Elective Opportunities

The student will perform histories and physical examinations on selected patients. Patients will be presented for discussion at daily attending rounds. Students will attend daily teaching conferences and will have the opportunity to review selected electrocardiograms with the attending physician. Students will observe patients in the cardiac catheterization laboratory, the electrophysiology laboratory, and during performance of cardiac stress tests and echocardiograms. OBJECTIVE: 1. To evaluate patients with a broad range of cardiovascular problems, emphasizing the inpatient management of specific cardiovascular diseases. 2. To improve the student's physical examination skills, with particular emphasis on the cardiac physical examination. 3. To understand fundamentals of cardiac noninvasive testing and integration of these tests into the diagnostic and treatment plan. 4. To understand the rationale for catheterization and catheter-based interventional techniques in patients with coronary artery disease. 5. To improve recognition and treatment of common cardiac arrhythmias. DUTIES: The student will participate as a member of the inpatient cardiology team. This is an inpatient service. There is no night call.

The student will be on the Consultation Service and see consultations under supervision. She/he will present patients during teaching consultation rounds which will be directed toward synthesizing the data base and principal findings to direct management of the patient. The student will attend coronary care unit rounds on a daily basis. In addition to the above experience, the student will receive daily electrocardiograms to interpret and after reading them on his/her own, they will be read with a preceptor to become the official reading on the chart. The student will attend cardiology Ambulatory Clinic one afternoon and one morning a week. The department has two dimensional and doppler echocardiography, Holter Monitoring, Nuclear Cardiology, EKG teaching, cardiac catheterization, coronary intervention including angioplasty, stents, and atherectomy and cardiac surgery. The student will attend a cardiac catheterization conference, a working conference of cardiologists and cardiac surgeons. OBJECTIVE: To teach students: 1) methods of study and investigation of the problems of patients with cardiovascular disease including: a) improvement in the physical diagnostic skills in the cardiovascular system; b) the application of the special aspects of history taking; c) introduction to specialized diagnostic methods including Echocardiography, Nuclear Cardiology, Holter Monitoring, and Cardiac Catheterization; and d) the learning of scaler electrocardiography to a degree that the student will be qualified in interpreting the usual clinical electrocardiogram; and 2) the management of such patients, medical, rehabilitative and surgical. DUTIES: The student will be part of the medical team and will be immediately supervised by a Cardiology Fellow. His/her preceptor will be a Staff or Consulting Cardiologist. No night work or weekend assignments required. PREREQUISITE: Completion of core clerkship in Medicine. This course is available to 3rd or 4th year students for both two or four weeks.

Fourth year students will participate in all activities of the Cardiology consult service at UH which includes exposure to a broad range of problems in clinical cardiology in all arenas of medicine, surgery OB/GYN, and other specialized areas on the UH campus including SICU and cardiac telemetry units. Students are expected to work up at least once consult per day, present on rounds, follow patients daily until discharged or sign off and write daily notes for co-signature. Each month, the service is staffed by a fellow for the entire month, and two attendings each splitting the service for one half month. All patients having cardiothoracic procedures are seen at least once on post-op day one, until stable, or as needed, providing a unique exposure otherwise generally unavailable to this aspect of cardiovascular medicine and hemodynamics. Service and rounding takes place Monday - Friday, Saturday A.M. until noon, with remaining coverage by the on-call cardiology fellow. There are no night or on-call responsibilities. Students are encouraged to attend and participate in the daily departmental didactic conferences and activities. OBJECTIVE: To expand knowledge and competency in clinical cardiovascular medicine in a broad, commonly encountered spectrum of situations DUTIES Identical to cardiology fellows with one-on-one supervision and oversight of clinical performance by fellow and attending PREREQUISITE: Completion of all core clerkships

