Description:

A general exposure to a rural family medicine practice, including office work, preventive medicine, sports medicine, inpatient including ICU and office procedures.  Students will follow patients  with diabetes, CAD, hypertension, and general medicine concerns.  They will be able to have home visits along with working with hospice patients.  Will work in free clinic with indigent patients.

At the end of the course, the student will be able to:

• Provide for patients in an outpatient setting in preventive medicine
• Follow patients in an in patient setting
• Assist in office procedures such as lesion removal, suturing, I and D of abcess
• An overall view of the rural doctor/patient relationship

Course #: FAMMD-850

 Title: Family Practice

 Instructor: Alec Chessman, M.D.

 Location: Medical University of South Carolina

Charleston, SC

 Number of students: Variable
(depends on availability of physicians in community)

Duration: 4 weeks

 Credit hours: 5

 Course offered: Fall, Spring

Description

The students work closely with a family physician, gaining genuine experience in family practice and health care delivery. This elective should be beneficial in choosing a career in medicine for those considering family practice, and future consultants may gain an appreciation for the role of the family practitioner.

Course Objectives

Describe features of private practice that differ from hospital-based or academic practice

• Identify and address the patient's reasons for the visit
• Negotiate the assessment and plan with the preceptor and patient
• Discuss the methods to improve the business of providing health care services in an ambulatory practice
• Analyze the life style of the preceptor in relationship to practice style
• Describe the opportunities and optimal approaches for integrating disease prevention/health promotion into a clinical practice.

Instructional Methodology (approximate # of hours per week)

• Lectures - none
• Rounds/Discussions - none
• Patient Contact - 40
• Lab - none
• Patient Load - none
• Call - none

Course Objectives

A. Know the base knowledge content of sports medicine.

B. Understand the role of exercise in health promotion and be able to prescribe an individualized exercise program.

C. Emphasize injury prevention and be able to manage common exercise and sport related injuries, acutely and chronically.

Rotation Activities

 The student will be scheduled to assist with direct patient care activities with sports medicine physicians.  In addition, the student will rotate through physical therapy  Finally, the student will be expected to develop and present a morning report / noon conference on a primary care sports medicine topic.

Specific Curriculum Objectives

The student should be able to discuss the following information upon completion of this rotation.

General Knowledge

I. Basic Knowledge Content
A. Anatomy and Biomechanics 
1. Explain the biomechanics of the musculoskeletal system for running, jumping and throwing. 
2. Apply the principles of fracture repair, including rate of healing, type of healing and complications to the management of
    acute bony injuries and stress fractures. 
3. Describe the anatomy of commonly injured joints including major muscle groups, tendon insertions and ligaments.

B. Exercise Physiology 
1. Compare the physiologic principles of aerobic and anaerobic metabolism in terms of oxygen and energy utilization      and give examples of types of exercise which use aerobic and anaerobic metabolic pathways. 
2. Identify the beneficial physiologic adaptation to regular aerobic exercise.
3.  Define maximum oxygen uptake (V02 max) and describe methods to measure.
C. Sports Nutrition 
1. Explain the role of dietary carbohydrate, protein, fat and glycogen stores in performance of exercise or athletic events. 
2. Give examples of sports/activities in the following categories of caloric expenditure: 
a. low  200-400 Kcal/hr 
b. moderate 400-600 Kcal/hr
c. high  >600 Kcal/hr
3. State nutritional advice and the rationale behind the advice for exercising individuals on the following:
a. fluid and electrolyte replacement
b. ergogenic aids and vitamin supplements
c. weight loss/gain
d. pre-competition meals
D. Drug Use and Abuse
1. List classifications of drugs generally purported to be performance enhancing and/or potentially harmful to the health and safety of an athlete and discuss the pharmacophysiology of each.
   2. Differentiate between established and theoretical effects of steroids.
   3. List reversible and irreversible side effects of steroid use.
   4. Describe common myths held by athletes about steroid use.

II. Medical Aspects of Sport and Exercise
A. Heat-related illness
1. Describe the difference between heat cramps, heat syncope, heat exhaustion and heat stroke.
   2. Discuss methods of treating the above conditions.
   3. Describe measures to prevent heat-related illness.
B. Cold-related illness
   1. Recognize the signs and symptoms of frostbite and hypothermia.
   2. Describe the proper treatment of frostbite and hypothermia.
C. Hematology
1. List the causes of "sports anemia."
2. Identify individuals at risk for this condition.
3. Outline a treatment plan for "sports anemia."
E. Renal
1. Describe the features of exercise-induced hematuria which distinguishes it from other causes of hematuria.
2. Develop a management plan for the individual with exercise-induced hematuria.
F. Pulmonary
1. Describe the features of exercise-induced asthma (EIA).
2. Identify individuals at risk for EIA.
3. Recommend therapeutic measures or modifications of activity for those with EIA.

