Advanced Core

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Advanced Core

• (1) Enhance student skills in clinical reasoning
• developing the students ability to acquire,
  organize and analyze clinical data to justify a
  diagnostic evaluation, therapy or management
  plan
• improve sophistication in oral and written
  communication.
• (2) Create an opportunity for students to build
  on core skills and knowledge developed during the
  Core Blocks
• (3) Acquire and Develop cognitive and technical
  skills in patient care
• (4) Expand knowledge of the health care system
  and various physician roles in the health care
  system through clinical experience in specific
  clinical areas including
• perioperative medicine
• aging
• chronic disease management
• undifferentiated and emergent care.

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Chronic Care UH/VA

• Primary focus in adults
• Diabetes
• Heart Failure
• Hypertension
• Emphasis on the team concept of multidisciplinary
  care
• Quality improvement in outcomes
• Evidenced based care

3
Chronic Care UH/VA

• Outpatient clinic experience
• Heart failure clinic at UH
• Heart failure/geriatric clinics at UH
• Diabetes shared medical appointment clinic at
  VA
• Hypertension clinic at the VA
• Heart Failure shared medical appointment clinic
  at the VA
• Chronic Lung disease clinic
• Chronic care rotations will also be offered
  through pediatrics by Dr. Michael Dell

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Chronic Care Didactics

• Didactics will consist of cases, journal club,
  web based modules and oral presentations. Some
  presentations may be made by the students.
  Didactics will be held at CCF for the entire
  system.
• Evidence Based Medicine 1
• Cost-effectiveness
• Use of guidelines in Medicine
• Laboratory testing
• Quality of Life and how to assess
• Chronic disease management
• Evidence Based Medicine 2
• Role of the patient and the role of the provider
• Role of performance measures

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Chronic Care Pediatrics

• Caring for Children with Complex Medical Needs
• Peds Neuro
• Trach-Vent clinic,
• Myelodysplasia clinic,
• CP clinic
• Visits to centers for hearing impaired and
  visually impaired kids
• Work at a special needs preschool
• Meetings with Help Me Grow/Early Intervention
  (coordinates outpatient evaluation and support
  for special needs kids) probable visit(s) to
  Hattie Larlham (chronic care facility run by
  former RBC resident) required project on
  Medical Home and/or legislation affecting care
  of special needs population. 
• will only be offered 3-4 months /yr
• Probable rotations
• Chronic Dz in Hematology focus on Sickle Cell
  Dz, with inpt. rounds, clinics for both kids and
  adults, weekly team care conferences, visits to
  American Sickle Cell Foundation. 
• Pulmonology rotation as well will include RAD,
  maybe CF meeting next week
• Endocrine (esp Diabetes)

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EMERGENCY and UNDIFFERENTIATED CARE

• The focus of this 4-week advanced core curriculum
  in Emergency and Undifferentiated Care is to
  provide each student with the knowledge, skills,
  and attitudes that are necessary for any
  physician to evaluate patients presenting with
  acute medical and surgical conditions, develop
  differential diagnoses, develop management plans,
  and demonstrate the ability to carry them out.

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EMERGENCY and UNDIFFERENTIATED CARE

• At University Hospital students will select their
  areas of interest to establish learning goals.
• Adult emergency medicine,
• Pediatric emergency medicine
• Veterans emergency medicine
• Urgent Care
• Student will chose from and personalize their
  undifferentiated experience.
• Each student will spend a total of 4 weeks in the
  Undifferentiated Rotation at UH.