DESCRIPTION: Clerks will be assigned to attending staff at University and VA Hospitals and work closely with Endocrine Fellows in consultation and patient rounds. Other activities include attendance at General Endocrine and Thyroid Clinics, Journal Clubs and Endocrine Grand Rounds. Arrangements may be made for students to accompany faculty while conducting private practices, if desired Clerkship may be elected for 1 to 5 months, allowing for selection of clinical experience and if desired, clinical and basic research experiences commensurate with career goals. OBJECTIVE: Provide a concentrated basic experience aimed at (1) teaching the student how to obtain in detail and interpret the endocrine portion of medical history and physical examination and (2) interpretation of laboratory evaluation of endocrine function and management of endocrine and metabolic disorders. DUTIES: Patients are seen first by the student but responsibilities are minimal at this stage of training. Responsibility primarily in outpatient clinics, private practice and consultation service. No night call. PREREQUISITE: Completion of clinical year (third year of core, depending on curriculum), including two months in Internal Medicine as well as Pediatrics, Surgery and OB-GYN. This applies to both 3rd and 4th year students.

DESCRIPTION: Students will be involved primarily in seeing hospitalized patients referred in consultation to the gastrointestinal service. Their work will be largely in-hospital based but will also consist of an outpatient experience. All work will be closely supervised by the GI fellow and attending physician. The student will have exposure to all diagnostic procedures including therapeutic endoscopy, diagnostic radiology, and motility. Daily educational rounds will be conducted with the attending physician. Daily rounds with the GI fellow will consist of seeing all patients on the gastrointestinal service and review of all pertinent pathology and radiology. OBJECTIVE: To provide experience in the diagnosis and management of gastrointestinal diseases and expand upon information learned in the gastrointestinal core curriculum. DUTIES: Students will serve as a primary consultant on cases assigned and are expected to write legible, concise, well-reasoned notes that are focused on the issues consulted. Inpatient experience consists of seeing initial consultations and consultations with the gastrointestinal fellow. All cases will be discussed with the GI attending daily. Students are expected to read relevant literature and attend regular conferences of the Gastroenterology Division. PREREQUISITE: Completion of 2nd year of Medical School.

DESCRIPTION: This option offers experience providing consultation on patients of the Medical and Surgical Services and exposure to procedures including diagnostic radiology, gastrointestinal endoscopy, biopsy of liver and other tissues, and use of malabsorption tests and secretory function tests when required for diagnosis in particular cases. The student works closely with, and under the supervision of, the GI Consulting Fellow (PG IV-VI) and the Attending Staff Physician. The student will meet at least once a week with the course sponsor or another senior staff member to discuss one of his cases. OBJECTIVE: To provide experience in the diagnosis and management of gastrointestinal tract, and pancreatic hepatobiliary illnesses with emphasis upon the deductive approach using pathophysiologic principles during close, informal contact with the Staff. A second objective is to gain experience in collating and integrating often complex historical, physical and lab data into a reasonable differential diagnosis and management plan, under the guidance of Staff members. DUTIES: The student serves as the primary consultant on the case assigned and is expected to write legible, concise, and well-reasoned consultation notes that are focused on the issue consulted. We urge that the student include pertinent literature references. A departmental Reprint Library is available as well as endoscopy and pathology slide collections. Students participating in this elective will attend the formal activities of the combined GI Unit including two weekly GI Unit conferences, a weekly histopathology review of all biopsies and a monthly Journal Club. Students also attend the weekly VA GI Clinic where they see selected patients under the supervision of a gastroenterology staff physician. PREREQUISITE: Completion of second year of medical education and completion of a least one core clerkship in Medicine, General Surgery or Pediatrics. Students of other medical schools are welcome.

DESCRIPTION: The program provides an introduction to the comprehensive assessment and management of frail elderly patients. The student has primary responsibility for elderly veterans who are admitted to the Geriatric Evaluation Management Unit (GEM) at the Veterans Administration Hospital. The GEM is a 20 bed intermediate care service that utilizes a multidisciplinary approach to assessment and physical rehabilitation of chronically ill veterans. The student participates in the team management of these patients under the supervision of staff physicians. The student participates in work rounds daily, attends teaching rounds and conferences, and spends two half days per week attending ambulatory geriatric clinics at the Veterans Administration and University Hospitals with staff geriatricians, neurologists and psychiatrists. OBJECTIVE: 1. To develop competence in the evaluation of common geriatric problems including urinary incontinence, dementia/delirium/depression, gait instability and falls, immobility, pressure sores and introgenic illness. 2. To complete comprehensive geriatric assessments including evaluation of the patient's activities of daily living, special senses, mental and psychosocial status. 3. To become familiar with community resources that are available for home care of frail elderly patients and methods of financing healthcare for this population.

