SYLLABUS College of Medicine AY 2016-2017

Course title and number MEID 809-00R Teamwork in Wilderness Medicine Elective Term (e.g., Fall 200X) Spring 2017 Meeting times and location 4/3 – 4/14/2017; The Retreat at Balcones Springs, Marble Falls, Texas

Course Description and Prerequisites

The purpose of the Teamwork in Wilderness Medicine Elective is to enable senior medical students to excel as first year residents by providing a capstone experience that requires confident application of medical knowledge and skills in challenging environments where success is only possible with effective leadership and extraordinary teamwork. Prerequisites: 4th year status.

Instructor Information

Elective Director Coordinator

Name Roque Ruggero, MD, FAAEM Name Katy Thaler Telephone number 512-573-3969 Telephone number 512-341-4994 Email address [email protected] Email address [email protected] Office hours By appointment Office hours 8am – 5 pm Office location Round Rock Campus Office location Round Rock Campus

Nelson Avery, MD Other instructors: Tyler Jorgenson, MD Ed Sherwood, MD

Learning Outcomes & Objectives

Goals: At the conclusion of this elective experience, participants will have…

 Increased self-confidence derived from performing outside their “comfort zones;”  Improved communication skills in the face of extraordinary distractions;  Proficient team skills in stressful and challenging environments;  Understood approach and unique challenges to delivery of medical care in wilderness settings;  Identified and treated common and life-threatening injuries that may be encountered in wilderness settings;  Achieved effectiveness in leading small groups to perform difficult tasks; and  Had fun.

Created: 5/22/15 by J. Ping, Revised: 4/27/16 by R. Ruggero Wilderness medicine requires meeting the challenges of working in a low resource environment. Wilderness medicine requires one to look at delivering medical care from a unique perspective that is not readily taught in most hospital or clinic based practices. In addition, requires exceptional leadership and teamwork to achieve optimum outcomes. The learning objectives for this course fall under four major competency goals:  Participating as a safe and effective team member.  Leading a small team in the provision of urgent care under hazardous conditions without incurring additional casualties;  Providing emergent field care for common wilderness medicine situations;  Achieving certification as a Wilderness First Responder (WFR). The first week of this elective will consist of the Wilderness Upgrade for Medical Professionals (WUMP) Course provided by the National Outdoor Leadership School (NOLS) taught primarily by NOLS faculty assisted by COM faculty. The second week of this elective reinforces material learned during the first week through extensive application in wilderness medical emergency simulations and other outdoor activities. Participants will need to arrive the evening before classes begin. Learning activities extend into the evenings, allowing a generous break for the holiday weekend. The course delivery is at The Retreat at Balcones Springs, 104 Balcones Springs Drive, Marble Falls, Texas 78654. Participants will need to arrange their own transportation and reside at the venue during both weeks of the course. Participants MUST remain on site at The Retreat at the Balcones site including overnight on the scheduled days of the elective (they may leave The Retreat from Friday afternoon after the first week to Monday at 2 pm of the second week) Shared housing will be provided for Sunday through Friday of the first week and Monday through Friday of the second week.

Participants that will be training in various outdoor settings and are required to bring the following items for the course:  Hat for sun protection.  Boots with ankle support highly recommended.  Suitable clothing for outdoor activities in temperatures ranging from 50 F. to 100 F.  Raingear suitable for search and rescue operations. Class exercises are conducted rain or shine.  Headlamp and/or handheld flashlight with extra batteries.  Old clothes that can get stained with simulated blood, torn, or otherwise subject to being damaged. We recommend that due to the strenuous nature of search and rescue activities; participants should be in good physical condition and/or secure a professional evaluation of their medical condition prior to enrolling in this course. The NOLS Wilderness Upgrade for Medical Professionals requires a minimal enrollment of ten (maximum of fifteen) participants by July 1, 2016. If you want to take this elective, please contact course coordinator prior to July 1, 2016. If minimum enrollment is met and available slots are open, students may enroll after that date.

Created: 5/22/15 by J. Ping, Revised: 4/27/16 by R. Ruggero VI. Course Objectives and Evaluation Method Upon completion of the course, students will be able to:  Learn standard triage protocols  Learn how to maximize effectiveness in setting of overwhelmed medical resources  Learn common environmental emergencies  Learn basic orthopedic reduction techniques and splint applications  Create presentations on specific wilderness medicine topics  Define mass casualty incident  Assess medical rescue, treatment and transport capacity  Provide emergent field care for common wilderness medicine situations  Participate as a safe and effective team member  Lead a small team in the provision of urgent care under hazardous conditions without incurring additional casualties

COM Competency Based Learning Objectives: http://medicine.tamhsc.edu/academic- affairs/curriculum/objectives/ Principles and Guidelines for Curriculum Development: http://medicine.tamhsc.edu/policies/pdf/curriculum-principles-guidelines.pdf

COM Competency Taught (T) Based Learning Course Objective: and/or Evaluation: Objectives Evaluated (E): (CBLO): Observation by faculty of group Learn common environmental MK1, MK2 T,E participation and emergencies individual presentations. Observation by faculty of group Learn basic orthopedic reduction PC9, MK4 T,E participation and techniques and splint applications individual presentations. Observation by faculty of group Create presentations on specific PBL13, PBL14, T,E participation and wilderness medicine topics PBL15 individual presentations. Observation by faculty of group participation and individual Define mass casualty incident PC6 T,E presentations. Successful completion of NOLS WUMP course.

