College of Medicine
AY 2015-2016
Course title and number / IMED 920-00D Transplant Hepatology
Term (2016-17) / Academic Year
Meeting times and location
Course Description and Prerequisites
1. Reinforce clinical and diagnostic skills obtained during third-year Medicine clerkships, including obtaining a complete medical history, physical examination, and case presentation.
2. Introduce students to diagnostic procedures commonly performed in management of patients with liver disease including endoscopy, liver biopsy, and paracentesis.
3. Familiarize the student with an approach to the diagnosis and management of liver disease, including interpretation of laboratory studies, imaging, and liver biopsy.
Instructor Information
Elective Director / Coordinator
Name: / Stevan A. Gonzalez, MD MS / Name: / Priscilla Robledo
Telephone number: / 817-922-9968 / Telephone number: / 214-818-6498
Address: / / Email address: / Priscilla Robledo
Office hours: / By appointment / Office hours: / By appointment
Office
Location: / 1400 8th Avenue, Bldg C, 1st Floor,
Fort Worth, TX 76104 / Office location: / BUMC in Dallas
3500 Gaston Ave., Dallas, TX 75246
Learning Outcomes & Objectives
Principles and Guidelines for Curriculum Development: http://medicine.tamhsc.edu/policies/pdf/curriculum-principles-guidelines.pdf
*Assessment Methods MUST be used from the following list:
http://medbiq.org/curriculum/vocabularies.pdf
COM Competency Based Learning Objectives: http://medicine.tamhsc.edu/academic-affairs/curriculum/objectives/
Course Objective: / Taught (T) and/or Evaluated (E): / *Assessment Method: / Notes/ Comments/ Explanation: / COM Competency Based Learning Objectives (CBLO) linked to Course Objective:
1. Recognize clinical signs and symptoms of liver disease based on knowledge of liver pathophysiology. / T, E / Clinical Performance / Standard TAMHSC COM Clinical Evaluation Form
Observation by Faculty / MK1, MK2, PC1, PC2, ICS1
2. Understand and interpret liver function tests; distinguish patterns of liver injury and cholestasis. / T, E / Checklist / Standard TAMHSC COM Clinical Evaluation Form
Discussion with Faculty / MK2, PC3, PC5, PC14
3. Recognize normal anatomical structures on abdominal imaging, including MRI, CT, and ultrasound. / T, E / Clinical Performance / Standard TAMHSC COM Clinical Evaluation Form
Observation by Faculty / MK1, MK2, PC3, PC5
4. Recognize microscopic structure of the liver seen on liver biopsy, including components of the lobule; differentiate between normal and disease states. / T, E / Clinical Performance / Standard TAMHSC COM Clinical Evaluation Form
Discussion with Faculty / MK1, MK2, PC5, PC14
5. Discuss complications of liver failure and inpatient management including ascites, anasarca, and hepatic encephalopathy. / T, E / Checklist / Standard TAMHSC COM Clinical Evaluation Form
Discussion with Faculty / MK2, PC1, PC2, PC4, PC7, ICS1, ICS2, ICS3, ICS5, PBL15
6. Differentiate acute versus chronic liver failure based on medical history, clinical presentation, physical exam, and diagnostic studies. / T, E / Checklist / Standard TAMHSC COM Clinical Evaluation Form
Discussion with Faculty / MK2, PC1, PC2, PC3, PC4, PC6, PC7, ICS1, ICS5
7. Discuss indications for endoscopy in patients with cirrhosis, including management of bleeding and nonbleeding gastroesophageal varices. / T, E / Checklist / Standard TAMHSC COM Clinical Evaluation Form
Discussion with Faculty / MK2, PC1, PC2, PC3, PC4, PC6, ICS2, ICS5, PBL15
8. Discuss pathophysiology of acute-on chronic liver failure and associated risks of infection and multisystem organ failure in a critical care setting. / T, E / Checklist / Standard TAMHSC COM Clinical Evaluation Form
Discussion with Faculty / MK2, PC1, PC2, PC3, PC4, PC11, PC7, ICS3, ICS5, PROF6
9. Recognize signs of malnutrition in the setting of chronic liver disease; discuss management. / T, E / Clinical Performance /Checklist / Standard TAMHSC COM Clinical Evaluation Form
Observed & Discussed with Faculty / MK1, MK2, PC1, PC2, PC4, PC12, ICS3, ICS5
11. Discuss surveillance, diagnosis, and treatment of hepatocellular carcinoma. / T, E / Checklist / Standard TAMHSC COM Clinical Evaluation Form
Discussion with Faculty / MK4, MK5, PC13, PC14, PC15, ICS2, PBL15
12. Understand indications and evaluation of liver transplant candidacy. / T, E / Checklist / Standard TAMHSC COM Clinical Evaluation Form
Discussion with Faculty / MK2, PC1, PC2, PC4, PROF1, PROF2, PROF3, SBP7
Textbook and/or Resource Material
1. Students will rotate through the Baylor All Saints Medical Center of Fort Worth inpatient hepatology consultation service with a transplant hepatology attending faculty member. This will include rounding on patients admitted to the 28-bed transplant unit and patients seen in consultation on medical-surgical hospital floors and intensive care units. Students are expected to present their patients on hepatology rounds.
2. An emphasis will be placed on obtaining a medical history, attention to physical exam findings associated with liver disease, and discussion on management of disease states including acute and chronic liver failure, complications of cirrhosis, nutrition, and selection of liver transplant candidates.
3. Students will observe procedures including upper endoscopy, colonoscopy, endoscopic management of bleeding complications, liver biopsy, and paracentesis.