DESCRIPTION: For every older person living in a nursing home, there are three more people equally fragile and infirmed living at home. A small but significant percentage of most outpatient clinical practices include homebound elders who, because of their shut-in status, do not receive primary care or must pay for expensive transportation to be seen in the doctor's office. Home healthcare has been the fastest-growing segment of Medicare's budget, but few physicians understand what home health professionals actually do. Physicians are generally not trained to provide care in the home. Knowledge of the Aging Network that provides home care and social services to homebound frail and vulnerable elders is not formally taught in most U.S. medical schools. This rotation will provide students with an opportunity to work side by side with a University Hospitals House Calls geriatrician and/or gerontologic nurse practitioner to manage homebound frail seniors. Visits may be made to the patient's home, assisted living facility, or independent living facility. Students will learn the principles and practices of chronic disease management, care delivery systems, geriatric medicine, and available community services. GOAL: Learn how a visit to a patient's home or residence can enhance the provider's knowledge about the patient's psychosocial and medical circumstances and help to impact the patient's care. OBJECTIVES: 1) Understand the physical environment in which a patient resides and the care opportunities or limitations associated with this environment. 2) Observe a medication reconciliation being conducted. 3) Learn about the services available to home bound patients. NOTE: Currently we have the capacity to take only 1 student out a couple times per week. Requests should be made at least 1-2 months in advance.

DESCRIPTION: Medical students will work as a member of an interdisciplinary team comprised of geriatrician, nurse practitioner, nurse, social worker, and rehabilitation therapist to manage frail older adults in a Medical Home model of care through the McGregor Program of All-inclusive Care for the Elderly (PACE). PACE is an innovative primary care program that focuses on coordinating medical care to older adults and aims to keep them out of the hospital. There are many PACE sites located in the USA and McGregor PACE is the only site in Ohio. Student will work closely with a geriatrician and gerontologic nurse practitioner while performing comprehensive assessments and acute care visits in the PACE office. Student will also make hospital, nursing home, and home visits with the physician, depending on the clinical needs. Student will be expected to obtain medical histories, perform physical exams, as well as neurologic and mental status examinations, under the supervision of attending geriatricians. Student will present at least one participant at the weekly Interdisciplinary Team Conference. OBJECTIVES: Student will 1) describe the components of a comprehensive interdisciplinary assessment; 2) be able to integrate diverse bio-psychosocial information into a care plan in collaboration with other health science clinicians; 3) complete at least four geriatric medical assessments, including written reports, and will present at least one case at an IDT Conference. 4) become familiar with successful models of care for the geriatric patient outside of the traditional fee for service system. GOALS: 1) Provide student the opportunity to participate as a member of the interdisciplinary team involved in the comprehensive assessment of frail older patients and their families. 2) Teach students how to evaluate the physical, psychosocial and economic factors that influence the health of older persons. 3) Stimulate the student's interest in furthering his/her knowledge and expertise in the evaluation and treatment of older adults. Prerequisites: Family Medicine or Medicine clerkship.

