Vanderbilt University Medical Students

 

med

 

Course Information​

  • Foundation Clinical Care (FCC) – 2-week Course
    2-year Vanderbilt Medical Students

    Course Resources

    Course Administration:

    Director: Dr. James Powers
    Co- Directors: Ralf Habermann, Kiffany Peggs, Parul Goyal. Victor Legner, and Mariu Duggan

    Course Description:

    In this two-week elective, students will join a team of attending, resident, and interdisciplinary team members on the Vanderbilt Acute Care for Elderly (ACE) Unit in the mornings. Experiences will include diagnosis and management of geriatric syndromes including falls, delirium, dementia, and transitions of care. Students will become acquainted with several patients and present them on rounds. Afternoons will consist of geriatric primary care and consult clinics with exposure to geriatric medication management, chronic illness, and home and community-based services. In the second week students will round mornings with the VA Geriatric Evaluation and Management Unit Team, following and presenting selected patients and contrasting VA with Medicare resources. Afternoons will consist of VA Geriatric Consult and Primary Care Clinics, including a new Patient-Centered Aligned Care Team with a patient-centered medical home model. Relevant handouts and orientation materials will be provided, and students will participate in the ongoing Geriatrics and Palliative Care didactic series with rotating residents. At the conclusion of the course, students will be able to perform a functional assessment, contribute to an interdisciplinary team meeting, appreciate the clinical decision tree concept while managing patients with multi-morbidity states, and have an awareness of the array of community and institutional resources required to successfully manage transitions of care for frail elderly. 

    First - Day meeting location:

    Students start with Dr. Powers on Monday morning at 9 AM at the Village at Vanderbilt, Suite 3000, 1500 21 St Ave South (Hillsboro Medical Group). The course director will orient and guide students through the elective.

    Course Resources

    See course syllabus for educational activities and learning objectives

    NOTE: VA system access is required. Before you start an Immersion Phase rotation, be sure your VA computer codes are still active by going to the VA and logging in to any VA computer. See the website here for instructions on reactivating an expired code and more information regarding VA Access.

    You MUST renew your mandatory VA training each year. If you do not, you will be locked out of the system and it can take up to 3 days to reactivate. Not having current VA access could result in you having to drop the course.

  • Integrated Science Course: Health Aging and Quality Dying
    IDIS 5630
    3rd and 4th Year Vanderbilt Medical Students

    Course Administration:

    Directors: Mariu Duggan, MD, MPH & Andy Woolridge, MD


    Course Resources


    Course Description:

    The purpose of this course is to expand the foundational science knowledge of aging and dying in order to slow down the aging process of patients, prevent iatrogenic events in older adults, and improve the quality of life and dying. The course accomplishes this through a variety of classroom didactic and other educational activities such as case-based learning and creation of an enduring educational project, as well as a variety of patient-care experiences.

    Our course allows opportunities for translation of the foundational knowledge gained into several patient care sites, mentored by Geriatrics and Palliative Care faculty. Students will encounter relevant patient populations (Geriatrics, Palliative, Hospice) where they can apply foundational science knowledge which they have gained elsewhere in the course. These clinical settings include: inpatient and Outpatient Geriatrics, Community Nursing Home, Palliative Care Unit (inpatient), Home Hospice, and Inpatient Hospice.
     

    Course-Specific Learning Objectives:

    By the conclusion of this course, students should be able to:

    1. Describe the epidemiology of aging and its impact on the healthcare system.
    2. Explain the cellular mechanisms of aging and identify behavioral and pharmacologic interventions to delay aging. 
    3. Explain how age-related physiologic changes contribute to homeostenosis and result in clinical syndromes associated with aging. 
    4. Describe the science of medication safety with attention to age-appropriate drug and dose selections, accurate medication reconciliation, avoidance of prescribing cascades, and evidence based deprescribing in the older adult. 
    5. Compare and contrast different settings of care in terms of admission criteria, level of care, financing, and potential hazards associated with each; and describe an evidence-based approach to improve the quality of transitions of care. 
    6. Construct a plan to communicate with patients and family members to deliver bad news, to identify goals of care, to elicit preferences of care along a spectrum of serious illness, and to explain palliative care and hospice.

