M4 Required Rotations & Modules

• MED MD 421: Sub-Internship: Emergency Medicine
  
• MED MD 427: Sub-Internship: Family Medicine
  Students will work as interns with the family medicine inpatient team. They will care for a wide variety of patients from the HealthNet Rounder system, acting as the primary caregiver for their patients. They will have all the responsibilities of an intern, including daily management of their patients, new admissions, attending conferences and participating in daily teaching.
• 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 467: Sub-Internship: Neurosurgery
  The neurosurgery sub-internship is designed to immerse the student in neurological surgery, a specialty focused on the identification and treatment of neurological disorders managed surgically. The student will be an integral part of the neurosurgery team at Boston Medical Center (BMC) working in the operating room, inpatient unit, surgical ICU, emergency department and outpatient clinics during this 4-week sub-internship experience under the direct supervision and mentorship of neurosurgery faculty, residents, NPPs and fellows. All students are welcome to take this course and those who plan to apply for Neurosurgery residency should prioritize this course over other Neurosurgery electives.
• MED MD 471: Sub-Internship: Inpatient Gynecology
  The student participates as a subintern in all aspects of the inpatient and ambulatory gynecology service, assisting in minor and major gynecologic surgical procedures and following patients post-operatively.
• MED MD 472: Sub-Internship: Maternal-Fetal Medicine
  The student works with the Maternal Fetal Medicine and resident staff caring for high-risk pregnant patients, in both ambulatory and in-patient settings. The student will function as an acting intern for patients on the ante partum service. The student will attend the high risk prenatal clinics and spend one day per week on the labor floor. They will attend conferences run by the High Risk Department; additionally the student is expected to present at a MFM Thursday noon conference. To receive honors in the clerkship the student will write a paper or create a teaching tool for clerkship students.
• MED MD 485: Sub-Internship: Otolaryngology-Head and Neck Surgery
  This elective provides an intense learning experience for students interested in a career in Otolaryngology - Head and Neck Surgery, and for others with specific interest in head and neck cancer, facial plastic and reconstructive surgery, allergy involving the nose and sinuses, and the auditory system. Students observe and work with faculty and residents in the Department of Otolaryngology - Head and Neck Surgery at the Boston Medical Center. Approximately half of the time is devoted to learning how to evaluate and treat ambulatory outpatients with otolaryngologic disorders. The other half of the time is spent observing and assisting in the operating room and evaluating hospitalized patients. Students are expected to attend weekly teaching conferences including Friday morning case conference, Pathology conference, Radiology conference, Audiology conference, Tumor Board conference, and structured Wednesday afternoon didactic lectures. Student Responsibilities - Fourth year medical students are required to do the following: 1. Be present and on time for clinics, rounds, surgeries, conferences 2. Acquire specified knowledge and skills (as delineated in "Otolaryngology Student Knowledge/ Skills Checklist") 3. Assist residents in providing patient care 4. Prepare and present an eight minute PowerPoint presentation on a chosen topic. Participation, Expectations of Performance, and Grading The Department of Otolaryngology uses elements adapted from the ACGME Residency Review Committee Guidelines for General Competencies in Medical Education as a basis for student evaluations. Because the clinical rotation can be considered an opportunity to begin learning skills that a medical school graduate will be expected to acquire, we shall judge student performance in the categories of the six ACGME1 competencies listed below: 1. Patient care that is compassionate, appropriate, and effective for the treatment of health programs and the promotion of health 2. Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patient care 3. Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care 4. Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals; 5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds; 6. Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger contMAS and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
• MED MD 509: Sub-Internship: Pediatric Inpatient Medicine
  An experience in inpatient pediatric medicine during which the student will have supervised responsibilities on the pediatric ward at a level which the inpatient team judges to be commensurate with an individual student's abilities. The student will admit and have responsibility for his/her own patients under the direction of the faculty and house staff on the inpatient service. He/she will be an integral member of the inpatient team participating in all levels of activity.
• MED MD 511: Sub-Internship: Pediatric Intensive Care
  The PICU is a multidisciplinary six bed unit caring for children and adolescents from newborns to 22 years; the sub-intern will work closely on a team with a senior pediatric resident from the Boston Combined Residency Program in Pediatrics (BCRP) and the PICU attending. The sub-I will act as the primary provider for their assigned patients. Major teaching objectives of the rotation are the pathophysiology of childhood critical illness, pediatric advanced life support (PALS), and the various types of intensive care support (i.e. forms of mechanical ventilation, critical care nutrition and coordination of care) as well as psychological and social support for patients and their families.