DESCRIPTION: The palliative care elective at UHCMC is a multidisciplinary elective that can encompass either 2 weeks of only palliative care or a 4 week elective with combined palliative care and geriatrics. The weeks on palliative care will provide an overview of what palliative care encompasses including inpatient adult consults, inpatient pediatric consults, outpatient clinic, didactics with ethics, SW, music and art therapy, as well as chaplain services. There will also be the possibility to spend time with UH hospice doing home visits. Students will function within the limits of their education from an observatory capacity as 1st or 2nd year students to following their own panel of patients having a patient load as 3rd and 4th year students. They will be attending morning interdisciplinary team meetings (physician, NPs, nurse, chaplain, SW) at which time they will be presenting and updating the team on the patients that they are following. They will be responsible for one new consult per day and at least one follow up with full written consult H&P and progress notes. The medical student will be a spectator in goals of care discussions observing and learning about the communication skills but will work on the plan of care in conjunction with their preceptor. Students may be asked to make a short presentation on a palliative care topic of their choosing, based on clinical experience during the rotation. OBJECTIVES: 1. Improve pain assessment/management skills 2. Improve management of non-pain symptoms 3. Learn the steps of a family meeting as well as the skills required to conduct a family meeting and discuss goals of care/advanced directives. The overarching goal is to provide medical students with an exposure to palliative care and the effective use of a multidisciplinary team. Assessment will be Pass/Fail (AE/U) and based upon attendance and presentation of a topic at our inter-disciplinary team meeting. PREREQUISITES: Core Clerkships in Internal Medicine and Aging/Geriatrics required. This elective is offered to CWRU/CCLCM students ONLY.

OBJECTIVE: Students will develop expertise in common clinical hematologic and oncologic diagnostic and therapeutic problems. They will participate in the hematology-oncology inpatient consultative service and attend teaching sessions. They will gain expertise in the diagnosis and management of anemias, cytopenias, coagulation disorders, leukemias, solid tumors, and gain exposure to the use of chemotherapeutic agents. DUTIES: Students will be directly responsible to the attending physician or the hematology/oncology consultation service with hours of 8:30am -5:30pm Monday-Friday. Students will have direct patient contact, do the appropriate literature review and help in establishing a therapeutic plan and managing the patient. PREREQUISITES: Completion of core clerkships.

DESCRIPTION: Students will become part of the Hematology/Oncology Team, and will participate in the evaluation and treatment of patients housed on UH Seidman 3, the hospital division devoted exclusively to the comprehensive care of patients receiving intensive chemo-radiation therapy with or without peripheral blood and marrow transplantation. Patient treatments include allogeneic transplantation for leukemia, lymphoma and aplastic anemia, autologous transplant for hematologic malignancies and various solid tumors, and intensive chemotherapy for leukemia and solid tumors. Students will attend rounds, patient management conferences, participate in the harvest, cryopreservation and infusion of marrow and peripheral blood stem cells, observe/participate in clinical research studies and protocols. OBJECTIVE: To gain knowledge and experience in clinical, laboratory and research applications of intensive chemo-radiation therapy with and without peripheral blood, marrow and umbilical cord blood cell transplantation for the treatment of hematologic and solid tumor malignancies. Students will participate in rounds, conferences, procurement, freezing and infusion of peripheral blood, marrow, and umbilical cord blood cells, perform diagnostic marrow aspirations and biopsies, and evaluation, treatment and management of such patients. DUTIES: No primary patient responsibility, although student is encouraged to interact directly with patients on rounds and participate in diagnostic and treatment procedures. A premium is placed on self-learning under supervision. No night call. PREQUISITE: Completion of all core clerkships.

DESCRIPTION: The student will evaluate and follow patients for whom infectious diseases consultation has been requested. She/he will participate in daily attending rounds and weekly joint UH/VA case conferences and seminars. OBJECTIVE: To gain experience in the clinical and laboratory management of patients with infectious diseases. DUTIES: The Infectious Diseases service is a consultation service. The student ordinarily will perform the initial workup on patients for whom the infectious diseases consultation has been requested. The student will discuss his/her initial impressions and plan with the fellow or resident before presenting the patient on attending rounds. The student is responsible for following the patient as long as the infectious disease problems remain active. There is no night call. PREREQUISITE: Successful completion of core clerkship in medicine.

