Below is a comprehensive list of all electives open to visiting students for the 2017-18 academic cycle. All rotations must coincide with our academic calendar. Please note that not all electives are offered every month. All visiting applications are processed through VSAS.
Vanderbilt's VSAS application opens March 15, 2017 to begin receiving applications.
ANES-5610: Perioperative Medicine and Surgical Home
This course is designed to emphasize the concepts of oordinated perioperative medicine and enhanced recovery after surgery (ERAS). Evidence-based guidelines, optimization/ standardization of perioperative care, and multimodal strategies to decrease post-operative morbidities are key components of ERAS. The student will function as integral part of the Perioperative Anesthesia Consult Service and learn fundamental aspects of anesthetic care that maximize perioperative pain control and reduce morbidity and healthcare costs related to cardiac, pulmonary, renal, endocrine, PONV complications or surgical site infections. The student will have an opportunity to be involved in the preoperative, intraoperative, and postoperative management of surgical patients on ERAS pathways.
ANES-5611: Advanced Clinical Anesthesiology
This ACE will define the role of Anesthesiology as a Perioperative Medicine Specialty in which students will gain broad understanding of the perioperative management of patients across all age groups undergoing surgical procedures. Course content will emphasize the following principles: preoperative assessment, development and execution of an anesthetic plan (including induction of anesthesia, airway management, maintenance of anesthesia, and emergence), and management of acute pain. Students will become an integral part of an anesthesia care team model (attending anesthesiologist and resident). Working side-by-side with this care team, students will learn and actively participate in the anesthetic management of patients presenting for surgical procedures and diagnostic or therapeutic interventions.
EM-5950: Emergency Medicine
“Is there a doctor on the plane?” Emergencies happen in all specialties and even in life. The 4 week Emergency Medicine course will introduce the student to emergency medicine and the initial management strategies for common life threatening emergencies. Students will develop an approach to common undifferentiated patient complaints and a practical skill set in: acid-base emergencies, basic airway management, electrocardiogram interpretation, and electrolyte emergencies. Students will also complete Basic Life Support (BLs) and Advanced Cardiac Life Support (ACLS) training. During the week, there are daily didactic sessions as well as procedure labs and high fidelity simulations. Clinical shifts are spread across a variety of practice settings (adult and pediatrics) and offer a broad exposure. Students work closely with emergency medicine faculty and residents to identify sick patients and develop differential diagnoses and management plans. Students also have the opportunity to participate in procedures and trauma resuscitations.
MED-5610: Clinical Nephrology
This experience is designed to give the immersion phase student significant experience in practical clinical nephrology and prepare him or her for future house staff training. Students will participate in daily rounds with the nephrology attending, the nephrology fellow, and the medical resident assigned to the Vanderbilt Hospital nephrology service or the VA nephrology service. Patients with various clinical disorders including fluid and electrolyte abnormalities, acid-base disturbances, glomerular diseases, and disturbances of renal function, including acute and chronic renal failure, will be seen and discussed. Students will have the opportunity to perform renal consults and present patients to the rest of the rounding team. Frequently, the nephrology service is requested to perform emergency consultation which requires acute hemodialysis or acute plasmapheresis. Students may participate in these acute consultations, assist with acute dialysis catheter placement, and develop an understanding of renal emergencies and their treatment.
MED-5613: Critical Care
This course is a four-week experience in multidisciplinary critical care medicine from the perspective of internal medicine. The student will be expected to fulfill much of the role of a junior level house officer, but will be closely supervised by interns, residents, and a senior critical care fellow, as well as a critical care attending. The unit is a very active critical care facility which manages a wide variety of medical emergencies using extensive monitoring and support equipment. The emphasis is on pulmonary disease, infection, and renal dysfunction, but covers all aspects of critical illness, including endocrinology, nutritional support, cost containment, and ethical issues. Teaching rounds are given daily, and these are supplemented with didactic lecture-discussions several days each week.
MED-5655: Geriatric Medicine
The intent of this course is to provide students with an advanced educational experience in geriatric medicine. Students will gain familiarity with multiple geriatric syndromes: polypharmacy, gait instability, dementia, fragility, pain management, pressure sores, incontinence, osteoporosis; appreciation for continuity of care across different levels of care; and the ability to differentiate between normal aging and disease processes. Students' knowledge of ethical issues will also be enhanced including patient autonomy, driving, and elder abuse. Students will also be able to identify and use community resources effectively, assess and treat multiple geriatric syndromes, organize management of multiple acute and chronic diseases simultaneously, and communicate sensitively and effectively with older persons and caregivers.
MED-5680: Infectious Diseases
Students will participate as part of the inpatient infectious diseases consultation service for at least two weeks of their rotation. They will be active participants in the initial evaluation, management, and follow-up of patients on the consult service. They should gain competence in diagnostic skills and in the management of infected patients, including the choice and use of antibiotic therapy. Special emphasis will be placed on understanding the epidemiology, pathophysiology, and natural history of infectious diseases. Students will also have a comprehensive experience in the care of HIV patients by participating in both the inpatient and outpatient settings. This portion of the experience will involve spending time at the Vanderbilt Comprehensive Care Clinic (Vanderbilt's outpatient HIV clinic) and/or the inpatient Rogers Infectious Diseases service (the inpatient service that serves the majority of HIV-infected individuals). While in these settings, students will spend time with many members of the HIV care team, including pharmacists, dieticians, clinical pharmacy nurses, case managers, and others to better appreciate the multidisciplinary care needed to address medical comorbidities, medication adherence, psychosocial issues, and other issues pertinent to HIV-infected individuals. Learning opportunities in the course will include live sessions in the form of core content lectures, grand rounds, and/or small groups; online lectures; and recommended readings. Core infectious diseases and HIV/AIDS topics will include antibiotic selection and pharmacology; skin and soft tissue infections; endocarditis; opportunistic infections; HIV antiretroviral therapy; and others.
MED-5735: Palliative Care
Students will rotate through VUMC, the VA Hospital, and community hospice agencies under the supervision of palliative care specialists. Students will follow their own patients and work with an interdisciplinary team (IDT). This opportunity will allow students to learn and apply the fundamentals in pain and symptom management, how to communicate at the end of life, care of the dying patient, and hospice criteria. Students will spend roughly two weeks with the VUMC consult service, one week at the VUMC Palliative Care Unit, and one week at the VA. They will also work several days with community hospice members, child life specialists, chaplains, case managers, social workers, and nurses. At VUMC and the VA Hospital, students will work with the inpatient consultative team and see patients throughout the hospital from all disciplines of medicine assisting in symptom management, advanced care planning, and hospice information. During their time with hospice, they will accompany members of the IDT on home visits and learn more about their various roles in end of life care. The palliative care physicians and nurse practitioners will supervise and evaluate the students on the basis of the six clinical core competencies as delineated by the ACGME. Creative structuring will allow students to make modifications to the rotation to meet individual needs.
