UC COM :: M3/M4 Course Syllabi

M3/M4 Course Offerings

2023-2024 M3/M4 Course Syllabi

Family & Community Medicine

COURSE NUMBER:

06 01 40

TITLE:

Global Health – Indian Health Service Elective -ICE
This will be a four week elective where the student will work one on one with a US board certified physician at an Indian Health Service Site. Indian Health Service (IHS) electives are similar in many aspects to a global health elective. The trainee works in a limited resource setting which provides care to an underserved population from a different culture. This culture has often suffered historical trauma and continues to manifest the consequences of this trauma in their healthcare outcomes. At present there are four sites on the Navajo Reservation which will accept our students: • Chinle Comprehensive Health Care Facility • Gallup Indian Medical Center • Shiprock – Northern Navajo Medical Center • Tuba City Regional Health Care Corporation Students will do a mix of inpatient and outpatient work based on preferences and future career goals. Students will have direct clinical / patient care time of at least 35-40+ hours per week. This clinical time will all be face to face patient interactions. They will participate in the care of patients as a member of the health care team at the site.

PREREQUISITES:

Student must be an M4 in good standing and student must have completed all M3 clerkships.

expand all

GENERAL INFORMATION

COURSE YEAR:

CREDIT HOURS:

CREDIT WEEKS:

DOMESTIC VISITING:

INTERNATIONAL VISITING:

GRADED:

Honors/High Pass/Pass/Fail

COURSE QUALIFICATIONS:

ICE

STATUS:

Full-Time
OFFERED AS FULL-TIME AND PART-TIME: NO
ALLOWS OVERLAP: NO

COURSE LENGTH:

4 Weeks

DIRECTOR:

Andrea Rosado, MD
rosadoam@ucmail.uc.edu
(513) 558-7342

Shanna Stryker
STRYKESA@UCMAIL.UC.EDU
(513) 558-7342
MSB, 4453C

ADMINISTRATIVE SUPPORT PERSON:

Sarah Jadeed
jadeedsh@ucmail.uc.edu
(513) 558-1504
MSB, 4011

SITE(S):

Chinle Comprehensive Health Care Facility
Gallup Indian Medical Center
Shiprock – Northern Navajo Medical Center
Tuba City Regional Health Care Corporation

MAX ENROLL:

ROTATIONS:

Rotation	Dates	Max
1	05/29/2023 - 06/23/2023	4
2	06/26/2023 - 07/21/2023	4
3	07/24/2023 - 08/18/2023	4
4	08/21/2023 - 09/15/2023	4
5	09/18/2023 - 10/13/2023	4
6	10/16/2023 - 11/10/2023	4
7	11/13/2023 - 12/08/2023	4
8	12/11/2023 - 01/05/2024	2
9	01/08/2024 - 02/02/2024	7
10	02/05/2024 - 03/01/2024	4
11	03/04/2024 - 03/29/2024	4
12	04/01/2024 - 04/26/2024	0

NOTE: If a rotation is offered in both 2 and 4 week slots, the max capacity is limited to the actual spots offered for the 4 weeks. (ie: the 2 week rotations listed share the max of the 4 week rotation)

WORKING HOURS:

8:00 am - 5:00 pm Monday - Friday (Occasional Overnight Call and Weekend Days)

REPORT 1^ST DAY:

Student will receive an email with detailed information prior to the elective.

COMMENTS:

The onsite supervisor will be determined prior to the elective and this physician will be US board certified. Rotation: This will be a 4 week rotation Type/format: The clinical experience will be a mix of inpatient and outpatient experience though anchored by the outpatient work. The student will also be expected to attend any available conferences / lectures. There will also be time for self-directed learning with library / independent study time. Total commitment is 40-50 hours per week. Learning activities: • Inpatient and/or Outpatient direct patient care (35-40 + hours per week) with on-call duties • Attend and participate at clinics • Work up and follow patients • Written patient encounters • Oral Patient presentations • Interpreting clinical data (X-rays, lab results, etc.) • Reading of literature and research • Attendance of conferences, lectures, seminars • Prerequisite reading assignments • Presentation given by elective participants upon return to Cincinnati

INSTRUCTION

LEARNING ACTIVITIES:

Case-Based Instruction/Learning
Clinical Experience - Inpatient
Clinical Experience - Inpatient (Nights)
Conference
Demonstration (description, performance, or explanation of a process, illustrated by examples, observable action, specimens, etc)
Patient Presentation--Faculty
Patient Presentation--Learner
Research
Ward Rounds

LEARNING ENVIRONMENT POLICIES:

UCCOM strives to provide medical students with a learning environment that is conducive to their professional growth. All UCCOM and visiting medical students are encouraged to review the Student Handbook.

