Family Medicine

Family Medicine Sub-Internships and Electives

Telephone: 414-6237 email: chenille@bu.edu

Location: BMC-Dowling 5 Room 5414

SUB-INTERNSHIP IN FAMILY MEDICINE

030.1i Sub I – Family Medicine

Instructor: Talia Singer-Clark, M.D.

Interim Instructor (end of June): Lizzeth Alarcon, M.D.

Administrative Contact: Chenille Hogan Email: chenille@bu.edu

Location: Menino Pavilion. Boston University Medical Center

Team:                                     Family Medicine Inpatient Service Team A or Team B
Students per Block:              One per team
Period offered:                      Block 9-20

Orientation: First day of the rotation

Overview

Students will work as interns with the family medicine inpatient team. They will care for a wide variety of patients from the HealthNet Rounder system, acting as the primary caregiver for their patients. They will have all the responsibilities of an intern, including daily management of their patients, new admissions, attending conferences and participating in daily teaching.

Due to COVID-19, the structure of the day has been adjusted to ensure physical distancing and optimize the safety of the student, other members of the medical team, and patients.

Location: Menino 7E

Team A: The Team A workroom is located in the hallway outside of the 7E unit (room 7115). Maximum capacity: Four people.
Team B: The Team B workroom is temporarily located in the 7E family room. Maximum capacity: Five people.
Swing space- Workroom down the hall on the right on 7E floor (room 758). Maximum capacity: Three people.

Daily schedule:

Generally 6:15am to 6:30pm, 6 days per week. One day per week will be extended until 8pm to allow for an independent admission.

6:15am: Chart pre-rounding on prior patients (swing space or medical school)
6:50 am: The student will touch base with the resident via phone call and double check if there are new patients assigned to the student for the day.
7am: Team sign-out. The student will be in the swing space/medical school and join sign-out remotely via Zoom. The supervising resident will ensure the student is on the zoom call prior to starting sign out.
7:30-8:15am Examine patients in person in Menino, check telemetry
8:30am Rounds
If the team is doing table rounds, the student will join remotely from the swing space/medical school via Zoom and present patients via Zoom.
If the team is doing walk rounds, the student will join walk-rounds ensuring appropriate physical distancing. The sub-I will only go into their patients’ rooms with the attending and the supervising resident
After rounds, put in orders, talk to consultants, complete notes. The student will call supervising resident with any questions, and to ensure orders are co-signed in timely matter.
Noon conference Monday-Friday, the student will ask residents for most updated information and zoom conference details.
Afternoon- Follow up on tasks and complete notes, update sign out, and place morning labs. Complete an admission if the patient is expected to arrive before 5pm. Ideally, the student should do an admission once per week. If they haven’t, then they are expected to stay late once a week to complete an admission and staff with the evening attending.
Sign-out at 6pm. The student should call into sign out via Zoom.

Additional COVID-19 Information

The student will:

Not provide care for any person confirmed to have COVID-19 or be a person under investigation for COVID-19.
Wear a surgical facemask and scrubs at all times when inside the hospital.
Wear a surgical mask, face shield, and gloves when physically interacting with a patient, and practice appropriate hand hygiene before and after each patient interaction.
Be able to call into a patient’s room if needed for follow up questions, afternoon check-ins, etc.
Practice physical distancing (6 feet apart) if meeting the team outside of a patient’s room in person.
In general, will not be in the same workroom area as the rest of medical team unless the number of people in the workroom allows for appropriate physical distancing (see limits under Location above).

Weekends

Students are expected to work three weekend days during the month, arranged in discussion with the senior resident. NOTE: students follow the holiday/vacation schedule of the team not of Boston University, speak with the team prior to making any travel arrangements.

Supervision

Students will be directly supervised by the 2^nd or 3^rd year resident in addition to the family medicine ward attending.
During the times of the day during which the student is working in a different space than the rest of the team, students will contact residents via page or phone call for patient care questions.
If after seeing their patients in-person (but before rounds), the student is worried about a patient being sick or unstable, they will immediately come to the work room to alert the supervising resident who will then evaluate the patient.