MED-5740: Pulmonary Consult
This course consists of seeing all pulmonary consultations at VU Hospital, presenting the cases to conferences and rounds, participating in pulmonary laboratory testing, fiberoptic bronchoscopy, and cardiopulmonary exercise testing, and attending joint pulmonary conferences. Case mix includes chronic obstructive pulmonary disease, pulmonary renal syndromes, vasculitis, sleep apnea, pulmonary nodules, infectious and non-infectious pulmonary infiltrates.
Time will be spent primarily and rheumatology clinic at the Vanderbilt clinic in the VA Hospital (VAH). Students will have an opportunity to be involved in the consultation from the hospital with the rheumatology team at VUMC and VAH. Students will have an exposure to several clinics with different rheumatologists each day, and they will observe patient evaluations and treatments. Materials for study will be given. There will be an expectation from a student to perform patient assessment especially in terms of history taking and physical examination focusing on rheumatology. Students will have an opportunity to attend all rheumatology conferences, in both clinical and research meetings.
MED-5780: Medical Oncology
This advanced clinical experience will provide the student with a broad overview of clinical oncology. Inpatient exposure will be centered at Vanderbilt Hospital, where the student will assist in the evaluation of new oncology service admissions and new consultations. The student will make morning rounds and present new cases to the oncology attending. In addition to inpatient exposure, the student can attend two to three outpatient clinics per week. During the rotation, the student will also attend the Division of Oncology conferences at Vanderbilt.
MED-5790: Clinical Dermatology
This clinical experience will be in the outpatient clinic setting and the inpatient consultation setting with direct faculty interaction. The location of clinic assignments will be in the VU Dermatology Clinic at Vanderbilt One Hundred Oaks and the Dermatology Clinic at the Nashville VA Hospital. There will be participation in weekly conferences specifically for the rotators on the clerkship. The didactic lectures during the month will focus on the identification, treatment, and management of common dermatologic diseases. The clinical experience will reinforce the lectures plus give insight into the role of the dermatologist as a consultant for less common and difficult to treat conditions.
NEUR-5612: General Neurology
Students will participate in a four-week general neurology advanced clinical experience that will have a flexible schedule to allow students to pursue specific interests. The schedule will be individually tailored through discussion/planning with the ACE director and involve participation in the following venues: outpatient clinic, general inpatient neurology service and adult neurology consult service. Students may choose to spend all four weeks in one venue or put together a combination of two or three venues.
Students will participate in a four-week stroke advanced clinical experience that will involve inpatient, outpatient and procedural activities. The main venue of participation will be the inpatient stroke service where students will be responsible for carrying a census of patients (presenting on rounds), going to and assisting with stroke alerts, and participating in the education of clerkship students on the service. Students will also have the opportunity to go to stroke clinic and the angiogram suite to learn about and observe diagnostic angiograms and intra-arterial procedures. Students will also attend the weekly multidisciplinary cerebrovascular conference, and spend time with the Neuro ICU team. Students will be expected to stay for overnight call at least two times during the four-week rotation.
OBGN-5630: Maternal Fetal Medicine
During this rotation, the student receives advanced training in high-risk obstetrics at the student level. Students may help to direct either the outpatient, antepartum,or inpatient peripartum care of women with common complications of pregnancy, including preterm labor, pre-gestational diabetes, chronic hypertension, PPROM, and preeclampsia. By the end of the rotation, the student should be familiar with common complications of pregnancy and be confident in delivering directed and concise patient assessments and treatment plans. Inpatient learning activities include daily MFM teaching rounds, inpatient service responsibilities with the resident team, and appropriate OR experience. Outpatient learning activities include MFM consult and return clinics, obstetric ultrasound, and genetic counseling. Students will interact with the MFM faculty, OB house staff, midwives, and generalist faculty. Over the course of the rotation there will be four (4) overnight L&D calls and two (2) independent presentations on a topic of interest with an identified MFM preceptor.
OBGN-5655: Gynecologic Oncology
During this rotation, the student receives training in the management of gynecologic oncology patients. The student will participate in the evaluation and treatment of patients, gaining experience in surgery, colposcopy, pathology, chemotherapy, and radiation techniques. Learning activities include pre-operative and post-operative care of surgical patients, assistance in operative cases, and attendance in oncology attending clinics. Students will assist in the case of admitted patients under the direct supervision of the resident team and faculty. Overall goals include familiarity with staging of gynecologic malignancies, treatment modalities, and prognostic indicators affecting survival.
OBGN-5660: Female Pelvic Medicine and Reconstructive Surgery
During this rotation, the student receives training and practical experience in the diagnosis and management of pelvic floor defects and dysfunctions. The student will participate in outpatient evaluation, preoperative planning, surgical management, and post-operative follow-up of operative cases. There is also exposure to conservative treatment modalities including pelvic floor physical therapy and insertion of pessaries. History and physical exam in the setting of pelvic floor defects are particularly emphasized.
OBGN-5665: Operative Gynecology
During this rotation, the student receives training in the management of gynecologic surgery patients. The student will gain experience in general gynecologic surgery and work closely with the residents, fellows, and attendings to provide postoperative care. The student will also participate in inpatient consultations and decision-making regarding urgent gynecologic care.
PATH-5620: Anatomical Pathology
This four week Advanced Clinical Experience is designed to provide in-depth exposure to the practice of anatomic pathology via a mixture of services and is an ideal way to gain additional insight into the field for both those students considering pathology as a career and those who plan to pursue clinical specialties which frequently make use of pathology services. Depending on specific student interest and service availability, the setting for this clerkship may include the sub-specialty-oriented surgical pathology service at VUMC, the general surgical pathology service at the VA Hospital, the cytopathology service at VUMC, the pediatric surgical pathology service at Monroe Carell, Jr. Children's Hospital and the autopsy pathology service at VUMC. Emphasis is placed on introducing the student to the methods of specimen processing, evaluation and diagnosis in anatomic pathology with a particular focus on the relationship that anatomic pathologists maintain with clinical colleagues in the context of patient care efforts. Opportunities will exist for students to see a range of specimen types from fine needle aspiration biopsies to multi-organ resections and full autopsies. Students will work closely with pathology residents and fellows and will participate in a variety of tasks including pathologist performed biopsies, intra-operative consultations, gross specimen evaluation and selection of histologic sections for microscopic review. Additionally students will preview microscopic slides and dictate draft reports for selected cases and will subsequently participate in case review, ancillary test ordering/evaluation and final case sign out with the attending pathologist. Students will be expected to attend the various intradepartmental educational conferences in anatomic pathology as they occur.