Exercise

 I. Role of Exercise in Health Promotion
A. Discuss the role of exercise in modifying health risk factors such as smoking, obesity, adverse dietary habits and emotional stress.
B. Identify risk factors for atherosclerotic disease which may be favorably modified by regular and appropriate exercise.

II. Fitness Evaluation 
A. Define the difference between cardiovascular fitness and other types of conditioning such as strength or flexibility training.
B. Describe appropriate tests for assessment of cardiovascular (aerobic) fitness, strength and flexibility.

III. Exercise Prescription 
A. Guidelines 
1. Given the following information: age, gender, health history, medications, physical exam findings and results of a fitness evaluation, prescribe an individualized exercise program including aerobic, strength and flexibility training.
B. Aerobic Training 
1. Formulate a plan for aerobic training based on the American College of Sports Medicine recommendations for the quantity and quality of training necessary for developing and maintaining aerobic fitness including guidelines for frequency, intensity, duration, mode of activity and rate of progression. 
2. Calculate a maximum heart rate and training heart rate range for a patient based on age or the results of exercise testing. 
3. Advise patients on the proper intensity of exercise based on the target heart rate range including modifications of type of activity, duration of exercise, and warm-up and cool-down procedures for a heart rate above or below the target range.
C. Strength Training 
1. Define strength training and explain the importance of it in an exercise program. 
2. Compare and contrast the use of concentric, eccentric and isokinetic exercises in a strength training program. 
3. Compare and contrast low weight-high repetition and high weight-low repetition strength training. 
4. Suggest methods of improving strength other than those which use free weights or machine weights. 
5. Recommend the appropriate frequency of strength training sessions as a component of a complete exercise program.
D. Flexibility Training 
1. Define flexibility training. 
2. Explain the theoretical basis of warm-up, cool-down and stretching in an exercise program including the physiologic effect on muscles and connective tissue, the cardiovascular response and the relation to injury prevention. 
3. Demonstrate proper exercises to stretch all major muscle groups.
 

EXERCISE AND SPORT INJURIES

I. Evaluation 
A. History 
 1. List components of the history necessary in the evaluation of acute and chronic injuries.
B. Physical Examination
 1. Demonstrate proficiency in performing an exam of the joints to identify presence of effusion, soft tissue damage, joint stability, range of motion, muscle strength, neurovascular integrity and signs of fracture or dislocation.
 2. Identify locations on major muscle groups where tears commonly occur at musculotendinous junctions.
 3. List high risk areas for more serious injury even when the initial exam shows minimal findings.
C. Diagnosis
 1. State criteria for ordering an x-ray to rule out a fracture or dislocation and evaluate the x-ray for signs of fracture or dislocation.
 2. Given negative plain x-rays, list conditions in which a bone scan is useful in diagnosing sport injuries.

II. Specific Injuries
A. Given participation in the following sports, specify the joints or body parts most at risk for acute injury and develop a differential diagnosis and management plan for these injuries:
 1. running
 2. football
 3. basketball
 4. baseball
 5. tennis
 6. racquetball
 7. soccer
 8. swimming
 9. cycling
B. Overuse Syndromes
 1. List the general classification of injuries included in overuse syndromes.
 2. Identify individuals at risk for overuse syndromes.
 3. Develop a clinical guideline for evaluation, treatment and prevention of overuse syndromes regardless of body site.
C. Injuries in Children
 1. Define the Salter-Harris classification of growth plate injuries.
 2. Identify common growth centers that may develop an apophysitis.
 3. Correlate the biochemical properties of growing bone, ligaments, muscles and tendons with respect to:
  a. reactions to stress
  b. susceptibility to injury
  c. location of injury
  d. rate of healing.
4. Using information from (3) above, describe the following pediatric injuries and outline a treatment plan for each:
  a. greenstick/torus fractures
  b. epiphyseal fractures
  c. apophyseal avulsions
  d. "Little league elbow"
  e. Osgood-Schlatter's disease
D. Injuries in Women
 1. List sport injuries unique to or more common in women because of physical structure or physiological function that differs from men.
 2. List types of injuries for which women are at lower risk.
 3. Review the etiologic theories of exercise-induced amenorrhea and its effect on bone mineral density.
E. Injuries in the Elderly
 1. Describe age-related changes which affect susceptibility to injury in the geriatric individual.
 2. Recommend measures to prevent injury during exercise or sport for individuals over 65.

III. Injury Prevention
 A. Given a particular exercise or sport, identify the area(s) of the body most at risk for injury and recommend appropriate protective equipment and modifications of training techniques to prevent initial or recurrent injury.
 B. List indications for protective taping or bracing of various joints.
 C. Identify physical variants or deformities (static and dynamic) that may predispose an athlete to an injury and prescribe an intervention to prevent the injury.

