M4 Internal Medicine & Medical Subspecialties

• MED MD 405: Anesthesiology
  The Anesthesiology Elective is a 4-week clinical experience. In this elective, students will learn the principles and concepts of the practice of anesthesiology and the multiple roles the anesthesiology plays both in and outside of the operative room. Students will participate in the management of patients undergoing general surgery, head and neck surgery, neurosurgery, thoracic and cardiac surgery, obstetrics and gynecology procedures, orthopedic surgery, pediatric surgery, urologic procedures, and vascular surgery. Educational sites include the Boston Medical Center operating rooms, the pain clinic, off site imaging locations (CT/MRI), labor and delivery, and the gyncelogy procedure unit. Learning will primarily occur in the Boston Medical Center operating rooms, where medical students will be paired with residents and attending faculty. The experience will involve the perioperative evaluation and care of the surgical patient. Students will participate in the management of patients undergoing general surgery, head and neck surgery, neurosurgery, thoracic and cardiac surgery, obstetrics and gynecology procedures, orthopedic surgery, pediatric surgery, urologic procedures and vascular surgery. Additional educational sites include the pain clinic, off site imaging locations (CT/MRI), labor and delivery and the gynecology procedure unit. On their first day students will receive an orientation from the rotation director. During the elective, medical students will attend a series of lectures and case conferences. These will serve to enhance their knowledge, skills and understanding of the field. Students will also attend Departmental Grand Rounds, held most Fridays. Logistics: 1- Students will receive a packet of information via e-mail prior to the start of the rotation. 2- Students must report to the Anesthesiology Office at 6:30 AM on the first day (or when otherwise specified) for orientation. (Location: Powerplant Building, 750 Albany St., Floor 2R) 3- Students are expected to be present for all departmental academic activities. 4- There are no call responsibilities for this rotation.
• MED MD 406: Anesthesiology Multimedia
  The Anesthesiology Multimedia is a 4-week experience focused on medical education. In this elective, students will work in the Department of Anesthesiology's multimedia laboratory, where they will become familiar with computer-assisted instruction, digital media applications for educational purposes, and image and video editing using industry standard software such as Photoshop, Premiere, and Illustrator. Students will be introduced to script development, storyboard building, instructional design, digital photography and video, and computer applications used for the creation of digital media for medical education. The materials produced in collaboration with students maylead to presentation at national meetings and publication in peer-reviewed journals and textbooks. Four weeks prior to the start of the elective, the student will meet wiht the technical advisor to develop a plan of operations and a learning timeline to be followed during the elective. A 4-week elective allows students to become familiar with filming procedures, collecting digital assets, and designing computer-based educational projects. The students will learn digital photography and video editing using industry standard software such as Photoshop, Premiere, and Illustrator. The student will meet with the technical advisor 4 weeks in advance prior to the start of the elective for one hour at which time they will agree to a plan of operations and a learning timeline to be followed during the elective. The plan of operations includes an agreed upon number of work hours per week to satisfy the BUSM minimum of 40 hours per week, a description of the specific activities to be performed by the student, and the required deliverables of the rotation. Finally, in this preparatory meeting, they will also agree on completing all operational project pre-requirements to fulfill prior to the elective's start date. The multimedia elective will take place in the Department of Anesthesiology Media Laboratory. During the first few days of the rotation, the student will be trained on the specific photographic and video equipment (including cameras, computers, and software) by the technical advisor or by a senior member of the laboratory. During the elective, the student will meet with the technical advisor daily to review the project progress. Furthermore, a mid-clerkship review by the technical advisor will be performed, which will be submitted to the course director. This review will be documented, with any points for improvement relayed, and will include a statement on whether or not the student is at the expected timeline for the project. If the student is not meeting the expected timeline, then the reviewer will provide a plan (which may be as short as a statement or longer depending on the needs) on how to get the student back on the timeline if possible. If getting back on track with the project is not possible, then an alternate plan need to be defined where the student can meet project
• MED MD 410: Clinical Cardiology