PATH-5630: Clinical Pathology
Clinical pathology (also known as Laboratory Medicine) includes diverse laboratory services that provide diagnostic testing for all areas of medical practice. Services include transfusion medicine/blood bank, clinical chemistry, special chemistry (including toxicology), hematology and urinalysis, special hematology (bone marrow and lymph node analysis), coagulation, microbiology, virology, molecular infectious disease, molecular genetics, cytogenetics, and immunopathology (including flow cytometry). The student may rotate in one or multiple labs with training individualized according to their interest and future plans. Training consists of a mixture of observation and both didactic and case-based learning. At the end of the rotation, the student will have an understanding of efficient use and interpretation of diagnostic and monitoring tests in the areas of the lab through which the student has rotated.
PATH-5650: Clinical Microbiology
Medical microbiology is the subspecialty of pathology concerned primarily with the laboratory diagnosis, treatment, and control of infectious diseases. Medical students with an interest in medical microbiology, pathology, or infectious diseases may elect to do a rotation in medical microbiology. Formal training in medical microbiology at VUMC is administered by the Department of Pathology, Microbiology, and Immunology and consists of an integrated program of experiential and theoretical education in the laboratory diagnosis and management of infectious diseases. The program is designed to provide concurrent training in the technical, mechanistic, consultative, managerial, administrative, and pedagogical aspects of clinical microbiology throughout the pathology residency period. Thus, medical students and pathology residents are placed in a learning environment that synthesizes the spectrum of clinical microbiology precepts within the daily routines and reinforces fundamental interconnections between clinical infections diseases, microbial pathogenesis, and laboratory diagnostic approaches. Further harmonization of concepts in medical microbiology is achieved via consistent, direct mentoring of trainees by program faculty, medical student and resident participation in conferences covering relevant topics in infectious diseases and diagnostic microbiology, and progressive increases in trainee responsibility commensurate with experience. The goal of individual rotations is to foster a detailed understanding by trainees of the biochemical, molecular, genetic, analytical, and engineering principles of contemporary testing methodologies and link these insights to the pathophysiology, clinical presentation, therapy, and prevention of microbial diseases.
PED-5612: Adolescent Medicine
Adolescent Medicine is a unique subspecialty in pediatrics in that it combines both primary care with consultative care for adolescents and young adults ages 12 to 22 years of age. During this ACE students will have the opportunity to learn comprehensive care of the adolescent using both a primary care and a multidisciplinary team approach. Students will have the ability to function within the Adolescent/Young Adult Clinic and will be exposed to a multidisciplinary team which includes a social worker, nutritionist and psychiatrist in conjunction with an adolescent medicine physician. At the end of the course, students will feel comfortable performing a complete psychosocial assessment of an adolescent using the HEADDSS assessment tool. They will have the opportunity to provide primary and basic gynecologic care for adolescents to include (1) how to perform a sports clearance exam; (2) how to take an appropriate menstrual history and screen for menstrual disorders; (3) how to take an appropriate sexual history; (4) how to counsel an adolescent on contraception. Students will also gain experience in the care of adolescents/young adults with eating disorders and major depression. Evaluations will be based on the student's ability to take a complete and appropriate history/physical and develop a cohesive and appropriate treatment plan. This course will fulfill the primary care requirement.
PED-5615: General Pediatric Neurology
Course description to come.
PED-5620: Pediatric Epilepsy
Pediatric Epilepsy Advanced Clinical Experience (PEACE) is an exciting multi-disciplinary specialty that encompasses pediatric neurology, neurosurgery, neuroradiology and neuropathology. Patients present with seizure onset ranging from birth into young adulthood. While due to many etiologies, most patients do well with standard medications achieving excellent seizure control. However, a substantial subset requires additional evaluations as well as dietary or surgical approaches. PEACE students will function within inpatient and outpatient clinical teams, as well as participate in divisional teaching conferences and also learn basic EEG reading skills. PEACE students will (1) deepen their understanding mechanisms causing epilepsy in children, (2) learn the basic principles of EEG reading and medical management of epilepsy in children, and (3) participate in multi-disciplinary evaluations of patents with epilepsy and participate in neurosurgical assessments and procedures.
PED-5635: Pediatric Hematology/Oncology
Once students have finished this ACE, they will have a better understanding of the pathology, treatment, and survival of common childhood cancers. They will also gain experience in working up and treating anemias and bleeding disorders. These objectives are accomplished through a combination of inpatient time and outpatient time. Half of the course will be on the inpatient service where the students will be expected to follow their own patients, present on rounds, write daily progress notes, and prepare a short 10-15 minute discussion of a patient of interest. The student should also participate in walk rounds with the fellow and faculty for more informal discussion. The other half of the course will be in the outpatient clinic. While there, the student will see both new patients and patients returning for therapy. The student will take a history from the family, perform a physical exam, interpret lab tests, present these patients to the faculty, and write notes. The student will also have the opportunity to attend "specialty" clinics to see a group of patients with a focused set of problems (for example sickle cell clinic).
PED-5680: Pediatric Cardiology
The advanced clinical experience in pediatric cardiology is a four week course that aims to expose medical students to the broad spectrum of cardiac disease in children. The students will spend two weeks on the inpatient service getting exposure to acute cardiac disease and their care during perioperative period. Students will be responsible for examining patients, presenting in rounds, and participating in the team care of the patients. An additional two weeks will be spent focusing on the outpatient side of cardiology. The student will participate in a variety of different cardiology outpatient clinics. Throughout the experience, the student will have the opportunity to accompany the inpatient cardiology fellow on inpatient consults. There will also be opportunity to watch cardiac catheterizations, watch a cardiac surgery, and spend time in the echocardiography laboratory.