DESCRIPTION: The student will evaluate and follow patients for whom infectious diseases consultation has been requested. She/he will participate in daily attending rounds and weekly joint UH/VA case conferences and seminars. OBJECTIVE: To gain experience in the clinical and laboratory management of patients with infectious diseases. Infectious Diseases service is a consultation service. The student ordinarily will perform the initial workup on patients for whom infectious diseases consultation has been requested. The student will discuss his/her initial impressions and plan with the fellow or resident before presenting the patient on attending rounds. The student is responsible for following the patient as long as infectious diseases problems remain active. There is no night call. The student will be exposed to I D patients seen in the ambulatory clinic as well. I D clinic is 2 days a week (Tuesday and Wednesday mornings). Successful completion of core clerkship in Medicine.

DESCRIPTION: Students will be rotating between UHC, MHMC, and VAMC for 1/2 day clinics Monday through Friday. No clinics on the weekends. Students need to pick up syllabus and directions to clinics in our office (Foley Bldg. Room 416A). OBJECTIVE: To gain experience in the outpatient clinical settings in patients with AIDS and AIDS-related disorders. DUTIES: After becoming acquainted with the clinic, the student will see HIV patients in all stages of the disease presenting for routine or sick visits. The student will perform a directed history and physical, present to the attending and then both will return to complete the visit with the patient. PREREQUISITE: Successful completion of core clerkship in medicine.

DESCRIPTION: The Department of Medicine offers one month Acting Internships in Internal Medicine at University Hospitals Case Medical Center. Students will work under the direct supervision of a Senior Resident and an Attending Physician on the inpatient medical wards. The call and admitting schedules will be organized according to the residency ward schedule. An acting intern will work as part of an inpatient medical team with a workload of up to six patients. The faculty and house staff of the Department of Medicine are committed to making this rotation an exceptional educational experience by making the student an integral part of the team and allowing for supervised direct patient care. OBJECTIVE: Acquisition of skills in the evaluation and management of the hospitalized medical patient. DUTIES: Direct patient care under the direction of Resident and Attending Physicians. PREREQUISITE: Completion of Core Clerkship in Internal Medicine.

For many graduating medical students, transitioning to the role of intern physician is one of the most challenging and anxiety-provoking changes that they will face in their careers. The aim of this course is to build the knowledge base and confidence of graduating medical students as they approach the beginning of their residency. Students will learn from current faculty and resident physicians how to approach common scenarios seen in a hospital. Some examples of topics that will be covered include night float issues, rapid response scenarios, pain management, and delivery of bad news. Information will be conveyed through multiple modalities incorporating large-group presentations, small group discussion, and simulation. Students will have the opportunity to get experience with performing common bedside procedures such as ultrasound-guided central line placement, paracentesis and thoracentesis in the VA state-of-the-art simulation center. This course is always highly rated by students, and fills up quickly.

Learning Objectives:

• Assess a variety of common acute medical issues through simulation exercises
• Quickly and accurately triage patients by acuity
• Formulate initial treatment plan, including specific diagnostic tests, imaging, and medications
• Respond appropriately to acute changes in patient status with additional treatment steps
• Improve speed and accuracy of diagnosis and treatment in response to feedback from case scenarios
• Recall common topics through lectures designed to MS-4 level of learning, understand the evidence behind these topics, and apply learned concepts to related simulations
• Increase confidence in ability to care for acutely ill patients
• Better understand the realities of intern year, and develop strategies to address the non-clinical stressors they will encounter

Goals:

• Increase students' comfort and knowledge regarding common conditions pertinent to inpatient internal medicine internship via engaging lectures focused on practical management
• Simulate acute presentations of illness and changing patient status, while providing individual, formative feedback on student performance
• Strengthen students' communication skills with patients, medical staff, and learners in the context of medical residency
• Discuss organization strategies, time management techniques, and self-care during residency.

DESCRIPTION: The Department of Medicine offers one month Acting Internships in Internal Medicine at the Louis Stokes Cleveland VA Medical Center. Students will work under the direct supervision of a Senior Resident and an Attending Physician on the inpatient medical wards. The call and admitting schedules will be organized according to the residency ward schedule. An acting intern will work as part of an inpatient medical team with a workload of up to six patients. The faculty and house staff of the Department of Medicine are committed to making this rotation an exceptional educational experience by making the student an integral part of the team and allowing for supervised direct patient care. OBJECTIVES: Acquisition of skills in the evaluation and management of the hospitalized medical patient. DUTIES: Direct patient care under the direction of Resident and Attending Physicians. Prerequisite: Completion of Core Clerkship in Internal Medicine.

