The purpose of this elective, given near the end of the senior academic year, is to survey in depth selected medical topics useful to a physician entering internship, especially an internal medicine or family practice residency. Emphasis is placed on (1) correlation of the basic science and clinical aspects of the diseases being discussed, and (2) current therapies and the rationale behind them. To achieve maximal medical success, differential therapeutics must follow as logical a course as differential diagnosis. Clinical therapeutics and problem solving will be highlighted. Teaching methods will include lectures, and discussion groups focusing on clinical case histories. Attendance is required at the discussion groups and the student is expected to come with previously prepared management plans for each of the clinical cases. The subject matter is clinical but there are no patient care responsibilities. Level 3 achievement in Lifelong Learning competency is offered.

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This course may be dropped or added within 15 days of the beginning of the elective month.

Note:

This course is the elective counterpart to one of the required fourth year sub-internships. Availability of this course will depend on enrollment in its associated sub-I. Students interested in enrolling should contact the medicine coordinator (630-2673) for approval procedures.

This elective is designed for students wanting an additional month of medicine sub-I experience beyond the required sub-I clerkship. Successful completion of this elective WILL NOT SATISFY THE MEDICINE SUB-I REQUIREMENT.

Description:  

This elective is designed as a short course to extend the base Internal Medicine framework of knowledge and experience gained in the Junior year. Problem solving techniques will be emphasized. Each student will be supervised by a House Staff Team. Participation in the ward team educational rounds and conferences will be mandatory. Increased responsibility for patient care will be given as the student progresses.

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This elective is designed to give the student experience normally gained in the Internship year. The student will have complete diagnostic and patient care responsibilities supervised by the Ward Resident and Attending physician. These responsibilities include history and physical examination, all orders, progress notes, procedures, and discharge summaries. By the end of the rotation the student should be and feel confident in the day to day management of patients hospitalized on a General Internal Medicine Service.

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This elective will give the students experience in the health care of older adults that will be fundamental for adult medical and surgical residencies. Students will select from a menu of clinical venues where they would like to focus their time during the rotation and will meet with the Course Director prior to the rotation to decide these areas of clinical emphasis. Options for clinical training venues include, for example, the Acute Care for Elders Service, House calls for Seniors and Center for Senior Health at Wishard Memorial Hospital; Lockefield Village Nursing and Rehabilition Center; and Older Adult Clinic at the Veterans Administration Hospital. Students will see both "well" older adults and those who have functional and cognitive disabilities in these venues. During their rotation, students will practice along side residents who are completing a one-month required geriatrics rotation and will be supervised by geriatricians. In addition to the clinical experiences, students will attend an interactive conference series that covers core geriatrics clinical topics including delirium and drug prescribing in older adults. There are no night call or weekend responsibilities for this elective.

Objectives:  

This general medicine inpatient rotation differs from others in several respects.  First, the attending physicians are drawn from private practice Hospitalist medicine physicians, IU clinical teaching faculty, and HealthNet physicians.  Second, a preceptorial approach to teaching increases the direct interaction between student and faculty.  Third, a multidisciplinary approach to hospital medicine utilizing pharmacists, nutritionists, care coordinators, nurse practitioners, social workers and Geriatrics personnel is employed.  The student may be assigned four to six inpatients to co-manage with the attending.   Diseases encountered will be typical for the broad range of general internal medicine admissions to non-ICU beds at Methodist and are likely to include TIAs/stroke, syncope, GI bleeding, acute coronary syndromes, arrhythmias, community acquired pneumonia and other acute infectious diseases, COPD and hepatobiliary disease.  The student will be expected to attend teaching conferences including daily morning report and the departmental noon conferences.  At the completion of the rotation, a student should be capable of a logical approach to patient evaluation and development of an appropriate management plan.   The student will be required to take call on this elective approximately every fifth night.

Any student wanting to drop or add this elective after the initial computer scheduling should contact Kathy Head at 962-5419.

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The course will provide an introduction to the care of the critically ill adult with emphasis on the concept of titrated care. The student will be an active member of the ICU team and will be taught current concepts of: airway management and mechanical ventilation; hemodynamic pressure monitoring; enteral and parenteral nutrition; management of shock; management of multi-system trauma and burns; fluid and electrolyte therapy. The student will gain an awareness of cost containment issues and the medical, legal and ethical dilemmas of critical care. A core curriculum for senior students will provide the basis for teaching on ICU rounds, clinical conferences, and didactic lectures. Night call is optional.