IV. Rehabilitation
 A. Discuss the rationale for recommending a rehabilitation program for all major joint injuries.
 B. Discuss the indications for the following treatment modalities and explain the physiologic basis by which each promotes healing:
  1. ice
  2. heat
  3. ultrasound
  4. electrical stimulation/TENS

C. Demonstrate exercises to rehabilitate the following: injured ankle, knee, hip, back and shoulder.
 D. Demonstrate the differences between isometric, isokinetic, isotonic and eccentric strengthening maneuvers.

SKILLS/PROCEDURES

1. Tape, splint or immobilize ankle, knee, wrist/fingers, elbow.
2. Apply short arm cast, thumb spica cast, short leg cast, ulnar radial gutter splint, posterior elbow, figure-of-eight splint, finger splints.
3. Arthrocentesis, joint and soft tissue injections.
4. Physical exam techniques, especially neck, shoulder, wrist/hand, back, knee and ankle.

Primary References and Recommended Text

FuFH and Stone DA. Sports injuries: Mechanisms, prevention, and treatment. Baltimore MD, Williams & Wilkins, 1994.

Mellion M.B., Walsh WM Shelton GL. The Team Physician's Hand Book. Hamley & Belfus, Inc. Philadelphia, 1990

Appenzeller O. Sports Medicine: Fitness, Training and Injuries. Urban and Schwarzenberg. Baltimore, 1989.

Course #: FAMMD-862

Title: Clinical Medicine, Spirituality and Health

Course Director: Dana E. King, M.D.

Location: Medical University of South Carolina

Charleston, SC

Number of Students: Minimum of 1   Maximum of 1

Duration: 2 weeks

Credit Hours: 2.5

Course Offered: Year Round
(not available July, August, December)

Description:

Readings, rounds and discussions of spirituality and health issues including how to deal with spiritual issues in practice, recent research regarding spirituality and health, and ethical considerations.

Course Objectives:

• Deal more effectively with spiritual issues in the clinical setting
• Be more familiar with recent research regarding spirituality and health
• Be more aware of resources for continued learning in the field

Instructional Methodology (approximate # hours per week)

• Lectures - 1
• Rounds/Discussions - 8
• Patient Contact - 20
• Reading - 11
• Lab - none
• Patient Load - 4-8
• Call - none

Course #: FAMMD-865

Title: Family Medicine Inpatient Externship

Instructor: Peter J. Carek, M.D.

Location: Medical University of South Carolina

Charleston, SC

Number of Students: 2
During the fall semester, this externship is only open to students
who are pursuing a career in Family Medicine.

Duration: 4 weeks

Credit Hours: 5

Course Offered: Year Round
(not available in July)

Description:

This elective is structured to provide the student an inpatient experience consistent with the practice of community family medicine physicians. Based on the common discharge diagnoses of the 836 admissions for fiscal year 1999, the Inpatient Service is able to provide a comprehensive educational experience for a fourth year student.

Course Objectives:

• Learn the basic components for inpatient medicine
• Become more familiar with the problems seen in the hospitalized patient
• Be exposed and learn the emergent problems commonly seen in the hospitalized patient
• Be exposed to and learn many of the procedures commonly performed by a family physician in a community hospital.

Instructional Methodology (approximate # hours per week)

• Lectures - 5
• Rounds/Discussions - 10
• Patient Contact - 25
• Lab - none
• Patient Load - 4
• Call - every 4th night

Course #: FAMMD-871

Title: Student Medical Director of the Cares Clinic Project
Student Medical Director Syllabus (pdf)

Instructor: Wanda Gonsalves, M.D.

Location: Medical University of South Carolina

Charleston, SC

Number of Students: 1

Duration: 4 weeks

Credit Hours: 5

Course Offered: Fall, Spring

Description:

The Student Medical Director of the CARES Clinic Project is a 4th year service-learning elective activity administered through the Department of Family Medicine. Students will build upon their experience achieved through their participation in the “Caring for the Community elective” and or volunteer experience at the CARES Clinic. One student each month will act as the student medical director overseeing the operations of the clinic, providing patient care, and assuming the role of coach and teacher of 1st through 3rd year medical students who participate in the “Caring for the Community” elective, and or volunteers at the CARES Clinic. You will also get an insight into other community clinics that serve the underserved in the Charleston area that will help guide your administration of the CARES Clinic.

Course Objectives:

• Work in multidisciplinary teams
• Serve as a community advocate for the underserved/uninsured by a) helping to form community partnership; b) attending at least one community Board meeting.
• Improve upon clinical skills by providing patient care in the "CARES Clinic."
• Develop practice management skills by acting as "medical director" of CARES Clinic.

Instructional Methodology (approximate # hours per week)

• Independent Study
• Clinic Administration - 2 half days per week
• Patient Contact - 2 clinics/week