Elective Proposal Form | Teaching for Medical Student Education

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Elective Course Information

Elective Course Title*

Department/Discipline*

Elective Course Director*

First Last Credentials: M.D., D.O., Ph.D., etc.

Email*

Campus/Region*

Facility Location(s) of Elective

Please specify all sites that will be used for this rotation

Does the Course Director have a current faculty appointment?*

Faculty appointment with the School of Medicine is required for ALL Course Directors

Yes

Please complete a personal profile form. Failure to submit an application for faculty appointment may result in declination or will delay the elective approval process.

Proposal Contact Name, if different from Above

Proposal Contact Email, if different from Above:

Name of Primary Contact for Adds/Drops*

First Last

Primary Contact Email Address*

Elective Course Description

Elective Category

Definitions:

AC- Advanced Clinical

Students will be exposed to a substantial load of patient encounters, with clinical experience in either the inpatient, procedural, or ambulatory setting. Students are expected to actively participate in the care decision discussions for the patients they encounter. Students will be integrated into the patient care team interactions, which may be any combination of physicians, residents, fellows, advanced practice providers, social workers, care managers, pharmacists, nursing, or practice staff under the supervision of the lead physician of the rotation. Students will discuss foundational science concepts as they relate to the diagnosis, treatment, and management of clinical disease states commonly encountered in the discipline with the supervising physician or care team. The elective will set clear expectations of the student’s role in the care environment at the start of the rotation and allow reflection time at the end, both from the student and the supervising physician, with attention to acquired skills that relate to the student’s preparedness for internship.

AS – Advanced Science

Designed to give each medical student the opportunity to pursue a personal scholarly experience in biomedical sciences (broadly defined) and to develop fundamental understanding in new areas of biomedical science relevant to clinical medicine. In these courses students will, after several years of clinical experience, revisit some aspects of basic science. Because of the level of sophistication that students have developed by this stage in their medical education, they can better understand the relevance of basic science to clinical problems.

CP – Clinical Practice

Students will become familiar with the fundamental principles of practicing in a particular specialty including diagnostic reasoning; evidence-based medicine; cost effective care; and self-directed learning. Further, students will learn to recognize manifestations of disease and manage the course of common illnesses found in the particular specialty. Finally, students will develop skills that address care of the healthy patient including preventive medicine; care of the patient with acute illness; and longitudinal care of the patient with chronic illness as well as care through the course of the complete illness/condition.

PD – Professional Development

Students will be exposed to the knowledge and skills outside the traditional medical school curriculum that will advance their success in medical practice.

CC - Critical Care Selective

Critical Care Selective: Students will develop the knowledge, skills, and attitudes necessary for the assessment and management of critically ill patients. This rotation will occur in an ICU environment in which students will be active members of a multidisciplinary ICU team. Students will be expected to participate in bedside patient care and develop a basic approach to the diagnosis and management of common ICU conditions.

CE - Career Exploration

Career Exploration: Designed to allow Phase 2 students a beginning level immersion into a career of interest. Please note these electives are intended for Phase 2 (Third-year) students. Phase 3 (Fourth-year) students can apply only via a Special Elective form with special permission from their Lead Advisor and the Course Director.

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Elective Category (Choose One)

AC- Advanced Clinical: Students will be exposed to a substantial load of patient encounters, with clinical experience in either the inpatient, procedural, or ambulatory setting. Students are expected to actively participate in the care decision discussions for the patients they encounter. Students will be integrated into the patient care team interactions, which may be any combination of physicians, residents, fellows, advanced practice providers, social workers, care managers, pharmacists, nursing, or practice staff under the supervision of the lead physician of the rotation. Students will discuss foundational science concepts as they relate to the diagnosis, treatment, and management of clinical disease states commonly encountered in the discipline with the supervising physician or care team. The elective will set clear expectations of the student’s role in the care environment at the start of the rotation and allow reflection time at the end, both from the student and the supervising physician, with attention to acquired skills that relate to the student’s preparedness for internship.

AS – Advanced Science: Designed to give each medical student the opportunity to pursue a personal scholarly experience in biomedical sciences (broadly defined) and to develop fundamental understanding in new areas of biomedical science relevant to clinical medicine. In these courses students will, after several years of clinical experience, revisit some aspects of basic science. Because of the level of sophistication that students have developed by this stage in their medical education, they can better understand the relevance of basic science to clinical problems.

CP – Clinical Practice: Students will become familiar with the fundamental principles of practicing in a particular specialty including diagnostic reasoning; evidence-based medicine; cost effective care; and self-directed learning. Further, students will learn to recognize manifestations of disease and manage the course of common illnesses found in the particular specialty. Finally, students will develop skills that address care of the healthy patient including preventive medicine; care of the patient with acute illness; and longitudinal care of the patient with chronic illness as well as care through the course of the complete illness/condition.

PD – Professional Development: Students will be exposed to the knowledge and skills outside the traditional medical school curriculum that will advance their success in medical practice.

CC - Critical Care Selective: Students will develop the knowledge, skills, and attitudes necessary for the assessment and management of critically ill patients. This rotation will occur in an ICU environment in which students will be active members of a multidisciplinary ICU team. Students will be expected to participate in bedside patient care and develop a basic approach to the diagnosis and management of common ICU conditions.

