SYLLABUS College of Medicine AY 2015-2016
Course title and number Term (e.g., Fall 200X) Meeting times and location
IMED 904-00R Coronary Care Unit Year Round It is student’s responsibility to contact the preceptor one week prior to the scheduled start date to confirm when and where to report on first day.
Course Description and Prerequisites https://medicine.tamhsc.edu/elective/2015-16/imed/rr/index.html
This elective will allow a 4th year student to work directly with an attending for a 2 or 4 week rotation. Patients will be evaluated and admitted by the student / attending, as a part of their daily activities. Patients will be seen in different settings including the ED, office setting, and in-hospital, depending on the attending. Different levels of acuity patients are expected to be seen, from admissions with heart failure to STEMI patients who are going acutely to the cath lab. The student will attend cardiology conferences (as available) with the attending in addition to rounds.
Instructor Information Elective Director Vijay Divakaran, MD, Name MPH 512-509-0200 Telephone number
[email protected] Email address Office hours Office location
By Appointment Scott & White Healthcare–RR 302 University Blvd. RoundRock, TX 78665
Name
Coordinator Natalie Washburn
Telephone number Email address Office hours Office location
512-341-4960
[email protected] amhsc.edu M-F / 8-5 3950 N. AW Grimes, 3rd Floor Round Rock, TX 78665
Learning Outcomes & Objectives The Faculty will strive to: 1. Improve student skills in obtaining a thorough history and performing a physical examination with particular emphasis on pertinent cardiovascular history as well as comprehensive examination of the cardiovascular system that encompasses the following five key areas: 1. General examination of the patient 2. Assessment of the venous pulse, both in normal and diseased states. 3. Assessment of the arterial pulse, both in normal and diseased states. 4. Precordial examination 5. Auscultation of the cardiovascular system, including identification of cardiac murmurs. 2. Review with student relevant cardiovascular anatomy and physiology. 3. Improve understanding of coronary artery disease, including the mechanisms underlying progression of disease states with specific reference to the cellular and molecular basis of atherosclerotic disease. 4. Improve knowledge of and treatment of cardiac emergencies including acute coronary syndromes, congestive heart failure, cardiac arrhythmias and cardiogenic shock. Date Created/Revised: 5/1/2015 By: NW
5. Discuss the diagnostic utility of electrocardiogram (EKG) and improve student skills in identification of EKG abnormalities and arrhythmias. 6. Discuss the importance of bedside hemodynamic monitoring, and review normal hemodynamic waveforms, and alterations in disease states. 7. Introduce student to non-invasive testing and its role in risk-stratification of patients with suspected heart disease. This includes two-dimensional echocardiography, stress echocardiography, tread-mill stress testing and nuclear cardiac imaging. 8. Introduce student to invasive and interventional cardiology including diagnostic cardiac catheterization, percutaneous coronary intervention, peripheral vascular intervention, cardiac pacemaker implantation and follow up. 9. Integrate the use of evidence-based medicine in making routine clinical decisions in the care of cardiac patients. COM Competency Based Learning Objectives: http://medicine.tamhsc.edu/academicaffairs/curriculum/objectives/ Principles and Guidelines for Curriculum Development: http://medicine.tamhsc.edu/policies/pdf/curriculum-principles-guidelines.pdf
Course Objective: 1. Perform a thorough history and physical examination and plan the initial diagnostic workup for common cardiac problems including angina pectoris and heart failure. 2. Understand the pathophysiology of major cardiac conditions
COM Competency Based Learning Objectives (CBLO):
Taught (T) and/or Evaluated (E):
Evaluation:
PC1, PC2
Taught AND Evaluated
MK1, MK2
Taught AND Evaluated
3. Know the therapy for all significant arrhythmias. 4. Understand the role of hemodynamic monitoring of acute myocardial infarction and be familiar with the variations in wedge pressure and cardiac output
PC4, MK3, MK4, PC15
Taught AND Evaluated
Multisource Assessment (360 eval) Multisource Assessment (360 eval) Multisource Assessment (360 eval)
PC4, PC5, PC14
Taught AND Evaluated
Multisource Assessment (360 eval)
5. Understand the rational therapy of hypertension. 6. Recognize major abnormalities on the electrocardiogram including supraventricular and ventricular arrhythmias, heart block, ischemia, myocardial infarction and hypertrophy. 7. Interpret an uncomplicated echocardiogram report, hemodynamic profiles and nuclear imaging 8. Understand the benefits, precautions, and limitations of stress testing.
