

 Students will also spend time involved in self-directed teaching sessions, using a curriculum developed by the National Cancer Institute.  Modules include topics such as how to perform a comprehensive palliative care assessment, cancer pain management, loss/grief/bereavement, survivorship, the last hours of living, communicating effectively, clarifying diagnosis and prognosis, negotiating goals of care, clinical trials, withdrawing nutrition/hydration, conflict resolution, advance care planning, physician-assisted suicide, cancer doctors and burnout.   Students will complete all modules by the conclusion of the four-week elective.  Additionally students will be asked to conduct a literature search on topics relevant to palliative care and will be asked to present one topic weekly to the faculty.

033.2 Geriatrics/Home Medical Care

Instructors:Lisa Norton, M.D., Serene Chao, M.D.,M.Sc., Dan Oates, M.D., M.Sc. and Matthew Russell, M.D., M.Sc.

Location: Robinson 2700 – Boston Medical Center, Robinson Complex
Telephone: 638-6155
Course Director: Lisa Norton, M.D. lisa.norton@bmc.org
Course Administrator: Julia Bruno   email:  julia.bruno@bmc.org

www.bumc.bu.edu/geriatrics

Number of Students: Varies (see note below)
Period to be Offered: One month

Description of Elective:

During this rotation, students will have the unique opportunity (few medical schools offer this experience) to go out regularly on house calls with a physician or nurse preceptor. There will also be home visits, which trainees will conduct independently (paired with one other student). Additional experiences may include going to community sites such as an adult day health center or nursing home. Students will attend lectures, prepare a written case study and participate in a Geriatrics OSCE (Objective Structured Clinical Exam). Both physician and nurse preceptors will evaluate students’ performance in the rotation. Course objectives include: students will learn about common geriatric syndromes, understand and use functional assessment in the evaluation of older adults, work with an interdisciplinary team including nurses, social workers, and community health care providers to develop care plans, and learn about home care and what is possible to provide medically for elderly patients living in the community.

Note: This is a required rotation at BUSM but may be taken as an elective by external students on a space available basis only.

420.3 Nutritional Support in Clinical Practice

Instructors: Caroline Apovian, M.D. and Peter Burke, M.D.

Location: Boston Medical Center – Harrison and East Newton Pavilions
Telephone: 638-8443   Contact: Myriam Castagne

Number of Students: Two
Period to be Offered: One month

Description of Elective:

This elective provides “hands on” exposure to the problems of malnutrition in the hospitalized patient in both medical and surgical wards. Instruction is by the Nutrition Support Team with time divided between both campuses at Boston Medical Center. Clinical responsibilities include completion of nutrition support consultations with full nutritional assessment and formulation of plan of nutritional intervention on all patients receiving parenteral nutrition, and many patients receiving enteral therapy. Metabolic and fluid management is closely monitored on daily rounds and adequacy of nutritional support documented. The Service follows approximately 10-12 patients daily. Advanced training in central venous access techniques is offered depending on patient need. It is the overall purpose of this elective to provide students planning careers in internal medicine or surgery with basic skills to recognize and treat all forms of malnutrition in adult hospitalized patients.