DESCRIPTION: 1) Student will join the assistant resident and clinical fellow on the service and will learn with/from them. Patients referred for consultation will be evaluated and followed by the students with the help of the resident, fellow and consultant. 2) Students will be expected to participate in the weekly Clinical Nephrology Conference. 3) They will be asked to spend several hours a week with the full-time nephrologist acting as a consultant for the month in order to systematically cover some of the major issues pertinent to the area of nephrology. 4) Students may also participate in Rounds on the Renal Transplant Service. 1) To provide students with the opportunity to participate in the care of patients with acute and chronic renal disease, electrolyte and water abnormalities and hypertension. 2) To enable students to develop experience with outpatient problems such as complex hypertension, medical management of nephrolithiasis and diagnostic workup of nephrotic syndrome. DUTIES: Students will be responsible for the primary evaluation of two or three patients per week with a subsequent presentation to the faculty attending. Furthermore, they will be responsible for detailed follow-up of each patient and will make daily rounds with the resident, fellow and faculty attending. There is no specific night or weekend call, but a commitment beyond normal working hours is expected if a significant opportunity for learning presents itself. Students will participate in renal clinic if time and space allow.

DESCRIPTION: The pulmonary consult service at University Hospitals evaluates inpatients with a broad spectrum of lung disease. During this course, students will be familiarized with the approach to and evaluation of patients with lung disease, chest imaging, pulmonary function testing, sleep studies, exercise testing and bronchoscopy. Upon completion of this course, students will be competent in the interpretation of these tests. Students will be exposed to common pulmonary diagnostic procedures, such as thoracentesis and pleural biopsy. Objective: To obtain an overview of Pulmonary Disease managed in a hospital and ambulatory setting. DUTIES: No primary responsibility for patients. Assists with management of patients. PREREQUISITE: None necessary, though benefit derived will obviously vary with previous exposure to clinical medicine.

The Pulmonary Consultation Service at the Veterans Affairs Medical Center evaluates patients with broad spectrum of lung diseases, including lung cancer, chronic obstructive pulmonary disease, asthma, pneumonia and other infections, sleep apnea, respiratory failure, interstitial lung diseases including sarcoidosis, pulmonary emboli, and respiratory muscle disorders. Patients are seen on an outpatient basis in the Pulmonary, Tuberculosis and Sleep Clinics. Inpatient evaluation occurs on the Medical, Surgical and Psychiatric Wards, and in the Surgical Intensive Care Unit. Opportunities are available to participate in the care of patients and in the Medical Intensive Care Unit. Students will gain experience with the interpretation of chest X-rays, chest CT scans, pulmonary function tests, and sleep studies. Students will be familiarized with chest x-rays, chest CTs, pulmonary function testing, sleep studies, exercise testing and bronchoscopy. Upon completion of this course, students will be competent in the interpretation of these tests. Students will be exposed to common pulmonary diagnostic procedures, such as thoracentesis and pleural biopsy, and ICU procedures, such as arterial and central line placement. The student will team with the medical resident, Pulmonary/Critical Care fellow and staff to participate in the management of inpatients and outpatients with pulmonary disease or in the Intensive Care Unit. Students will assume responsibility for some patient care. Active participation in daily rounds and didactic lecture series is required. No requirements, though benefit derived will vary with previous exposure to clinical medicine.

