MD Courses — Medicine

First year

M25 507 THE PRACTICE OF MEDICINE I
Instructor: Tim Yau, MD
POM I is a large course which spans all 3 blocks of the first year. It is composed of three content areas:

  • Clinical Skills
  • Patient, Physician, and Society
  • Scientific Basis of Clinical Medicine

Each of these three content areas has two or more sections, each run by a faculty section leader.
POM I employs a variety of teaching techniques, instructors and venues. This includes lecture, small group discussions, panel sessions, one-on-one hospital interviews, standardized patient sessions, a patient home visit, and visits to both a primary care office and a city clinic.
What are the educational goals of POM I?

Students will learn to:

  1. Perform a complete history and physical examination with thoroughness, accuracy, sensitivity and compassion.
  2. Communicate effectively, efficiently and compassionately with patients, families and other health professionals.
  3. Describe and analyze the statistical methodology of clinical studies and apply the results to individuals and groups of patients.
  4. Identify and investigate ethical, cultural, socioeconomic and political factors relevant to medical interactions.
  5. Examine and analyze personal and professional competencies, limitations and behaviors.

How do we accomplish these goals?

  1. Learning skills and techniques requires a cycle of steps: preparation, background reading, attempts at skill performance, analysis and reflection on performance, discussion of potential improvements,an d successive performance of the skill with advancement to a new level of expertise.
  2. The focus is on learning skills. You practice each skill, such as interviewing, in a variety of venues and situations of varying complexity. This course is for learning about how to do things that you will use for taking care of patients and families.
  3. You work in multiple learning environments.
    a. Academic environments: Small group sessions for discussion, small group practice sessions, peer learning, small group presentations, individual and group writing assignments, and reflections on experiences are the preferred learning locations.
    b. Clinical environments: Inpatient units with faculty and WUMS IV mentors, standardized patient experiences with videotape review, physicians’ offices, patient’s homes with and without home care professionals, and a city clinic.

Selectives

M04 5009 MEDICAL SPANISH
Instructor: Marcos Rothstein, MD, 286-0801
This course is designed to provide educational opportunities for people speaking at all levels of Spanish fluency. The classes will consist of basic grammar and the movie/book club/charlas (chats)/roundtables with physicians interspersed throughout the course. Students will learn medically relevant vocabulary, cultural sensitivity and fluency with the goal to improve treatment of the growing U.S. Latino population.

M04 520H ART AND MEDICINEM04 528H TERMINAL ILLNESS AND DEATH
Instructor: Ellen F. Binder, MD, 314-286-2707, ebinder@wustl.edu
In this seminar we will examine such topics as: 1) psychological, social, and professional responses to terminal illness and death; 2) communicating bad news to patients; 3) grief and bereavement; 4) palliative care and physician-assisted suicide. Teaching sessions will include discussion of readings, interviews with practitioners and/or patients, and will rely heavily on student participation. Students are also required to spend a half-day making rounds with a BJC Hospice nurse.

M04 528H TERMINAL ILLNESS AND DEATH

Instructor: Ellen F. Binder, MD, 314-286-2707, ebinder@wustl.edu
In this seminar we will examine such topics as: 1) psychological, social, and professional responses to terminal illness and death; 2) communicating bad news to patients; 3) grief and bereavement; 4) palliative care and physician-assisted suicide. Teaching sessions will include discussion of readings, interviews with practitioners and/or patients, and will rely heavily on student participation. Students are also required to spend a half-day making rounds with a BJC Hospice nurse.

M04 5302 FRONTIERS IN LEUKEMIA
Instructor: John Welch,  jwelch@dom.wustl.edu
Hematopoietic research is rapidly and in some cases dramatically changing the clinical management of patients with leukemia. Most notably, the development of imatinib, a drug specifically designed to inhibit the bcr-abl oncogene, has fundamentally altered the way we treat patients with chronic myelogenous leukemia (CML). The objective of this course is to introduce students to scientific investigation in hematopoiesis with an emphasis on leukemogenesis. We will focus on how research is advancing our understanding of the pathogenesis and treatment of this group of diseases. Specific topics will include CML and the development of imatinib and newer inhibitors, acute myelogenous leukemia, and the preleukemic syndromes severe congenital neutropenia and myelodysplasia. The faculty is all physician-scientists actively engaged in these areas of research. Students will be able to demonstrate the impact of molecular biology on the understanding of the pathogenesis of leukemia and its clinical management.

M04 538H DOCTORS ON FILM

Instructor: Thomas M. De Fer, MD, 747-4366
This course will explore the relevant social themes of films in which physicians and/or the medical profession are the main focus. There are countless portrayals of physicians in the cinema. There are also many films that deal extensively with various features of health care delivery. For good or for bad, viewers of these films outside our profession are strongly influenced by these portrayals. Common stereotypes are perpetuated. If it’s in the movies, there must be some truth to it. Depictions of physicians and major medical themes have evolved with time and under the influence of social and scientific developments. The course will investigate these depictions and themes using a selection of films (from the classic era to more modern films) to provoke thought and discussion. Some discussion of film craft is also included. Emphasis is given to older movies, 1940s to 1970s. Those not interested in film craft or classic films should consider these latter points very carefully. The essence of this selective is the collective group experience of watching the movies and the discussion that follows. Most of the films are not readily available for rental or purchase, and lending of the VHS tapes or DVDs is not practical. For these reasons, attendance at five of the six sessions is required (all students must attend the introductory session). Each session will run from 3:15 p.m. to 4:55 p.m. (1 hour and 40 minutes). Students will be able to:
1. Discuss the common themes in doctor movies
2. Discuss the evolution of these themes over time in the context of social and scientific developments
3. Discuss the various portrayals of physicians frequently seen in doctor movies
4. Discuss the effects of these themes and portrayals on patient expectations
5. Appreciate how an understanding of these portrayals and themes can be used to improve medical care

M04 582H PHILOSOPHY OF MEDICINE

Instructor: Stephen S. Lefrak, MD, 454-7116
Medicine is a complex enterprise that has a major impact on our society. As such it draws increasing attention from those within the health care professions as well as those outside medicine whose expertise may lie in law, social science, philosophy, policy, etc. Physicians, in addition to their clinical and research responsibilities, must become increasingly adept at interdisciplinary activities. It is never too early in a career to begin to examine “medical” concepts that are frequently employed without being clarified, thus hindering communication rather than solving problems. It is this clarification process that philosophy addresses. The very issues that philosophy has dwelled on throughout the centuries are the very ones that are critical for medicine; think of “death” or “personhood”, for example. Also, whether medical concepts are “real” or “constructed” is important for both the disciplines of medicine and philosophy. And dare we even mention such issues as the relationship between mind and body, notions of causality, how and what we mean when we “know something” and “free will”? This selective is looking for students who would be interested in beginning such a study with the goals of developing their own understanding as well as introducing it into the medical school curriculum in a formal way. The classical subdivisions of philosophy such as ontology (science of being, existence), epistemology (science of knowing), ethics (moral philosophy) and social philosophy may all serve to clarify important issues in medicine. For example, physicians focus on disease in many ways, yet are diseases descriptive realities or normative (value) concepts? The impact of which answer is accepted is felt throughout society ? as what will be reimbursed as health care, what is enacted into policy and law (Americans with Disability Act), and to what the range of medicine is and where are its boundaries. The epistemology of medicine may also be somewhat unique. What physicians take as evidence and what we mean by causality may be very different than what is meant in other scientific disciplines. The terms used by physicians such as evidence, causality, explanation, hypothesis, theory, etc. should be critically analyzed by physicians. The impact of our understanding of this has great effect on our patients both in clinical care and what research is pursued and accepted. Of course, ethics plays an important role in medicine, but this course is focused on a philosophical analysis of the medical concepts and the constructs of medicine with emphasis on ontology and epistemology. Students will be able to:
1. Expound the “arguments” whether “philosophy of medicine” exists or is needed.
2. Thoughtfully discuss what “medicine” is and some of the legitimate “goals of medicine”.
3. Discuss some of the major domains of philosophy.
4. Become familiar with some of the major philosophical problems and methods.
5. Describe what metaphysics are.
6. Discuss the “concept of disease”.
7. Discuss what kind of activities clinical medicine and reasoning are.
8. Become familiar with the analysis of “scientific method” and how that model compares, fits with clinical medicine.
9. Discuss the method of medicine and compare it to other fields.
10. Think critically about what is required of a mechanistic explanation.
11. Think carefully about the nature of causal relevance.
12. Discuss the virtues and limits of reductive explanations and methods in neuroscience and physiology.
13. Understand the principles of evidence-based medicine.
14. Understand some individuals believe evidence-based medicine is not scientifically sound.
15. Understand the care of individual patients is complex, and rigid adherence to one model may not be sufficient.
16. Discuss the relationship between the metaphysics of medicine, the epistemology of clinical medicine and clinical ethics.
17. Attempt to adopt a unified outlook toward the commonly employed concepts of clinical medicine and their relationship to the patient, physicians and their interaction.
18. Proceed throughout their medical education and careers more aware of the impact of the views that are taken of “disease”, clinical judgment and ethical decision making.
19. Be familiar with the development of disease ontology.

M04 524H MAJOR RELIGIOUS TRADITIONS AND HEALTH CARE
Instructor: Chaplain William V. Trogdon,BCC, Director Spiritual Care Services,314-609-8238
This course will introduce the students to the tenets of mainline world religions and how their beliefs and practices can best be considered in understanding the whole patient/family for treatment, planning and decision-making. Primary attention will be given to the five major world religions: Christian, Buddhist, Hindu, Jewish and Muslim faith traditions as well as others with particular considerations for health care. Special attention will be paid to end-of-life issues, decision-making and interpersonal dynamics. The students also will be introduced to a clinical model of understanding faith and spirituality within the context of health care. Students will be able to:
1. Be more comfortable considering patient/family religious/faith dynamics.
2. Understand the role of patient/family faith commitments in their healing, well-being and development.
3. Increase basic knowledge of tenets of mainline religions found in the United States and how their beliefs/practices can best be considered in understanding the whole patient/family for treatment planning and decision-making.

M04 588H MUSIC AND MEDICINE

Instructor: Steven Cheng, MD, 362-7211and David Windus, MD, 362-7211
Music and medicine reflect one another in several fascinating ways. During this selective, students will participate in six highly-interactive sessions that will include lively discussions, guest speakers and demonstrations. Students will discuss how music evokes certain characteristics of disease, suffering and illness; discuss how illnesses in musicians/composers and rock stars influences their work; understand the role of music in the healing process; and recognize medical problems that arise in performing artists.  Students will also see first-hand how music can impact the elderly and ill during a performance at a local nursing home.

M04 5875 OLIN GRAND ROUNDS: THE BUSINESS AND PRACTICE OF MEDICINE
Instructors: Cynthia Wichelman, MD, FACEP, Associate Professor of Emergency Medicine, wichelmc@wustl.edu, and Bart Hamilton, PhD, Robert Brookings Distinguished Professor of Entrepreneurship
Grand Rounds at medical schools are forums for presenting new and challenging clinical problems and cases. The goal of Olin Grand Rounds is to focus on the challenges facing the business of medicine and consider possible solutions. The course provides a broad introduction to the current issues facing the health care sector, while integrating management tools and clinical knowledge. This fall semester course was first offered in 2006 and has become a popular course for premed and business undergraduates, as well as students in the MBA program. More medical students should take this class! The information is invaluable for any one pursuing a career in medicine or in the health care sector of business. In addition to several outstanding guest speakers, a number of business case study discussions are complemented with clinical patient presentations. Topics covered include clinical practice compensation distribution, concierge medicine, health care reform, ACA, health care systems comparison, hospital management, analysis of walk-in clinics (i.e., Walgreens. CVS), organ transplantation, research and development and marketing of pharmaceuticals, sickle cell anemia and management of Medicaid and care to the underserved, the business of cosmetic surgery, and biotech startup methods used by local physician-entrepreneurs, to name a few. The course also includes a tour of Express Scripts.
August 29 – December 5, 2016. Monday Nights 6:15 PM – 9:15 PM.