PED-5690: Pediatric Endocrinology
Pediatric Endocrinology is a wonderful sub specialty of Pediatrics which involves studying about and caring for patients who have abnormalities involving hormonal regulation of basic body systems. Students will study physiology, pathology, molecular biology, genetics and pharmacology during the time they care for these patients. Some examples of endocrine disorders they will be expected to learn about will include: growth and pubertal disorders, disturbances in calcium homeostasis, hypo and hyperthyroidism, adrenal disorders, some disorders of sexual development and common disorders of glucose regulation. Students will also learn about how to manage acutely ill pediatric diabetes patients in the hospital setting and they will learn the fundamentals of chronic, out-patient diabetes management. Under the supervision of the endocrine attending physician, students will see patients in the out- patient endocrine and diabetes clinics, and they will be an integral part of our ward team on the inpatient Endocrine service.
PED-5710: Pediatric Gastroenterology
The Pediatric Gastroenterology Advanced Clinical Experience (ACE) provides exposure to a broad range of gastrointestinal, nutritional, and liver diseases in both the inpatient and ambulatory settings. Students will have the opportunity to observe and participate in outpatient evaluations of infants and children referred to the pediatric gastroenterology clinic under the direct supervision of faculty attending pediatric gastroenterologist, attend endoscopic procedures, participate in inpatient pediatric gastroenterology inpatient care and consults, and attend scheduled divisional didactic conferences. The rotation provides students with experience in the workup of common pediatric symptom complexes such as abdominal pain, vomiting, diarrhea, jaundice, and many other common complaints, as well as the opportunity to participate in multidisciplinary care of complex gastrointestinal disorders such as inflammatory bowel disease and chronic liver disease. Attendance in the endoscopy suite allows familiarity with esophago-gastroduodenoscopy, colonoscopy, polypectomy, and rectal suction biopsy. The rotation will include core reading on the pathophysiology and management of important gastrointestinal diseases such as inflammatory bowel disease, biliary atresia, and short bowel syndrome. The student will prepare one in-depth talk on a gastrointestinal topic of their choice and receive feedback from the attending on the content and delivery.
PED-5720: Pediatric Nephrology
Pediatric Nephrology is an exciting specialty that functions at the intersection of renal physiology, pathology, anatomy, genetics, pharmacology, and immunology. Students who participate in this Advanced Clinical Experience will actively participate in the evaluation and management of patients who demonstrate the consequences of alterations in renal development and the genes that direct development. Students will have the opportunity to see in inpatients and outpatients with acute and chronic alterations in renal physiology including those with acute kidney injury, hypertension, glomerulonephritis, and chronic kidney disease in addition to those with congenital abnormalities of the kidney and urinary tract. Advanced understanding of renal physiology and pathophysiology will be an asset in any career path, because the kidney controls homeostasis for the entire body.
PED-5740: Pediatric Pulmonary Medicine
Students in this course will participate in consultations on children referred for evaluation of lung disease in the hospital and in the outpatient clinic. The purpose of this ACE is to provide the student with expertise in the clinical evaluation of pulmonary disease in infants, children, and adolescents, and students will gain expertise in the relevant history, physical exam findings, and diagnostic testing used in a pulmonary evaluation. Participation in multi-disciplinary clinics in cystic fibrosis, bronchopulmonary dysplasia, and asthma will facilitate training in caring for children with chronic lung diseases. Didactic experiences that will reinforce the patient care experiences include our weekly Pediatric Pulmonary Imaging Conference, our weekly Pediatric Pulmonary Core Curriculum Conference, and other monthly conferences that constitute our fellowship training program. Students will have the opportunity to participate in bronchoscopies.
PED-5760: Spanish Language Pediatric Clinic
Demographics in the USA are changing and Latinos are now the fastest and largest growing minority group in the United States. Students need to be prepared to provide effective care to Spanish speaking population. This ACE offers student the opportunity to function within the Primary care pediatric clinic as they participate in well-child visits and acute visits for Spanish speaking families, as well as exposes students to community resources that are targeted to this population. The course will focus on 1) enhancing students’ fluency in Spanish, 2) learning appropriate medical terminology for developmental screening, anticipatory guidance, and explaining disease processes, 3) learn about immigrant experience (Immigration process, Barriers to access to care, Education and Culture), and 4) Explore various views of disease within this population, including alternative health beliefs, use of alternative medicines and therapies, and traditional interaction with medical professionals. In addition student will be expected to participate in a small project.
Neonatologists care for newborns with a wide variety of conditions, ranging from prematurity to surgical conditions, infections to congenital cardiac disease, and respiratory distress to genetic disorders. Students in this rotation will work in the Children's Hospital Neonatal Intensive Care Unit on the Red Team. The Red Team cares for patients primarily with congenital heart disease, surgical and genetic disorders. This team does not attend deliveries. The AI will provide care for 3-5 patients with a wide range of conditions. The AI will be expected to pre-round on all patients, write orders and assist with TPN orders, review X-rays and lab results and contact and interact with consultants. He or she will be required to write History and Physicals, Daily Progress Notes, and Discharge Summaries.
This is a high intensity Acting Internship (AI) with very complex and sick infants and is only recommended for the highly motivated and extremely responsible AI with an interest in neonatal medicine. It is best suited for the student considering a career in neonatology or pediatric critical care or a another pediatric subspecialty. Schedule is 6am-6pm six days per week. There is no overnight call. Days off are scheduled with team members upon starting the rotation. Daily multi-specialty rounds starts with both cardiology and NICU attendings at 8:30am. Required lectures are Monday, Wednesday and Thursday mornings at 7:45-8:15am and weekly simulation sessions are generally on Fridays 7:45-8:30am.
Topics which will be covered and which the AI must read about include: respiratory distress syndrome, ventilator management, surgical conditions in the newborn, congenital heart disease in the newborn, nutrition of the premature infant, apnea of prematurity, jaundice and anemia in the newborn. The AI must set up biweekly review with his or her NICU attending at beginning of rotation to review written notes and daily performance. He or she will also be required to give a weekly brief talk to the team on a relevant topic of choice. Recommended reading is Fanaroff and Martin’s Neonatal-Perinatal Medicine, which is available through the digital library. Volume 2 contains the conditions by organ system.