The Office of Student Affairs and Admissions is available to all UCCOM and visiting medical students to discuss any concerns/questions related to the learning environment. Please call 558-6796 to access faculty/staff that can assist you.

TEACHING:

70%	Attending Physician
20%	Senior Resident
10%	Other Allied Health Professional(s)

FEEDBACK:

ASSESSMENT:

Assessment Methods:

Narrative Assessment
Portfolio-Based Assessment
Self-Assessment

ASSESSMENT METHODS:
Narrative Assessment
Portfolio-Based Assessment
Self-Assessment

FINAL GRADE:

GRADE ASSIGNED BY:

OBJECTIVES

Curricular Resources :

Cultural pre-reading: a choice of reading: Navajos wear Nikes (Kristofic); On the Rez (Frazier); Bighorse the Warrior (Bighorse); Blood and Thunder (Sides); Also available is the Physician Orientation Packet for the Navajo Area Indian Health Service: October 2015 (Hu); In addition, Dr. Schubert is working with Dr. John Tisdale from the Chinle IHS site to develop a compendium of articles related to Native American Health.

Instructional Methods:

Please note the instructional methods listed below. The M4 will learn in much the same way as a trainee learns on an Acting Internship. The clinical experience is the foundation of the learning paradigm during this rotation complemented by didactic conferences, case presentations, self-directed reading / learning and personal reflection.

Knowledge/Skills:

Learning Objectives:

Patient Care Objectives

Provide competent preventative, diagnostic and therapeutic management in a general clinic on a rural Native American reservation.
Learn about similarities and differences in the approach to diagnosis, consultation, referral and management of diverse health conditions in a small remote community with limited resources verses a large urban referral hospital
Examine the prominent social determinants of health that contribute to the morbidity and mortality in on the Navajo Nation and how these are addressed in the provision of healthcare and community outreach programs.
Learn how to leverage patient care through the use of community health workers and partnerships with community organizations.
Examine how historical events have influenced relationships between the community and the healthcare system and how this impacts individual healthcare seeking behaviors.
Describe the administration and provision of health care to Native American communities through the Indian Health Services.

_______________________________________________________________________

Medical Knowledge Objectives

Expand personal knowledge of the regional health concerns for people of the Navajo Nation.
Gain comfort in commonly asked questions and concerns frequently seen during outpatient clinic exams, including mental health evaluations.
Research in depth a topic (i.e. STDs, contraception, asthma management, etc.)

_____________________________________________________________________________

Practice-Based Learning and Improvement Objectives

Determine via interaction with patients their perspectives upon areas of strength and weakness in their healthcare system
Demonstrate adaptability to a new EMR and clinic setting.
Gain insight into how practice-based learning and improvement occurs in a remote clinic. In particular, understand how physicians stay informed of research and recommendations when in an isolated setting.
Identify how quality improvement occurs in the Indian Health System.

Professionalism Objectives

Provide high quality, patient centered care, while respecting patient privacy and autonomy.
Follow through on patient care, arrive on time and be reliable.
Demonstrate effective, professional and respectful working relationships with physician, nursing, community health worker, and administrative staff.
___________________________________________________________________________
Interpersonal and Communication Skills Objectives
- Demonstrate cultural humility and actively seek opportunities to engage with the community to foster trusting relationships.
- Explores ways to engage families and build trust during primary care appointments.
_____________________________________________________________________________

Systems Based Practice Objectives
- Gain greater understanding of the Indian Health Services.
- Understand how to decide on referrals and how to obtain specialty expertise when not readily available.