M04 5013 INTRODUCTION TO EMERGENCY MEDICINE I

Instructor: Cynthia Wichelman, MD, FACEP, Associate Professor of Emergency Medicine, wichelmc@wustl.edu
Over six sessions, we will review the physiology and clinical management of common emergencies: cardiovascular emergencies; trauma resuscitation and shock; environmental emergencies, such as high-altitude cerebral edema and snake bites; pediatric emergencies; gynecological and urological emergencies; and toxicological emergencies. Each session will include a lecture followed by case studies that highlight critical aspects of a patient’s history, physical examination, laboratory and radiological studies, as well as procedural intervention and pharmacological treatment. Group participation is encouraged. This selective is intended to give students an exposure to emergency medicine. Students will become familiar with the methods used to evaluate and treat patients with medical emergencies in preparation for their clinical training.
October 25 – Nov. 29th, 2016. Tuesdays, 3:15 PM – 5PM.

M04 5016 INTRODUCTION TO EMERGENCY MEDICINE II

Instructor: Cynthia Wichelman, MD, FACEP, Associate Professor of Emergency Medicine, wichelmc@wustl.edu
This class is a second session on emergency medicine (in response to student requests!) exploring topics not covered in the fall session. Although it would be beneficial to take the Introduction to Emergency Medicine I course offered in the fall, it is not a prerequisite for this class. Six sessions will review the physiology and clinical management of abdominal emergencies, obstetric emergencies, ophthalmic emergencies, endocrine emergencies, environmental emergencies such as lightning and hypothermia, plus a few neurologic emergencies, renal emergencies, orthopedic emergencies and oncologic emergencies. Each session will include a lecture followed by case studies that highlight critical aspects of a patient’s history, physical examination, laboratory and radiological studies, as well as procedural intervention and pharmacological treatment. Group participation is encouraged. This selective is intended to give students further exposure to emergency medicine. Students will become familiar with the methods used to evaluate and treat patients with medical and surgical emergencies in preparation for their clinical training and board preparation.
April 4 – May 9, 2016. Tuesdays, 3:15 PM – 5PM.

M04 587L INTERNATIONAL HEALTH

Instructor: Cynthia Wichelman, MD, FACEP, Associate Professor of Emergency Medicine, wichelmc@wustl.edu
This course is an excellent opportunity to prepare for a summer abroad through FIHTM or for a fourth year away rotation. Speakers include WUSM faculty who have incorporated international healthcare in their practices — from surgery (e.g., ophthalmology, neurosurgery, ENT, ob/gyn), and anesthesiology, to emergency medicine and pediatrics, as well as give students an opportunity to hear from the Global Health faculty heroes at WUSM. Each lecture is followed by an interview with the speaker. The course will help you explore different avenues for adding an international component to your career and to learn which specialties may more readily lend themselves to this. Other topics include how to protect your health while abroad and the ethics of research in a global setting, and organizations such as Doctors Without Borders and ORBIS. WUSM II and IV students will also share their experiences administering health care and doing research abroad. This course, which consists of six sessions, was first introduced in 2004 and grew quickly. On the last day, students present for 10-15 mins. on a topic of their choice.
January 24 – February 28, 2016. Tuesdays, 3:15 PM – 5PM.

M04 537 SIMULATIONS IN CARDIOVASCULAR PHYSIOLOGY

Instructor: David Murray, MD, 747-2136
The purpose of this selective is to demonstrate cardiovascular physiologic principles including control mechanisms using interactive patient simulators (computerized mannequins) to replicate common cardiovascular disease conditions and potential treatment modalities. Several clinical scenarios with case histories will be presented to small groups for interpretation and subsequent treatment, thereby providing the opportunity to explore alterations in preload, afterload, isotropism and chronotropism. During the selective clinical conditions associated with changes in these cardiovascular determinants as well as various cardiovascular control mechanisms will be explored through scenarios. Scenarios include shock, arrhythmias, congestive heart failure, myocardial infarction and some “unknowns”. Variables monitored in the patient simulator include ECG, arterial, venous, ventricular and capillary wedge pressures, cardiac output, stroke volume, heart rate, systemic and pulmonary vascular resistance and ventilation. A class-wide discussion and systematic review will follow the individual small group workshops to allow synthesis of all the material.

M04 586H HEALTH AND HUMAN RIGHTS

Instructor: Kim Carmichael, MD, 454-7116
There is a strong belief among many physicians that our responsibilities extend beyond our individual patients to our communities, countries and even to our entire world. This humanities selective is an excellent forum for interested students to actively learn and discuss the impact of human rights violations on health. Topics include reproductive and pediatric health rights, communication issues and interactions with interpreters. Each meeting will consist of a brief presentation and a discussion on the topic. There will be a different presenter for each topic. Readings will be provided. Students will be able to:
1. Explore human rights issues that are relevant to the health professions from both local and worldwide perspectives.
2. Describe the boundaries and challenges involved in solving human rights issues.
3. Describe strategies for the implementation of programs that address human rights issues.
4. Develop successful initiatives and interventions pertaining to health and human rights.

M04 587A PHYSICIAN AS HEALTH PROTECTOR AND PATIENT ADVOCATE

Instructor: Steven I. Plax, MD, 994-0109
Investigation into clinical topics again will be offered. Last year’s students did an educational program teaching our population how to read the nutrition information on products they were purchasing. For further information, students may call Dr. Plax at (314) 994-0109. The Office of Medical Student Education has copies of our medical handbooks and their supplements. This course is a component of the Health Protection and Education Service, which meets on the third Saturday of each month except December and July. Sessions are held in the University City Library, 6701 Delmar from 9 a.m. to 11:30 a.m. Students share the goals of the HPES.
1. To do multiple screening testing ranging from height, weight, body mass index, blood pressure, eye and vision evaluation, hearing tests by audiologist, skin and dental exam, blood sugar, hemoglobin, and cholesterol measurement, and EKGs.
2. Educate people in protecting their health — a trained historian records each individual’s medical history — at conclusion of person’s tests and recording of history, a one-on-one conference is held with a member of MD staff. Medical students participate in screenings and in history-taking and final conferences in telephone follow-up.
This is an opportunity for Washington University medical students to correlate the basic information gathered from first-year courses with their experience with our patients — and in-the-trenches participation in preventive medicine. Students actively participate in the screening and in history-taking (with trained historian) and in individual conferences between patients and physicians. Students may take part in statistical analysis of data and join in the production of another supplement as in preceding years.

M04 580H THE HEALER’S ART

Instructor: Anna Lijowska, MD, 454-6148
The Healer’s Art combines seed talks and experiential exercises in a large group setting along with small group experiential exercises. The course engages students in a discovery model of community of inquiry focusing on the meaning of physicianhood and the practice of medicine. Faculty participate in the discovery model process on an equal footing with students as well as facilitating the process of the small groups. The course is designed to encourage medical students to trust the power of listening and presence to heal; formulate a personal, comfortable and compassionate response to loss; experience the healing power of grief; recognize that who they are is as important to the healing relationship as what they know; recognize awe and mystery in the daily practice of medicine; explore the concept of calling; write a personal mission statement; and explore the personal meaning of physicianhood. The Healer’s Art facilitates students in clarifying, strengthening and making a personal commitment to medicine as their life’s work. Students also have the opportunity to explore their personal values and commit to developing and preserving their personal values, such as service, harmlessness, compassion, altruism, self-care, equality, justice, respect and nurturing wholeness. There will be additional instructors for this course.
Students will be able to:
1. Make an active commitment to strengthening and preserving their humanity
2. Experience the effects of listening and being listened to generously and compassionately
3. Experience healing relationships with other students
4. Experience tools of self-remembering
5. Identify effective and ineffective behavioral responses to loss and grief
6. Identify when they first became aware of wanting to serve others
7. Articulate and strengthen a personal commitment to medicine as their life’s work
8. Experience practicing physicians sharing their experiences of loss, grief, mystery, and awe in practicing medicine
9. Witness the unity of commitment to service that lies beneath the diversity of expertise and experience

Second year

Teaching by the Department of Medicine is designed to: 1) prepare students for the transition from the preclinical sciences to the study of the sick patient at the bedside, 2) help them analyze the clinical manifestations of disease in terms of the responsible mechanisms and 3) introduce them to the techniques of examination that are used regularly on all clinical services. This instruction is undertaken jointly with members of other clinical departments and is coordinated with subject matter presented by the Department of Pathology and Immunology.

The major areas of clinical medicine are presented in detail to illustrate the application of biochemical, physiological and anatomical information to the understanding of pathological states. Cardiovascular, renal, neurological, gastrointestinal, pulmonary, hematological, metabolic, nutritional and developmental diseases are discussed. Emphasis is placed on the use of fundamental information in approaching clinical problems as a way of thinking that prepares the student for a lifetime of medicine, during which new information will constantly be acquired.

M25 607 THE PRACTICE OF MEDICINE II

Course Master: Megan E. Wren, MD, 286-3480
The goal of The Practice of Medicine (POM) course is to provide students with the knowledge, skills and attitudes essential to patient care regardless of specialty. POM II is a continuation of POM I and will continue to address various interfaces between patients, physicians and society and will also introduce the advanced physical exam and approaches to clinical thinking and decision-making. The sections of POM II include Clinical Skills, Case Development, Communication Skills, Ophthalmology, Radiology, Community and Public Health, Ethics and Health Policy Humanities, and Scientific Methods. The learning objectives for each section of POM II emphasize topics and skills used in all fields of medicine, and the majority of the course work will be taught in small groups or through clinical experiences. 89 clock hours.

M25 605A INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY

Instructors: Nigar Kirmani, MD, 454-8276 and Steven Lawrence, MD
The infectious disease pathophysiology course emphasizes both organism-specific and organ-specific approaches to diseases caused by microbes. The course expands on material presented briefly in the first year concerning bacteria, viruses, fungi and parasites and their involvement in human disease. Mechanisms of disease production, clinical manifestations and therapy are discussed, along with public health implications. In addition to lectures, small group case discussions enable students to apply the information they learn to clinical situations.

M25 606A RHEUMATOLOGY
Instructor: Richard D. Brasington, Jr., MD, 454-7255
The rheumatology pathophysiology course begins with an overview of the approach to the patient with arthritis and related disorders. Diagnoses covered include rheumatoid arthritis, systemic lupus erythematosus, vasculitis syndromes, infectious arthritis, and crystalline arthritis. Clinical features and treatment will be emphasized. In small group sessions, students interview and examine patients to gain a fuller understanding of the typical history and physical findings of these disorders. Students are strongly encouraged to attend the small group sessions with patients, who make a major contribution to teaching students about these conditions

M25 611B CARDIOVASCULAR DISEASE

Instructors: Dana R. Abendschein, PhD, 362-8901 and Justin Sadhu, MD
The purpose of this course is to consider the mechanisms and manifestations of acquired cardiovascular disorders as well as their pharmacologic treatment. Lectures and small group discussions that emphasize the major areas of cardiac and vascular pathophysiology and pharmacology are provided.

M25 612B PULMONARY DISEASE

Instructor: Adrian Shifren, MD, 314-454-8764
The objectives of the pulmonary pathophysiology course are to classify, compare and contrast the major categories of human lung disease. This will be achieved through description of pathophysiologic mechanisms underlying lung disease in humans including alterations in pulmonary mechanics, gas exchange and lung ventilation.