PED-5830: Pediatric Emergency Medicine
Pediatric Emergency Medicine physicians need to be prepared to care for minor ailments to life-threatening events. The Pediatric Emergency Department rotation will expose students to a wide variety of patient pathology in a fast paced setting. Students will simultaneously obtain a history and perform a physical exam on pediatric patients from newborn to adolescence. Under the direct supervision of attendings, fellows and senior residents, students will exercise critical thinking and develop differential diagnosis, management and disposition for pediatric patients presenting with medical illnesses, surgical workups, and traumatic injuries. The course will focus on common infectious diseases, pediatric surgical/orthopedic emergencies and toxicology emergencies. The student will increase their communication skills with children, families, consultants and emergency medicine staff. Students will participate under supervision in common procedures in pediatric emergency medicine such as suturing, sedation, and splinting of extremity injuries. Students work fifteen, 8 hour shifts which may include weekends and overnights. Students may also participate in weekly fellow conferences as well as journal clubs and simulation scenarios.
PED-5910: Pediatric Infectious Diseases
The Pediatric Infectious Diseases (PID) Advanced Clinical Experience (ACE) provides students the opportunity to evaluate and participate in the management of children with a wide range of suspected or proven infectious diseases. The PID rotation allows the learner to gain experience in the workup of common symptom complexes such as prolonged fever, joint pain / limp, respiratory illnesses, rash, and many other common pediatric presentations. The rotation also provides valuable experience in the pharmacology and pharmacodynamics of antimicrobial agents, as well as the proper use and potential adverse effects of these commonly prescribed drugs. The rotation will include core reading on the pathophysiology and management of infectious diseases such as meningitis, osteomyelitis, and pneumonia. Students will actively participate in the evaluation and management of children on the PID service in both the ambulatory and inpatient settings.
PED-5990: Pediatric Critical Care
Pediatric Critical Care is an exciting specialty that cares for the sickest patients from birth into young adulthood. The Pediatric Intensive Care Unit (PICU) and the Pediatric Cardiac Intensive Care Unit (PCICU) both offer unique blends of physiology, pharmacology and pathology in disease processes ranging from to sepsis, respiratory failure, and traumatic brain injury to congenital heart disease and its repair. Students will have the opportunity to function within the PICU and/or PCICU clinical teams, as well as participate in divisional teaching conferences. The course will focus on enhancing student clinical practice-based learning skills. Students will have the opportunity to (1) deepen understanding of the complex pathophysiology of critically ill children, (2) learn the basic principles of multidisciplinary management and resuscitation of critically ill children, and (3) review common diseases seen in a busy pediatric critical care unit. Additionally, students will be expected to stay for overnight call at least four times during the four-week rotation.
PMR-5611: Introduction to PM&R
Hands-on exposure to the practice of physical medicine and rehabilitation (PM&R) with an emphasis on musculoskeletal and neurological rehabilitation is offered in this course. Many of our patients have had acute illness, trauma, surgical procedures, and hospitalization and the student will have an opportunity to follow the patients post-acutely. The primary responsibility is the care of those patients with spinal cord injury, stroke, amputations/complex fractures, multiple trauma, traumatic brain injury, and general debilitation. The attending physician on the PM&R Service will define participation in patient care. The student will be expected to  participate in the evaluation, functional diagnosis, and treatment of individuals with significant impairment and disability who require long-term hospitalization to achieve maximal independence and  Integrate medical and surgical knowledge in the care of patients in the hospital for rehabilitation and in the outpatient clinic. Additionally, adult and pediatric outpatient clinics are available to expose students to the long-term problems which these patients encounter.
This advanced clerkship (elected after completing rotations in both neurology and psychiatry) is an introduction to clinical practice and research at the interface of psychiatry and neurology. Under supervision, the student will examine patients with psychiatric and neurologic diseases affecting emotions, such as temporolimbic epilepsy, frontal lobe lesions, strokes in the non-dominant hemisphere, or degenerative conditions such as Alzheimer's Disease, Parkinson's Disease, vascular dementia, and Huntington's Disease. Readings will focus on the neurology of emotion, including functional neuroanatomy, experimental neuropsychology, and electrophysiology. The student may participate in research protocols involving quantitative behavioral assessment, autonomic measures, and structural and metabolic imaging of the brain. Each experience in this clerkship is unique and will be tailored to the specific interests of the student. Consequently, we can only accept one student per rotation.
PSYCH-5625: Child and Adolescent Psychiatry Consult-Liaison
This advanced clerkship is an introduction to clinical practice as a consultation liaison psychiatrist working with children and adolescents. Under supervision, the student will examine patients with psychiatric diseases complicating pediatric management including delirium, catatonia, anxiety and mood disorders both complicating pediatric illness and mimicking pediatric illnesses (somatoform disorders), management of chronic pain in collaboration with the pediatric pain team, acute stress and post traumatic stress disorder on the trauma service and in the intensive care unit, and psychiatric consultation regarding eating disorders. Readings will focus on the neurobiology of trauma and the neurobiology of the interface between emotions and physical disorders. The student may participate in research studies if available at that time.
PSYCH-5640: Psychotic Disorders
Psychosis (i.e., delusions, hallucinations, disorganized thought and behavior) is a cardinal feature of several psychiatric disorders. This ACE emphasizes a clinical appreciation of psychosis and training in the use of diagnostic instruments for clarification of psychotic symptoms. The course can be tailored to the interests of the student by dividing time among inpatient treatment units and routine outpatient offices, in both clinical and research environments. Activities under the purview of the faculty (including Drs. Heckers, Amison, Stovall, Clark, Maley, Peters, Jacobs and Woodward) include a) participation in assessments and treatment planning and b) exposure to neuroimaging and cognitive neuroscience research. The student will be expected to prepare and lead a journal club meeting or case presentation relevant to one of these settings for an audience of attendings and peers.
PSYCH-5645: Adult Psychiatry Consult-Liaison
The Adult Psychiatry Consultation Service at VUMC provides psychiatric services for a broad range of patients with psychiatric and neuropsychiatric disorders in the context of medical, surgical, and obstetric (and other) inpatient settings at Vanderbilt University Hospital and Stallworth Rehabilitation Hospital. Our service is one of the busiest in the country and offers an opportunity to see the intersection of psychiatric conditions with medical illness. Commonly treated conditions include delirium, dementia, depression, anxiety, suicide attempts, substance withdrawal, conversion disorder, somatic symptom disorder, and factitious disorder. Regardless of the diagnosis, we also help with agitation management and capacity evaluation. The sub-intern will become an integral part of the team, with assigned primary focus on the care of a discrete set of patients, and will be directly supervised by Psychosomatic Medicine fellows and Psychiatry attendings. A practical focus on areas of special interest to the student may be arranged.