CE - Career Exploration: Designed to allow Phase 2 students a beginning level immersion into a career of interest. Phase 3 (Year 4) students may only enroll in these courses via the Special Electives process and must have permission from the Course Director and their Lead Adviser.

Elective Type/Category*

AC - Advanced Clinical

AS - Advanced Science

CP - Clinical Practice

PD - Professional Development

CC - Critical Care Selective

CE - Career Exploration

Is this elective in-person, online, or a hybrid course?*

On-site elective

Online elective

Hybrid elective (online and on-site)

Will students have patient contact in this elective?*

Yes

Brief elective course description*

The description will be viewed by students on the IUSM Elective Catalog. Provide a brief summary of the student expectations, activities for the elective, etc.

Elective course activities*

Provide additional detailed information about the activities a student will be required to complete for the elective. Include the number of hours in clinic, laboratory work, weekly schedule, call requirements, etc.

Work hours per week*

Learning Objectives*

List specific and attainable learning objectives designed for this elective. Content should complete the following: By the end of this course, a student will be able to... (Tips for Writing Student Learning Objectives)

Assessments*

Describe the method(s) by which you will determine that the students have achieved the course objectives and by whom the assessment will be completed.(Examples may include observation, oral exam, written exam, logbook entries, case presentation, oral presentation, written essay, discussion with faculty, etc.). Include % allocation of each component and grade

Assessment Tools (Choose All that Apply)*

Clinical Practice & Advanced Clinical Performance Evaluation Form (See Preview)

Critical Care Selective Clinical Performance Evaluation Form (See Preview)

Professional Development Evaluation Form (See Preview)

Research Evaluation Form (See Preview)

Career Exploration Course Rubric (See Preview)

Other (Attach sample(s) of the assessment rubrics used in the elective)

Attach samples of assessment rubrics

Accepted file types: pdf, doc, docx, Max. file size: 32 MB.

Will your course participate in open enrollment (during the initial elective scheduling period) or does your course require permission prior to enrollment?*

Open Enrollment

Require Permission

Additional elective course information

(e.g., enrollment instructions not otherwise listed, housing provisions, off-site locations, or other special working conditions)

Additional faculty*

List additional faculty who will be working with students. If none, enter N/A

Will residents be teaching?*

Yes

If yes, what program are the residents from?

Prerequisites (Choose All that Apply)*

Third year status (Successful completion of second year)

Fourth year status (Successful completion of third year)

Clerkship prerequisite (Please specify):

Other (Please specify):

Clerkship prerequisites

Please specify if you chose this option.

Other prerequisites

Number of consecutive times a student may take this course:*

Note: Most electives will be 1 month in duration. Exceptions (e.g., research electives) will be considered for longer periods. Students may only re-enroll in Advanced Science Research electives. Students may re-enroll once in two-week electives for a total of four-weeks.

Duration:*

2-week

4-week

Longitudinal

Number of students (maximum students per rotation) you will take at one time
Fill in the blank with “0” (zero) if the elective is not offered that rotation. Please refer to the Phase 3 Rotation Schedule and Phase 2 Rotation Schedule for the rotation dates.

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Number of Students Per Rotation.

Rotation 1*

Rotation 2*

Rotation 3*

Rotation 4*

Rotation 5*

Rotation 6*

Rotation 7*

Rotation 8*

Rotation 9*

Rotation 10*

Rotation 11*

Rotation 12*

Longitudinal Elective Rotation Months & Duration*

Please specify the length of time students will participate in this rotation (i..e. 3 months) and the rotation months during which this rotation is available (i.e. Students will complete this rotation over the course of 3 months. This rotation is available during Rotations 3-6 and Rotations 9-11).

Rotation 1A*

Rotation 1B*

Rotation 2A*

Rotation 2B*

Rotation 3A*

Rotation 3B*

Rotation 4A*

Rotation 4B*

Rotation 5A*

Rotation 5B*

Rotation 6A*

Rotation 6B*

Rotation 7A*

Rotation 7B*

Rotation 8A*

Rotation 8B*

Rotation 9A*

Rotation 9B*

Rotation 10A*

Rotation 10B*

Rotation 11A*

Rotation 11B*

Rotation 12A*

Rotation 12B*

Number of weeks a student must contact faculty prior to beginning elective:*

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Estimated Time Distribution

Estimated Time Distribution
Include the percentage of time a student will spend in each for the following categories. If none, enter 0.

% Clinical*

% Laboratory or Scholary Research*

% Lecture/Seminar*

% Library/Research*

% Online*

Does this course include service learning activities?*

IUSM defines Service Learning as a structured learning experience that actively engages students, faculty, and community members in a dynamic partnership that intentionally connects community-identified concerns with institutional learning objectives. Each structured learning experience must have the following requirements:

-Identified community partner and/or need
-Pre-experience orientation
-Service experience
-Post-experience reflection

Yes

Please describe.

Does this course include intentional opportunities for interprofessional collaboration?*

Interprofessional collaborative experiences are opportunities for medical students to work collaboratively on health care teams that include students or practitioners from other health professions (e.g. dentistry, nursing, pharmacy, physical therapy, psychology, social work) as they provide coordinated services to patients.

Yes

Please describe.

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