M25 613B RENAL AND GENITOURINARY DISEASES

Instructors: Steven Cheng, MD, 362-7211
This course uses basic principles of renal physiology and ion homeostasis to understand commonly encountered fluid and electrolyte disorders (especially hyper-/hypo- natremias, acidoses/alkaloses) and the action of diuretic drugs. The pathophysiology of diabetic kidney disease, glomerular and tubulointerstitial diseases, hereditary kidney diseases, and the relationship between hypertension and the kidney are discussed. It also applies basic principles of urinary system anatomy and physiology to the understanding of kidney stones, disorders of the bladder and prostate, and of micturition. The course also introduces basic principles of dialysis and kidney transplant. Lectures, small group problem-solving and team-based learning sessions focus special attention on: 1) how a working knowledge of fundamentals, diagnostic testing and arithmetic manipulation can have important predictive value; and 2) how the courses of acute and chronic renal failure are both adaptive and maladaptive for the organism.

M25 614 DERMATOLOGY

Instructor: David M. Sheinbein, MD, 996-8005
The dermatology second-year course is designed to teach medical students how to describe skin lesions and the pathophysiologic basis and clinical characteristics of major dermatologic diseases. Major categories of clinical skin diseases and their most prominent constituents will be discussed, including papulosquamous diseases, blistering diseases, infectious diseases, and benign and malignant neoplasms.

M25 615A ENDOCRINOLOGY AND METABOLISM

Instructor: William E. Clutter, MD, 362-8094
This course aims to develop understanding of the pathophysiology, clinical manifestations and diagnosis of common endocrine disorders. History, physical examination and interpretation of diagnostic laboratory tests are emphasized. Principles of treatment of endocrine disorders and pharmacology of relevant drugs also are discussed. Students are expected to apply their knowledge in clinical case discussions.

M25 620A GASTROINTESTINAL AND LIVER DISEASES/NUTRITION
Instructor: Deborah C. Rubin, MD, 362-8935
This course discusses the pathophysiologic mechanisms related to the diseases of the gastrointestinal tract including esophagus, stomach, small and large intestines, liver, gallbladder and pancreas. The emphasis is on changes that occur in normal physiology, biochemistry, anatomy, immunology and cell biology that result in human gastroenterologic diseases. Included also are lectures on the pharmacology of gastrointestinal drugs and basics of human nutrition in clinical practice. Lectures are supplemented by group seminars that focus on clinical case presentations.

M25 625A HEMATOLOGY AND ONCOLOGY

Instructors: Dr. Meagan Jacoby – 314-454-8304 and Dr. Eric Knoche – 314-289-6305
The hematology and oncology pathophysiology course exposes students to common hematologic disorders and hematologic malignancies. The course uses lectures, clinical case discussions and practical sessions involving microscopy.

Third year

M25 710 MEDICINE CLERKSHIP
Instructor: Thomas M. De Fer, MD, 362-8050
The medicine clerkship provides supervised study of patients in both inpatient and ambulatory settings. The 12-week clerkship is divided into three four-week rotations: two inpatient and one outpatient. For the inpatient rotations, students are assigned as clinical clerks to patients admitted to the cardiology and general medical teaching services of Barnes-Jewish Hospital and the St. Louis VA Medical Center — John Cochran Division. For the outpatient rotations, students are placed with community-based internal medicine or family practice physicians and will almost always require a car for transportation. Teaching is provided by the chief of service, attending physicians, house staff, consultants, chief residents, community-based preceptors and regularly scheduled conferences. Formal instruction is given regarding core internal medicine topics during the clerkship. Teaching activities include Chief Resident Rounds, Core Lecture Series, Physical Diagnosis Rounds, Radiology Rounds, Professor’s Rounds and other departmentally based conferences.

Clinical Pathological Conference

The clinical course, laboratory and radiologic studies, and pathological findings of a patient are discussed using a problem-solving format at a weekly conference by members of the Departments of Medicine, Pathology and Immunology, and Radiology; Melvin Blanchard, MD, internal medicine; chief residents and medical staff; Louis P. Dehner, MD; and pathology staff.

M25 707 PRACTICE OF MEDICINE III
Course Master: Tim Yau, MD
Clerkship Coordinator: Melody Cox, 362-3480

Objectives:
1. To review challenges and dilemmas relevant to the practice of clinical medicine.
2. To examine clinical experiences from a variety of perspectives.

In this course, themes and topics relevant students in their clinical stage of training are discussed. Session formats include lecture, panel discussion and/or small group. As students exchange problematic scenarios and questions, the group develops potential solutions and management schemes.

*Topics in the past have included:
Session 1: Complimentary and Alternative Medicine
Session 2: Safe and Quality Care at BJH
Session 3: Communicating Serious Adverse Events to Patients and Families
Session 4: Intimate Partner Violence
Session 5: Medical Malpractice/Tort Reform
Session 6: Healthcare Financing
Session 7: Update on the Patient Protection and Affordable Care Act (PPACA)
Session 8: Clincal Practice Management
Session 9: Recognizing Personal Biases
Session 10: Evaluation and Treatment of Patients with Disabilities

Attendance at 8 out of 10 POM III sessions is required to pass this course. Student may use 2 absences for any reason and are recommended to save them for their ACES rotation, Labor & Deliver rotation, or an emergency.
Sessions will be from 12:00 pm – 2:00 pm on the 3rd Tuesday of every month except for November and December. (Please note that the 1st session is held on the 4th Tuesday of June).

The dates for 2016-17 are:
6/21/16,  7/19/16,  8/16/16,  9/20/16,  10/18/16,  1/24/17,  2/21/17,  3/21/17,  4/18/17,  5/16/17

Students are excused from clinical activities to attend.
Location: Connor Auditorium, Farrell Learning and Teaching Center
* Topics subject to change

M25 714 EMERGENCY MEDICINE
Instructors: Mark Levine, MD, 362-6743
The WUMS III Emergency Medicine Rotation takes place in the main emergency department of Barnes-Jewish Hospital. Up to six students at a time are assigned to this four-week rotation. Students will spend their first day in an orientation session that will include an ED introduction, a suture lab, an airway lab, a central line lab, and an ultrasound lab. A digital course “text” will be provided. The student may request a written copy as well. Students will be evaluating and treating patients throughout the Emergency Department. Although the majority of the time will be spent in the areas of the ED that see “bread and butter” EM cases, the students will have assigned shifts in the trauma/critical care area and report directly to an attending or senior resident. There are five hours of mandatory lecture per week. Students can expect to gain a wide range of skills in evaluating a variety of complicated and non-complicated patients. At the end of the rotation, students will be familiar with the approach to complex medical conditions like chest pain, undifferentiated abdominal pain and complications of pregnancy as well as treatments of lacerations, abscesses, simple respiratory tract infections and minor trauma. Opportunities will be provided to the student to perform the necessary procedures on their patients as required. The student will also spend a day in an interdisciplinary approach with other EM support services (respiratory, social work, nursing, physical therapy).

WUMS III will be graded on their clinical skills, their ability to make a formal patient presentations during a shift, professionalism, and their conference attendance. There will be a written test on the last Friday of the rotation based entirely on the material provided to the students at the start of the rotation.

M25 740 DERMATOLOGY CLERKSHIP

Instructor: Lynn Cornelius, MD, 454-8622
The goal of the dermatology clerkship is to provide a guide for the student to appreciate dermatology within the broader perspectives of medicine and biology. The student will develop familiarity with dermatologic vocabulary, learn to recognize and initiate therapy of common dermatologic disorders and become cognizant of uncommon or complicated dermatologic problems that require specialty care. Emphasis will be placed on careful history taking and physical examination. Students will always work under the direction of the resident physician and the attending physicians in the clinic setting.

The student will participate in outpatient care at the following hospitals and affiliated clinics: Barnes-Jewish Hospital, St. Louis Children’s Hospital, Barnes-Jewish West County Hospital, and the Veterans Administration Medical Center. These hospital settings will provide the student with ample exposure to a diverse patient population. Students will attend all clinical teaching rounds and conferences in addition to the basic science and cutaneous histopathology conferences. Normal workday hours are 8 a.m. to 5 p.m. with no night or weekend on-call responsibilities. Each student is provided with copies of the two recommended textbooks, The Washington Manual of Dermatology Diagnostics by M. Laurin Council, et al. and The Color Atlas and Synopsis of Clinical Dermatology by T.B. Fitzpatrick for use during the clerkship; the textbooks are returned to the clerkship coordinator at the end of the clerkship for use by other students rotating in the dermatology division.

The rotation attending physician and the resident physician will submit an evaluation based on the student?s clinical skills, presentation, attitudes, overall performance and the end-of-rotation written exam score. Students are not eligible to take the fourth-year rotation if they complete this clerkship.

M25 750 GERIATRIC MEDICINE CLERKSHIP
Instructor: Ellen F. Binder, MD, 286-2707

Program Coordinator: Stephanie Paule, 286-2909
The primary goal of the four-week clerkship in Geriatric Medicine is for students to gain proficiency in the principles of geriatric evaluation and interdisciplinary team management, including medical, psychological, social, and functional assessments of older adults. Students are expected to participate in the evaluation of at least three to five patients per week, in a variety of settings including the outpatient Geriatric Assessment Clinic, in-patient Geriatric consults, nursing home visits at Parc Provence, home visits with the VA Home-Based Primary Care Program, and at the Rehabilitation Institute of St. Louis (TRISL). Students will also have the opportunity to participate in hospice and home care visits, and observe an assessment at the WU Alzheimer’s Disease Research Center. Students are expected to attend weekly conferences and didactic sessions while on the rotation, and give an oral presentation on a topic of their choice.

The day usually begins at 8:30 a.m. and ends by 5:30 p.m. There is no night or weekend call. Time is provided to read the syllabus/bibliography and complete web-based learning modules.
Location: Wohl Clinic Building, Third floor, Room 338
Other Information: Meet at the Department of Geriatrics office, Wohl Clinic Building, Third floor, Room 338, 9:00 a.m. first day of elective.
Pre-requisite: Students must have completed the Internal Medicine clerkship before taking this elective; completion of the Neurology clerkship is encouraged but not required.

M25 730 PHYSICAL MEDICINE AND REHABILITATION
Coursemaster: Neringa Juknis, MD, 454-7757
Clerkship in PM&R for third-year medical students provides an opportunity to gain basic knowledge and clinical skills in evaluation and management of a wide range of neurological and musculoskeletal diseases and conditions that require specialized rehabilitative medical and therapeutic care. Students spend two weeks on the Spinal Cord Injury Unit (SCI) and two weeks on the Brain Injury (BI) and Stroke Unit at The Rehabilitation Institute of St. Louis. Students are expected to be a part of the rehabilitation team, follow three to five patients, participate in daily morning rounds, participate in performing consults and attend team meetings and family conferences.

Students are required to attend several outpatient clinics such as SCI, BI, Amputee and Stroke. During the entire rotation, students work with PM&R residents and fellows, and under direct guidance of the NeuroRehabilitation faculty. The usual duty hours are 7:30 a.m. to 5 p.m. weekdays and 8 a.m. to noon on Saturdays. There is no night call.

Students are required to attend all PM&R curriculum lectures and conferences. On the first day of rotation, students meet with the PM&R program director to go over goals, objectives and schedules. Upon completion of the rotation, students are required to fill out the evaluation form to provide feedback regarding rotation experience.

M25 810  GERIATRIC MEDICINE
Instructor(s): Ellen Binder, MD, 286-2700, press option 1
Enrollment limit per period: 1
Valid start weeks for 4-week blocks are: Weeks 5, 13, 17, 21, 25, 29, 33, 37, and 41.

The primary goal of the four-week clerkship in Geriatric Medicine is for students to gain proficiency in the principles of geriatric evaluation and interdisciplinary team management, including medical, psychological, social, and functional assessments of older adults. Students are expected to participate in the evaluation of at least three to five patients per week, in a variety of settings including the outpatient Geriatric Assessment Clinic, in-patient Geriatric consults, nursing home visits at Parc Provence, home visits with the VA Home-Based Primary Care Program, and at the Rehabilitation Institute of St. Louis (TRISL). Students will also have the opportunity to participate in hospice and home care visits, and observe an assessment at the WU Alzheimer’s Disease Research Center. Students are expected to attend weekly conferences and didactic sessions while on the rotation, and give an oral presentation on a topic of their choice.