Created: 5/22/15 by J. Ping, Revised: 4/27/16 by R. Ruggero Observation by faculty of group participation and individual Assess medical rescue, treatment and PC6, PC7 T,E presentations. transport capacity Successful completion of NOLS WUMP course. Observation by faculty of group participation and Assess medical rescue, treatment and individual transport capacity PC6, PC7 T,E presentations. Successful completion of NOLS WUMP course Observation by faculty of group Provide emergent field care for PC3, PC6, PC7 T,E participation and common wilderness medicine situations individual presentations Observation by faculty of group participation and ICS1, ICS2M ICS3, Participate as a safe and effective team individual PROF2, PROF6, member T,E presentations. PROF10 Successful completion of NOLS WUMP course Observation by ICS1, ICS2, ICS3, faculty of group PROF2, PROF4, participation and Lead a small team in the provision of PROF6, PROF7, individual urgent care under hazardous conditions PROF8, PROF10, T,E presentations. without incurring additional casualties PROF11, PROF12, Successful PBL12, CC2 completion of NOLS WUMP course

Textbook and/or Resource Material

This elective will focus on wilderness medicine and be comprised of team building and leadership exercises, small group lectures, and outdoor experiences/workshops. Small group lectures will be held by faculty and students on wilderness medicine topics.

Textbooks (Required and Recommended Resources)

REQUIRED: There is no required textbook, but additional reading will be provided.

RECOMMENDED: Wilderness Medicine: Expert Consult, 6th edition, Auerbach Field Guide to Wilderness Medicine: Expert Consult – 4th edition (companion book)

Created: 5/22/15 by J. Ping, Revised: 4/27/16 by R. Ruggero Grading Policies

The final course grade will be based on the following: active participation in team building and leadership activities (50% of the grade) and successful completion of the NOLS WUMP course (50% of the grade).

Attendance and Make-up Policies

While expectation is 100% attendance, absolute maximum of two excused absences may be allowed with prior approval by course director, but only during second week if significant extenuating circumstances. The five day course by NOLS during first week requires 100% attendance. Additional information on attendance can be found at http://student-rules.tamu.edu/rule07.

Course Topics, Calendar of Activities, Major Assignment Dates

This elective will focus on wilderness medicine and be comprised of team building and leadership exercises, small group lectures, and outdoor experiences/workshops. Small group activities and simulations will be conducted by faculty and students on various wilderness medicine topics as outlined in course calendar (see appendices B and C).

Course calendar and NOLS WUMP outline are attached.

Other Pertinent Course Information

Clerkship Courses MUST include patient encounter and Log Information here. Actual log list can be included in the appendix. Include information that is pertinent to ALL campus locations here like processes and procedures. If there are campus specifics, include those locally not in this syllabus. Indicate where course materials can be accessed for example Blackboard, One45, etc.)

Americans with Disabilities Act (ADA)

The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive civil rights protection for persons with disabilities. Among other things, this legislation requires that all students with disabilities be guaranteed a learning environment that provides for reasonable accommodation of their disabilities. If you believe you have a disability requiring an accommodation, please contact Disability Services, currently located in the Disability Services building at the Student Services at White Creek complex on west campus or call 979-845-1637. For additional information, visit http://disability.tamu.edu.

Academic Integrity

“An Aggie does not lie, cheat, or steal, or tolerate those who do.” For additional information please visit: http://aggiehonor.tamu.edu

Created: 5/22/15 by J. Ping, Revised: 4/27/16 by R. Ruggero 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.

Created: 5/22/15 by J. Ping, Revised: 4/27/16 by R. Ruggero Appendix A: College of Medicine Competency Based Learning Objectives

1. Medical Knowledge

Upon completion of the medical school curriculum, our students will be able to:

MK1 - Demonstrate knowledge of normal human structure and function at the organ‐system, tissue, cellular and molecular level; and of the interaction of human systems in maintaining homeostasis MK2 - Describe the basic mechanisms involved in the causation of human disease and their influence on clinical presentation and therapy MK3 - Demonstrate an understanding of how healthy lifestyles and psychosocial factors influence health MK4 - Apply evidenced-based methods to clinical problem solving MK5 - Demonstrate an understanding of the epidemiology of common diseases within a population and the approaches which are useful in reducing their incidence and prevalence MK6 - Demonstrate knowledge of common societal problems such as domestic violence and substance abuse, including diagnosis, prevention, reporting, and treatment