RAD-5610: Diagnostic Radiology
Students will rotate through all diagnostic subspecialties in radiology, getting a broad exposure to various pathologies and imaging modalities. The purpose of this course is to acquaint medical students with the fundamentals of diagnostic imaging and to highlight optimal imaging pathways for various clinical conditions. Other key topics such as ionizing radiation risks, contrast media, the strengths, limitations, and relative costs of the various imaging modalities, management of equivocal findings and negative examinations, the importance of open communication between clinicians and radiologists, and basic use of the PACS workstation will be covered as well. The course is designed to be relevant and suitable for all medical students, regardless of their ultimate career choice or interests; this course is not designed solely for students interested in pursuing a career in radiology. Besides getting daily instruction in the reading rooms by faculty, fellows, and residents, students will be engaged in a number of other educational activities. Students will watch Radiology faculty lecture podcasts on various topics, complete reading assignments, attend live lectures presented by radiology residents, attend daily Radiology noon conferences, solve weekly unknown case challenges, and prepare a final “unknown case” presentation. The course has a pre-test and a final exam.
RAD-5630: Pediatric Radiology
This course will introduce the medical student to the principles of diagnostic imaging in a children's hospital setting. The medical student experience consists of interactive reading room sessions covering all diagnostic imaging modalities, such as radiography, fluoroscopy, computed tomography (CT), MRI, nuclear medicine, and subspecialities in pediatric radiology such as neuroradiology and interventional radiology. The students have the opportunity to attend radiology teaching conferences and many interdisciplinary conferences which highlight imaging. In addition, we offer a host of self directed activities outside the reading room, such as recommended reading assignments, learning modules, and teaching files. The successful student will learn the radiologist role in the care of the patient and how to interact with radiologists, as well as the appropriate work up of common pediatric conditions. The importance of the clinical question in the role of choosing the best and most appropriate diagnostic imaging studies is emphasized.
The month will allow a broad exposure to the field of neuroradiology with a strong focus on review of clinically relevant neuroanatomy. The primary role of the student will be as an observer, working alongside residents, fellows and faculty as imaging studies are interpreted and procedures are performed. Students will be responsible for delivering a single informal presentation during the month.
RAD-5650: Adult Interventional Radiology
Interventional Radiology is an exciting, fast paced, advanced specialty performing minimally invasive procedures on virtually every organ in the body. This course provides an immediate immersion into the daily life of an IR. You will be involved in every aspect of treating patients, including outpatient clinic visits, researching and working up the patient the day of the procedure, presenting the patient in morning rounds, consenting and performing physical exams, scrubbing in on the procedure, admitting and post procedural care, inpatient rounds, and long term follow-up. You will also have the option to visit other specialty areas of IR, including Pediatric IR, the One Hundred Oaks Vein Center, and read CTA/MRA with our noninvasive vascular specialists. You will be required to research and present one case report while on the service. The typical day lasts from 7 am to 6 pm and there are no call responsibilities. Typical procedures include angioplasty and stent placement in the arteries and veins, embolization of bleeding, embolization of tumors, uterine fibroid embolization, bronchial artery embolization, gonadal vein embolization, chemo-embolization, percutaneous treatment of tumors (ablation), placement of nephrostomy, biliary, gastrostomy, venous catheters, and TIPS.
RADO-5620: Radiation Oncology
This 4 week clinical rotation in radiation oncology is designed for students who are interested in pursuing a career in radiation oncology. Students are integrated into the clinical workflow. They are assigned to work one on one with individual attendings covering all aspects of radiation oncology including malignancies of the head and neck, lung, breast, gastrointestinal, gynecological, prostate and brain. Students work with radiation oncology residents in the initial evaluation of patients, formulation of treatment, supervision of treatment, and follow-up evaluations. Students will learn indications and techniques for radiation therapy.With each new patient, the student will be expected to go in to see the patient first and obtain a basic history and physical. This will be presented to the resident who will then review these findings directly with the attending. The clinical team (resident/attending/student) will then discuss treatment options with the patient and formulate a treatment plan. At the conclusion of this course students will be able to take a focused oncologic history, perform a pertinent exam, and understand the basics of diagnosis, staging, and treatment options for cancer patients. They will learn about the multidisciplinary nature of oncologic care. At the end of the rotation students are required to give an oral presentation at the departmental teaching seminar.
Ophthalmology is a wonderful specialty, combining both medical and surgical care of the eye and the peri-ocular structures. The ACE will allow medical students to participate in care delivered at the Vanderbilt Eye Institute, the Nashville Veterans’ Affairs Hospital and the Vanderbilt University Hospital’s inpatient and emergency room. Through shadowing attendings and performing ophthalmic exams, it is expected at the conclusion of the ACE a medical student will be able to (1) perform a basic slit-lamp examination and a dilated fundus examination with a direct ophthalmoscope, (2) have a working understanding of the major etiologies of vision loss in the United States, including cataracts, glaucoma, age-related macular degeneration, diabetic retinopathy and amblyopia, and (3) accurately diagnose common ophthalmic issues, including corneal abrasions, conjunctivitis and acute-angle closure glaucoma. Additionally, the societal impact of loss of vision on a person’s activities of daily living, the reestablishment of independence following restoration of sight and the evolving role of the ophthalmologist providing this care should be appreciated by the medical student.
SURG-5611: General Orthopaedics
This course provides hands-on exposure to all aspects of orthopaedic surgery. The student will be able to integrate medical and surgical knowledge in the care of patients with musculoskeletal diseases in both inpatient and outpatient settings. Emphasis will be placed on initial evaluation, preoperative and postoperative management as well as intraoperative surgical procedures. Students will act as part of a multi-disciplinary team during this course. Students are also allowed to share the call experience where they are independently providing casting and splinting care and patient evaluations. . Exposure to musculoskeletal oncology and adult orthopaedics is incorporated. Didactic sessions are held for one hour each morning prior to surgical cases or clinic during which the student will be able to integrate medical and surgical knowledge in the care of patients.
SURG-5613: General Surgery (at the VA Hospital): Open to Meharry Medical College students only
Meharry students rotating on surgery at the Veterans Affairs Hospital can elect to spend time on general surgery, vascular surgery, cardiothoracic surgery, or a combination thereof. Students will be exposed to the full range of clinical activities of each of these services, and they will also have the opportunity to participate in preoperative evaluation, intraoperative management, and postoperative care. The student will actively participate in a weekly clinic. Each service has a full complement of conference activities, which the student will attend. There will be close observation of the student's activities by the house staff and the attendings. Weekly feedback will be provided for reflection. Students will have in-house overnight call at least four times during the four-week rotation and participate on morning ward rounds Saturday and Sunday twice during the four weeks. Workups, progress notes, and clinic notes will be read and feedback provided for the student’s reflection and improvement. The strengths of this ACE on VA Surgery include the residents and attendings, the active role of the student, the breadth of clinical exposure, and the personal coaching provided.