The day usually begins at 8:30 a.m. and ends by 5:30 p.m. There is no night or weekend call. Time is provided to read the syllabus/bibliography and complete web-based learning modules.
Pre-requisite: Students must have completed the Internal Medicine clerkship before taking this elective; completion of the Neurology clerkship is encouraged but not required.

Fourth year

Electives

M25 – INTERNAL MEDICINE

M25 801 / HONORS MEDICINE – GENERAL MEDICINE
Instructor(s): Thomas De Fer, MD, 314-362-8050
Location: Barnes-Jewish Hospital
Elective Contact: Amber Specter, 314-362-8050
Other Information: Students will receive e-mail communication regarding where to report on the first day prior to the beginning of the period.
Enrollment limit per period: Limit 8/period for Weeks 1, 5, 9; 4/period for Weeks 13, 17, 21, 25, 29, 33, 37, and 41.

The purpose of the “Honors Medicine” elective (sub-internship) is the development of expertise in the care of hospitalized patients in a well-supervised teaching environment. Sub-interns act as their patients’ interns under the supervision of residents and attending physicians. Sub-interns have the same on-call and admitting schedules as the interns on their teams and are assigned up to two new patients on each admitting day. Sub-interns are not required to spend call nights in the hospital. Except in emergencies, sub-interns are the first individuals to evaluate patients admitted to medical service teams. A diagnostic and therapeutic approach to the patient is planned in consultation with the resident. Sub-interns assume primary responsibility for the daily care of their patients, under the supervision of resident and attending physicians. This includes evaluation on daily rounds, scheduling and obtaining results of diagnostic studies, planning therapy, making arrangements for care after discharge and communicating with patients and their families. Sub-interns attend the same conferences as the house staff.

Student time distribution: Inpatient 90%; Conferences/Lectures 10%; Primary Care 50%; Subspecialty Care 50%
Major teaching responsibility: Attending, chief resident, and resident
Patients seen/weekly: 8-12
On call/weekend responsibility:  Yes

M25 805 / RHEUMATOLOGY

Instructor(s): Richard Brasington, MD; Prabha Ranganathan, MD; John Atkinson, MD; Deborah Parks, MD; 314-454-7279
Location: Barnes-Jewish Hospital, 5C Center for Advanced Medicine
Elective Contact: Department secretary, 314-454-7279
Other Information: Students should contact the Rheumatology office, 314-454-7279 prior to first day for assignment.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Students will be involved in the diagnostic work-up and management of patients with rheumatic illnesses including systemic lupus erythematosus, rheumatoid arthritis, vasculitis (polyarteritis, Wegener’s, temporal arteritis), spondyloarthropathies (ankylosing spondylitis, reactive arthritis), osteoarthritis, gout and regional musculoskeletal problems. By working closely with a faculty member, fellows and medical residents, students become integral and active members of the rheumatology service for inpatient consultations and outpatient clinics at Barnes-Jewish Hospital. An emphasis is placed on the physical examination of joints and the musculoskeletal system, synovial fluid analysis, and interpretation of diagnostic tests and radiographs. Students attend two rheumatology conferences held weekly.  A rotation limited to outpatient rheumatology is possible by prior arrangement with Dr. Brasington.

Student time distribution: Inpatient 40%; Outpatient 50%; Conferences/ Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Attendings
Patients seen/weekly: ~25 per student
On call/weekend responsibility: None

M25 807 / HONORS MEDICINE – VA MEDICAL CENTER
Instructor(s): Amy Joseph, MD, 314-289-7030
Location: St. Louis Veterans Affairs Medical Center
Elective Contact: 314-289-6308
Other Information: Students will receive e-mail communication regarding where to report on the first day prior to the beginning of the period.
Enrollment limit per period: Limit 3/period for Weeks 1, 5, 9; 1/period for Weeks 13, 17, 21, 25, 29, 33, 37, and 41.

The purpose of the “Honors Medicine” elective (sub-internship) at the VA Medical Center is to develop practical experience and expertise in the care of hospitalized patients on an internal medicine ward. With appropriate supervision by the attending and resident physicians, sub-interns will have similar responsibilities as interns. They have the same on-call/admitting schedules as the interns and participate in the same teaching conferences, but they do not take overnight call. Sub-interns should admit at least two patients per call day, and they should be the first to evaluate the patients admitted to the medical service, except in emergencies.  A diagnostic and therapeutic approach to evaluating each patient is planned in consultation with the resident. While being supervised as listed above, sub-interns assume primary responsibility for the daily care of their patients, including evaluation on daily rounds, scheduling and obtaining results of diagnostic studies, calling consults, planning therapy, making arrangements for care after discharge. and communicating with patients and their families.

Student time distribution: Inpatient 80%; Conferences/Lectures 20%; Subspecialty Care 100%
Major teaching responsibility: Attending, Chief Resident and Resident
Patients seen/weekly: 6-8 on average
On call/weekend responsibility: On-call every fourth day

M25 810 / GERIATRIC MEDICINE
Instructor(s): Ellen Binder, MD, 314-286-2700, press option 1
Location: Wohl Clinic Building, 3rd Floor conference room
Elective Contact: Stephanie Paule, Program Coordinator: 314-286-2909
Other Information: Meet at the Department of Geriatrics office, Wohl Clinic Building, 3rd Floor conference room, 8:30 a.m. first day of elective.
Enrollment limit per period: 1
Valid start weeks for four-week blocks are: Weeks 5, 13, 17, 21, 25, 29, 33, 37, and 41.

The primary goal of this rotation is for students to gain proficiency in the principles of geriatric evaluation and management, including the medical, psychological, social, and functional assessments of older adults.  Students are expected to participate in the evaluation of three to five patients per week, in a variety of settings including the outpatient Geriatric Assessment Clinic, in-patient Geriatric Consult service, Parc Provence nursing home, and the Rehabilitation Institute of St. Louis (TRISL).  Students will also have the opportunity to participate in hospice and home care visits, interdisciplinary team meetings, and observe an assessment at the WU Alzheimer’s Disease Research Center.  Students are expected to attend weekly conferences while on the rotation.

The day normally begins at 8:30 a.m. and is usually finished by 5:30 p.m. There is no night or weekend call.  Time is provided to read the detailed syllabus/bibliography.  Students will be expected to give an oral presentation on a topic of their choice once during the rotation.

Student time distribution: Inpatient 20%; Outpatient 80%; Primary Care 20%; Subspecialty Care 80%
Major teaching responsibility: Attendings
Patients seen/weekly: 10-15
On call/weekend responsibility: None

M25 811 / CLINICAL INTERNAL MEDICINE – HOSPITALIST
Instructor(s): Caroline Kahle, MD, 314-362-1700
Location: Barnes Jewish Hospital, West Pavilion Corridor main level
Elective Contact: Mary Russell, 314-362-1707, mrussell@wustl.edu
Other Information: Students should contact Mary Russell one to two weeks prior to first day of elective for information on where to meet.
Enrollment limit per period: 1
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

This course allows the student to work one-on-one with hospitalist physicians on a patient care team. The student acts as the intern under the direct supervision of the attending physician. Daily responsibilities include admission history and physicals, daily notes and discharge summaries on assigned patients. S/he also will have the opportunity to perform indicated procedures on patients on this service. Students are encouraged to participate in Department of Medicine conferences.

Student time distribution: Inpatient 95%; Conferences/Lectures 5%; Primary Care 100%
Major teaching responsibility: Hospitalist attendings
Patients seen/weekly: 10
On call/weekend responsibility: None

M25 814 / CLINICAL EMERGENCY MEDICINE, BARNES-JEWISH HOSPITAL
Instructor(s): Mark Levine, MD, 314-362-6743
Location: Barnard and/or Wohl Hospital
Elective Contact: Mary Hummert, 314-747-4156
Other Information: Contact Emergency Medicine Division office at 314-747-4156, for scheduling one week prior to the rotation. If a student is needing any time off, approval will be needed by the Course Coordinator before the start of the rotation. Students are required to work at least 12 to 14 shifts.
Enrollment limit per period: 6
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

This rotation offers practical experience in the evaluation and management of acutely sick and injured patients. Students will function as sub-interns, initially evaluating their assigned patients and developing a plan for further diagnostic studies and therapy. They will report to a senior level resident or an attending physician.

The student can expect to get an opportunity to perform a wide variety of procedural skills such as suturing, splinting, peripheral and central venous access, and cardiopulmonary resuscitation. Shifts will be eight hours and students will rotate between day, evening and night shifts, including weekend shifts, in order to gain maximum exposure to all types of emergencies. A core content of lectures will be provided.

Students will gain an understanding of prehospital care by doing a ridealong shift with the St. Louis Fire Department EMS. Students will also have a shift with the toxicology attendings and residents and will gain knowledge of the basics of ultrasound during their time in the department. Students interested in EM will be doing 1:1 shifts with a single attending during their last two weeks of the rotation.

Students desiring a letter of recommendation from Dr. Michael Mullins, Director of Research, or any other EM attending should take this WUMS IV Emergency Medicine rotation. Students will be scheduled for required weekend and overnight shifts and changes will not be allowed to the schedule unless approved prior to the start of the rotation by the course coordinator.

Please be advised that there is a limit of days off while on this rotation during interview season; otherwise, students should arrange to take the elective at a different time during the year.  Days off during the rest of the year will conform to university policy. Days off should be requested from Mary Hummert at least two weeks prior to the beginning of the rotation for scheduling purposes.

Student time distribution: Outpatient 80%; Conferences/Lectures 20%; Primary Care 40%; Subspecialty Care 60%
Major teaching responsibility: Attendings and senior residents (PGY 3 & 4)
Patients seen/weekly: ~5 per shift
On call/weekend responsibility: Evenings and weekends; no on call

M25 821 / INPATIENT CARDIOLOGY
Instructor(s): Anita Bhandiwad, MD 314-362-1291
Location: 13th Floor, Northwest Tower
Elective Contact: Anita Johnson, 314-747-3606
Other Information: Students meet on the 13th Floor, Northwest Tower, 9:00 a.m. first day of elective.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Students will participate as members of the Barnes-Jewish Cardiology at Washington University Consultative Team. They will be part of a team composed of faculty members, fellows, residents, and nurse specialists that sees a large population of cardiac patients and follows them through all aspects of their in-hospital care. Emphasis will be placed on physical examination and the interpretation of modern cardiac diagnostic tests including electrocardiograms, echocardiograms and coronary angiograms and their role in clinical decision making.

Student time distribution: Inpatient 90%; Outpatient 0%; Conferences/ Lectures 10%; Primary Care 0%; Subspecialty Care 100%
Major teaching responsibility: Attending and fellow
Patients seen/weekly: 10-15
On call/weekend responsibility: None

M25 822 / HONORS MEDICINE – CARDIOLOGY
Instructor(s): Thomas De Fer, MD, 314-362-8050
Location: Barnes-Jewish Hospital
Elective Contact: Amber Specter, 314-362-8050
Other Information: Students will receive e-mail communication regarding when/where to report on the first day prior to the beginning of the period.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

The structure and functioning of the “Honors Medicine-Cardiology” elective (sub-internship) is very similar to the general medicine sub-internship (M25 801). The basic purpose is to develop expertise in the care of hospitalized patients in a well-supervised teaching environment. The majority of patients admitted to the service will have a cardiology diagnosis as the main reason for admission. Some general medical problems will also be seen. All attendings on the service are cardiology subspecialists. Cardiology fellows act as the chief resident for the service on a monthly basis. Sub-interns act as their patients’ interns under the supervision of residents and attending physicians. Sub-interns have the same on-call and admitting schedules as the interns on their teams and are assigned up to two new patients on each admitting day. Sub-interns are not required to spend call nights in the hospital. Except in emergencies, sub-interns are the first individuals to evaluate patients admitted to medical service teams. A diagnostic and therapeutic approach to the patient is planned in consultation with the resident. Sub-interns assume primary responsibility for the daily care of their patients, under the supervision of resident and attending physicians. This includes evaluation on daily rounds, scheduling and obtaining results of diagnostic studies, planning therapy, making arrangements for care after discharge and communicating with patients and their families. Sub-interns attend the same conferences as the internal medicine house staff. There are also several conferences specific to the cardiology service.