II. Patient Care Upon completion of the medical school curriculum, our students will be able to: PC1 - Obtain both complete and system-focused medical histories that include psychosocial determinates of health PC2 - Perform both complete and system-focused physical examinations PC3 - Develop appropriate differential diagnoses by integrating collected clinical information PC4 - Develop contextual and individualized diagnostic and treatment plans based upon collected clinical information PC5 - Interpret the results of commonly used laboratory and radiologic studies

PC6 - Recognize common, immediately life‐threatening conditions and initiate therapy

PC7 - Formulate an initial management plan for critically ill patients PC8 - Demonstrate an understanding of the principles involved in the care of patients across the spectrum of the human life cycle PC9 - Perform technical procedures including: venipuncture and arterial puncture; insertion of intravenous, central venous and urethral catheters; insertion of a nasogastric tube; lumbar puncture; basic suturing; and basic airway management PC10 - Discuss the principles of pain management and formulate a basic multidisciplinary care plan

PC11 - Assist in the provision of appropriate end‐of‐life care within a multidisciplinary team

PC12 - Educate patients in personalized health maintenance PC13 - Perform basic health risk assessment and formulate appropriate screening plans PC14 - Properly utilize clinical, laboratory, radiologic, and pathologic examinations to diagnose and treat common maladies PC15 - Formulate preventive, curative, rehabilitative, and palliative therapeutic strategies for common disorders

III. Interpersonal and Communication Skills Upon completion of the medical school curriculum, our students will be able to: ICS1 - Demonstrate effective listening skills ICS2 - Discuss diagnostic and treatment options in a manner comprehensible to the patient ICS3 - Communicate effectively with patients, patients' family members, peers, and other members of the health care team ICS4 - Educate patients, patients' family members, peers, and other members of the health care team at an appropriate level using appropriate technologies ICS5 - Maintain accurate medical records

Created: 5/22/15 by J. Ping, Revised: 4/27/16 by R. Ruggero IV. Professionalism Upon completion of the medical school curriculum, our students will be able to: PROF1 - Demonstrate an understanding of legal and ethical principles governing the physician-patient relationship PROF2 - Display honesty, integrity and ethical behavior PROF3 - Act in the patient's best interest and serve as a patient advocate PROF4 - Treat patients and patients' family members respectfully and compassionately, regardless of age, disability, gender, race, ethnicity, culture, religion, sexual preference, and socio‐economic status

PROF5 - Respect the privacy of patients PROF6 - Work with other health professionals in a collaborative fashion PROF7 - Demonstrate an awareness of leadership roles in medicine and society PROF8 - Recognize potential conflicts of interest and demonstrate awareness of appropriate courses of action PROF9 - Demonstrate an understanding of peer review and the expectations of professional licensing boards, including medical jurisprudence PROF10 - Demonstrate knowledge of responsibilities to patients, peers, and other members of the health care team PROF11 - Respond to conflicts in a professional manner PROF12 - Project a professional image in demeanor and personal appearance

V. Systems-Based Practice Upon completion of the medical school curriculum, our students will be able to: SBP1 - Apply knowledge of health care systems to improve and optimize patient care SBP2 - Advocate for continuous quality improvement in patient care and patient safety SBP3 - Demonstrate an understanding of cost containment principles and their application in the delivery of health care SBP4 - Demonstrate an understanding of the legal and regulatory frameworks governing the practice of medicine which affect payment, reimbursement, referrals and incentives SBP5 - Recognize various approaches to the organization, financing, and delivery of health care SBP6 - Utilize information technology in providing medical care for individuals SBP7 - Recognize health care system deficiencies regarding social needs, access to care issues, and health disparities when they arise and develop strategies for optimal care of each individual patient.

VI. Practice-Based Learning and Improvement Upon completion of the medical school curriculum, our students will be able to: PBLI1 - Identify and rectify deficiencies in their knowledge base and skill set PBLI2 - Incorporate formative evaluation feedback into personal performance

PBLI3 - Accomplish learning and improvement goals with appropriate self‐directed activities

PBLI4 - Utilize information resources and available data to support life‐long learning

PBLI5 - Select, appraise, and utilize evidence from scientific studies related to clinical questions and patients' health problems PBLI6 - Demonstrate an understanding of the basic principles and importance of scholarly activity in the practice of medicine

VII. Cultural Competence Upon completion of the medical school curriculum, our students will be able to: CC1 - Demonstrate an understanding of the manner in which diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. CC2 - Recognize and appropriately address gender and cultural biases in themselves, in others, and in the process of health care delivery.

Created: 5/22/15 by J. Ping, Revised: 4/27/16 by R. Ruggero Please refer to Blackboard for example of prior outline and for most recent course outline.

Created: 5/22/15 by J. Ping, Revised: 4/27/16 by R. Ruggero