Education/Curriculum

The Sub-I student is expected to:

Be responsible for the care of their patients and should be the primary contact for the patient, consultants, and nursing. During the first week, the sub-I will care for two patients on the team and work up to four patients by the end of the month
Participate in all conferences/daily teaching.
Attend dedicated sub-I teaching organized by the course director twice per week via Zoom.
Organize two presentations on a pertinent topic for the rest of the team.
Complete one admission per week.
Complete two discharges per week.

Feedback

Students will ask for informal feedback during the course of the rotation from supervising residents and attendings.
Once per week (Thursdays), the outgoing attending will chat with the student and provide feedback about the past week working together.
The course director will meet with the sub-I student half way through the rotation to check in and review an H/P together. They will meet again at the end of the rotation.
The student can always email the course director if there are any concerns that come up during the rotation.

Objectives

Assess, formulate a differential diagnosis, and propose initial evaluation and management for patients with common acute illness presentations (U,R)
Demonstrate competency in advanced history-taking, communication, physical examination, and critical thinking skills (B, C, A)
Manage an acute exacerbation of a chronic illness for patients with common chronic diseases (U, C, R, S)
Develop an evidence-based plan to minimize future exacerbations of specific chronic conditions (U, R)
Discuss the principles of family medicine care as they apply to inpatient medicine (B, U, C, E, S)
Discuss the value of the provision of multidisciplinary team care to any health care system (U, S)

Evaluation:

Evaluation based on above goals and standard BU student evaluation (CSEF) completed by supervising resident and all FM inpatient attendings for the four-week rotation.
Summative evaluation will be completed by course instructor at the conclusion of the rotation

Guidelines for Absences

Students are reminded to maintain standards of professionalism, courtesy and common sense when scheduling residency interviews that take place during fourth year rotations. Try to schedule interviews during vacation blocks whenever possible. In general, a student may, with advance permission from the rotation director, be away for no more than four days during the four-week rotation.

Please take note of the following guidelines:

Students must work a minimum of two continuous weeks with no absences in order to pass the rotation.
If a student is absent for more than four days, those missed days must be made up in order to pass the rotation. In some cases, a student may be required to repeat the rotation.
Students follow the holiday/vacation schedule of the team, not of Boston University. Speak with the rotation director prior to making any travel arrangements during the rotation.

ELECTIVES IN FAMILY MEDICINE

030.1e Advanced Ambulatory Family Medicine

Instructors: Sara Tepperberg, M.D., M.P.H., Heather Miselis, M.D., M.P.H. and Rachel Mott-Keis, M.D.

Administrative Contact: Chenille Hogan Email: chenille@bu.edu

Locations: Two of three possible outpatient sites: Codman Square Health Center, South Boston Community Health Center, East Boston Neighborhood Health Center

Number of Students: One or Two Fourth Year Medical Student(s)-This is an elective for students considering residency in Family Medicine

Period to be offered: Blocks 11, 12 and 14 (one student per block) Block 13 (2 students)

Description of Elective:

Students who are entering the field of family medicine are the target for this elective. Students will see ambulatory patients at one or two of the affiliated residency sites, including South Boston Community Health Center, East Boston Neighborhood Health Center and Codman Square Health Center. The student will work with a variety of Family Medicine residents and preceptors, and as such will not likely have opportunity for significant summative assessments and advanced accolades from faculty. With appropriate supervision, students will be expected to have first contact with patients and to do the initial work-up. Students will advance their skills in the diagnosis of the undifferentiated patient, and the assessment and management of acute and chronic problems which commonly present in family medicine. Instruction in patient education and preventive medicine in the family context will be emphasized. Students will participate in staff conferences and may attend rounds, conferences and lectures that are part of the BMC Family Medicine Residency Program.

This elective is also available through the Boston Medical Center Minority Recruitment Program.

EVALUATION

The student will be evaluated by the same BU Chobanian & Avedisian School of Medicine assessment tool that is used for BU Family medicine clerks or by the elective evaluation supplied by their sponsoring institution.