PC3, PC4, PC5, MK3
Taught AND Evaluated
Multisource Assessment (360 eval)
PC5
Taught AND Evaluated
Multisource Assessment (360 eval)
PC5
Taught AND Evaluated
MK3, PC2, PC5
Taught AND Evaluated
Date Created/Revised: 5/1/2015 By: NW
Multisource Assessment (360 eval) Multisource Assessment (360 eval)
Textbook and/or Resource Material The following books and case study materials will be used in this course: Cardiology Texts & Manuals provided by preceptor Cardiology Articles provided by preceptor Cardiology Journals Course materials are available online 24/7 in TAMU online library. Grading Policies GRADING SCALE Satisfactory 70-100 Unsatisfactory 69 and below Should the course director determine remediation is required, the remediation plan will be at the discretion of the course director and on a case by case basis depending on the issues involved. Remediation plans could entail some (or all) of the following examples: Additional clinical shifts, research papers, presentations, article reviews, exams, directed reading, web-based modules, etc. If the student performance results in a failure of the elective, it will be recommended that the elective be taken again in its entirety.
Attendance and Make-up Policies
TAMHSC – COM student handbook states: Students who miss more than 20% of a 4th year elective for any reason (2 weekdays during a two-week rotation or 4 weekdays for 4 week rotation) will require a remediation plan. To request an absence all students must use the online Phase IV Absence Form at: http://medicine.tamhsc.edu/current/absence-forms/m4absence.html For further information please refer to page 21 in the student handbook: http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf
Course Topics, Calendar of Activities, Major Assignment Dates 1. Students will make daily work rounds with the staff cardiologist. The student will be encouraged to participate in discussions concerning the patient and his disease. 2. The student will work-up 5 to 7 patients a week and participate in the care of those patients. Some of the patients during the daily round may be in the cardiac ICU or on the cardiac telemetry (stepdown) services. The faculty will conduct teaching during rounds and during consultative times. 3. The student will participate in the reading of electrocardiograms daily and interpretation of echocardiogram reports and other noninvasive and/or invasive procedures relevant to the care of the patients in (2). 4. The student will participate in non-invasive testing and its role in risk-stratification of patients with suspected heart disease. The student will spend one-half day during the rotation in one or more of the following areas: 1. Two-dimensional echocardiography and stress echocardiography 2. Tread-mill stress testing 3. Nuclear cardiac imaging laboratory 5. Introduce student to invasive and interventional cardiology. The student will spend one-half day during rotation in one or more of the following areas: 1. Diagnostic cardiac catheterization 2. Percutaneous coronary intervention 3. Peripheral vascular intervention 4. Cardiac pacemaker implantation and follow up 6. Attend morning report conducted by the staff cardiologist every week as well as cardiology journal club every other week. Date Created/Revised: 5/1/2015 By: NW
7.
Discuss journal articles and major trials with Cardiology attending. ** Students will follow the schedule of the attending.
Week
Topic
Required Reading
Other Pertinent Course Information
Students are expected to be present for the various elective activities that will be noted by your staff. Attendance is expected at the various clinical activities including morning ward rounds, operating room when assigned, afternoon rounds, conferences, and any activity specifically requested by your attending. Students are expected to be punctual for all of the various activities noted on the weekly schedule. Failure to adhere to the schedule will result in undue delays and inconveniences to patients, students and faculty.
