Third Year Medical Student Continuity Clerkship VA Greater Los Angeles Healthcare System

1. Third Year Medical Student Continuity ClerkshipVA Greater Los Angeles Healthcare System Gregory A. Brent, MD Art Gomez, MD Co-Directors West Los Angeles VA Sepulveda VA

2. VA Continuity Component Rotations • WLA VA Inpatient Medicine (4 weeks) • Psychiatry (5 weeks) • Neurology (3 weeks) • Ambulatory Medicine-WLA or Sepulveda (4 weeks), • “Partner Rotations”: Family Practice (4 weeks), Cedars-Sinai Inpatient Medicine (4 weeks) • Capacity for 16 weeks block within Track B-16 students, offering 2-times per year=32 students

3. VA Continuity Component Rotations • WLA VA Inpatient Medicine-WLA IM027 -Dr. Neil Paige (Cedars-Sinai Inpatient Medicine-Dr. Amanda Ewing) • Psychiatry-BVA-PS010)-Dr. Joseph Pierre • Neurology-WVA-NE017 Dr. Antonio Delgado-Escueta • Ambulatory Medicine-WLA or Sepulveda (4 weeks) SVA-AM016-Dr. Giulia Michelini , WLA-AM017-Dr. David Leaf

4. Overall Goals • To provide outstanding patient-centered care within an integrated health care system. • To understands the components of effective transitions of care across a variety of inpatient and outpatient clinical settings. • To understand and apply the elements of patient-centered care in the inpatient and outpatient setting. • To participate in a health care team and understand the roles and contributions of the various disciplines to care of the individual patient.

5. Overall Goals (continued) • To understand the goals and practice of clinical performance measures to improve care for the individual patient and the impact on the healthcare system. •  To utilize the electronic medical record across inpatient and outpatient settings. •  To experience the integration of medical and mental health primary care. 

6. Clinician-Educator Coach • Two students will be assigned to a Clinician Educator Coach and will meet together once weekly for the 24 week block with accommodations for time in "partner" rotations • These sessions will be an opportunity to discuss interesting cases, review physical exam findings, and strengthen basic skills in history taking, physical exam, and differential diagnosis. Skills in written and oral presentations will be emphasized. Will emphasize the themes of continuity transitions, quality improvement through performance measures, and integrated women's health.

7. Clinician Educator Coach (continued) • After the first several weeks of the continuity, students will be asked to identify an inpatient or outpatient quality improvement measure to track during the continuity (eg. Diabetes care, suicide prevention, CHF or CAD treatment goals). They will be given guidance on the groups working on improvement and will learn how it is being addressed and propose an intervention they can work on during their continuity experience. This will be coordinated with their Clinician Educator.

8. Logistics of Patient Continuity • Continuity patients will include patients seen as inpatients that return for ambulatory care appointments in medicine, psychiatry, or neurology. • Patients assigned to students while on inpatient rotations will be entered into a patient list in the CPRS electronic medical record. The students will then track the follow-up appointments and work with their Clinician Educator to identify clinic locations and sites that are compatible with the rotation schedule.

9. Logistics of Patient Continuity (continued) • During the ambulatory medicine rotation, any patient seen by a student who will be coming for a return visit in the time period of the rotation, will be seen again by the same student. • Any patient managed on an inpatient rotation and discharged to the VA Community Living Center or State Nursing Home on the West LA campus, can be seen by the student in follow-up. • The goal will be a total, across inpatient and outpatient, of at least 3 such continuity patients.

10. VA Continuity Rotation Core Faculty • VA Clerkship Site Directors • VA Continuity Clerkship Co-Directors • Gregory Brent, MD, Art Gomez, MD • Clinician Educator Coach Coordinator • Ari Weinreb, MD • Transitions of Care -Kristina Cordasco, MD • Women's Health-Fatma Batuman, MD • Performance Measures/Quality Improvement • Caroline Goldzweig, MD • Psychiatry/Mental Health Integration-Ilje Fitzgerald, MD

11. Learning Objectives • Understand the issues faced by the patient when seeking care for an acute problem, or coping with a chronic disease. •  Develop a personal bond with your patient across inpatient and outpatient care settings and understand effective transitions to provide continuous care of acute and chronic medical conditions. •  Apply core competencies in evaluation and care of a patient including professionalism, history taking, diagnostic reasoning, and formulation and implementation of a management plan.

12. Learning Objectives (continued) • Utilize the electronic medical record in care of patients, integration of care across the inpatient and outpatient setting, and in quality improvement. •  Apply the principles of patient-centered care through effective transitions of care and working within a multidisciplinary team.