031.0 Family Medicine 360° Clinical Elective

Instructor: Elizabeth Ferrenz, M.D.

Administrative Contact: Chenille Hogan Email: chenille@bu.edu

Location: Boston Medical Center

Number of Students: Four-4th year BU medical students only

Period to be offered: Block 10

Description of Elective:

The Family Medicine 360⁰ Clinical Elective is an opportunity for fourth year medical students to delve into the many roles of a family doctor. This elective is designed for medical students strongly considering a career in Family Medicine who would like additional exposure to outpatient, inpatient, maternal child health and specialty care provided by family doctors.

The elective experience will take place at Boston Medical Center, at Family Medicine affiliated community health centers, and at the Ryan Center (Sports Medicine).

The student will have a clinical home throughout their rotation at a community health center. Each student will be paired with a resident, and will participate in that resident’s continuity clinic 2 sessions/week on their inpatient and mom-baby weeks and 5 sessions/week on the outpatient week. These supervising residents will receive Resident as Teacher training and will get teaching support and mentoring during the rotation from Dr. Cohen-Osher. The student will see a subset of patients on the resident’s schedule. The clinical care provided by the student-resident pair will be supervised by the attending physician who is precepting in resident clinic. The student will also work with additional clinicians at the community health center to understand the comprehensive services available for the care of patients such as integrated behavioral health and nutrition counseling.

The inpatient experience during the elective will include 2 weeks on the Family Medicine inpatient service caring for hospitalized adults. During the week of nights, the student will work directly with the Family Medicine intern and attending physician to admit new patients and cross-cover patients on the Family Medicine resident teams. During the week of days, the student will follow their own assigned patients with supervision from the resident team and attending physician.

The maternal child health week gives students a true Family Medicine-centered experience to include prenatal/perinatal care (including labor and delivery), inpatient postpartum care for women, as well as newborn nursery care for their infants. The student will spend mornings on the postpartum floor caring for women and their infants- focusing on issues such as breastfeeding (including spending time with a lactation consultants), the newborn exam, routine postpartum care, maternal counseling and anticipatory guidance.

During the outpatient/specialties week the student will have an opportunity to tailor their clinical experiences to their individual interests. All students will have the opportunity to spend clinical time with the Sports Medicine fellowship trained Family Medicine faculty and fellows. Students will also be able to experience other areas of focus in Family Medicine such as integrative medicine, transitions of care, office based substance use treatment, geriatrics, and student health and these will be tailored (as much as possible) to the student’s clinical interests.

Inter-professional experiences are built-in to many components of this elective. On the inpatient Family Medicine service there are board rounds twice daily where the MD team, nurses, and case management come together to discuss all patients. During the maternal child health week, there is daily communication with nursing and often with lactation consultants and social workers. Our outpatient clinics have team care nursing and integrated behavioral health.

During the four-week rotation the student will select a topic of interest relevant to Family Medicine and prepare an oral presentation to be shared with Family Medicine residents and faculty which will be evaluated by the presentation coordinator. This will happen in the 3^rd or 4^th week of the clerkship.

032.1 Maternal Child Health

Instructor: Caroline Mullin, M.D.

Administrative Contact: Chenille Hogan Email: chenille@bu.edu

Location: Boston Medical Center

Number of Students Per Block: one student, Selective Blocks

Period to be offered: Blocks 9 – 10 and 12-19 (academic year 23-24); Blocks 9 and 11-21 (academic year 24-25)

Description of Elective:

This elective offers students a true family medicine-centered experience while focusing on maternal child health, including outpatient perinatal and breastfeeding medicine, inpatient labor and delivery, inpatient postpartum care as well as inpatient and outpatient newborn care. The student will spend mornings rounding on mother-baby dyads with one Family Medicine resident and one Family Medicine attending. Students focus on postpartum maternity care and newborn care, including breastfeeding medicine. Afternoons are spent focusing on maternal child health visits either within a Family Medicine clinic, or within our Maternal Fetal Medicine clinic with a Family Medicine attending. One or two afternoons are spent either working with a Lactation Consultant or completing a breastfeeding medicine self-study. Each Tuesday evening, students take call overnight on labor and delivery, allowing them an opportunity to be actively involved in deliveries. Each student chooses one clinical topic to research and presents this topic to our Family Medicine resident education session at the end of the rotation. Participation in this elective provides you with a wonderful opportunity to be an active and important team member with a lot of independence managing common complications of maternal child health care from a Family Medicine perspective. Students who will derive the most benefit from this rotation are self-motivated and active learners.