Student time distribution: Inpatient 90%; Conferences/Lectures 10%; Primary Care 25%; Subspecialty Care 75%
Major teaching responsibility: Attending, chief resident, and resident
Patients seen/weekly: 8-12
On call/weekend responsibility: Yes

M25 823 / CLINICAL CARDIOLOGY – VA HOSPITAL
Instructor(s): Wade Martin, MD, 314-289-6329
Location: John Cochran VA Hospital
Elective Contact: Wade Martin, MD, 314-289-6329
Other Information: Students should meet in Room B206, 2nd Floor, VA Hospital.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

The major purpose of this elective in clinical cardiology at the John Cochran VA Hospital is to improve evaluation and management skills for diagnosis and treatment of important cardiovascular conditions such as coronary artery disease including acute myocardial infarction, congestive heart failure, hypertension, and valvular heart disease. The rotation is designed to be flexible enough to accommodate a wide variety of course objectives but includes the opportunity to participate in 1-3 outpatient clinics per week; 1-4 weeks of inpatient intensive care, telemetry, or cardiology consultation rounds; and ECG, stress testing, nuclear imaging, or echocardiographic reading sessions, cardiac catheterization and electrophysiologic procedures. The emphasis will be on improvement of the ability to diagnose and treat cardiovascular disease on the basis of information obtained from a thorough history and physical examination that is integrated with data from appropriate highly targeted laboratory studies in a manner that optimizes patient outcome and minimizes risk and costs.

Student time distribution: Inpatient 45%; Outpatient 55%; Conferences/ Lectures 5-10%; Primary Care 25%; Subspecialty Care 75%
Major teaching responsibility:  Attendings and fellows
Patients seen/weekly: 20
On call/weekend responsibility: Varies

M25 825 / CARDIAC ARRHYTHMIAS AND ELECTROPHYSIOLOGY
Instructor(s): Timothy Smith, MD, PhD, 314-454-7877
Location: Barnes-Jewish Hospital
Elective Contact: Timothy Smith, MD, PhD, or Gina Gentilini, 314-747-4166
Other Information: Students meet in the Cardiology Division, 13th Floor Northwest Tower,  8:00 a.m. first day of elective or page the EP Fellow at 314-424-4680.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

This elective provides the student with exposure and teaching in the diagnosis and treatment of complex cardiac rhythm disturbances. Specifically, the student is expected to evaluate patients referred for evaluation and treatment of complex or life-threatening rhythm disturbances, unexplained syncope or sudden cardiac death. Rounds are made daily on hospitalized patients, and students are welcome to observe electrophysiology studies or implantation of pacemakers and defibrillators. This elective also provides an intensive opportunity to learn clinical electrocardiography and the systematic use of anti-arrhythmic drugs. Finally, since patients with chronic, complex rhythm disturbances frequently have organic heart disease, a broad-based exposure to general cardiology is also part of this elective.

Student time distribution: Inpatient 80%; Outpatient 10% (optional); Conferences/Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Attending physician
Patients seen/weekly: 2 new consults/day
On call/weekend responsibility: None

M25 827 / HEART FAILURE/CARDIAC TRANSPLANTATION
Instructor(s): Gregory Ewald, MD, 314-454-7009
Location: Barnes-Jewish Hospital, North Campus, Suite 4455
Elective Contact: Gregory Ewald, MD, 314-454-7009
Other Information: Students should page the attending physician, 8:00 a.m. first day of elective.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

This rotation is intended to provide trainees with a comprehensive experience managing patients with advanced heart failure. In addition to daily rounds, trainees are invited to attend both heart failure and transplant clinics. Further, the curriculum is supplemented by a comprehensive syllabus that contains the critical literature pertinent to this patient population. The trainees will also have experience with the evaluation of patients for operative heart failure therapies and will have the opportunity to observe these surgical procedures.

Student time distribution: Inpatient 70%; Outpatient 20%; Conferences/ Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Attendings
Patients seen/weekly: 30
On call/weekend responsibility: None

M25 830 / DERMATOLOGY
Instructor(s): Dermatology Staff, 314-454-8622
Location: 7705 Wohl Hospital
Elective Contact: Rosemarie Brannan, 314-454-8622
Other Information: First Monday of rotation students will attend both the 7:30 a.m. lecture in the Dermatology Library, 7706 Wohl Hospital and the 9:00 a.m. orientation, Room 7714 Wohl Hospital.
Enrollment limit per period: 4
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 29, 33, 37, and 41.

THIS COURSE HAS A STRICT ATTENDANCE POLICY!

The aim of this elective is to provide a guide for the student so that s/he is able to appreciate dermatology within the broader perspectives of medicine and biology. Emphasis will be placed on the dermatologic variations encountered in a normal physical examination of the skin, the identification of common skin diseases, dermatologic clues to systemic disease, as well as those dermatologic conditions that are life threatening. The student will participate in outpatient care in the Barnes-Jewish Hospital and affiliated clinics. Students will attend all clinical teaching rounds and conferences in addition to the basic science and cutaneous histopathology conferences.

M25 830 is essentially the same as the 3rd Year Dermatology Clerkship.  Students are limited to taking either one or the other – NOT BOTH.

Student time distribution: Inpatient 25%; Outpatient 50%; Conferences/ Lectures 25%; Specialty Care 100%
Major teaching responsibility: Course Master for rotation and senior resident
Patients seen/weekly: 25-50
On call/weekend responsibility: None

M25 831 / PEDIATRIC DERMATOLOGY
Instructor(s): Carrie Coughlin, MD
Location: 7706 Wohl Hospital
Elective Contact: Rosemarie Brannan, 314-454-8622
Other Information: Call 314-454-8622 prior to first day of elective. Reporting time is 7:30 a.m. first day of elective.
Enrollment limit per period: 1
Valid start weeks for 4fourweek blocks are: Weeks 1, 5, 9, 13, 17, 21, 29, 33, 37, 41.

This clinical rotation will be available to students interested in dermatology, pediatrics or both. Students will follow the dermatology rotation (M25 830) with an emphasis on pediatric dermatology by attending pediatric dermatology clinics, seeing consults, etc. Enthusiastic students will have an opportunity to write up a case report if they wish, but need to notify Dr. Bayliss before the course.

Students can take either this elective or M25 830/Dermatology — NOT BOTH.

Student time distribution: Inpatient 1%; Outpatient 74%; Conferences/ Lectures 25%; Subspecialty Care 100%
Major teaching responsibility: Two attendings
Patients seen/weekly: 50-100
On call/weekend responsibility: None

M25 834 / CLINICAL MENTORING
Instructor(s): Gregory Polites, MD, 314-747-5268
Location: Office of Medical Student Education (OMSE), 5th Floor Becker Medical Library
Elective Contact: Melody Cox, 314-286-2546
Other Information: To be determined
Enrollment limit per period: 62

This elective is designed to develop the teaching and mentoring skills of our 4th year medical students through structured hospital sessions with 1st year medical students and supervised sessions with clinical faculty. The primary format of the elective is observation of the 1st year students during hospital sessions where the first years perform the H&P and the 4th year mentors offer constructive feedback. Each H&P write-up is also thoroughly reviewed and critiqued by the mentor. Supervisory sessions also occur with clinical faculty who give feedback on both the performance of the 1st year students as well as the mentoring skills of the 4th year.

Student time distribution: TBD
Major teaching responsibility: TBD (assigned)
Patients seen/weekly:
On call/weekend responsibility: None

M25 836 / CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
Instructor(s): Gregory S. Sayuk, MD, MPH, 314-454-8201
Location: Barnes-Jewish Hospital, East Pavilion
Elective Contact: Beth Buschard-Steiger, 314-454-8201
Other Information: Students meet in the Digestive Disease Clinical Center, street level East Pavilion, Barnes-Jewish Hospital, 8:00 a.m. first day of elective.
Enrollment limit per period: 4
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

The GI Hepatology elective is integrated into a very active inpatient/outpatient and endoscopy service at Barnes-Jewish Hospital. Students will participate in the evaluation of inpatients and outpatients with a spectrum of gut and liver disorders, will make patient rounds with the faculty and fellows, and have responsibility for patients on whom consultations have been requested. In addition, they will observe biopsy, endoscopic, and intubation techniques and participate in outpatient clinic and GI conferences.

Student time distribution: Inpatient 65%; Outpatient 25%; Conferences/ Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Attending and fellows
Patients seen/weekly: 12 new
On call/weekend responsibility: None

M25 838 / MEDICINE CONSULT SERVICE
Instructor(s): Caroline Kahle, MD, and Gina LaRossa, MD, 314-362-1700
Location: Barnes-Jewish Hospital, West Pavilion Corridor main level
Elective Contact: Mary Russell, 314-362-1707, mrussell@wustl.edu
Other Information:  Students should contact Mary Russell, 314-362-1707, one to two weeks prior to first day of elective for information on where to meet.
Enrollment limit per period: 1
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41. Two week rotations are also available.

The focus of the Medicine Consult Service elective is the evaluation and management of medically complex patients admitted to the hospital on non-medicine services.The issues involved with perioperative management are particularly stressed. The student will function as a member of the consult service team. Duties will include performing initial consultations and follow-up care under the supervision of a Hospital Medicine attending and a senior medical resident. Attendance at Department of Medicine and division conferences is encouraged.

Student time distribution: Inpatient 90%; Conferences/Lectures 10%; Primary Care 100%
Major teaching responsibility: Consult Service attending (from the Division of Hospital Medicine)
Patients seen/weekly: 10-15
On call/weekend responsibility: None

M25 842 / INTRODUCTION TO WILDERNESS MEDICINE
Instructor(s): Nicholas Musisca, MD; Bill Dribben, MD; Kurt Eifling, MD
Location: Emergency Medicine Teaching Classroom
Elective Contact: Nicholas Musisca, MD; Bill Dribben, MD; Kurt Eifling, MD, 314-362-7998
Other Information: Students report at 8:00 am first day of elective
Enrollment limit per period: 10
Valid start weeks for two-week blocks are: Weeks 15-16

The purpose of this course is to introduce medical students to common medical problems both emergent and nonemergent seen in various wilderness settings.  After taking this course the student should have a basic understanding on the pathophysiology and management of these problems in an environment with limited access to medical aid.  The course will involve four days of four-hour lectures each week along with one 1-2 day required overnight camping trip.  Requirements to pass this course include completing a presentation on a topic of their choosing that is approved by the course master as well as a skills and written test.

Attendance is required at all lectures & events.  Grading will be pass/fail

Student time distribution: Conferences/Lectures, 100%;  Subspeciality Care, 100%
Major teaching responsibility: Bill Dribben, MD; Nicholas Musisca, MD
Patients seen/weekly: 0
On call/weekend responsibility: No call, required outdoor activity

M25 843 / MEDICAL TOXICOLOGY
Instructor(s): Evan S. Schwarz, MD, 314-747-3690
Location: Emergency Medicine office, 8th Floor of Barnard, Suite 8813
Elective Contact: Mary Hummert, 314-747-4156
Other Information: Students meet in 8th floor Emergency Medicine Conference Room, 8th Floor, Barnard, 8:00 a.m. first day of elective
Enrollment limit per period: 5
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

This rotation offers practical experience in the evaluation and management of the acutely ill poisoned patient. Students will function as subinterns and either report to the senior resident, fellow, or directly to the toxicology attending.

Students will gain familiarity and experience evaluating and treating patients who have intentionally and unintentionally overdosed on medications or illicit drugs, been envenomated (such as by spiders, snakes, or other reptiles), or been exposed to toxic substances or chemicals. Students will also gain experience in administering antidotes and learning to properly decontaminate someone after an ingestion or exposure.