  The Clinical Cardiology Elective is a 4-week clinical experience at Boston Medical Center. In this elective, students will become a member of the Cardiology Consult team comprised of a staff cardiology, a cardiology fellow, and one to three PGY-2s. Students will be exposed to a wide variety of cardiac patients and share in the responsibilities for patient evaluation, management, and disposition. This elective emphasizes the fundamentals of the cardiac examination and therapeutics. Students will learn the significance, usefulness and manner of performing special diagnostic studies including electrocardiograms, echocardiograms, exercise stress tests, holter monitors, nuclear scans and cardiac catheterizations and will apply these to patient care. Teaching activities include daily rounds with staff cardiologist, EKG reading, Cardiology Grand Rounds, and Conferences. Students are expected to develop competency in EKG reading during the rotation. By special arrangement, additional elective time can be provided for certain students with a special interest in arrhythmia, cardiomyopathy, echocardiography, stress testing or clinical research." All students and residents are expected to develop competency in EKG reading offered during the rotation. By special arrangement, additional elective time can be provided for certain students with a special interest in arrhythmia, cardiomyopathy, echocardiography, stress testing or clinical research. Teaching activities include: 1. Daily rounds with Staff Cardiologist 2. EKG reading 3. Cardiology Grand Rounds 4. Medical/Surgical Conference 5. Arrhythmia Conference 6. Imaging Conference 7. Research Conference 8. Cardiomyopathy Conference 9. Core Curriculum Conference
• MED MD 411: Clinical Cardiology - Kaiser San Jose
  The Cardiology Elective will expose the medical student to the field of Cardiology as practiced within an integrated multispecialty group. The rotation takes place in the Cardiology Department at Kaiser San Jose with rotations both in the clinic and hospital setting. The student will learn about the most common Cardiology conditions such as coronary artery disease, valvular heart disease, arrhythmias, congestive heart failure, hypertension and congenital heart disease. Learning about various diagnostic modalities in the evaluation of various cardiac conditions such as stress testing, coronary angiography and other imaging modalities such as echocardiography, CT angiography and cardiac MRI are also part of the experience. Acquiring a general understanding of the various management options for patients with cardiac conditions, such as appropriate medical therapy, coronary percutaneous interventions, and coronary, valvular or other structural heart surgery will be imparted. Students will work closely with a faculty member to evaluate patients, perform some procedures under direct supervision and be exposed to a broad spectrum of cardiac conditions presenting to a community hospital and medical center setting. They will be assigned to one of seven attendings during the weekday hours of 8:30-5:30 pm, who will supervise them while evaluating consultations both in the outpatient and inpatient settings.
• MED MD 412: Clinical Cardiology - Santa Clara
  The Cardiology Elective will expose the medical student to the field of Cardiology as practiced within an integrated multispecialty group. The rotation takes place in the Cardiology Department at Kaiser San Jose with rotations both in the clinic and hospital setting. The student will learn about the most common Cardiology conditions such as coronary artery disease, valvular heart disease, arrhythmias, congestive heart failure, hypertension and congenital heart disease. Learning about various diagnostic modalities in the evaluation of various cardiac conditions such as stress testing, coronary angiography and other imaging modalities such as echocardiography, CT angiography and cardiac MRI are also part of the experience. Acquiring a general understanding of the various management options for patients with cardiac conditions, such as appropriate medical therapy, coronary percutaneous interventions, and coronary, valvular or other structural heart surgery will be imparted.
• MED MD 415: Dermatology
  The Dermatology Elective is a 4-week clinical experience. In this elective, students will develop fundamental dermatology skills and be exposed to general dermatology, pediatric dermatology, dermatology specialty clinics, and dermatologic procedures. Students will attend ambulatory clinics, inpatient consultations, grand rounds, and didactics. Our group is comprised of attending dermatologists, dermatopathologists, procedural dermatologists, doctorate scientists, dermatology residents, international trainees, dermatopathology fellows and a skin oncology fellow. Boston University is a center of excellence in basic cutaneous biology research, skin oncology, wound healing, psoriasis, connective tissue disease, photomedicine, hair disorders, dermatologic surgery/oncology, dermatopathology and dermatology education. COMPETENCY BASED GOALS AND OBJECTIVES The purpose of the dermatology elective is to provide BUSM IV students the content, functional knowledge and practical skills needed to identify, evaluate, manage and prevent common and important disorders of the integumentary system.