The development and maintenance of a professional attitude is an ongoing responsibility of each student. Professional behavior is expected at all times. All students will be expected to dress in an appropriate manner, convey a professional appearance or image, and are encouraged to be neat and clean. For further information please see Student Code of Conduct requirements here: http://medicine.tamhsc.edu/dean/policies/student-policies/student-code-conduct.html Americans with Disabilities Act (ADA) The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive civil rights protection for persons with disabilities. Among other things, this legislation requires that all students with disabilities be guaranteed a learning environment that provides for reasonable accommodation of their disabilities. If you believe you have a disability requiring an accommodation, please contact Disability Services, in Cain Hall, Room B118, or call 845-1637. For additional information visit http://disability.tamu.edu Any student with a disability who needs accommodation should inform the instructor at the beginning of the course. Academic Integrity For additional information please visit: http://aggiehonor.tamu.edu “An Aggie does not lie, cheat, or steal, or tolerate those who do.”
College of Medicine Professionalism and integrity Statement (Academic Honesty and Plagiarism)
Date Created/Revised: 5/1/2015 By: NW
All College of Medicine students are required to comply with the student code of conduct and the academic integrity and honesty standards published in each component’s Student Handbook. Disciplinary action will be taken in accordance with the policies of each component. Students found guilty of Academic Dishonesty will receive an “F”/Unsatisfactory in the course. For a full list of actions qualifying as academic dishonesty, please review the College of Medicine Student Handbook at http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf. According to the Aggie Honor System Office, plagiarism is defined as the appropriation of another person's ideas, processes, results, or words without giving appropriate credit. Intentionally, knowingly, or carelessly presenting the work of another as one’s own (i.e., without crediting the author or creator). Plagiarism and other academic misconduct definitions can be viewed on the Aggie Honor System Office website; http://aggiehonor.tamu.edu/RulesAndProcedures/HonorSystemRules.aspx#definitions. E-mail Access and FERPA The College of Medicine is communicating all official information to students through the students’ TAMHSC e-mail accounts. Please check the account frequently during the semester for updates. This course is supported with web-based and/or e-mail activities. In order to take advantage of these additional resources and participate fully in the course, you have been assigned an e-mail address by the Texas A&M Health Science Center. This e-mail address is for internal use only, so that faculty may communicate with you and the entire class. By registering for this course, you are agreeing to allow your classmates to have access to this e-mail address. Should you have any questions, please contact the TAMU’s Office of the Registrar at 979-845-1031. The Family Educational Rights and Privacy Act of 1974 (FERPA), which the HSC complies fully, is intended to protect the privacy of education records, to establish the rights of students to inspect and review their education records and to provide guidelines for the correction of inaccurate or misleading data through informal and formal hearings. Students also have the right to file complaints with the Family Educational Rights and Privacy Act Office of the Department of Education in Washington, D.C., concerning alleged failures by the HSC to comply with the act. Mistreatment of Students The College of Medicine is committed to providing a positive learning environment in which students can meet their academic goals based on mutual respect in the teacher/learner relationship. Both parties must be sensitive to the needs of others and differences in gender, race, sexual orientation, religion, age or disability. As outlined in the Student Handbook under the section titled Standards of Conduct in the Teacher-Learner Relationship, belittlement, intimidation and humiliation are unacceptable for effective learning and undermine self-esteem. Breaches involving student mistreatment may result in a faculty or staff member being sanctioned or the loss of faculty and/or staff appointment. These policies address student mistreatment involving College of Medicine employees, residents, affiliate staff, or patients. Mistreatment may be reported through the College of Medicine telephone hotline, 1(855)-397-9835 or through an online form at http://medicine.tamhsc.edu/current/student-mistreatment-form.html. For a full list of reporting avenues, please refer to the Student Handbook under the Mistreatment Policy. Exposure and Occupational Hazard The Needle Stick Policy and Bloodborne Pathogen Exposure information for Medical Students may be accessed in the Student Handbook at: http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf Note: More information is available on the aforementioned topics to all students on the College of Medicine website.
Date Created/Revised: 5/1/2015 By: NW