There are no overnight or weekend shifts. Daily activities start in the morning and are generally concluded by the early afternoon. A core content of lectures will be provided. The students will also be assigned small projects during their rotation that will enhance their experience particularly in environmental and occupational toxicology.

Opportunities to increase their experience with occupational toxicology also exist during this rotation; those with this interest can ask for further information during their rotation. Students will also have the opportunity to go to the Missouri Poison Center and evaluate patients in the outpatient toxicology clinic.

Students desiring a letter of recommendation from one of the toxicology attendings (who are also Emergency Medicine and Internal Medicine attendings) or interested in Emergency Medicine or Medical Toxicology should take this elective. Also, students considering other specialties such as Pediatrics or Internal Medicine should consider this rotation as they will be responsible for evaluating these patients as part of their inpatient or outpatient practice.

Please be advised that there is a limit of days off while on this rotation during interview season; otherwise, students should arrange to take the elective at a different time during the year. Days off should be requested from Mary Hummert at least two weeks prior to the beginning of the rotation for scheduling purposes. Students should receive a course guide just prior to their rotation. However if they do not, they can page the toxicology pager at (314) 672-0284 to determine when and where to meet for rounds.

Student time distribution: Inpatient 70%; Outpatient 10%; Conferences/ Lectures 20%; Subspecialty Care 100%
Major teaching responsibility: Toxicology Faculty
Patients seen/weekly: 12
On call/weekend responsibility: None

M25 844 / HEMATOLOGY AND HEMOSTASIS
Instructor(s): Morey Blinder, MD, and Evan Sadler, MD, 314-362-8857
Location: 8801 Clinical Sciences Research Building
Elective Contact: Morey Blinder, MD, 314-362-8814
Other Information: Students will meet in Barnes-Jewish Hospital South. Contact Kim French at 314-454-8532 for time and location.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Activities planned include work-up of patients at Barnes-Jewish Hospital under the supervision of the hematology fellow and his staff consultant; attendance at clinical rounds three to five hours weekly; participation in out-patient clinics; experience in various procedures, especially blood and bone marrow morphology and in interpretation of coagulation tests. Daily student rounds with a senior staff person.

Student time distribution: Inpatient 80%; Outpatient 10%; Conferences/ Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Attending and fellow
Patients seen/weekly: 3-5
On call/weekend responsibility: None

M25 847 / BONE AND MINERAL DISEASES
Instructor(s): Michael Whyte, MD; Kathryn Diemer, MD; Roberto Civitelli, MD; and Carolyn Jachna, MD
Location: Barnes-Jewish Hospital; Barnes-Jewish Hospital West County; Shriners’ Hospital for Children
Elective Contact: Michael Whyte, MD, 314-872-8305
Other Information: Please contact Dr. Whyte a week before elective for instruction and meeting location.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 17, 21, 25, 29, 33, 37, and 41.

The course is designed to acquaint the student with the clinical, radiological and pathological manifestations and treatment of disorders of bone and mineral metabolism, including osteoporosis, Paget’s disease of bone, hyperparathyroidism, osteomalacia, and more rare disorders of bone development and homeostasis. The student will rotate through clinics of the Division of Bone and Mineral Diseases, and see patients at Barnes-Jewish Hospital, Barnes-Jewish West County Hospital and Shriners Hospital for Children.

Acquired and heritable bone diseases will be studied in the context of derangements of mineral homeostasis with emphasis on vitamin D and peptide hormone metabolism and skeletal formation and remodeling. The role of non-invasive methods for measuring bone mass in the diagnosis and management of skeletal diseases also will be stressed. Faculty and medical students will be present interesting cases for discussion or the students can present a pertinent topic related to bone metabolism they have researched during their rotation.

Responsibilities: Shriners Hospital Wednesday a.m. (Dr. Whyte); CAM, 2nd and 3rd Monday (a.m.), and 4th Thursday (p.m.) of each month; Barnes-Jewish West County Prof. Building 2; Tuesdays or Wednesdays, p.m. Metabolic Bone Disease Case Conference, Fridays 8:00 a.m., BJC Institute of Health Building, 11th Floor, Conference Room AB; Avioli Musculoskeletal Research Seminars, Fridays 9:00 a.m., BJC Institute of Health Building, 11th Floor, Conference Room AB.

Student time distribution: Outpatient 85%; Conferences/ Lectures 15%; Subspecialty Care 100%
Major teaching responsibility: Attendings
Patients seen/weekly: ~20
On call/weekend responsibility: None

M25 853 / BONE AND JOINT INFECTIOUS DISEASE CONSULT
Instructor(s): Hilary Babcock, MD, 314-454-8225, HBABCOCK@DOM.wustl.edu
Location: 15th Floor, Northwest Tower
Elective Contact: Dawn-Michele Cannon, 314-454-8225
Other Information: Students should page the Bone and Joint attending at 314-510-3805 at 8:00 a.m. on the first day of the elective.
Enrollment limit per period: 8
Valid start weeks for two-week blocks are: Weeks 3, 7, 11, 15, 19, 23, 27, 31, 35, 39, and 43. Must be done in conjunction with 2 weeks of General Infectious Disease

Study of infectious diseases of the bones and joints, including infections in both native and prosthetic joints. The elective is designed to teach students the fundamentals of evaluating clinical orthopedic infections and formulating plans for workup and therapy. Students see consultations in infectious diseases in every part of Barnes-Jewish Hospital under the supervision of a faculty member who rounds with them every day. They work closely with the infectious diseases attending and nurse practitioner, follow their own patients and play an important role in their management. They are expected to read the literature about their patients and participate in clinical conferences. They attend teaching rounds and conferences and lectures in infectious diseases. They also learn appropriate use of antibiotics and antifungal agents. The role of surgical and medical management is discussed, and the students will interact with surgical staff in understanding the risks and outcomes of these common infections.  Two weeks of General Infectious Disease are a prerequisite to this course.

Student time distribution: Inpatient 90%; Conferences/Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Single Attendings
Patients seen/weekly: 20
On call/weekend responsibility: None

M25 854 / TRANSPLANT INFECTIOUS DISEASE
Instructor(s): Steve Lawrence, MD, 314-454-8214, slawrenc@dom.wustl.edu
Location: 15th Floor Northwest Tower
Elective Contact: Dawn-Michele Cannon, 314-454-8225
Other Information: Students should page the Transplant fellow at 314-536-5253 at 8:00 a.m. on the first day of the elective.
Enrollment limit per period: 2
Valid start weeks for two-week blocks are: Weeks 3, 7, 11, 15, 19, 23, 27, 31, 35, 39, and 43. Must be done in conjunction with 2 weeks of General Infectious Disease

Study of infectious diseases in patients who have had bone marrow or solid organ transplants, or who have a hematologic malignancy. The elective is designed to teach students the fundamentals of evaluating clinical infections in these complex and interesting patients and formulating plans for workup and therapy. Students see consultations in every part of Barnes-Jewish Hospital under the supervision of a faculty member who rounds with them every day. They work closely with infectious disease fellows, follow their own patients and play an important role in their management. They are expected to read the literature about their patients and participate in clinical conferences. They attend teaching rounds and conferences and lectures in infectious diseases. They also learn appropriate use of antibiotics, antifungal and antiviral agents in this highly immune suppressed population. A wide distribution of infectious diseases is covered including management of neutropenic fever, invasive fungal infections in the transplant population, acute and chronic infections, infection prophylaxis and monitoring and interactions between immunosuppressive agents and antibiotics.

Student time distribution: Inpatient 90%; Conferences/Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Single Attending and Fellow
Patients seen/weekly: 6
On call/weekend responsibility: None

M25 858 / AMBULATORY INFECTIOUS DISEASE
Instructor(s): Nigar Kirmani, MD, 314-747-1214
Location: 15th Floor Northwest Tower and Storz Building
Elective Contact: Lori Watkins, 314-747-1214
Other Information: Students should report to the ID Clinic in the Storz Building, 8:00 a.m. first day of elective.
Enrollment limit per period: 8
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

The elective is designed to teach students the fundamentals of evaluating clinical infections in the outpatient setting. Students see patients under the supervision of a faculty member. Students will participate in the care of HIV infected or otherwise immunosuppressed patients as well as general infectious disease and travel patients. The clinic is the primary provider for HIV infected patients, and students will learn the pathogenesis of HIV, become familiar with most antiretroviral medications, and have the opportunity to learn about opportunistic infections and their prophylaxis. They will also have the opportunity to see patients with bone and joint infections, endovascular infections, endemic and opportunistic mycoses, sexually transmitted diseases and travel plans. Patients seen will have a wide range of acute and chronic infections with a heavy emphasis on HIV/AIDS, including indigent and insured patients, of both sexes and a wide range of ages. The students will play an important role in the management of these patients. They are expected to read the literature about their patients and participate in clinical conferences.

Student time distribution: Outpatient 90%; Conferences/Lectures 10%; Primary Care 20%; Subspecialty Care 80%
Major teaching responsibility: Clinic Attendings
Patients seen/weekly: 15
On call/weekend responsibility: None

M25 859 / GENERAL INPATIENT INFECTIOUS DISEASE
Instructor(s): Nigar Kirnani, MD, 314-454-8214; Rachel Presti, MD, 314-454-8214, rpresti@dom.wustl.edu
Location: 15th Floor, Northwest Tower
Elective Contact: Dawn-Michele Cannon or Alicia Cicerelli, 314-454-8214
Other Information: Students should call Infectious Disease Fellows at either mobile number 314-536-5310 or 314-536-5311 on the first morning of the elective.
Enrollment limit per period: 8
Valid start weeks for two- or four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.  Two week blocks must be done in conjunction with Transplant Infectious Disease or Bone and Joint Infectious Disease.

Study of patients with infectious diseases, including inpatient care of HIV infected patients and general infectious disease consults. The elective is designed to teach students the fundamentals of evaluating clinical problems in infection and formulating plans for workup and therapy. Students see consultations in infectious diseases in every part of Barnes-Jewish Hospital under the supervision of a faculty member who rounds with them every day. They work closely with medical residents and infectious disease fellows, follow their own patients and play an important role in their management. They are expected to read the literature about their patients and participate in clinical conferences. They attend teaching rounds and conferences and lectures in infectious diseases. They also learn appropriate use of antibiotics, antifungal and antiviral agents. A wide distribution of infectious diseases is covered including community acquired acute and chronic infections, opportunistic infections in HIV infected patients, hospital acquired infections, and basic infection control practices. This is a four-week rotation. Two-week rotations are allowed, but must be done in conjunction with two weeks of Transplant Infectious Disease or Bone and Joint Infectious Disease.

Student time distribution: Inpatient 90%; Conferences/Lectures 10%; Subspecialty Care 100%. Students must be present at 75% of the elective to receive a passing grade.
Major teaching responsibility: Single attending and fellow
Patients seen/weekly: 7 new consults, 15 total
On call/weekend responsibility: None

M25 861 / ONCOLOGY-INPATIENT
Instructor(s): Anna Roshal, MD, 314-454-8306
Location: Division 7900, 7th Floor CAM
Elective Contact: Janet Weier, 314-747-7509
Other Information: Students meet on the 7th Floor CAM, POD B, Medical Oncology Outpatient Area, 8:00 a.m. first day of elective.
Enrollment limit per period: 6 students per block, on average one per attending
Valid start weeks for four-weeks blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Medical Oncology is a complex subspecialty that is undergoing a rapid evolution as a result of new systemic treatment approaches that stem from biological insights into the nature of cancer.  During the course of the elective medical students will be able to interact with attending physicians and patients for bed side teaching and attend tumor boards and lectures focused on the care of patients with solid tumors.  At the end of the rotation the students will appreciate the principles of our approach to cancer patients and should have gained insights into the pharmacological basis for systemic cancer treatment.  The ethical and medical challenges of caring for patients with advanced incurable malignancies will also be an important theme, as well as the conduct of clinical research in this patient population.  Students will learn to care for hospitalized patients suffering from complications from their cancer or from toxicities due to treatments.  Oncologic emergencies will be covered. Issues such as palliative care treatment options and end-of-life decision making will be explored as well.