• MED MD 416: Dermatology (Kaiser)
  The General Dermatology Elective takes place in the Dermatology Department at Kaiser Santa Clara, Kaiser San Jose, and Kaiser Milpitas with rotations both in the clinic and hospital setting. The goal is to expose the medical student to the field of Dermatology as practiced within an integrated multispecialty group. Students will have the opportunity to work closely with a faculty member to evaluate patients, perform procedures under direct supervision including Mohs surgery, contact Dermatology, pediatric Dermatology, and complex medical Dermatology and be exposed to a broad spectrum of dermatologic conditions presenting to a community hospital and medical center setting. Medical students will learn how to perform dermatology focused history and physicals, develop a methodical assessment and plan and perform supervised procedures for diagnostic testing and/or treatment of some of these patients.
• MED MD 434: Geriatrics Clerkship
  This four-week clerkship provides students with the basic knowledge and skills to participate in the care of older adults. Students will learn about common geriatric syndromes, understand, and use functional assessment in the evaluation of older adults, work with an interdisciplinary team to develop care plans, learn about home care and what is possible to provide medically for older patients living in the community. Students will participate in clinic, nursing home visits and home visits with clinicians to provide medical care for older patients. In addition, students will complete on-line assignments, attend lectures, prepare a narrative focused on My Life My Story (MLMS), complete a Social Determinants of Health (SDOH) worksheet, and create an end of life (EOL) project.
• MED MD 440: Sub-Internship: Medicine
  The Sub-Internship in Medicine is designed to challenge and enhance the capacity of the student to work as an increasingly independent, highly competent, and compassionate caregiver and contributing team member. To achieve this goal, the acting intern will work as an advanced care provider under the direct supervision of a medicine ward resident and teaching attending. Students will assume increasing responsibility for the initial evaluation and management of assigned patients. The student is expected to combine medical knowledge with clinical and interpersonal skills in order to demonstrate independent thought and develop a plan of action. The student is expected to develop a balance between acting independently and acknowledging his/her limitations and seeking help as appropriate. Clinical work will be supplemented by conferences offered by the Department of Medicine. There are 2 pathways of experience in the Acting Internship. Pathway A (Integrated Acting Internship): Running throughout the year, the Pathway A experience provides a ward experience with 5 students per block. In this experience, students are integrated onto a typical ward team consisting of a resident and 2 interns. Students on the integrated team will have the opportunity to interface with 3rd year students on their Medicine clerkship. Responsibilities of the Pathway A Integrated Acting Internship include: 1. Admitting patients to the team - you will likely start at one admission per day during several days of the week but should work toward admitting two patients regularly on long call days, and hopefully, three or more patients on one or more occasions. 2. Following a core of patients (on average 3-6 patients) 3. Providing patient care through the last Sunday of the rotation Pathway B (Acting Internship): Only occurs from June to September. We have the capacity for 6 students to participate in this experience per block. You will be part of a team with a resident and two other acting interns and no interns. Responsibilities of the Pathway B Acting Internship include: 1. Admitting patients to the team 2. Following a core of patients (team of 3 students covers on average 4-10 patients) 3.Taking overnight shifts 3-4 nights over the 4-week block (# of nights to be determined) 4. Providing patient care through the last Sunday of the rotation After selecting a block for your Acting Internship in Medicine, you will be assigned to either Pathway A or Pathway B and be notified within ~4 weeks of the start of your block.
