A&M Integrated Medicine Program

AIM COMPONENTS

Orientation

AIM students will attend the introduction of the required third-year clinical orientation. AIM students will also receive an additional skills orientation to include basic instruction in the areas of surgery, OB-GYN, pediatrics, family medicine, internal medicine and psychiatry.

Ambulatory Practices

AIM students will work for a half day and/or a full day in each of the following types of community practices: family medicine, internal medicine, pediatrics, psychiatry, OB-GYN and surgery. Each student will have a cohort of patients to follow through the system over the course of the academic year. Students will have two to three half days built into their schedule each week for self-directed learning (opportunity time). The students are allowed to follow their cohort of patients through the system, accompanying them for consultations, hospitalizations, surgeries, therapies and diagnostic evaluations.

On-Call Experiences

AIM students will be scheduled for call in labor and delivery, or surgery departments. Students will be on call six weekdays per year andfour weekend days per year. This experience is designed to expose the students to the acutely ill, undifferentiated patient so that the student learns from pattern recognition the presenting symptoms and signs of common urgent conditions. Students will be encouraged to learn common procedures such as suturing, incision and draining of abscesses, L.P.'s and other required procedures.

My AIM Patient - Case Based Learning

AIM students will meet as a group with a clinician/facilitator to discuss active patient cases. Students will present their cases, discuss possible differentials, plans of treatment and family impact of proposed treatment plan.

NBME Shelf Exams

AIM students will take the required NBME shelf exams during the last four months of the academic year.

OSCE Exams

AIM students will participate in OSCEs during the last months of the academic year.

SPECIALTY CURRICULUM

All Clerkships will have the same goals and objectives as on a traditional campus. While the program is completed longitudinally, a student will have a comparable experience to that of a student in a traditional block

Family Medicine

The Family Medicine Clerkship in the AIM program allows medical students the unique opportunity of getting to know a panel of patients and their families over the academic year. As part of this curriculum, a medical student will spend a half day each week with a family medicine AIM attending and share a group of patients with him or her. These patients will represent the wonderful range of patients that family medicine physicians are able to see and get to know over time. These patients will range from young infants to the elderly, some healthy, some with acute illnesses or injuries, and some facing chronic illnesses such as diabetes or COPD.

The student will be able to follow this cohort of patients through time and follow them to any specialty referral offices or any procedures they may need. If hospitalization or an emergency room visit is required, the student could be there with them as well. As most family physicians see the patient's entire family, students will become familiar with not only that patient, but their family, and see the impact one member's health can have on the family as a unit. As part of the health care team of one clinic, students will also get to know the community in which their clinic resides and how it may impact their patients' health, both positively and negatively.

There will be instruction in primary care procedures as well as focus on the musculoskeletal exam, both individually with their attendings as well as in dedicated sessions. There will also be sessions on helping patients achieve their health care goals through patient education and preventive care instruction.

OB-GYN

The AIM clerkship in OB-GYN will encompass obstetrics and gynecology in both the inpatient and outpatient settings. In the longitudinal component, the student will be assigned to an OB-GYN community physician or the labor and delivery department and follow a panel of patients for a half day every other week. With the high volume of obstetric care provided in our community, students will have an active role in all aspects of their patients' prenatal care, labor and delivery, and post-partum care.

The AIM students' have the opportunity to attend the delivery of their continuity patients. Gynecologic visits will include both preventive and problem visits. With gynecologic visits scheduled every day of the week, students will have the opportunity to follow their patients through pre-operative visits, surgical procedures and post-operative care as well. Students will have opportunity time (self-directed learning time) so they will be able to follow their cohort of patients to surgery, ultrasounds and other required procedures/appointments.

Pediatrics

The pediatrics component of the AIM curriculum for our students will provide an education program that allows the student to mature in their pediatric medical knowledge. The highlight of the program will be the opportunity to spend sessions with a longitudinal attending who is a practicing pediatrician in a primary care office, and see what pediatrics is about.

Primary care pediatrics mainly occurs in the outpatient setting - as most children are well and only occasionally get ill. Of course, for a medical education program there must be an inpatient hospital-based program, and that is incorporated as a two-week inpatient rotation at Driscoll Hospital in Corpus Christi, Texas. The students who participate in this program will have a complete experience in pediatrics and by doing this longitudinally, will see the uniqueness of pediatrics as compared to other specialties.