DESCRIPTION: Students are assigned to one of two MICU teams at University Hospitals of Cleveland. The team includes two medical residents and a Pulmonary/Critical Care fellow, all under the guidance and supervision of a medical intensivist from the Pulmonary and Critical Care staff. OBJECTIVE: To acquire basic knowledge in the evaluation and management of critically ill patients. The student will be exposed to disease states such as respiratory failure, shock, sepsis, and severe metabolic derangements. With this exposure, students will learn the principles and techniques of respiratory physiology, mechanical ventilation, cardiovascular support, hemodynamic monitoring, venous and arterial access. Duties: The student will be assigned to a MICU resident team and have supervised responsibility for patient care. Active participation in daily rounds and didactic lectures series is expected. All activities are under the guidance of the MICU attending physicians. Night call is optional. The maximum allowed night call frequency is once every fourth night. The maximum allowed night call frequency is once every fourth night. The maximum allowed consecutive time spent in the hospital is 30 hours. Students choosing to take night call will have full accommodations, similar to residents on call. Prerequisite: Completion of Medicine clerkship. Advanced Internal Medicine elective (Acting Internship) beneficial, but not required.

DESCRIPTION: Students are assigned to one of two MICU teams at University Hospitals. The team includes two medical residents and a Pulmonary/Critical Care fellow, all under the guidance and supervision of a medical intensivist from the Pulmonary and Critical Care staff. OBJECTIVE: To acquire basic knowledge in the evaluation and management of critically ill patients. The student will be exposed to disease states such as respiratory failure, shock, sepsis, and severe metabolic derangements. With this exposure, students will learn the principles and techniques of respiratory physiology, mechanical ventilation, cardiovascular support, hemodynamic monitoring, venous and arterial access. DUTIES: The student will be assigned to a MICU resident team and have supervised responsibility for patient care. Active participation in daily rounds and didactic lectures series is expected. All activities are under the guidance of the MICU attending physicians. Night call is optional. The maximum allowed night call frequency is once every fourth night. The maximum allowed night call frequency is once every fourth night. The maximum allowed consecutive time spent in the hospital is 30 hours. Students choosing to take night call will have full accommodations, similar to residents on call. PREREQUISITE: Completion of Medicine clerkship. Advanced Internal Medicine elective (Acting Internship) beneficial, but not required.

GOALS AND OBJECTIVES:

1. Comprehend the scope of patient encounters within the Sleep Medicine program and the biologic substrates for sleep disorders.
2. Exhibit skills needed to collect a patient history in the context of sleep and circadian biology and its associated disorders (insomnia, sleep apnea, narcolepsy, and restless legs syndrome).
3. List features of a study (polysomnograph, MSLT, or actigraphy) by a sleep medicine specialist.

The specific learning objectives are outlined in the curriculum and are summarized by:

1. Developing proficiency in the assessment of a wide variety of sleep medicine illnesses. Students will acquire skills in history taking and knowledge to appropriately guide a referral for providing specialized care for such patients.
2. Understanding the basic physiology, pharmacology, and critical evaluation of the medical literature, which will provide a foundation for learning and application to patient care.
3. Gaining experience in how a sleep medicine program provides consultative management for disorders of sleep and circadian rhythm as they arise from inpatient and outpatient patient care.
4. Recognize the values in working with allied healthcare professionals (e.g. nurse practitioners, respiratory therapists, PSG technologists, etc.) to accomplish overall goals in providing patient care.
5. Developing skills to interact with patients and their families, inform, advise, and counsel them concerning important medical or ethical decision in sleep (drowsy driving, career choices, insurability issues).
6. Exposure to procedures, vital to this subspecialty, including but not limited to polysomnography, multiple sleep latency testing, maintenance of wakefulness testing and actigraphy.
7. List administrative and management principles in sleep medicine as a specialty.

The students will be taught the principles of history and physical exam and management of patients with rheumatic diseases. They will learn techniques of examining joints, muscles, joint fluid and multidisciplinary approach to patients with rheumatic diseases. They will participate in academic activities of the division and utilize the resources available in the division. Students will have the supervision of fellows and staff. To learn the comprehensive multidisciplinary care for patients with chronic arthritis and locomotor disease. Expanding on the musculoskeletal committee (second year), clinical and laboratory diagnosis, rehabilitation techniques and the role of occupational and physical therapy will be taught. Students will be assigned to different components of the program, inpatient and consultation, outpatient (office practice) at combined programs at UH/VAMC as they desire.