AC510M.17

PPC @ CHA/Revere Center

Director(s): Lenna Finger
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: May, Jul, Sept-Nov, Jan-Mar
Location: CHA - Cambridge Health Alliance (17)
Open to Exclerks: No (HMS only)
Description: Students in this one month elective will learn a team-based care approach to the diagnosis and management of a variety of acute and chronic diseases in adult and pediatric patients in a primary care community health center. A focus of this elective will be how the patient care team identifies and addresses social determinants of health (SDOH) with their patients. Students will spend time interacting with various members of the patient care team – learning about each person’s role on the team. They will be paired with a clinical pharmacist and/or pharmacy resident/student in the collaborative care of a patient(s) with a chronic disease whom they will follow together over the course of the elective. During the elective students will be asked to explore how factors such as economics, housing, education, food insecurity, employment, and transportation impact the health of their patients and how the members of the patient’s care team each play their role in screening for, addressing, and managing these issues. Students will also spend some time in the community itself – with immersion experiences such as visiting a food pantry/mobile market, patient home visit(s), school health center, senior center, housing, etc. Students will further explore SDOH through literature, narrative reflection, case presentation/discussion, and be asked to construct a time line of a patient’s life in collaboration with their pharmacy partner to see how a patient’s life path leads to their present situation. Students will observe and participate in our panel management - observing how we act as a team to manage patients with certain health conditions/risks and in the management of our more complex patients. Weekly interprofessional educational conferences will provide an opportunity to further discuss and process these experiences and further cement learning.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Students will learn to diagnose and manage acute and chronic diseases in the primary care setting. They will be asked to use the literature to apply evidenced-based management strategies. They will also be challenged to understand the underlying disease mechanisms in the diseases they are diagnosing and treating. They will also learn the science behind teamwork and what the evidence shows us about high functioning team-based care.
Grade Criteria:
Honors with Distinction:
Students completed all requested assignments in and exemplary and timely fashion. Students met the overall goals outlined for the elective and exceeded expectations regularly throughout the elective in every area.
Students exhibited regular attendance to clinical, educational, and immersion sessions. Students participated fully and enthusiastically in educational sessions - coming to these sessions well prepared and with new insight indicating deep understanding and connection with the material.
History and exam skills were exemplary at an intern level. They were able to develop robust differentials and management plans and demonstrated a deep understanding of the patient, the disease process, the current literature, and the psychosocial barriers to care. Notes were timely placed in the EPIC medical record and are appropriately detailed and clear - particularly in discussion of the assessment and plan. The student patient presentations were focused, organized, and clear and showed insight into the patients’ condition and psychosocial factors. Students consistently followed through with their patients without preceptor prompting.
Students’ medical knowledge was excellent and students actively increased that knowledge with the use of appropriate sources. Students also reviewed the literature when indicated to research evidence based patient management questions to add further to the care of their patients.
The student fully integrated onto the team such that they demonstrated excellence with regard the understanding and practice of the IPEC competencies.
Students demonstrated highly professional behavior such as punctuality, respect for patient and team, good communication, good attendance, and participation in educational and clinical sessions.
Students developed a deep understanding of team-based care principles and practice and evaluation and management of SDOH. Students also developed understanding systems of care and how systems interact with patient care. They demonstrated high levels of initiative in understanding and advocating for their patients in these areas.

Honors:
Students completed all requested assignments with excellence and in a timely fashion. Students met the overall goals outlined for the elective.
Students exhibited regular attendance to clinical, educational, and immersion sessions. Students participated fully and enthusiastically in educational sessions - coming to these sessions prepared.
History and exam skills were excellent, rarely missing key details in the history or in their focused exam. They were able to develop robust differentials and management plans and needed minimal prompting from the preceptor to make more comprehensive differentials and plans. Notes were timely placed in the EPIC medical record and were adequately detailed and clear - particularly in discussion of the assessment and plan. The student patient presentations were focused, organized, and clear.
Students’ medical knowledge was excellent and students continued to increase that knowledge with the use of appropriate sources over the course of the elective.
The student fully integrated onto the team such that they demonstrated excellence with regard the IPEC competencies.
Students demonstrated highly professional behavior such as punctuality, respect for patient and team, good communication, good attendance, and participation in educational and clinical sessions.
Students developed a deep understanding of team-based care principles and practice and evaluation and management of SDOH. Students also developed understanding systems of care and how systems interact with patient care.

Satisfactory:
Students completed all requested assignments to a satisfactory level in a timely fashion. Students, in general, met the overall goals outlined for the elective.
Students had regular attendance to clinical, educational, and immersion sessions. Students participated but perhaps not completely in educational sessions and comes without much preparation.
History and exam skills are sufficient but perhaps a bit less than would be expected for a post-PCE elective such that they may be missing few key details in the history or be incomplete in their focused exam. They were able to develop reasonable differentials or management plans, but they were limited and need significant prompting and input from preceptor to make more comprehensive differentials and plans. Notes are timely placed in the EPIC medical record, but may lack some detail or clarity, particularly in discussion of the assessment and plan. Students showed satisfactory ability to present patients to preceptor but may not be as focused, organized, or clear as expected for their level.
Students’ medical knowledge was adequate but needs improvement and student did show some improvement over the course of the elective.
Student was able to participate on the medical team but may not have fully integrated onto the team such that they may not have always fully understood or practiced the IPEC competencies.
Students demonstrated professional behavior such as punctuality, respect for patient and team, good communication, good attendance, participation in educational and clinical sessions.
Students developed a basic understanding of team-based care principles and practice and evaluation and management of SDOH.

Unsatisfactory:
Students were unable to complete course assignments and/or did not complete them to a satisfactory level. Students were overall not able to meet the goals set out for the elective.
Students do not have regular attendance to clinical, educational, or immersion sessions and/or are disengaged in these sessions.
History and exam skills are deficient such that students are unable to take a complete but focused history and physical. Students are unable to develop differentials or management plans. Students did not complete notes in timely fashion within the EPIC medical record. Student had difficulty and limited proficiency in efficient presentation of the patient to the preceptor.
Students showed limited medical knowledge and did not seek to improve that knowledge significantly throughout the course of the elective.
Students did not work well with the team or develop an understanding of team-based care principles and practice.
Students demonstrated lack of professionalism such as lateness, poor communication, lack of follow through with patients or team members. Students were unresponsive to feedback given throughout the elective.
Students did not attempt to develop rapport with patients or staff and did not develop and understanding of SDOH and how they impact patient lives.