• MED MD 441: Sub-Internship: Medical Intensive Care Unit
  The Sub-Internship in the Medical Intensive Care Unit (MICU) is designed to provide highly motivated students with an introduction to the diagnosis and management of critically ill patients with single and multi-system organ failure. The MICU is designed to provide state of the art care to seriously or critically ill patients in an environment that emphasizes learning, teaching and independence. Students are exposed to a large spectrum of clinical problems including, but not limited to, respiratory failure with or without mechanical ventilation, ARDS, shock, sepsis, gastrointestinal hemorrhage, diseases related to alcohol or drug excess, HIV-related conditions, pulmonary edema, pulmonary emboli, renal, hepatic or cardiac failure, DKA, fluid, electrolyte or thermic disturbances, CVA or complications of malignancies. Care is provided in a team format which besides physicians, nurse practitioners and senior medical students, includes nurses, respiratory therapists, pharmacists, nutritionists, physical therapists and social workers. This multi-disciplinary approach provides excellent care to patients by capitalizing on the expertise of many services. Students are expected to participate on daily ventilator and work rounds, and to contribute to the management of patients by collecting and assimilating data for presentation to the attending, arranging consults and tests, and by placing orders and performing common procedures under direct supervision. Patients are cared for by three teams. Two teams (Red and Blue) consist of 2 PGY2 or PGY3 residents, 2 PGY1 residents, a pulmonary/critical care attending and a pulmonary/critical care fellow. The third team (Green) consists of 2 PGY2 or PGY3 residents, 2 PGY1 residents, a nurse practitioner and pulmonary/critical care attending. The PGY2 or PGY3 admits and performs the initial management on all patients in the MICU with the supervision of the MICU Attending/Fellow during the day or the Special Care Unit Night Coverage (SCUNC) at night. Subsequent daily care is then assumed by a PGY1 resident, Nurse Practitioner or a Medical Student on a sub-internship rotation. Students are assigned to the Red and Blue MICU teams preferentially but if necessary can be assigned to the Green Team. Students are required to be present for 6 days of the week (weekdays and either Saturday or Sunday). There is no night call.
• MED MD 443: Ambulatory Medicine
  Advanced Internal Medicine, Medicine II Block: All Students will complete a required four week Ambulatory Medicine rotation in the fourth year. For the 4 week ambulatory medicine rotation, students will be assigned to one of the following sites: Jamaica Plain/West Roxbury VA, Bedford VA, Roger Williams Medical Center, Neighborhood Health Centers, Private Practices or BMC. BUSM is exploring additional possible clinical venues for training in Ambulatory Internal Medicine and may add new venues in the coming year.
• MED MD 444: Internal Medicine Internship Prep Course
  This elective will prepare students who are planning to enter an Internal Medicine Residency. It is designed to build specific skills and knowledge to facilitate the transition from medical student to intern. Students will participate in small group activities and didactic learning. These will take place in the Boston Medical Center Simulation Center (for procedural/simulation sessions) and the Boston University Chobanian & Avedisian School of Medicine (for classroom learning sessions). BUSM IV students will be oriented to the elective on the first day of the rotation during a formal orientation session with the course directors. The sessions will include a mixture of case-based, small-group classroom learning, as well as hands-on simulation and procedural sessions led by content-expert faculty members and procedurists. There will be no direct patient contact. By the end of the two week Internal Medicine Internship Prep Course students will be able to: 1. Identify, evaluate, and manage acute medical situations including hypoxia, altered mental status, hypertensive emergency, shock, and chest pain as observed by faculty in simulated medical scenarios. 2. Interpret common diagnostic tests, such as EKGs and chest X-rays, during simulated medical scenarios. 3. Describe and demonstrate the steps for performing common medical procedures, including central line placement, intravenous line placement, and arterial puncture as observed by faculty in simulated procedures. 4. Discuss how to effectively and respectfully communicate with patients from different cultural backgrounds about end of life issues, decision making capacity, and bad news during small group discussions. 5. Demonstrate techniques to communicate effectively and respectfully with a medical team from different cultural backgrounds when presenting a new patient, responding to pages, calling consults, handing off or discharging patients as observed during small group discussions and during simulated pages. 6. Discuss strategies to balance responsibilities and wellness as interns through effective learning, time management, and organization during small group discussions.