033.1 Latino Health Elective

Department of Family Medicine

Boston University Chobanian & Avedisian School of Medicine

Course Director: Elizabeth Ferrenz

Email address: Elizabeth.ferrenz@bmc.org

Administrative Contact: Chenille Hogan Email: chenille@bu.edu

Clinical Faculty (may vary depending on availability each block):

Carol Singletary, Registered dietician, EBNHC

Dr. Sonia Ananthakrishnan, Endocrinology

Dr. Jose Betances, Pediatrics

Dr. Charles Bliss, Gastroenterology

Dr. Miriam Hoffman, Family Medicine

Dr. Jessica Levi, Pediatric Otolaryngology

Dr. Jose Romero, Neurology

Dr. Peter Smith, Chronic Disease Education and Management (CDEM), EBNHC

Number of Students: One fourth year medical student

Period to be offered: 4 weeks

Available Blocks: 17

Please note: Students must contact the course director before signing up for this elective to ensure that their level of Spanish proficiency will be adequate for a successful experience on this rotation.

DESCRIPTION OF ELECTIVE:

The Latino Health Elective is an opportunity for fourth year medical students to improve their ability to provide medical care in Spanish, to increase their understanding of Latino health issues and disparities, and to research a topic of relevance to the health of Latino communities.

The elective experience will take place at East Boston Neighborhood Health Center (EBNHC), Boston Medical Center, and Boston area community agencies.

Students will participate in clinical sessions in Family Medicine and Chronic Disease Management at EBNHC. Specialty clinical sessions will take place at BMC. Students will be responsible for conducting history and physical examinations in Spanish and presenting their findings in standard oral presentation format in English.

At community agencies, students will learn about outreach to the Latino community around issues of immigration, housing, education, and more. Latino elder care will be explored with an adult day health program.

Selected readings will be provided to students to expand their knowledge of Latino communities in the United States and health disparities facing Latinos. These readings will be reviewed independently and discussed with the course director.

During the four week rotation the student will select a topic of interest relevant to the Latino community and prepare an oral presentation to be shared in the final week.

Students will be evaluated on the basis of their participation in clinical sessions and engagement with community agencies and independent readings. The final presentation will be evaluated on the basis of relevance to Latino health and skills in oral presentation.

Latino Health Elective additional information

034.0 Primary Care Sports Medicine

Instructor: Christopher Ma, M.D.

Administrative Contact: Chenille Hogan Email: chenille@bu.edu

Telephone: 617-414-6237

Number of Students: One 4^th year BU medical student

Period to be offered: 2023/2024 academic year: Blocks 12, 13, 14, 15, 17, 18 and 19; 2024/2025 academic year: Blocks 13, 14, 15, 16, 18, 19 and 20

LOCATIONS: BU Ryan Center for Sports Medicine, Boston Medical Center, East Boston Neighborhood Health Center (Winthrop location), South Boston Community Health Center, Boston Sports Performance Center, BU Student Health Services, BU Athletic Training Room and various athletic fields/venues for event coverage

OBJECTIVE: To gain exposure and experience in the field of primary care sports medicine.