Student time distribution: Inpatient 90%; Conferences/Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: All Medical Oncology Attendings
Patients seen/weekly: 50
On call/weekend responsibility: None

M25 862 / INPATIENT INTERNAL MEDICINE/ONCOLOGY-FIRM
Instructor(s): Anna Roshal, MD, 314-454-8306
Location: North Campus, 7900 Inpatient Floor
Elective Contact: Janet Weier, 314-747-7509
Other Information: Students meet in North Campus, 7900 Inpatient Floor, 7:30 a.m. first day of elective and find an on call resident.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Medical Oncology is a complex subspecialty that is undergoing a rapid evolution as a result of new systemic treatment approaches that stem from biological insights into the nature of cancer. During the course of the elective medical students will be able to interact with attending physicians and patients for bed side teaching and attend tumor boards and lectures focused on the care of patients with solid tumors and lymphoma.  At the end of the rotation the students will appreciate the principles of our approach to cancer patients and should have gained insights into the pharmacological basis for systemic cancer treatment.  The ethical and medical challenges of caring for patients with advanced incurable malignancies will also be an important theme, as well as the conduct of clinical research in this patient population.  Students will learn to care for hospitalized patients suffering from complications from their cancer or from toxicities due to treatments. Oncologic emergencies will be covered. Issues such as palliative care treatment options and end-of-life decision making will be explored as well. Major learning goals:

(1) Become familiar with frequent complications of cancer treatment such as neutropenic fever, nausea/vomiting, diarrhea, infectious complications and their management.

(2) Become familiar with oncologic emergencies (spinal cord compression, hypercalcemia, neutropenic sepsis) and their management.

(3) Become more comfortable interacting with patients and families requiring difficult psychosocial and end-of-life discussions.

Student time distribution: Inpatient 100%; Subspecialty Care 100%
Major teaching responsibility: All Oncology attendings
Patients seen/weekly: 50
On call/weekend responsibility: One-in-four call, with their assignjed inpatient team.

M25 863 / EMERGENCY ULTRASOUND
Instructor(s): Deborah Kane, MD, and staff, 314-747-4156
Location: Barnes-Jewish Hospital, North Campus
Elective Contact: Mary Hummert, 314-747-4156
Other Information: Students meet at the Emergency Department at Barnes Jewish Hospital at 10:00 a.m. on the first day of the elective.
Enrollment limit per period: 1 unless otherwise approved by Course Master
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

This rotation will focus on ultrasound and all of its many applications and uses in the Emergency Department. Students will participate in the performance of bedside ultrasound of patients in the Emergency Department. Common applications of Emergency Ultrasound include the FAST exam, pelvic ultrasound, Abdominal Aortic Aneurysm (AAA), vascular access, renal, gallbladder, and DVT. In general, the student will be in the Emergency Department during weekdays to perform these exams.

Students will not be involved in direct patient care during this rotation. Students will have access to a lecture bank of the common applications. In addition, the student will meet with the Ultrasound Director 1-2 times/wk to review images and have direct hands-on instruction. At the end of the rotation the student should have gained the knowledge of basic Emergency Ultrasound including its indications and applications; as well as becoming more adept at the performance of ultrasound.

Student time distribution: Outpatient 80%; Conferences/Lectures 20%; Primary Care 40%; Subspecialty Care 60%
Major teaching responsibility: Attendings
Patients seen/weekly: 25
On call/weekend responsibility: None

M25 865 / INTENSIVE CARE MEDICINE – BARNES-JEWISH 8300
Instructor(s): Warren Isakow, MD, and staff, 314-454-8762
Location: Barnes-Jewish Hospital, 8300 South Campus
Elective Contact: Lisa Wetzel, 314-454-8762
Other Information: Students meet at the MICU (8th Floor Barnes-Jewish Hospital, South Campus), 7:30 a.m. first day of elective.
Enrollment limit per period: 1
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

This elective in intensive care is offered in the Intensive Care Unit at Barnes-Jewish Hospital, South Campus. This unit has 16 intensive care beds providing intensive nursing care and life-support technology. The patients represent a mixture of patients with primarily medical problems. Patient care responsibility includes night call. In addition to patient responsibility, there are regularly scheduled conferences and attending rounds.

Student time distribution: Inpatient 100%; Subspecialty Care 100%
Major teaching responsibility: Attendings and residents
Patients seen/weekly: 8
On call/weekend responsibility: Every third night

M25 867 / MEDICAL INTENSIVE CARE
Instructor(s): Warren Isakow, MD, 314-454-8762
Location: Barnes-Jewish Hospital, South Campus
Elective Contact: Lisa Wetzel, 314-454-8762
Other Information: Students report to the Medical Intensive Care Unit, 8400 Barnes-Jewish Hospital, South Campus, 7:30 a.m. first day of elective.
Enrollment limit per period: 1
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

This elective is offered as an opportunity to gain additional experience in acute, primary care medicine. The elective is an advanced course in patient care involving complex medical problems. Responsibilities involve working up new patients with the MICU team, case presentations and attendance at conferences. Conferences consist of attending rounds Monday through Saturday, radiology rounds Monday through Saturday, pulmonary conference and medical grand rounds on Thursday, and critical care conference once each month. Call schedule is every third night.

Student time distribution: Inpatient 90%; Conferences/Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Attendings and residents
Patients seen/weekly: 3
On call/weekend responsibility: Yes

M25 869 / PALLIATIVE MEDICINE
Instructor(s): Maria Dans, MD, Course Master, 314-362-5800, mdans@dom.wustl.edu, BJH Palliative Care Service members
Location: 4105 Suite, Queeny Tower, Barnes-Jewish Hospital South Campus
Elective Contact: Nicole Williams, 314-747-5361, nsw2227@bjc.org
Other Information:  Please email the Course Master and Elective Contact at least one week before start of elective. Reporting time is 8:45 a.m. first day of elective
Enrollment limit per period: 1
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

The Palliative Medicine elective will focus on the care of patients with life-threatening or debilitating illness throughout the course of their care. Skills in symptom management, communication, and interdisciplinary team-based care will be the focus. Students will spend the majority of their time on the BJH Palliative Care Service. Based on the individual student’s interest, there may also be opportunities to work with the BJC Hospice Team and the St. Louis Children’s Hospital Palliative Care Service.

While in the hospital, students will be responsible for seeing patients upon initial assessment as well as delivering follow-up care with the team. Patients will be seen for both end-of-life care as well as symptom management. Students will learn to assess and treat refractory symptoms and participate in complicated advanced care planning. Students will attend interdisciplinary team meetings, and may participate in conversations about goals of care and coping with bad news. They may also make home visits with hospice care providers, if desired. Emphasis will be placed on observing and understanding the psychosocial and spiritual needs of the patients, as well as the impact of the burden on caregivers. In addition, students will be expected to lead bi-weekly presentations/group discussions on selected aspects of Palliative Medicine with the BJH Palliative Care team.

Student time distribution: Inpatient 85%; Conferences/Lectures 15%; Subspeciality Care 100%
Major teaching responsibility: BJH Palliative Care Attendings (Maria Dans, MD; Mike Koller, MD; and Anna Roshal, MD; BJH Palliative Care Team Members; BJC Hospice Medical Director (Bernard Shore, MD); SLCH Palliative Care Service Medical Director (Joan Rosenbaum, MD)
Patients seen/weekly: 10
On call/weekend responsibility: None

M25 870 / ENDOCRINOLOGY, DIABETES AND METABOLISM
Instructor(s): Clay F. Semenkovich, MD, and staff, 314-362-7617
Location: 8th Floor Southwest Tower, Barnes-Jewish South Campus
Elective Contact: Karen Muehlhauser, 314-362-7617
Other Information: Students meet on 8th Floor Southwest Tower, Barnes-Jewish South Campus, 8:15 a.m. first day of elective.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

In general, the four-week rotation will be divided into 2 weeks of general endocrinology and 2 weeks of diabetes. Students taking this elective will perform consultations with fellows and faculty on the inpatient services at Barnes-Jewish Hospital and will also see patients with endocrine and metabolic diseases in the Outpatient Consultation. They will present these cases daily on teaching rounds. They will also participate in case conferences and seminars on a weekly basis. Extensive interaction with patients with diabetes and a diabetes education program are included, as is involvement with patients with thyroid, pituitary, adrenal, gonad, metabolic bone disease, and lipid disorders. Ample opportunities will be provided for discussions of patient problems with the members of the division. A variety of outpatient clinics are offered in the division and interested students should speak with the fellows and faculty members to customize the learning experience to match his or her career goals.

At the end of the rotation, it is expected that students will have the ability to initiate inpatient and outpatient management of diabetes including insulin dosing and glucose monitoring, as well as evaluate and treat of a variety of endocrine disorders including but not limited to thyroid, pituitary, and adrenal disease. Students will learn to perform effective inpatient and outpatient consultations.

Student time distribution: Inpatient 60%; Outpatient 30%; Conferences/ Lectures 10%; Subspecialty Care 100%
Major teaching responsibility: Faculty consultant for inpatients, individual faculty one-on-one for outpatients and division chief for both
Patients seen/weekly: 8-10
On call/weekend responsibility: Elective for students

M25 871 / ONCOLOGY-OUTPATIENT
Instructor(s): Maria Baggstrom, MD, 314-362-5817
Location: Siteman Cancer Center, CAM Building, Siteman West County, Siteman South County
Elective Contact: Krista Mercille, 314-747-7409, kmercill@dom.wustl.edu
Other Information: On the first day of the elective, students will meet in clinic at 8:00 a.m.  Directions will be provided for each of the clinics.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Students will gain experience in the initial treatment of newly diagnosed malignancies and the outpatient management of oncology patients. Participation in multidisciplinary tumor conferences will stress a combined-modality approach to management, incorporating chemotherapy, radiotherapy and surgery. Students will see patients with a variety of malignancies, including lymphoma, myeloma, and tumors of the lung, breast, and colon. Management of hypercalcemia and other paraneoplastic syndromes, as well as cancer pain management will be covered.  Students will have the opportunity to see how most oncologists spend 90% of their workday. They will observe different styles that oncologists have in presenting news about prognosis, treatment options and other information to patients while they also learn about the molecular basis for cancer, the mechanisms of action for our therapies (particularly the newer agents which target specific molecular abnormalities) and the key studies that justify the use of therapies (e.g. randomized studies showing that after surgery, chemotherapy will reduce the risk of recurrence from a particular cancer with a particular regimen). By spending time with clinicians, students will learn how to identify hereditary syndromes, use drugs for symptom relief and also learn how radiographic and laboratory tests allow oncologists to care for patients.

Student time distribution: Outpatient 85%; Conferences/Lectures 15%; Subspecialty Care 100%
Major teaching responsibility: Oncology attendings and occasionally fellows
Patients seen/weekly: 30-50
On call/weekend responsibility: None

M25 877 / INTENSIVE ECG INTERPRETATION
Instructor(s): Robert E. Kleiger, MD; 314-454-8146
Location: 13th Floor Northwest Tower
Elective Contact: Marge Leaders, 314-454-8146; mleaders@dom.wustl.edu
Other Information: Contact Marge Leaders, 13th Floor Northwest Tower, on the first day of elective at 9:00 a.m.
Enrollment limit per period: 2
Valid start weeks for two-week blocks are: Weeks 1, 5, 11, 17, 19, 27, 29, 31, 33, 35, 37, 39, 41, and 43.

The student, during the two-week elective, will read 20-25 ECGs obtained from the Barnes-Jewish Heart Station and then over read by an experienced electrocardiographer. There will also be didactic sessions covering infarction, ventricular hypertrophy, heart block, arrhythmias, and aberrant conduction.