• MED MD 445: Addiction Medicine
  The Addiction Medicine elective will take place at Boston Medical Center’s inpatient wards, as well as various community sites, including but not limited to: HCRC Methadone Clinic, Fast Path Clinic, Envision, and SMART Recovery Meetings. This is an opportunity for a 4th year medical student to understand addiction as a chronic medical condition, and SUD as an important and prevalent public health issue. Students will engage in care of persons with SUD in a professional, health-oriented, responsible and proactive manner, in order to reduce substance-related harm, promote health and address co-existing medical problems. Students will interview and examine patients with attending physician supervision and be involved in the patient's treatment planning. Students are expected to participate, Monday through Friday, at least 40 hours/week. Students will attend teaching conferences that are scheduled during the elective time. Students will receive timely, formative feedback from the attending preceptors including a mid-clerkship evaluation to assess their progress in developing the skills needed to treat patients with SUD.
• MED MD 446: Vascular Medicine
  This is designed to be a comprehensive rotation in cardiovascular disorders with emphasis on vascular problems. Students will gain an exposure to the evaluation and management of vascular disorders affecting the arterial, venous, and lymphatic systems, as well as vasospastic disorders. Emphasis will be placed on learning the presentation, physical findings, diagnostics, and therapeutics. The indications, techniques, and interpretation of vascular studies will be taught. Students will be expected to fully participate in the clinical and educational activities including: - Inpatient vascular medical consultations including cardiac consultation for vascular surgery - Outpatient clinic, which includes new consultation and longitudinal care of patients with vascular disease - Non-invasive vascular laboratory and peripheral interventional laboratory - Vascular conferences including an interdisciplinary vascular conference and a vascular laboratory journal club As mentioned above, there is heavy emphasis placed on a comprehensive cardiovascular approach to the vascular disease patient. Students can expect to be exposed to and provide care for many cardiac disorders, including coronary artery disease, heart failure, valvular heart disease, and arrhythmias, especially during the perioperative evaluation and management. This will include an understanding and application of the diagnostic cardiac studies, including electrocardiograms, echocardiograms, exercise and pharmacologic stress test, and cardiac catheterization.
• MED MD 447: Obesity Medicine and Nutrition Support
  This elective provides "hands on" exposure to the problems of obesity and malnutrition in both inpatients and outpatients. The Obesity Medicine and Nutrition Support rotation at Boston Medical Center is a 4 week rotation. The students will gain experience managing individuals with morbid obesity by working in the Nutrition and Weight Management Clinic with nutrition physicians and dietitians. The students will get an overview of the medical management and surgical treatment options available for the morbidly obese patient. This includes an introduction to the comprehensive pre and post-operative management of these patients via clinic experience and inpatient follow-up where applicable. The option is available, based on student interest, to observe Culinary Nutrition Medicine classes in BMC's Nutrition Resource Kitchen with a professional chef/dietitian. The student will work closely with members of the multidisciplinary Nutrition Support Team. This includes an attending physician, clinical fellows, dietitians, pharmacists and research staff. Participation in daily patient and teaching rounds will be expected. Consultations will be undertaken with the supervision of a fellow or the Nutrition Support attending on service.
• MED MD 448: Gender Care Rotation
  This elective is for the BUSM student to learn the multi-disciplinary approach to appropriate care for transgender and gender nonbinary individuals. The transgender medicine elective will provide an introduction to the full spectrum of care for transgender and nonbinary individuals including establishing initial care, continuing primary care as well gender affirming hormone and surgical options. Students will interact with patients who are exploring gender identity, who identify as transgender and nonbinary, and who are pursuing hormonal or surgical gender affirmation. They will learn the endocrinological mechanisms of puberty as these parallel the hormonal and pharmacological interventions used in transgender medicines. Students will participate in clinical sessions and are expected to treat patients with respect and sensitivity. Students attend various clinical sessions during their elective including: endocrinology, primary care, adolescent medicine, and surgery clinics. Self-study of social work, pediatrics, psychiatry, ob/gyn and surgery aspects of transgender medicine is required. Students will be graded on interactions with patients in clinical session, knowledge of the subject from outside reading and a final 15 minute presentation in the 4th week of the rotation.