SURG-5614: Surgical Critical Care
The Surgical Critical Care Advanced Clinical Elective provides students with a multidisciplinary approach to care of the critically ill surgical patient. The units are very active critical care facilities with state-of-the-art monitoring and support technology. The course content emphasizes a physiologic approach to the care of critically ill general, vascular, transplant, geriatric, oncology, and emergency surgical patients. Students will gain experience with invasive hemodynamic monitoring, mechanical ventilation, enteral/parenteral nutrition, surgical infectious disease, and management of vasoactive medications. Topics such as cost containment, resource utilization, and medical ethics are an integral part of daily intensive care management. The patient care service consists of a surgical or anesthesia attending physician, a surgical critical care fellow, mid-level surgical/anesthesia residents, and surgical interns. Other staff available in the unit includes clinical pharmacists, respiratory therapists, and nurse practitioners. Teaching rounds are made each morning with didactic lectures and case-discussions Monday-Thursday. Friday morning attendance of surgical grand rounds and resident teaching conference is mandatory. A course syllabus containing management protocols and educational objectives is provided to all registrants. Evaluation of the student's performance is based on clinical knowledge, basic science application, integration into the team, and progression in learning throughout rotation. Mid-rotation and final evaluations of each student will be conducted by the critical care attendings, critical care fellow assigned to the unit, and the course director. This course fulfills the acute care requirement.
SURG-5615: Vascular Surgery
The field of Vascular Surgery has been markedly transformed over the last two decades, fueled by an explosion of technological advancement, research-supported clinical science development, and cross-disciplinary collaboration. Students enrolled in this ACE will experience a hands-on introduction to this rapidly evolving field by immersing themselves into the Vascular Surgery team at Vanderbilt Hospital. The engaged student can look forward to the prospect of caring for patients in the inpatient and outpatient settings, where he or she will learn about the various surgical manifestations and functional burdens imposed by atherosclerotic disease, aneurysmal disease, diabetes mellitus, and inherited disorders of the vascular and hematologic systems. As part of the care team, students may be asked to field consult requests from our affiliated services, and will have the opportunity to join the surgical staff in the operating theater to experience both open and endovascular surgery. By the end of this course, it is our sincere hope that the students develop an interest in pursuing a career in vascular surgery, or at least have a sound knowledge base that will help in the care of all aspects of adult medicine.
SURG-5617: Colon and Rectal Surgery
The Colorectal Surgery ACE focuses on the care of patients suffering from diseases and disorders of the colon, rectum and anus. This includes such diseases as colorectal cancer, anal cancer, inflammatory bowel disease, diverticulitis, colon polyps, and benign anorectal conditions. The goal of the rotation is to broaden the student’s understanding about the pathophysiology, clinical presentation, work-up and treatment of common colorectal diseases. The students will be exposed to all aspects of the care of the patient including evaluation in the clinic, pre-op teaching, operative management, post op care and discharge. Students will see a variety of surgical techniques including laparoscopic , open, and robotic cases as well as advanced endoscopic procedures and anorectal cases. Students will function as part of the colorectal team and will be assigned patients that they will follow throughout the duration of their hospital stay. They will be expected to participate on rounds as well as attend/present at the weekly colorectal surgery conference.
The hepatobiliary and liver transplant surgery rotation includes the full spectrum of benign and malignant disease of the liver, pancreas and bile ducts. This service allows exposure for rotating students to complex hepatobiliary anatomy and pathophysiology, including liver failure. Unique to this rotation is the opportunity to participate in organ procurements, a very popular operation amongst surgical students. Abdominal organ procurement offers unparalleled anatomic exposure to the abdomen and pelvis. Rotating students will participate directly in these operations and they have the right of first refusal on each procurement. As there is ample opportunity to see these operations, a waiting list is compiled for other students to travel for these operations, which are often off site. Students will have the opportunity to function as an integral member within the surgical resident clinical teams, as well as attend weekly clinics and teaching conferences, including Hepatobiliary Conference, Liver Transplant Selection Committee and Liver Team Walk Rounds. The course will focus on enhancing student clinical practice-based learning skills. Students will have the opportunity to (1) deepen their understanding of the complex anatomy and pathophysiology of the liver, (2) learn the basic principles of multidisciplinary management of liver failure, (3) review the differential diagnoses and therapeutic strategies for the liver mass and (4) understand the numerous complications seen after hepatobiliary and liver transplant procedures. Additionally, students will not be expected to stay for overnight call on a rotating schedule. However, given the emergency nature of procurements and transplants, after hour effort is common, as dictated by the on-call attending and resident staff.
SURG-5620: Neuro Surgery
Neurosurgery is a fast-paced, challenging field dedicated to the comprehensive treatment of critically ill patients with neurologic diseases. It is an incredibly diverse specialty, incorporating treatment of children and adults suffering from CNS tumors, cerebrovascular disease, movement disorders, spine disorders, peripheral nerve diseases, and trauma. Each student will spend their 4 weeks rotating through the 4 different neurosurgical services to gain a broad exposure to the field. Students will take part in the care of inpatients, the workup of consults, and the technical aspects of a variety of bedside and operative procedures. They will also attend several outpatient clinics and take overnight call with the junior resident on a Q4 schedule. Students will participate in career development sessions designed to prepare them for the residency application process and will give several short presentations to the clinical teams and the department throughout the rotation.
The Otolaryngology ACE is a surgical and medical course that offers immersion into the oldest medical speciality in the United States. This course deals with disorders of the ear, nose, and throat and involves the Head and Neck/Laryngology, Pediatric Otolaryngology, Rhinology/Plastic Surgery, and Otology services. Rotations provide the clinical complexity of various head and neck pathologies and explores medical and surgical treatment plans. The course will focus on the diagnosis, treatment, and management of many speciality specific disorders as well as primary care problems associated with pediatric and adult patients in the ambulatory, inpatient and operating room setting. Rotators will encounter disorders including ear disease and hearing loss, head and neck cancer, voice and communication disorders, obstructive sleep apnea, and airway abnormalities. The outpatient setting will enhance and reinforce a thorough head and neck examination, including the ear exam, and foster development of an Otolaryngologic assessment and plan. Additionally, students will be able to be involved with the inpatient otolaryngology team and aid in and observe operating room procedures. Students will have a unique look into the complexities of this speciality and become involved with the multi-disciplinary approaches to treatment with other team members including: audiologists, speech pathologists, radiologists, pulmonary and gastroenterology physicians.