Main Course Topics :

Indian Health Service (IHS).
Navajo Reservation.
Rural Native American Reservation.
Underserved Population.
Global Health.
Limited Resource Setting.
Inpatient and Outpatient Setting/Experience.
Primary Care
Preventative, diagnostic and therapeutic management.
Fracture Clinic.
Teen Clinic.
Lectures/Didactics.

Procedures:

N/A

Remediation Plan:

Self-Directed Assignments as determined by the Course Director.

SAMPLE WEEK

Monday:

8:00AM	12:00PM	Outpatient Clinic
1:00PM	5:00PM	Outpatient Clinic and Inpatient Rounds

Tuesday:

8:00AM	12:00PM	Outpatient Clinic
1:00PM	5:00PM	Outpatient Clinic and Inpatient Rounds

Wednesday:

8:00AM	12:00PM	Outpatient Clinic
1:00PM	5:00PM	Outpatient Clinic and Inpatient Rounds

Thursday:

8:00AM	12:00PM	Outpatient Clinic
1:00PM	5:00PM	Outpatient Clinic and Inpatient Rounds

Friday:

8:00AM	12:00PM	Outpatient Clinic
1:00PM	5:00PM	Outpatient Clinic and Inpatient Rounds

SCHEDULE NOTE:

Conferences:

Weekly noon time CME lecture for all physicians.

Weekly medical student lecture / didactics.

Weekly time for case based presentations by the medical students / residents based on a recent clinical encounter.

Specialty Clinic:

Including Fracture clinic, Teen Clinic at area schools and others depending on the month will occur intermittently throughout the month.

Public Health Nursing Home Visits:

One or two full days during the month.

ATTENDANCE AND ABSENCE POLICY

Session Attendance for M4 Students

Students may miss no more than two days of planned excused absences on a four week rotation without being required to make-up the work, at the discretion of the clerkship/elective/course director or his/her designee.
Non-AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the clerkship director to best align with the site schedule. Students may request to schedule 1 or more of these 4 days for planned absences that fall under 1 of the categories listed below for excused absences during non-AI rotations, in consultation with the course/elective director, who may or may not approve such planned absences.
AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the course director to best align with the site schedule. Students may request to schedule 1 or 2 of these days for planned absences that fall under 1 of the categories listed below for excused absences during AI rotations, in consultation with the course director, who may or may not approve such planned absences. Students must avoid scheduling Step 2 examinations during an Acting Internship.
Excused Absences - The following will be considered excused absences:
- Diagnostic, preventative, and therapeutic health services (e.g. doctor appointments, physical therapy, counselling, etc).
- Personal illness, accident or a major catastrophic event
- Death or serious illness of immediate family members. Immediate family members, as defined by UC, are Grandparents, Brother, Sister, Brother-in law, Sister-in-law, Daughter-in-law, Son-in-law, Father, Mother, Mother-in-law, Father-in-law, Step-sister, Step-brother, Step-mother, Step-father, Spouse or domestic partner, Child, Grandchild, legal Guardian or other person who stands in place of parent (in Loco Parentis)
Whenever possible, planned absences should be requested a minimum of six weeks in advance of the start of the clerkship/elective/course in which the absence will occur; this enables the clerkship/course/elective to help plan for educational event scheduling (e.g. a known appointment could be scheduled around with enough notice and the student might not have any required coursework to make up). Absences requested less than 1 week prior to the planned absence may not be considered for a possible excused absence unless extenuating circumstances prevented the student from providing timely notification per the policy. Students should first submit their request for a planned absence to the clerkship/elective/course director using the online MSSF. All planned/excused absences for any reason should be documented on the MSSF.
The COM abides by the UC Religious Observance Policy that respects the religious diversity of its students by providing opportunities, where possible, for accommodation in cases where conflicts exist between students’ religious beliefs/practices and educational activities. In clinical settings, such accommodations must honor the primacy of a commitment to patient care and avoid unduly burdening faculty, staff and the general student population involved in the affected educational and/or patient care activity.
The following items are explained in detail in the Medical Student Handbook:
- Excused/unexcused/unplanned absence, religious holidays, jury duty, and make-up work

See Attendance and Absences Policy, Religious Observance Policy, Medical Student Handbook.