• MED MD 514: Sub-Internship: Pediatric Emergency Medicine
  This sub-internship in pediatric emergency medicine will provide students with experience in the direct evaluation and management of pediatric patients, ages 0-21yrs. The rotation will focus on clinical problem solving, and will emphasize skills in the differential diagnosis and treatment of acutely ill children. There is no mandatory overnight call, but students may elect to have some weekend shifts in addition to weekday shifts to complete the required complement of shifts during the rotation. Approximately half of your shifts will be during the evening hours of 3-10 pm. During a 4-week block there are 19 required shifts and during the 3-week block (block 14) there are 16 required shifts irrespective of excused absences for residency interviews. Attendance at the Department of Pediatrics conferences and twice monthly resident conferences is encouraged. At the end of their rotation, students will be required to present a case-based evidence based medicine session to evaluate their ability to interpret and incorporate the medical literature into their practice.
• MED MD 546: Sub-Internship: Surgical Intensive Care Unit
  Fourth year medical students are eligible to participate in the Surgical Intensive Care Unit elective at Boston Medical Center. This can be a one or two month elective which will be spent at the Menino Pavilion surgical intensive care unit. Students will be active members of the team and will participate in daily rounds and will be responsible for presenting in detail, all patients whom they have called on previously. He/she will defend the therapy initiated and propose a comprehensive treatment plan. Additionally, the student will participate in all procedures performed in the surgical intensive care unit. The Section on Critical Care offers daily teaching rounds as well as didactic lectures. It is hoped at the conclusion of this elective the student will have an appreciation of the problems and care of the critically ill patient.
• MED MD 548: Sub-Internship: Plastic & Reconstructive Surgery
  The elective in Plastic and Reconstructive Surgery will consist of a two week period with exposure to general plastic surgery with an emphasis on the aesthetic aspects of the field. This will provide the student with a broad basis in the area of elective plastic surgery. All arrangements for electives must be made through the Medical Student Coordinator at Boston Medical Center.
• MED MD 549: Sub-Internship: Colon and Rectal Surgery
  The Fourth Year Sub-internship is a 4 week course in Colon and Rectal Surgery designed to immerse the 4th year student in all aspects of Colon and Rectal Surgery at Boston Medical Center. This rotation will provide students with the basic components of colon and rectal disorders and surgeries and the care of patients with these disorders. The student will be an integral part of the surgical team in the inpatient unit, the operating room, and the surgical clinic. The acquisition of knowledge and skills in the care of the colorectal patient will be conducted in the following setting and activities. Colon and Rectal surgery clinic - Shapiro 6th floor 1. evaluation of new and established patients 2. follow-up of medically and surgically treated patients 3. assist in basic endoscopy including anoscopy and proctoscopy 4. assist in office procedures such as drainage of abscesses, excision of thrombosed MASernal hemorrhoids and tags, rubber band ligation 5. assist in wound care 6. assist in ostomy care Emergency department - as above Surgical inpatient service - comprehensive perioperative management The 4th year student will be an integral part of the surgery team on the inpatient units, outpatient clinic, and in the operating room during the 4-week sub-internship. The student will function as acting interns responsible for the evaluation and continued management of their own patients, under the direct supervision of the attending physicians, residents and physician assistants. Specifically, the student will take on the management of at least three new patients each week, and will assume primary responsibility for the care of these patients, with appropriate supervision. In addition, the student will be expected to do the following: perform initial history and physicals, write orders, assist in coordinating care, assist with or perform supervised procedures as applicable and appropriate for the sub-intern, present cases, use evidence-based medicine principles to help guide patient care, participate in teaching sessions, and take at least 2 weekend calls during the 4 week rotation alongside residents and attending physicians. With supervision, the student will also perform or assist procedures as appropriate to educational level and patient safety including venipuncture, IV line placement, arterial blood gas, foley catheter placement, nasogastric tube insertion, preparing and draping for surgery, assisting with surgery, and closure of surgical wounds. All Sub-I activities will be performed under appropriate supervision which can include attendings, residents, APPs or other qualified individuals on the Service.