Student time distribution: Inpatient 0%; Outpatient 0%; Conferences/ Lectures 100%; Subspecialty Care 100%
Major teaching responsibility: Attending
Patients seen/weekly: N/A
On call/weekend responsibility: None

M25 879 / PULMONARY CLINIC FOR THE UNDERSERVED
Instructor(s): Barbara Ann Lutey, MD
Location: Wohl Hospital, 5th Floor
Elective Contact: Barbara Ann Lutey, MD, 314-747-8492, blutey@dom.wustl.edu
Other Information: Students should report to the Center of Outpatient Health, Suite 420, at 9:00 a.m. on the first day of the elective.
Enrollment limit per period: 2
Valid start weeks for two-week blocks are: Weeks 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, 35, 37, 39, 41, and 43.

Clinical setting: Outpatient Clinic dedicated to providing pulmonary specialty care to patients who are predominantly uninsured or who rely upon public assistance such as Medicaid.
Student role: Students independently interview and examine patients and present findings to the attending, tests and imaging are reviewed, and provider and attending develop plan.
Common problems/diseases: Asthma, COPD, sarcoidosis, lung cancer, and obstructive sleep apnea are commonly seen. Also, patients are referred for evaluation of abnormal x-rays and for symptoms such as dyspnea.
Primary learning objectives:
to understand and practice important history and exam skills in pulmonary medicine: symptoms, smoking history, work and environmental exposures, and important pulmonary physical exam findings.
to understand the basics of pulmonary function tests, chest imaging, and methods for tissue sampling.
to understand the basis of treatment of common pulmonary disorders.

Conferences: There is no conference associated with this clinic, but students may attend the usual Thursday morning Medicine Grand Rounds at 8:00 a.m. and the Pulmonary Grand Rounds at 11:00 a.m. if the subject matter is appropriate.

Student time distribution: Outpatient 100%; Conferences/Lectures Vary; Subspecialty Care 100%
Major teaching responsibility: Barbara Ann Lutey, MD
Patients seen/weekly: 12-20
On call/weekend responsibility: None

M25 880 / PULMONARY MEDICINE – BARNES-JEWISH HOSPITAL
Instructor(s): Daniel Rosenbluth, MD, and staff, 314-454-8762
Location: 15th Floor, Northwest Tower
Elective Contact: Lisa Wetzel, 314-454-8762
Other Information: Students should page Pulmonary Consult Fellow, 7:30 a.m. first day of elective.
Enrollment limit per period: 1
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Students will acquire skills in the evaluation and management of patients with pulmonary diseases and in the interpretation of pulmonary function tests. They will gain experience in outpatient Lung Center and attend regular pulmonary and critical care medicine conferences.

Student time distribution: Inpatient 60%; Outpatient 20%; Conferences/ Lectures 20%; Subspecialty Care 100%
Major teaching responsibility: Multiple attendings, fellows and residents
Patients seen/weekly: 20
On call/weekend responsibility: None

M25 882 / PULMONARY MEDICINE – VA HOSPITAL
Instructor(s): Michael Lippmann, MD, 314-289-6306
Location: John Cochran VA Hospital
Elective Contact: Michael Lippmann, MD, 314-289-6306
Other Information: Students meet in 6C-MICU John Cochran VA Hospital, 7:30 a.m. first day of elective.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Students will participate in several ambulatory care activities of the Pulmonary Section, including outpatient consultations of common respiratory disorders such as COPD, obstructive sleep apnea, lung cancer and tuberculosis, and follow-up of primary care patients with pulmonary disease. In addition, students will round in medical intensive care units, interpret pulmonary function tests, participate in bronchoscopy and attend scheduled teaching conferences of the Pulmonary Division.

Student time distribution: Inpatient 30%; Outpatient 50%; Conferences/ Lectures 20%; Subspecialty Care 100%
Major teaching responsibility: Several attendings
Patients seen/weekly: 6-10 (by student)
On call/weekend responsibility: None

M25 884 / BONE MARROW TRANSPLANTATION AND STEM CELL BIOLOGY
Instructor(s): John F. DiPersio, MD, PhD, 314-362-9339
Location: Bone Marrow Transplant Unit 13-100
Elective Contact: John F. DiPersio, MD, PhD, or Cathy Wiggins, 314-454-8491
Other Information: Students meet in the Bone Marrow Transplant Unit, 8:30 a.m. first day of elective.
Enrollment limit per period: 1
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Intense four-week clinical rotation exposing interested fourth-year medical students to the clinical world of bone marrow transplantation and to the basic science of hematopoiesis, leukemia, and stem cell biology. Students will be primarily responsible for the care of autologous and allogeneic BMT recipients and those patients being treated for a variety of hematologic malignancies such as AML, ALL, multiple myeloma and Non-Hodgkin’s Lymphoma. In addition they will be exposed to methods of stem cell harvest, cryopreservation, and immunophenotyping. This rotation plans to provide motivated students with an ideal mix of clinical medicine and basic science.

Student time distribution: Inpatient 60%; Outpatient 20%; Conferences/ Lectures 20%; Subspecialty Care 100%
Major teaching responsibility: Attending on service as well as all BMT physicians
Patients seen/weekly: 10-20
On call/weekend responsibility: None

M25 885 / OCCUPATIONAL/ENVIRONMENTAL MEDICINE
Instructor(s): Bradley Evanoff, MD, MPH, 314-454-8638
Location: Taylor Avenue Building
Elective Contact: Debbie Howard, 314-454-8638
Other Information: Students should meet at GMS Suite, Taylor Avenue Bldg., 9:00a.m. first day of elective.
Enrollment limit per period: 1 (2, by special arrangement)
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41. (Students may take this elective for up to 12 weeks.)

This elective is designed to introduce students to research and practice in the prevention of work-related injuries and illnesses, and prevention of health effects related to environmental exposures. Preventive activities will include work site visits and intervention projects, as well as involvement with work site health promotion and policy making. Research projects involve epidemiology and intervention projects in work-related injury and musculoskeletal disorders. Specific activities are flexible depending on the students’ interests.

Students may elect to participate in the Interdisciplinary Environmental Clinic at Washington University. Based in the law school, the clinic involves interdisciplinary teams of students (law, engineering,  environmental science) taking principal responsibility, under faculty supervision, for cases and projects on behalf of environmental and community organizations. The medical student(s) assist clinic students by evaluating the human health impacts involved in one or more of the clinic’s cases, and presenting such information to the client organization(s) and others.

Among the cases on which medical students might participate are: (1) air pollution associated with factories in the St Louis metropolitan area; (2) lead poisoning of children and adults in St. Louis and surrounding towns; (3) air and water pollution caused by concentrated animal feeding operations (factory farms) in Missouri. Students choosing this option will work with the Environmental Clinic staff and with Dr. Evanoff to evaluate and present evaluations of human health impacts of environmental exposures.

Student time distribution: Conferences/Lectures 10%; Policy activities/Research 90%; Subspecialty Care 100%
Major teaching responsibility: Attending
Patients seen/weekly: 0
On call/weekend responsibility: None

M25 887 / CLINICAL CARDIOVASCULAR MEDICINE
Instructor(s): Thomas F. Martin, MD, FACC; and Timothy J. Martin, MD, FACC, CCDS, 573-308-1301
Location: Phelps County Regional Medical Center, Rolla, MO
Elective Contact: Annette Wells, 573-308-1301, wellsa@pcrmc.com
Other Information: Students should arrive at Washington University Heart Care Institute in Rolla, 1050 W. 10th Street, Suite 500 at 8:00 a.m. the first day of elective, and will be escorted to the unit where Dr. Martin is rounding.
Enrollment limit per period: 1
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 25, 29, 33, and 37.

Clinical cardiology with some internal medicine in a rural setting. Inpatient and Outpatient care. Diagnostic Testing. Device Implants and follow up care. Cardiac Catheterization. Peripheral Vascular angiography and intervention.

Student time distribution: Inpatient 50%; Outpatient 50%; Subspecialty Care 100%
Major teaching responsibility: Attending
Patients seen/weekly: 100
On call/weekend responsibility: None

M25 890 / CLINICAL NEPHROLOGY
Instructor(s): Steven Cheng, MD, 314-362-3204
Location: Chromalloy American Kidney Center, Barnes-Jewish Hospital
Elective Contact: Kim Knolhoff, 314-362-7211
Other Information: Students meet in the Acute Dialysis Center, Division 14300, Barnes-Jewish Hospital, 8:00 a.m. first day of elective.  Ask for the Renal Fellow on the Consult Service.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Students rotate through inpatient and outpatient experiences to gain exposure to all facets of nephrology. They will spend time the majority of their time on an inpatient consult service, gaining exposure to acute and chronic renal failure, glomerulonephritis, and electrolyte disorders. During this time, they will serve as a fully integrated member of the consult team, evaluating underlying causes of kidney disease, performing diagnostic procedures, formulating management plans, and engaging in decision-making discussions with primary services and families. In addition, students will have the opportunity to experience ICU nephrology, the transplant service, the various CKD clinics, and all modalities of dialysis, including in-center, home, and peritoneal dialysis.

Student time distribution: Inpatient 70%; Outpatient 20%; Conferences/Lectures 10%; Primary Care 20%; Subspecialty Care 80%
Major teaching responsibility: Weekly pathophysiology/case conferences; Teaching rounds run by 3 attending physicians and 2 fellows.
Patients seen/weekly: Four consults per week
On call/weekend responsibility: Students are not required to take call or round on weekends.

M25 893 / ADULT ALLERGY AND CLINICAL IMMUNOLOGY
Instructor(s): H. James Wedner, MD, 314-454-7376
Location: 15th Floor, Northwest Tower
Elective Contact: Jill Munoz, 314-454-7376
Other Information: Students meet Jessica Champlin in the Allergy and Immunology division office, 15th Floor, Northwest Tower, 8:00 a.m. first day of elective.
Enrollment limit per period: 2
Valid start weeks for four-week blocks are: Weeks 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, and 41.

Students will participate in the allergy consult service at Barnes-Jewish Hospital, North and South Campus. The student will serve as the primary allergy consult for inpatient and Emergency Room consultation and present each patient to the allergy fellows on call and the attending physician. Students will attend The Adult Allergy Clinic, Pediatric Allergy Clinic, and the outpatient clinics at The Asthma & Allergy Center at Barnes-Jewish West County Hospital. Conferences on selected topics in allergy and clinical immunology will be held with the attending staff two to three afternoons a week.

Student time distribution: Inpatient 10%; Outpatient 75%; Conferences/ Lectures 15%; Subspecialty Care 100%
Major teaching responsibility: Attending and staff
Patients seen/weekly: 12
On call/weekend responsibility: Optional

M80 809 / AMBULATORY CARE – JACQUELINE MARITZ LUNG CTR
Instructor(s): Daniel Rosenbluth, MD, 314-454-8762
Location: Barnes-Jewish Hospital, North Campus, Lung Center, 8th Floor CAM
Elective Contact: Lisa Wetzel, 314-454-8762
Other Information: Students meet in the Lung Center, 8th Floor CAM, Barnes-Jewish Hospital, North Campus, 8:00 a.m. first day of elective.
Enrollment limit per period: 1
Valid start weeks for four-week blocks are:  Weeks 17, 21, 25, 29, 33, 37, and 41.

The Jacqueline Maritz Lung Center houses the ambulatory care activities of the Divisions of Pulmonary Medicine, Thoracic Surgery, and Allergy/Immunology, as well as the pulmonary function laboratory. The student will rotate through (1) both general pulmonary and subspecialty clinics in Pulmonary Medicine (cystic fibrosis, transplantation, emphysema, etc.), (2) Thoracic Surgery clinic, (3) Allergy/ Immunology clinic, and (4) interpretation of pulmonary function tests. Chest imaging is also emphasized in the evaluation process. The rotation can be streamlined to meet areas of emphasis desired by individual students.

Student time distribution: Outpatient 100%; Conferences/Lectures 3-5 week; Primary Care 15%; Subspecialty Care: 85%
Major teaching responsibility: Multiple attendings
Patients seen/weekly: >20
On call/weekend responsibility: None

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