GOALS:

To improve history taking and physical examination skills
Development of a solid musculoskeletal examination
Development of a focused differential diagnosis based on history of injury and physical examination findings
Determining what further testing modalities are needed based on the differential diagnosis
Exposure to athletic training and rehabilitation of the injured athlete
Understanding the role of the team physician, student athlete and athletic trainer
Gaining game coverage experience

FACULTY:

Christopher Ma, M.D.-Family Medicine/Primary Care Sports Medicine

Nathan Cardoos, M.D.- Family Medicine/Primary Care Sports Medicine

Ryan Narciso, M.D.-Family Medicine/Primary Care Sports Medicine

ADDITIONAL FACULTY:

Arturo Aguilar M.D., Medical Director of Sports Medicine and Athletic Training, Boston University

Jennifer Luz M.D., Sports Medicine Physiatrist, Boston Sports Performance Center

Jennifer Chadburn, Assistant Director of Athletic Training Services, Boston University

Current Primary Care Sports Medicine Fellow

Description of Elective:

The curriculum will include multiple experiences in primary care sports medicine. A sample of a weekly schedule of clinic time and other experiences would be the following:

-8-9 half days of Primary Care Sports Medicine at the Ryan Center, BMC at Melnea Cass, Boston Sports Performance Center, and community health centers

-Wednesday Morning Sports Medicine Conference 7 am via Zoom

-1/2 day BU Athletic Training Room physician clinic working one on one with one of the primary care sports medicine physician as they evaluate BU student athletes

-Game coverage: will vary depending on the time of year and block but anticipate at least 1-2 game coverage opportunities per week of the elective. Please note much of the game coverage occurs in the evening and/or the weekends so student needs to be aware they may have to work late and possibly on the weekends.

-A car is recommended, however we can make adjustments if the student does not have access to a car.

The student will be evaluated throughout their rotation on their musculoskeletal examination skills. Students who will derive the most benefit from this rotation are self-motivated and active learners.

036.0 Family Medicine Internship Prep Course

Course Director – Amanda DeLoureiro MD, MPH Family Medicine

Course instructors –Additional clinical involvement of faculty and family medicine residents who participate in teaching the modules and SIM center.

Administrative Contact: Chenille Hogan Email: chenille@bu.edu

NUMBER OF STUDENTS

6-10 fourth year medical students

LENGTH OF ELECTIVE

2 weeks

AVAILABLE BLOCK

Block 19B (3/25/24-4/7/24) (academic year 2023-2024), Block 20B (3/24/25-4/6/25) (academic year 2024-2025)

Description of Elective:

The Family Medicine Internship Prep Course is an opportunity for fourth year students to directly prepare for their transition from medical school to an internship in Family Medicine. Faculty and residents will lead small-group activities and simulations to review core procedural skills. These sessions will focus on key categories of Family Medicine training, including outpatient care, inpatient adult and pediatric care, and inpatient obstetric care.

The expected hours will be from 8 am to 5 pm on Monday through Friday. There will be no weekend activities.

The course will be taught in Boston University Chobanian & Avedisian School of Medicine (for case-based learning) and in the Boston University Chobanian & Avedisian School of Medicine Simulation Center (for procedural sessions). There will be no direct patient contact.

037.0 Primary Care Elective at BU Student Health Service

Course Director: Aaliyah Y. Rizvi Shaikh, M.D. email: arizvi@bu.edu

Administrative Contact: Chenille Hogan Email: chenille@bu.edu

Location: BU Student Health Services

NUMBER OF STUDENTS: 1

LENGTH OF ELECTIVE : 4 weeks

AVAILABLE BLOCKS:

2 blocks in an academic year. The blocks typically begin mid-September and mid-March.

Block 13 and 19 (academic year 23-24); Block 14 and 20 (academic year 24-25)

Description:

The Primary Care elective at BU’s Student Health Services’ (SHS) Department of Primary Care (PC) provides students with an opportunity to engage in a university-based, outpatient primary care clinic serving a diverse domestic and global population. The MS4 will be part of a multi-disciplinary team and will participate in daily patient care. Simulating a primary care physician, they will be expected to conduct and document a thorough history, physical, assessment, differential, and plan. They will be assigned and guided by a physician and may have opportunities to rotate in other departments of SHS (Behavioral Medicine, Health Promotion and Prevention (HPP), Sexual Assault Response & Prevention Center (SARP), and Athletic Training).