SURG-5630: Cardiac Surgery
The cardiac surgical service deals with congenital and acquired heart disease, pulmonary vascular disease, and anomalies of the arterial and venous systems in the chest in both pediatric and adult patients. Students will have the opportunity to evaluate patients in the clinic with complex vascular, valvular, and cardiac lesions and understand their anatomy and physiology. They will be introduced to cardiac ECHO, cardiac MRI, CT scans of the chest, and cardiac catheterization by the attending surgeon. They will follow the patient to the operating room where they will participate in the surgical repair and to the CVICU and step-down unit for postoperative care. In the CVICU the student will be introduced to the evaluation of hemodynamic parameters; use of vasopressors, dilators and antiarrhythmics; postoperative pacing, ECHO and ventilator management. During the four-week course the student may get the opportunity to participate in an aortic dissection repair, ventricular assist device insertion, cardiac transplant, or organ retrieval.
SURG-5632: Thoracic Surgery
The Vanderbilt Thoracic Surgery Advanced Clinical Experience will introduce the student to general thoracic surgery including preoperative workup, basic thoracic surgery operative skills, and postoperative care. This rotation will teach basic thoracic surgical and endoscopic techniques. The student will learn how to recognize and care for thoracic surgery patients, including placement of chest tubes, drainage of effusion, endoscopy, and participate in various thoracic surgery operations.
This ACE will encompass the care of the surgery patients admitted to the Urology service. The student will be expected to function as a member of the team at a supervised level for patient management and communication with other healthcare providers. This will include preparing the admission history and physical examination, entering orders, writing daily progress notes, presenting patients on daily work rounds, participating in surgical procedures, and coordinating discharge planning. Students will be additionally be given opportunity for outpatient experiences in the clinics. Students will be expected to participate in select weekend rounds and assist with triage of consults for the inpatient service.
SURG-5660: Pediatric Surgery
Pediatric surgeons provide care to a diverse patient population including neonates, children and even some young adults. Patients are in a variety of healthcare settings including the outpatient clinic, emergency room, trauma bay, inpatient wards, pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and of course, the operating room. The course will focus on honing the students’ clinical skills in accurate history taking, clinical assessment of both acute and chronically ill neonates and children, developing an appropriate operative (or non-operative) plan, participation in the operative management of these same patients and following their post-operative progress until discharge. The students will have the opportunity to (1) improve their knowledge of the common pathologies encountered in a pediatric surgical practice, (2) broaden their understanding of the surgical management of these problems, (3) gain firsthand experience with the depth and breadth of a clinically busy pediatric surgical service and (4) mentor younger students. During the rotation, students will spend time with the team in clinic, in the operating rooms, on the wards and seeing new consults. Students will be expected to present new consults and clinic patients in a concise, informed manner to the fellows and attendings. Additionally, students will be expected to stay for overnight call at least 4 times during a 4-week rotation with 2 over a weekend.
SURG-5670: Surgical Oncology
The Advanced Clinical Experience (ACE) in Surgical Oncology offers students a broad and detailed clinical experience in the treatment of malignancies. Emphasis will be on the multidisciplinary management of a variety of malignancies including those of the liver and biliary tract, pancreas, gastrointestinal tract, retroperitoneum, breast, skin and soft tissue and endocrine systems. Students will be active participants both in the inpatient (including the operating room and floor) and outpatient settings and participate in several educational conferences including multidisciplinary tumor board, surgical oncology conferences and others and Vanderbilt University Hospital. Students will be expected to take overnight call four times during the four-week rotation.
SURG-5680: Plastic Surgery
Are you interested in learning more about a surgical specialty that is so broad-based as to include all age ranges from pediatrics through geriatrics and virtually the entire body from head to foot? Are you interested in meeting with full-time faculty who are recognized nationally for their contributions to the specialty of plastic surgery? If so, consider the plastic surgery ACE as a part of your educational opportunities. During this advance clinical experience, the student works with the plastic surgery faculty and residents on the plastic surgery service at Vanderbilt University Medical Center participating in the diagnosis and management of patients, with a wide variety of reconstructive and aesthetic problems. This includes surgery of the hand, the breast and trunk, the head and neck, and the lower extremity. Patients range from pediatric to geriatric age groups and problems vary from congenital to acquired including deformity from neoplasm, burns, and trauma.
SURG-5700: Oral and Maxillofacial Surgery
Oral and maxillofacial surgery is the clinical discipline that focuses on the management of diseases, deformities, injuries, and defects of the oral and facial structures. With elements of dentistry, medicine, anesthesia, and surgery, the ACE provides exposure to a wide array of clinical conditions ranging from lesions and conditions of the oral cavity, odontogenic head and neck infections, cleft palate, oral/facial reconstruction, total temporomandibular joint replacement, complex facial fractures to congenital and acquired deformities of the jaws and facial bones. Students will be active participants in clinical and didactic activities. Practice-based learning and systems-based practice methods will be emphasized. Students will have the opportunity to (1) enhance their fund of knowledge in clinically relevant overlapping areas of dentistry/oral surgery and medicine, (2) improve their working understanding of head and neck anatomy, (3) review common infections of the oral and head and neck region, (4) learn fundamental principles of head and neck reconstruction, and (5) participate in the delivery of clinic-based ambulatory anesthesia. Students will be expected to take facial trauma call.
The trauma ACE allows students to follow injured patients from the moment they arrive until discharge. This includes management in all settings, ICU, floor, clinic and the option of time in the comprehensive traumatic brain injury clinic. Students will be introduced to high-level procedure-based situations including central venous access, tube thoracostomies, bronchoscopy, advanced suturing techniques and operative management of the trauma patient. Expectations will focus on the complex management of patients including coordination of care with other subspecialties, identifying and managing critical care issues such as ventilator management, massive resuscitation efforts, complexities of organ failure and sepsis, end-of-life decisions and organ donation. Opportunities for both day and night coverage will allow the student to obtain a complete understanding of the field of trauma (the #1 cause of death for all patients age 1-45). This course fulfills the acute care requirement.