Any student wanting to drop or add this elective after the initial computer scheduling should contact Kathy Head at 962-5419.

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This elective requires night call on consecutive nights; therefore, changes in the schedule must be made by the 10th of the preceding month the elective is scheduled to begin.

Note:

This course is the elective counterpart to one of the required fourth year sub-internships. Availability of this course will depend on enrollment in its associated sub-I. Students interested in enrolling should contact Patty Neureiter (630-2673) for approval procedures.

This elective is designed for students wanting an additional month of medicine sub-I experience beyond the required sub-I clerkship. Successful completion of this elective WILL NOT SATISFY THE MEDICINE SUB-I REQUIREMENT.

Description:  

The student will actively participate in the management of patients with acute and life-threatening illnesses in the Medical ICU setting, under the supervision of senior Internal Medicine Residents and Pulmonary/Critical Care Sub-specialists. The duty hours include 17-20 day shifts and 7-10 consecutive night shifts per month, with one full day off per week. The daily patient census will be 2-6 patients per student, with new admissions during most shifts. Procedural experience will include insertion of central venous catheter, Swan-Ganz catheter, radial arterial catheter, and endotracheal tube. Didactic sessions include daily Core Curriculum lectures, daily Noon Conference lectures, and daily staff interaction. 

Goals:

• Gain supervised clinical experience in the primary care management of adult patients with critical illnesses, with responsibility for decision making at every step in management.
• Gain a working knowledge of the pathophysiology, evaluation and management of adult patients with Severe Sepsis, Acute Respiratory Failure, Acute Cardiac Failure, Cardiac Arrhythmias, and advanced Metabolic Diseases.

Description:

The student will be expected to: (1) Make home visits with hospice physicians, nurses & social workers (2) make rounds on the hospice inpatient unit (3) read assigned papers and manuals (4) discuss cases one-on-one with staff.

Goals:  

The course is designed to familiarize the student with treatment modalities for all types of pain, including acute, chronic cancer, and non-cancer pain.   The course is taught from a primary care perspective.  NO direct interventional procedures will be learned.  Interaction with patients, familiarity with medical interventions, including opiod and non-opiod methods of pain control will be learned. Dealing with difficult patients is assured.

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Objective of the course is to familiarize the student who is considering a career in Internal Medicine with the "realities" of such a practice. The student will have exposure to such topics as office/practice management, income/lifestyle expectations, medical staff dynamics, etc., while participating in the care of my patients.

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The objective of this elective is to help the student develop an understanding of alcoholism and drug abuse and to provide the skills necessary to deal effectively with chemically dependent patients. The student will also have the opportunity to evaluate, treat, and follow patients with medical and psychosocial complications of alcohol and drug abuse. A curriculum of teaching materials including films and journal articles emphasizing issues in chemical dependency as well as topics in internal medicine, will be presented and discussed under the supervision of a staff internist.

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The student will have an opportunity to see a wide variety of medical problems, including both acute and semiacute medical admissions, as well as treatment and management of chronic disease. This elective will emphasize, under supervision, a first person experience in the workup, diagnosis and management of patients. A minimum of three selected patients per week will be assigned for a complete history and physical examination; diagnosis and therapeutic recommendations. This experience will be supplemented by seminars, didactic lectures, continuing medical education conferences and therapeutic conferences with the Radiologists and Pathologists. In addition to general medicine ward patients, there will be the opportunity to assist with the care of patients in the CCU and ICU.

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The primary objective of this course is to provide the senior medical student with knowledge, skills, and attitudes in handling seriously ill patients, requiring care in the ICU/CCU units. The senior student should develop a basic understanding of the seriously ill patient, including the pathophysiology of disease, with its psycho-social implications. Assessment for admission, including preparation and transfer to the ICU/CCU units is an integral part of such a course.