• MED MD 449: Pulmonary Medicine-Consultation Service
  The student will be an integral part of an active in patient clinical pulmonary consultation service. They will be responsible for the initial consultation in patients with a variety of respiratory disorders. The student's evaluation and plan of management will then be discussed with the pulmonary fellow and at daily staff attending rounds. The elective will provide an opportunity to evaluate chest roentgenograms, interpret arterial blood gases and pulmonary function tests, and discuss the role of and participate in such diagnostic procedures as fiberoptic bronchoscopy, pleural biopsy and thoracentesis. The student will participate in a full program of teaching conferences including work rounds, chest x-ray conferences, formal interhospital chest conferences, physiology seminars and research conferences, and a special weekly student case discussion conference.
• MED MD 481: Clinical Hematology/Oncology
  The course in clinical hematology/oncology is designed to prepare students to evaluate and manage hematologic and oncologic disorders. The student will be exposed to patients both in the ambulatory and inpatient hospital setting. He/She will be expected to participate in the initial evaluation of in-patient consultations. In addition, they will have the opportunity to work with an attending physician in at least one outpatient Hematology or Oncology clinical activity per week. The student will be instructed in the technique of performing a bone aspiration and biopsy. In addition considerable time will be spent with the attending interpreting both peripheral blood and bone marrow smears. The student will also attend the weekly clinical and research conferences, which will afford him/her an exposure to the scholastic activities of the section.
• MED MD 482: Ambulatory Hematology and Oncology
  This 2-week elective provides an immersive and educational experience in ambulatory hematology/oncology. This will allow students to explore interest in the field and apply their knowledge in a clinical setting. Student will gain experience in the outpatient care of patients with hematology and oncology conditions. Students will participate in the initial diagnosis and workup, treatment selection, and monitoring of patients during treatment. There will also be opportunities to attend educational meetings, including disease-specific tumor boards, joint BMC/VA case conference, and the rise and shine morning lecture series.
• MED MD 545: Medical Care of the Surgical Patient
  The elective is designed to provide an opportunity for the student interested in a surgical or medical career to gain experience in the management of medical problems in the surgical patient. Students spend one month on the Medical Consult Service and work under the direct supervision of two senior medical residents and the medical attending. He/she will actively participate in completing inpatient consultations including generation of management plans, daily work rounds and twice a week didactic sessions. The student is expected to work Monday through Friday, 8 am to 6 pm. There is no overnight call. The student will also participate in two half-day sessions per week in the Pre-Procedure Clinic, located in Shapiro Lower Level, where patients scheduled for elective surgery are assessed by providers from both Surgery and Anesthesia departments. Students considering surgery including orthopedics, anesthesia, or internal medicine careers have found this elective valuable. The interactions of medical and surgical illness are complex and may complicate management in the perioperative period. Many questions commonly arise. What are the risks of surgery and general anesthesia in patients with a given set of medical illnesses' What are the predictors of these risks' Can they be reduced by preoperative measures' How should medical problems be managed before and after surgery' What complications might be expected' It is hoped at the conclusion of this elective, the student will have an appreciation of how medical problems in the perioperative period should be approached diagnostically and therapeutically. The Medicine Consult service is also the primary care team for patients admitted to Boston Medical Center with acute hip fractures, as the patients have many medical comorbidities that make their preoperative and postoperative management challenging. Students should contact the Medicine Consult service director, Dr. Henry Trier, via email (Henry.Trier@bmc.org) in the week prior to starting service for more information as well as link to educational supplemental materials. A core syllabus of articles from the medical, surgical and obstetrical literature relevant to medical consultation is available and should be picked up from the coordinator one week prior to beginning the rotation.