    Common ISC Learning Objectives:

    By the conclusion of this course, students should be able to:

    1. Demonstrate knowledge and understanding of the foundational science for the ISC course topics (MK2a/MK2b/MK7a/MK7b/MK7c). 
    2. Integrate foundational science knowledge into clinical scenarios through the exploration of patient evaluation (symptoms, diagnostic studies, and underlying pathophysiology) and management plan development (MK2a/MK2b/MK7a/MK7b/MK7c/PC2a)
    3. Model a commitment to continuous self-regulated learning as evidenced by the collection, analysis, interpretation, and implementation of newly acquired information (MK7b/MK7c/PC7a/PBLI3a)
    4. Display professional demeanor and duty while demonstrating compassion and respect for all persons, utilizing effective communication strategies (honesty and transparency) with patients, families, and healthcare colleagues, regardless of their cultural background (PR1a/IPCS7b.1)
    5. Function as an effective member of the patient care team, including effectively managing interpersonal conflict and the incorporation of constructive feedback (SBP2a)

    See course syllabus for educational activities and learning objectives

  • Advanced Clinical Experience (ACE) – 4 Week Course
    MED 5655 - Geriatric Medicine
    3rd and 4th Year Vanderbilt Medical Students

    Course Resources

    Course Administration:

    Director: Dr. James Powers
    Co- Directors: Ralf Habermann, Kiffany Peggs, Parul Goyal. Victor Legner, and Mariu Duggan

    Course Description:

    The intent of this course is to provide students with an advanced educational experience in geriatric medicine. Students will gain familiarity with multiple geriatric syndromes: polypharmacy, gait instability, dementia, fragility, pain management, pressure sores, incontinence, osteoporosis; appreciation for continuity of care across different levels of care; and the ability to differentiate between normal aging and disease processes. Students' knowledge of ethical issues will also be enhanced including patient autonomy, driving, and elder abuse. Students will also be able to identify and use community resources effectively, assess and treat multiple geriatric syndromes, organize management of multiple acute and chronic diseases simultaneously, and communicate sensitively and effectively with older persons and caregivers.

    First - Day meeting location:

    Students start with Dr. Powers on Monday morning at 9 AM in at the Village at Vanderbilt, Suite 300, 1500 21st Ave South (Hillsboro Medical Group). The course director will orient and guide students through the elective.

    Course-Specific Learning Objectives:

    By the conclusion of this course, students should be able to:

    1. To identify and use community resources effectively
    2. To assess and treat multiple geriatric syndromes
    3. To organize management of multiple acute and chronic diseases simultaneously
    4. To communicate sensitively and effectively with older persons and caregivers

    Common ACE Learning Objectives:

    By the conclusion of this course, students should be able to:

    1. Perform situation-appropriate (problem-focused or complete) history and physical examinations and interpret clinical information to formulate a prioritized differential diagnosis that guides the creation of a patient-specific management plan (PC1a.2/PC1b.2/PC2b/PC2c/PC7b)
    2. Demonstrate knowledge and understanding of the science for the ACE course specialty (MK2b)
    3. Exhibit clinical judgment that is safe and commensurate for the level of training (PC7b)
    4. Model a sustainable approach to continuous self-regulated learning as evidenced by the collection, analysis, interpretation, and implementation of newly acquired information (MK7b/MK7c/PBLI3c/PBLI3d)
    5. Display professional demeanor and duty while demonstrating compassion and respect for all persons, utilizing effective communication strategies (honesty and transparency) with patients, families, and healthcare colleagues, regardless of their cultural background (PR1b/IPCS7b.1)
    6. Function as an effective member of the patient care team, including effectively managing interpersonal conflict and the incorporation of constructive feedback (PBLI3a/SBP2d)

     

    See course syllabus for educational activities and learning objectives

    NOTE: VA system access is required. Before you start an Immersion Phase rotation, be sure your VA computer codes are still active by going to the VA and logging in to any VA computer. See the website here for instructions on reactivating an expired code and more information regarding VA Access.

    You MUST renew your mandatory VA training each year. If you do not, you will be locked out of the system and it can take up to 3 days to reactivate. Not having current VA access could result in you having to drop the course.

  • Acting Internship (AI) 
    MED 5656 - Geriatric Medicine
    4th Year Vanderbilt Medical Students

    Course Resources

    Course Administration:

    Director: Mariu Duggan, MD, MPH
    Administrative Support: Terri Ray

    Course Description:

    In 2018, 1 in 3 adults admitted to Vanderbilt University Hospital was > 65 years-old. This AI immerses students on the Acute Care for the Elderly Unit on 7-round wing to learn how to provide age-friendly healthcare. Age friendly healthcare is guided by an essential set of evidence-based practices, causes no harms, and is consistent with what matters most to the older adult and their family.  A student is eligible to serve as an acting intern on the Vanderbilt geriatric medicine service after completion of the ISC: Healthy Aging & Quality Dying. Acting interns are directly supervised by an attending and upper-level resident, and work closely with a geriatric pharmacist and the interdisciplinary team. Students may carry up to 6 patients and may perform up to 2 admissions and 2 ICU transfers daily. Patients assigned will be selected for their teaching value, and the student will be expected to function as a member of the inter-disciplinary team at a supervised intern level for patient management and communication with other healthcare providers. This will include preparing the admission history and physical examination, entering orders, writing daily progress notes, presenting patients on daily work rounds, caring for a near intern-level patient census and coordinating discharge planning. 