Psychiatry

The psychiatric medicine longitudinal curriculum will provide students with teaching, collaboration and mentoring with experienced attending physicians. Students will spend half days each week in an outpatient setting evaluating patients in crisis and in treatment. Students, supervised by a psychiatrist, will help manage care for patients suffering acute symptoms of mental illness. Students will learn how to perform risk assessments, learn the indications for hospitalization and consider the medical, legal and ethical issues inherent in providing mental health care to patients. Students will spend two weeks in the Veteran's Hospital in Waco, Texas, or La Hacienda Treatment Center in Hunt, Texas for their inpatient experience.

Internal Medicine

The AIM Internal Medicine Clerkship uses inpatient rotations in which the student learns the acute, chronic and preventive management of the adult patient.

The IM experience will have eight weeks in the hospital setting, where the student will admit patients with a wide variety of diseases. Our general medical service admits all internal medicine patients and manages their medical problems comprehensively with subspecialty consultation as needed. The students will work with the medical care team while learning to convey details of clinical encounters through oral presentations and written documentation. An emphasis on learning to develop differential diagnoses and clinical management plans will be a crucial part of this curriculum. The student will also assist their attending physicians with admitting patients from the emergency room and follow patients with conditions including chest pain, diabetic ketoacidosis and sepsis, who come in acutely.

A focus on transitions of care (hospital to outpatient, outpatient to nursing home or hospice, hospital to rehabilitation hospital) will be an important element of the curriculum. The student will also develop an understanding of the clinical work in the context of a multidisciplinary team - home health services, nutrition, social work, clinical pharmacy and programs designed for specific chronic disease management. If any assigned patients are referred to other clinics, undergo diagnostic or therapeutic procedures, or are admitted to the hospital, the student can accompany the patient and assist with clinical management whenever possible.

Surgery

AIM students will experience surgery in a longitudinal setting as well as have a two-week rotation in surgery during the year. The rotations will consist of one week of general surgery and one week of cardiovascular surgery. In addition to the two week surgery rotation, students will spend one week immersed in anesthesiology. During the longitudinal phase, students will spend a half day in surgery clinic and a half day in surgery OR every other week.

Emergency Medicine

Emergency medicine plays a pivotal role in our health care system and the ER facility provides an ideal learning environment for medical students. Serving as the gateway through which over one third of our patients enter the hospital, it also provides acute care for the surgical, medical, trauma, pediatric, obstetric, psychiatric and geriatric patient. Staffed by physicians trained to be experts in resuscitation, rapid diagnosis and treatment, the emergency department also serves as a safety net for patients to receive primary care when other services are not available to them. AIM students can explore taking emergency medicine in their third year, once they have passed all their Midpoint NBME's.

AIM THREADS

Two afternoons each week is set aside for the AIM Thread that will reinforce and integrate the required competencies of the Texas A&M College of Medicine. Threads will consist of simulated experiences in the Simulation Center, as well as traditional lectures.

In our Simulation Center, students will have hands-on learning and real time clinical reasoning in a safe environment, allowing them to increase competence in procedural patient care, as well as communication skills. Additionally, ethics, social and system dynamics, and evidence based medicine will be woven into this longitudinal thread.

Simulation Thread

The Simulation Center curriculum for the AIM students is designed to provide hands-on learning along with real-time clinical reasoning in a safe environment. The learners will be introduced to a combination of simulation techniques including high­-fidelity mannequins, standardized patients and simulated procedural mannequins. Sessions will include cases and group discussions that will focus on a variety of topics from multiple specialties. An extensive amount of procedural training will also be included in the sessions. The learner will be encouraged to make clinical decisions and will receive feedback on their performance.

EKG Instruction

The AIM students will receive EKG instructional lectures. The focus of this course is to engage the student to use a systematic analysis for the 12 Lead ECG interpretation and to provide a better understanding of the concepts of normal cardiac electrophysiology as related to principles of 12-15-18 Lead ECG interpretations. A case-based approach will correlate abnormal 12 Lead ECG findings to pathology. The student actively participates in identifying electrical axis, bundle branch blocks, ischemia, injury and location of the area of ST elevation myocardial infarction (STEMI). The program concludes with additional case scenarios and a discussion of infarction mimics and key points in making differential diagnosis.

Radiology

The Principles of Radiology course provides students with the knowledge of the methods of medical imaging, conventional radiology, ultrasound, computerized tomography, magnetic resonance imaging, interventional radiology and nuclear radiology, and application of these methods to specific clinical problems. The course is taught in eight two-hour sessions throughout the academic year. AIM students will attend these sessions, have a review of the materials and be required the pass the radiology exam.