A&M Integrated Medicine Program
William Pieratt, DO
AIM Medical Director
TAMHSC-COM Office at St. Joseph Regional Health Center
2801 Franciscan Dr.
Bryan, TX 77802
AIM Program Mission
To develop caring, competent and compassionate physicians who provide seamless care for our state and nation by offering an educational program that emphasizes continuity, innovation, ethics and service within a community based health care system.
AIM Program Overview
The A&M Integrated Medicine (AIM) program is a longitudinal integrated clerkship — an instructional model that veers away from the traditional clinical block rotations. Rather than studying the six core disciplines in isolated blocks, AIM students will work with physicians in core specialties continuously throughout the year while simultaneously following a panel of patients representing a wide spectrum of medical conditions. A major concern noted in the traditional block rotation model is that students are emotionally removed from patients, causing them to lose the idealism that attracted them to medicine. With an integrated approach, students get to witness the natural evolution of an illness or condition and its impact on the patient and their family.
Longitudinal integrated clerkships have been around in various forms for decades. As medical schools seek to improve their instruction, more schools are adopting the model. Patient care has changed significantly, yet clinical training overall has stayed the same. The AIM program is developed to reflect the greatest strengths of a successful health care system, namely the development of enduring relationships with patients and the provision of personalized care.
Our vision is to be renowned for preparing physicians who can embrace the complexities of the changing healthcare milieu, who can navigate large systems, and provide collaborative care of high quality blending the latest medical knowledge and technology with the timeless professional values of compassion, ethics and service.
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.
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 three to four half days built into their schedule each week for self-directed learning (opportunity time). The students are expected to follow their cohort of patients through the system, accompanying them for consultations, hospitalizations, surgeries, therapies and diagnostic evaluations.
AIM students will be scheduled weekday call from 6 to 11 p.m. in the emergency, labor and delivery, or surgery departments. Students will be on call from 8 a.m. to 11 p.m. one to two weekend days per month. 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 in the emergency department such as suturing, incision and draining of abscesses, L.P.’s and other required lists of procedures.
AIM Teach - Case Based Learning
Once a week, AIM students will meet as a group with a clinician/facilitator to discuss active patient cases. Students will have the opportunity to 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.
AIM students will participate in OSCEs during the last months of the academic year.
Each student will be expected to maintain an electronic reflective portfolio throughout their M3 year. Each student is required to keep a reflective journal of at least seven of their cohort longitudinal patients. They will be asked to focus on the patient’s experiences in our complex health system, record them, and explore solutions.
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 full day per each two-week rotation 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 will 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.
The Family Medicine Clerkship will have the same goals and objectives as the traditional College of Medicine Family Medicine Clerkship. 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.
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 and follow a panel of patients for a half day per 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' top priority will be attending 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.
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 over 12 months. 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 — and most can be managed in the ambulatory setting. 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.
The psychiatric medicine longitudinal curriculum will provide students with one-on-one teaching, collaboration and mentoring with experienced attending physicians. Students will spend half days in an outpatient setting evaluating patients in crisis and in treatment. Students, supervised by emergency room physicians, will help manage care for patients suffering acute symptoms of mental illness at the point when patients often enter the healthcare system. 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 healthcare to patients. Students will spend one week in the Veteran’s Hospital in Waco, Texas, for their inpatient experience.
The AIM Internal Medicine Clerkship integrates both inpatient and outpatient clinical experiences through which the student learns the acute, chronic and preventive management of the adult patient.
The IM experience will have four to six 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 admit patients during emergency room shifts and follow patients with conditions including chest pain, diabetic ketoacidosis and sepsis, who come in acutely.
In the outpatient experience, the student will share a panel of adult patients with an assigned attending in community practice over the course of the year. The practice will include patients with chronic diseases including diabetes, hypertension, COPD, obesity, hyperlipidemia and depression. The student will become familiar with preventive counseling, chronic disease management and acute care of common outpatient problems, and follow patients on a recurrent basis.
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 will accompany the patient and assist with clinical management whenever possible. The student will be asked to keep a journal with reflections of their patient's journey through the health care system.
General surgery AIM students will spend two-week rotations in surgery during the year. The rotations will consist of core general surgery and specialty surgery. During these rotations, patients with complex surgical problems will be selected for longitudinal follow-up in coordination with the assigned AIM attending. During the longitudinal phase, students will be asked to make periodic contact with their cohort patients and record their encounters in the electronic medical record in order to refine their skills of integrating data from care providers within diverse domains, and articulate a comprehensive care plan for their patients in collaboration with the AIM attending. Students will meet for small group sessions with faculty mentors to debrief on their experiences and discuss the challenges of multi-system care.
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. As such, the emergency department will augment the education of our AIM students as they spend one evening per week and one Saturday per month in an ER rotation (ER, labor & delivery, surgery).
One afternoon 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. The core specialty directors will collaborate to offer a dynamic experiential curriculum that will make use of simulations in the teaching of the science and art of medicine.
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.
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.
The AIM students will receive the same EKG instructional course as the traditional students. 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.
Required Case Presentations
AIM students will be required to complete the clerkship requirements of case presentations. Students will be given the guidelines and their AIM mentor will assign the appropriate due date for the presentation well in advance.
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 during the first semester of the academic year. AIM students will attend these sessions with the traditional students from the other campuses and be required the pass the radiology exam.
William Pieratt, DO
AIM Medical Director
TAMHSC-COM Office at St. Joseph Regional Health Center
2801 Franciscan Dr.
Bryan, TX 77802