    Course-Specific Learning Objectives:

    By the conclusion of this course, students should be able to:

    1. Articulate an approach to assessing and acting on the 4Ms (What Matters, Medication, Mentation, and Mobility) for each patient.
    2. Develop a prioritized differential diagnosis and select a working diagnosis following each patient encounter. 
    3. Perform and interpret screening tests for geriatric syndromes. 
    4. Generate comprehensive admission orders and daily orders on each patient admitted to the care of the acting intern. 
    5. Give and receive a written and oral patient handover to transition care responsibility to another health care provider. 
    6. Recognize a patient requiring urgent or emergent care, initiate evaluation, and seek treatment. 
    7. Obtain informed consent for tests and/or procedures under the supervision of an upper level resident or attending. 
    8. Generate a comprehensive discharge summary detailing functional status, cognitive status, medication changes, goals of care, code status for each patient. 
    9. Generate comprehensive discharge orders for a patient transitioning to home including generating any necessary prescriptions. 
    10. Generate comprehensive discharge orders for a patient transitioning to another facility.

    Common AI Learning Objectives:

    By the conclusion of this course, students should be able to:

    1. Perform situation-appropriate (problem-focused or complete) history and physical examinations, and interpret clinical information to formulate a prioritized differential diagnosis that guides the creation of a patient-specific management plan (PC7a, MK2b)
    2. Demonstrate knowledge and understanding of the science for the AI specialty (MK2b) and exhibit clinical judgment that is safe and commensurate with an intern level of training (PC7a)
    3. Provide patient care in setting more consistent with intern-level responsibility, specifically including (PC7a, SBP2a, SBP2b):
      a.    Managing a larger patient care census more consistent with an intern-level group of patients including patient documentation
      b.    Under appropriate supervision, demonstrating safe and effective cross-cover of patients not routinely cared for by the student
      c.    Practicing evidence-based patient management that reflects individual patient, medical center, and overall health care system cost considerations
    4. Communicate effectively with the health-care team, both verbally and in written form using efficient, safety-oriented practices during (IPCS7a.1):
      a.    Care of the student’s primary patients
      b.    Cross-cover patients
      c.    Handovers of care
      d.    Discussing and entering patient orders
    5. Model a commitment to continuous self-regulated learning as evidenced by the collection, analysis, interpretation, and implementation of newly acquired information (PBLI3a)
    6. Display professional demeanor and duty while demonstrating compassion and respect for all persons, utilizing effective communication strategies (honesty and transparency) with patients, families, and healthcare colleagues, regardless of their cultural background (PR1a, PR5a, IPCS7a.1)
    7. Function as an effective member of the patient care team (SBP2a, SPB2b)

     

    See course syllabus for educational activities and learning objectives

    Welcome to the Acute Care for the Elderly(ACE) unit and we look forward to working with you. The goal of the ACE Unit is to provide high-quality care to a vulnerable geriatric population while training students and residents in effective evidence-based, interdisciplinary care for older adults aimed at maximizing function and quality of life. 

    We hope that you would become familiar with the Age-friendly Health systems. Becoming an Age-Friendly Health System entails reliably providing a set of four evidence-based elements of high-quality care, known as the “4Ms,” to all older adults in your system: What Matters, Medication, Mentation, and Mobility. We are currently in the process of making the ACE unit at Vanderbilt more Age-friendly. As this is an interdisciplinary effort, we ask you to do the following related to 4Ms care:

    • “What matters most” is our job!  We want you to 
      • Ask every patient on admission “what matters most to you so that we can work towards that goal.”
      • Align your care plan with what matters to patients
      • Document what matters most and “care plan aligned” using the template Geriatric H&P here 
    • Medication is addressed by our pharmacist who among many tasks engages the patients in deprescribing and discusses alternatives to medications on the Beer’s list. 
    • Mentation is assessed twice a day with assistance from the nurses using the Brief Confusion assessment method(B-CAM). You can find this in the flowsheet or by asking the charge nurse during rounds
    • Mobility is encouraged and documented daily by nursing staff using the Johns Hopkins Highest Level of Mobility Scale(JH-HLM)which is on the door of each patient’s room.

     

    Our fellow will lead didactics. The team picks a 30-min time each day Mon-Fri to cover each topic (ten topics) in the booklet.  Here is the FACETS curriculum you will use throughout the block.