Objectives:

1. The development of skills in coordinating care, when multiple specialties are involved.
   
2. The learning of procedures unique to ICU/CCU management of patients including:

a. Insertion of chest tube
b. Pericardiocentesis
c. Paracentesis
d. Thoracentesis
e. Endotracheal intubation
f. Insertion of Swan-Ganz catheter
g. Insertion of hyperalimentation cath
h. Ventilator management
I. Insertion of central lines and arterial line

3. .Learning of the care of serious diseases including:

a. Cardiac arrhythmias
b. Acute hypertensive crisis
c. Congestive heart failure
d. Cardiogenic shock
e. Renal failure
f. Respiratory insufficiency/failure
g. Coma of unknown etiology
h. Multiple organ trauma or failure
I. Metabolic derangements
j. Acute myocardial infarction
k. Diabetic ketoacidosis, severe
l. Overdosage of drugs or medications
m. Septic shock
n. Learn to work with family of patient in ICU/CCU, handling psycho-emotional reaction to severe illness

Training for this course will take place at St. Joseph Medical Center in the ICU and CCU departments.

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This elective is designed to give the student experience normally gained in the internship year. The student will have diagnostic and patient care responsibilities supervised by the Ward Resident and Staff Physicians assigned to the ward. These responsibilities include history and physical examination, order writing, daily progress notes and observation and performance of a broad spectrum of diagnostic and therapeutic medical procedures.

Daily didactic conferences and ample time for reading complement the above.

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The student will be an active member of the ICU team, consisting of a staff physician, a PGY 2 or PGY 3 resident and one or more PGY 1 residents. This elective will provide an introduction to the total management of the critically ill patient. The student responsibility will consist of overseeing the care of patients in the seventeen bed combined medical and surgical intensive care unit at Ball Memorial Hospital, Muncie, Indiana. The student will learn current concepts of airway management and mechanical ventilation, hemodynamic monitoring, nutrition, management of shock and fluid and electrolyte therapy. This elective gives the student ample opportunity to observe and to perform diagnostic procedures. This elective will include ICU attending rounds, clinical conferences, Medicine Grand Rounds and adequate reading time.

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Description:  

During this rotation, the student will be responsible for the admission, management, and therapeutic planning of patients admitted to the internal medicine service. He/she will be expected to rotate admissions with first and second year Family Medicine Residents and participate in management and care at the first post-graduate year level. Particular emphasis will be placed on the diagnosis and management of common medicine problems. In addition to the above experiences, teaching conferences in selected medicine topics will be available throughout the rotation, as well as daily ward rounds with an internist and family physician.

Objectives:

The student will admit patients to inpatient service, and perform complete history and physicals including a thorough assessment and plan. Students will be expected to present their patients at morning rounds. They will also give a thorough case presentation to the team.

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NOTE: This course may be dropped/added with 15 days of the beginning date for the elective.

The course will help students interested in primary care develop skills necessary for the outpatient management of allergic and immunologic diseases. Patients are private and include children and adults. No weekend or night call is required. The student will have the opportunity to:

• Participate in the evaluation and management of asthma, allergic rhinitis, anaphylaxis, drug allergy, venom hypersensitivity and food allergy.
• Learn appropriate use of diagnostic measures such as skin testing, RAST, pulmonary functions and rhinoscopy.
• Learn the fundamentals of immunodeficiency screening.
• Interview and examine patients with primary immunodeficiencies (e.g., Bruton's, Common Variable) receiving IV gamma globulin.

This course could either be taken as a two week elective (combined with another two weeks of Dermatology, etc.) or as a full four week elective.

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The experience is in an internal medicine office practice. There is heavy exposure to diabetes mellitus (all types), hyperlipidemias and hypertension. The natural history of illnesses and the longitudinal care of patients will be emphasized. The student will regularly see patients with multiple diagnoses and complex pharmacologic regimens. In addition to patient contact and teaching, the student will receive regular one-on-one didactic sessions and will regularly receive literature assignments.

This senior elective is an expansion of the elective offered over the past 12 years. In addition to general internal medicine, there is heavy emphasis on hypertension, lipid disorders and diabetes mellitus. The student will receive practical exposure and individual instruction on all aspects of diabetes management including oral agents, all types of insulin and insulin pumb ptherapy. There is also instruction on the management of diabetic complications including nephropathy, neuropathy, vasculopahty, foot care and ketoacidosis. Lipid disorders are reviewed in detail including pathophysiology, clinical manifestations and treatment. Recent and current literature is assigned for review and discussion. The student will assess patient with simple as well as complex medical problems usually requiring multifaceted decision making.

Any student wanting to drop or add this elective after the initial computer scheduling should contact Kathy Head at 962-5419.

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