• MED MD 550: Sub-Internship: Minimally Invasive Surgery
  The minimally invasive surgery elective at Boston University Medical Center is a combined clinical and research program with a strong focus in laparoscopic bariatric surgery and additional experience in laparoscopic foregut, endoscopic and robotic surgery. The elective is four weeks in duration and is designed to develop the surgical, educational and research skills of the medical student. The goals of the elective include: 1. Provide exceptional care for surgical patients 2. Learn pre-operative and post-operative management of bariatric surgery 3. Obtain introductory training in minimally invasive surgery with special focus in bariatric surgery
• MED MD 551: Sub-Internship: Orthopaedic Surgery
  The Orthopaedic Sub-I will take place at the Boston Medical Center at both the inpatient and outpatient setting that comprises of six total subspecialties: - Orthopaedic Trauma - Fracture Care - Hand and Elbow Surgery - Sports Medicine and Shoulder Surgery - Foot and Ankle The Sub-I will have the option to choose which subspecialty will fit their clinical interest and career goals. Please go to https://www.bumc.bu.edu/orthopaedics/ to read about the description of each specific subspecialty. The Sub-I on the Orthopaedic service will be responsible for the following: 1. Assist in the care for patients in the emergency room, clinics and operating room whom have orthopedic injuries. 2. Learn the preoperative and postoperative management of patients undergoing orthopedic procedures. 3. Learn how to evaluate patients in the clinic setting including taking pertinent orthopaedic history and performing an appropriate physical examination. 4. Obtain introductory training in orthopedic procedures such as casting, splinting, joint aspirations, wound closure, wound management, management of wound vacs, management of MASernal fixation devices, principles of surgical stabilization of fractures and basics in arthroplasty and spine fixation. 5. Function as a Acting-Intern with responsibilities commensurate with this educational requirement: 1. Function as acting intern responsible for the evaluation and continued anagement of patients under supervision of residents and attendings. 2. As part of the care team, will perform initial H&Ps, assist in coordinating care, assist with or perform supervised procedures appropriate for the sub-intern, present cases, use evidence-based medicine principles to help guide patient care, etc. 3. All Sub-I will be required to present a 12 min talk on the 3rd weds of the month during grand rounds on a case or topic of interest. 3 mins for questions at the end. 4. It is expected that the Sub-I will prepare for every single OR case by obtaining the patient history, indications for surgery, anatomy, surgical approach, steps to the procedure, and read two pertinent articles related to each case. 5. It is expected that the Sub-I will read daily, on the consults seen in the ED, patients seen in clinic the OR cases. Sub-I will meet with their respective supervisor and the senior resident on service for the subspecialty at the beginning, 2 weeks, and at the end of the month for formal feedback
• MED MD 552: Sub-Internship: Cardiac Surgery
  The rotation takes place at Boston Medical Center. Student will be part of the cardiac surgery team and expected to be involved in the day-to-day clinical care. Student will be working directly with the cardiac surgeons and physician assistants with goal to gain gradual comfort and supervised independency with basic surgical skills and management of cardiac surgery in the preoperative and postoperative setting as well as in the clinic.
• MED MD 554: Sub-Internship: Thoracic Surgery
  The thoracic surgery service sees a high volume of patients with chest disease, and performs a broad range of procedures related to the thoracic cavity including, but not limited to thoracotomy, thoracoscopy, bronchoscopy, mediastinoscopy, pulmonary wedge resection, lobectomy, pneumonectomy, endoscopy, esophageal stenting, esophageal myotomy, esophagectomy, hiatal hernia repair, antireflux surgery, etc. The service cares for a number of postoperative patients, and frequently consults on patients with complex needs on other services. Due to the nature of thoracic disease, patients can be quite ill during the perioperative and postoperative period. The sub-intern student will be an integral part of the thoracic surgery team in the operating room, inpatient unit, and outpatient clinic at Boston Medical Center during this 4-week sub-internship experience. Students will be responsible for evaluation and management of their own patients under the direct supervision of attending surgeons and residents, and will care for at least three new patients per week, performing histories and physicals, coordinating care, etc. They will perform procedures as appropriate, including venipuncture, IV placement, arterial blood gas, foley catheter placement, nasogastric tube insertion, bronchoscopy, thoracostomy, and closure of surgical wounds, all under appropriate supervision. The sub-intern will also take call with the surgical team on a regular schedule. As Boston University is a teaching program, students will also have the opportunity to enhance their teaching skills by assisting in the education of clerkship students in the operating room as well as the inpatient and outpatient settings. The goals for the rotation include: · Assist in the care for acute and chronic disease seen in these surgical patients, as evaluated and managed by the service · Learn pre-operative and post-operative management of patients undergoing thoracic procedures · Obtain introductory training in thoracic surgery procedures such as bronchoscopy, endoscopy, thoracentesis, chest tube placement/management/removal, etc · Function as a sub-intern with responsibilities commensurate with this educational requirement: o Function as acting interns responsible for the evaluation and continued management of their own patients, under the direct supervision of the attending physicians and residents. o Care for at least three new patients per week, and possibly more depending on the opportunities for patient care. o As part of patient care you will be expected to do the following: perform initial history and physicals, write orders, assist in coordinating care, assist with or perform supervised procedures as applicable and appropriate for the sub-intern, present cases, use evidence-based medicine principles to help guide patient care, participate in teaching sessions, and take call alongside residents and attending physicians. Students should report to morning rounds at the thoracic surgery workro
• MED MD 555: Sub-Internship: Acute Care and Trauma Surgery
  The Trauma and Acute Care surgery elective at Boston Medical Center is clinical program with a strong focus on management of acute general surgical disease and the multimodal and multidisciplinary management of traumatic injury. The elective is four weeks in duration and is designed to develop the complex peri-, intra-, and post-operative decision making and basic open and laparoscopic surgical skills of the medical student. The goals of the elective include: 1. Provide exceptional care for surgical patients 2. Develop pre-operative, intra-operative, and post-operative management strategies in acute general surgical and traumatic surgical maladies 3. Develop an understanding of co-morbid medical conditions that can influence surgical decision making.