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EMERGENCY and UNDIFFERENTIATED CARE
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EMERGENCY and UNDIFFERENTIATED CARE
Seminars Each Thursday morning there will be city
wide lectures held at Cleveland Clinic. These
lectures will be for all Undifferentiated Patient
students.
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EMERGENCY and UNDIFFERENTIATED CARE

• Peds ED (Dr. Dell)
• One student/4-week block

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Cleveland VAMC/University Hospitals Geriatric
core

• Goal
• To develop a basic understanding of the spectrum
  of care and principles of chronic disease
  management in the aged,
• To obtain an exposure to the principles of
  womens health.
• The core learning of this rotation will be
  acquired experientially through supervised
  evaluation of geriatric patients in several
  venues
• the geriatric evaluation and management
  ward(GEM) at the LS VAMC,
• the Fairhill geriatric assessment clinic,
• geriatric clinics at the VAMC,
• womens health clinic at the VAMC.
• Hospice/palliative care, rehabilitation, practice
  in the nursing home environment
• Didactic topics will covering basic aging related
  medical issues and be acquired through readings,
  computer aid instruction, discussions, and
  lecture.

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Cleveland VAMC/University Hospitals Geriatric
core

• Hospice afternoons Learning objectives
• l. Assess and identify the patient in need of
  palliative care
• 2. Recognize principles of palliative and hospice
  care.
• 3. Understand different sites of care provided by
  hospice
• Nursing home visit to be arranged during one
  afternoon during the rotation.
• Understand effect of site of care on patients
  trajectory through health system.

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Cleveland VAMC/University Hospitals Geriatric
core

• Didactics to be accomplished through
  discussion, readings and lecture during the
  rotation
• 1.. Dementia/Delirium
• 2. Medical Ethics 1
• 3. Managing the Hospitalized Elderly
• 4. Palliative Care/End of life issues
• 5. Falls
• 6. Menopause
• 7. Osteoporosis
• 8. Frailty
• 9. Changes in drug metabolism and excretion.
• 10. Drugs to avoid in the elderly

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Perioperative Medicine and Pain

• The block will be four (4) weeks in duration.
• Students will be assigned to the ICU for two (2)
  weeks, the operating room for one (1) week, and
  the pain service for one (1) week.
• Students who spend weeks 1 and 2 in the ICU will
  be assigned to the OR and pain rotations in weeks
  3 and 4. The opposite will be true for students
  who start on the OR and pain rotations first.

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Perioperative Medicine and Pain 2 weeks ICU

• Adult Medical ICU (UH),
• Adult Surgical ICU (UH),
• Pediatric ICU (Rainbow),
• Cardiac ICU (VA).
• Students will be expected to round with ICU team
  on morning rounds (8-12 AM, Monday Friday).
• Students will also arrange to take 3 overnight
  calls during the 2 week rotation.

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Perioperative Medicine and Pain 2 weeks ICU

• Learning objectives
• Hemodynamic monitoring and fluid and blood
  resuscitation
• Nutrition and the critically ill patient
• Basic airway management
• Ventilator management
• Radiology and the critically ill patinet

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Perioperative Medicine and PainOperating Room
rotation

• Students will work along side an anesthesiologist
  in the OR and PACU at either UH or VA
• Learning objectives
• Preoperative assessment
• Options for anesthesia
• Evidenced-based preoperative testing and risk
  reduction strategies
• Intra-operative stressors and hemodynamic
  monitoring
• Fluid and blood resuscitation
• Basic airway management

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Perioperative Medicine and Pain Pain Service

• Students will attend outpatient pain clinic and
  round with inpatient pain service (UH/VA)
• Learning objectives
• Assessment and management of acute pain
• Identification and management of chronic pain
  syndromes

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Perioperative Medicine and Pain

• Didactics will be city-wide
• 1. The Preoperative evaluation and testing
• 2. Cardiac risk assessment and risk reduction
• 3. Anesthesia techniques and effects on
  perioperative management
• 4. Common Postoperative complications
• 5. Acute Pain
• 6. Quality and safety in perioperative care
• 7. Chronic Pain
• 8. Transfusion medicine

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Perioperative Medicine and Pain Pediatrics

• ICU 2-3 students per block.
• To include ICU as home base with experience in
  sedation unit
• PACU
• Evaluating critically ill children as they come
  into ED,
• Following ICU patients to OR.  At least 2, maybe
  3 students per block.