ME540M.3

Outpatient Care of Patients with Down Syndrome Across the Age Spectrum

Credits: 4.00 CREDITS (Clinical Elective)
Directors: Schwartz, Alison
Offered: Full time every month, except December.
Open to Exclerks: Yes (may be restricted for international students)
Description:
This course is intended to provide advanced medical students with an exposure to the care of patients with Down syndrome across the age spectrum. People with Down syndrome typically have a number of health needs that arise from their chromosomal condition, which alters the screening tests and milestones that must be considered in the course of a regular clinic visit. They can also present with an array of developmental and pathological issues that require special attention. A global and holistic approach to their care demands that the health practitioner involve family members, school and/or work peers, social networks, expert medical consultants, and allied health professionals in the shared goal of supporting them to achieve their full potential and enjoy the best quality of life. The student will attend clinic sessions for newborns/toddlers, children, and adolescents at Boston Children’s Hospital ; infants, children, young adults, and adults at the Massachusetts General Hospital Down Syndrome Program; older adults at the Beth Israel Deaconess Medical Center and the Mclean Hospital, Aging and Developmental Disabilities Clinic In addition, observerships will be secured at specialty clinics that address medical issues more common in Down syndrome (e.g., obstructive sleep apnea, celiac disease, Alzheimer’s disease, cardiology), and home visits will be scheduled with participating host families. The student will be provided with a Reader that includes best practices in the care of people with Down syndrome and will attend regularly scheduled conferences at the various clinical sites where the rotation will be held. The rotation is entirely outpatient-based, although the student will be welcome in attending an occasional inpatient consultation were it to arise during the course of the rotation. There is no overnight or weekend call. Participation in ongoing clinical research activities is available but not required. Evaluation will be based on clinical performance (70%) and a final project (30%).
Learning Goals:
The student will develop an appreciation of the health conditions that occur disproportionately in people with Down syndrome at the various stages of their lives.

The student will learn the recommended guidelines for routine health screening in patients with Down syndrome across the age spectrum.

The student will assimilate best practices in clinical interactions with patients who have a cognitive disability, incorporating a patient-centered approach, broadening the goals of care, and employing people-first language.

The student will improve his/her skills in interacting with other health-care professionals in a multi-disciplinary environment.
Incorporation of Basic Science Content and Evidence-Based Medicine:
The American Academy of Pediatrics has developed clinical guidelines on the care of people with Down syndrome at all stages of development. These guidelines, which are based on expert opinion, clinical practice and the available literature, are constantly being updated; they have been implemented across the clinical sites that will participate in this rotation. The student will be provided with the most current set of guidelines and other recommendations issued by expert panels. During this process, the student will also identify knowledge gaps that could benefit from dedicated formal study, as a way to understand current limitations in the field and potential opportunities for research.
Evaluation:
Faculty that interacts with the student will be contacted during the last week of the rotation so that HMS evaluation forms can be collected from all (electronically and on a confidential basis). In addition, those attending the student's final presentation will be asked to provide a written evaluation of the presentation. A summary of all evaluations will be composed, and an Evaluation Committee composed by Drs. Schwartz, Florez, Lai, Moran, Davidson, and Skotko, will reach a consensus on the student’s final grade.
Grade Criteria:
High Honors:
Consistently exceeds expectations. Superb fund of knowledge. Exceptional physical examination skills. Outstanding rapport with the patient, his/her family and other professionals. Keen intellectual curiosity as evidenced by personally initiated searches of the primary literature. Utmost professionalism in all interactions. Sensitivity and empathy toward persons with disability. Compelling final presentation.

Honors:
Consistently meets expectations, and often exceeds them. Stage-appropriate fund of knowledge and physical examination skills. Good rapport with the patient, his/her family and other professionals. Intellectual curiosity as evidenced by outside reading. Professionalism in all interactions. Sensitivity and empathy toward persons with disability. Excellent final presentation.

Satisfactory:
Meets expectations. Acceptable fund of knowledge and physical examination skills. Adequate rapport with the patient, his/her family and other professionals. Intellectual curiosity as evidenced by responsiveness to teaching materials. Professionalism in all interactions. Sensitivity and empathy toward persons with disability. Good final presentation.

Unsatisfactory:
Often fails expectations. Inferior fund of knowledge. Physical examination skills below academic level. Inability to achieve rapport with the patient, his/her family and other professionals. Lack of initiative. Unprofessional interactions. Insensitivity toward persons with disability. Shoddy final presentation.
Copyright © 2014 by the President and Fellows of Harvard College