4. Students will have an outpatient clinic experience of a least one day per week, with an emphasis on outpatient management of liver disease including hepatitis B, hepatitis C, nonalcoholic fatty liver disease, alcoholic liver disease, metabolic and hereditary diseases, cholestatic liver diseases, and autoimmune hepatitis.
5. Students will attend all scheduled didactic conferences including a weekly liver histopathology conference, weekly noon conference, and monthly journal club.
6. Additional didactics will include weekly radiology review sessions with an emphasis on identifying normal abdominal anatomy as well as disease states including diagnosis of hepatocellular carcinoma and benign liver tumors.
7. Students will meet with a faculty mentor for at least one hour per week for teaching sessions on topics in liver disease.
8. Students may have the opportunity to participate in a clinical research project with a faculty mentor.
Textbooks (Required and recommended resources)
Additional learning materials will include literature reviews based on a core curriculum of liver diseases including:
1. Liver pathophysiology
2. Acute liver failure
3. Autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis
4. Metabolic and hereditary diseases including alpha-1 antitrypsin deficiency, hereditary hemochromatosis, and Wilson disease
5. Hepatitis B and hepatitis C
6. Nonalcoholic fatty liver disease
7. Alcoholic liver disease
8. Vascular disorders of the liver
9. Hepatocellular carcinoma
10. Management of liver failure, including ascites, hepatic encephalopathy, and variceal hemorrhage
11. Liver transplantation including selection of candidates and management following transplantation.
Additional textbooks that will be used to supplement core curriculum material (handouts will be provided to students):
1. Friedman LS and Keeffe EB, eds. Handbook of Liver Disease. 3rd ed. Philadelphia, PA: Elsevier; 2011
2. Clavien P, Trotter J, and Mullhaupt B, eds. Medical Care of the Liver Transplant Patient. 4th ed. Oxford: Wiley-Blackwell; 2012
Grading Policies
Case presentation / 20%
Clinical performance / 80%
Total / 100%
GRADING SCALE
Satisfactory / 70% and above
Unsatisfactory / 69% and below
Attendance and Make-up Policies
(Include website link to student rule 7 http://student-rules.tamu.edu/rule07. Make sure this information complies with COM policies and Student Handbook. Must include attendance and make-up policy, especially if attendance/class participation will count as a grade. Policies should detail excused absences, unexcused absences, and make-up policies. Attendance and make-up policies should not contradict student rules. REMEDIATION process and policy should be included HERE.
Academic Integrity
For additional information please visit: http://aggiehonor.tamu.edu
“An Aggie does not lie, cheat, or steal, or tolerate those who do.”
College of Medicine
Professionalism and integrity Statement (Academic Honesty and Plagiarism)
All College of Medicine students are required to comply with the student code of conduct and the academic integrity and honesty standards published in each component’s Student Handbook. Disciplinary action will be taken in accordance with the policies of each component. Students found guilty of Academic Dishonesty will receive an “F”/Unsatisfactory in the course. For a full list of actions qualifying as academic dishonesty, please review the College of Medicine Student Handbook at http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf.
According to the Aggie Honor System Office, plagiarism is defined as the appropriation of another person's ideas, processes, results, or words without giving appropriate credit. Intentionally, knowingly, or carelessly presenting the work of another as one’s own (i.e., without crediting the author or creator). Plagiarism and other academic misconduct definitions can be viewed on the Aggie Honor System Office website; http://aggiehonor.tamu.edu/RulesAndProcedures/HonorSystemRules.aspx#definitions.
E-mail Access and FERPA
The College of Medicine is communicating all official information to students through the students’ TAMHSC e-mail accounts. Please check the account frequently during the semester for updates.
This course is supported with web-based and/or e-mail activities. In order to take advantage of these additional resources and participate fully in the course, you have been assigned an e-mail address by the Texas A&M Health Science Center. This e-mail address is for internal use only, so that faculty may communicate with you and the entire class. By registering for this course, you are agreeing to allow your classmates to have access to this e-mail address. Should you have any questions, please contact the TAMU’s Office of the Registrar at 979-845-1031.
The Family Educational Rights and Privacy Act of 1974 (FERPA), which the HSC complies fully, is intended to protect the privacy of education records, to establish the rights of students to inspect and review their education records and to provide guidelines for the correction of inaccurate or misleading data through informal and formal hearings. Students also have the right to file complaints with the Family Educational Rights and Privacy Act Office of the Department of Education in Washington, D.C., concerning alleged failures by the HSC to comply with the act.
Mistreatment of Students
The College of Medicine is committed to providing a positive learning environment in which students can meet their academic goals based on mutual respect in the teacher/learner relationship. Both parties must be sensitive to the needs of others and differences in gender, race, sexual orientation, religion, age or disability. As outlined in the Student Handbook under the section titled Standards of Conduct in the Teacher-Learner Relationship, belittlement, intimidation and humiliation are unacceptable for effective learning and undermine self-esteem. Breaches involving student mistreatment may result in a faculty or staff member being sanctioned or the loss of faculty and/or staff appointment. These policies address student mistreatment involving College of Medicine employees, residents, affiliate staff, or patients. Mistreatment may be reported through the College of Medicine telephone hotline, 1(855)-397-9835 or through an online form at http://medicine.tamhsc.edu/current/student-mistreatment-form.html. For a full list of reporting avenues, please refer to the Student Handbook under the Mistreatment Policy.
Exposure and Occupational Hazard
The Needle Stick Policy and Bloodborne Pathogen Exposure information for Medical Students may be accessed in the Student Handbook at: http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf
Note: More information is available on the aforementioned topics to all students on the College of Medicine website.
Date Created/Revised: 1-1-2016____ By: _SG____
Phase IV Subcommittee Approval Date:
Curriculum Committee Approval Date: