Instruction in Medicine is provided during all four years of the medical curriculum, beginning with Practice of Medicine I (Medicine 507) in the first year. Teaching in the second year has two main objectives: the correlation of the basic sciences with clinical aspects of disease and training in the technical methods of physical examination and laboratory diagnosis. By the beginning of the third year, the student is ready for supervised clinical study of individual patients. A clinical clerkship of 12 weeks, divided into three four-week periods, is served by third-year students on the medical services of the department. In the final year, students may elect a sub-internship in general medicine and a series of elective courses in the medical specialties.

Website:https://internalmedicine.wustl.edu

For information about Primary Care Summer Preceptorships, please refer to the information at the bottom of this section.

M25 Medicine 900

Dana R. Abendschein, PhD
9924 Clinical Sciences Research Building
Phone: 314-362-8925

Research in this translational physiology laboratory is focused on development of novel antithrombotic approaches for use during acute myocardial infarction, stroke, and surgery where vascular injury is an underlying mechanism. Current studies are designed to define the efficacy of targeting antithrombotics to the surface of injured vascular cells and activated platelets on thrombus progression. One approach uses nanoparticles covered with epitopes to bind exposed receptors on thrombus and containing inhibitors of coagulation or platelet activation. Students will be expected to participate in experiments using animal models and will develop skills in experiment design, vascular physiology, clinical antithrombotic therapy, coagulation, histopathology and statistics.

John P. Atkinson, MD
Clinical Sciences Research Building, 10th Floor
Phone: 314-362-8391

A clinical research elective is offered in the evaluation of patients with complement deficiency or overactivity states and with undiagnosed rheumatic disease syndromes.

Roberto Civitelli, MD
BJC Institute of Health, 11th Floor, Musculoskeletal Research Center
Phone: 314-454-8408

The biology of cell-cell interactions and communication in bone via gap junctions and cell adhesion molecules. Function of connexins and cadherins in transcriptional control of osteoblast differentiation, osteoclastogenesis, and mechanotransduction. Modulation of mesenchymal lineage allocation and osteogenic differentiation by cadherins and beta-catenin signaling.

Nicholas O. Davidson, MD
910 Clinical Sciences Research Building, North Tower
Phone: 314-362-2027

Genetic pathways for nonalcoholic fatty liver disease (NAFLD) and colorectal cancer development. We have two major areas of research interest. Our laboratory is interested, first, in the molecular mechanisms of hepatic steatosis and the pathogenesis of NAFLD. This is the most prevalent liver disease in the U.S., likely affecting a quarter of the population. We have generated genetically manipulated mouse strains that offer insights into the mechanisms of hepatic steatosis. The student would work as part of a team, designing and conducting experiments that will test hypotheses concerning the mechanisms and consequences of hepatic steatosis. These studies will primarily involve mouse genetics, examining the expression of candidate genes under a variety of nutritional and pharmacologic settings that modulate hepatic lipid metabolism. In addition we are using microarrays to study the spectrum of genetic changes that may predict the extent of hepatic lipid accumulation in patients with steatohepatitis. Our goal is to test hypotheses using mouse genetics and to extend these studies to examine the same pathways in humans with NAFLD. Our second area of interest concerns the genetic pathways involved in colorectal cancer, the second leading cause of cancer-related deaths. We have developed a novel strain of mice in which the dominant effects of mutations in the APC tumor suppressor gene have been abrogated through deletion of an RNA binding protein, apobec-1. This deletion has a major effect on the expression of cox-2, abrogating the increase in expression seen in human colonic adenomas and wild type mouse intestinal adenomas. These findings suggest that apobec-1 is a genetic modifier of colon cancer development. We will study the importance of apobec-1 expression in human colon cancer specimens and continue our murine genetic studies of this novel pathway for modulating colon cancer development and progression.

Thomas M. DeFer, MD
6604 Wohl Hospital
Phone: 314-362-8050
Email: tdefer@wustl.edu

Special Projects in Medical Education. Through special arrangement with and approval by the course master, fourth-year students will participate in special projects in medical education. Typical projects will require approximately four weeks to complete. These four weeks can occur consecutively (preferred) or be spread out somewhat as needed. Medical education projects should be aimed at improving the curriculum, student experience, and/or administration of the Internal Medicine Clerkship or the Sub-Internship. Interested students should contact the course master via phone or email to discuss the proposed project. Those who are interested but would like guidance in designing a project should also contact the course master. This is open only to Washington University School of Medicine students.

Matthew Ellis, MB, BChir, PhD
Southwest Tower, Room 724
Phone: 314-747-3613

Genomics of Breast Cancer. The demonstration that the HER2 gene was amplified in breast cancer heralded the "genomic era" for this disease which ultimately led to major clinical advances for HER2-positive disease. The HER2 discovery was based on a search for cancer-specific anomalies in the cellular homologs of the acutely transforming retroviral oncogenes described in birds and mammals. However, HER2 gene amplification is now recognized to be only one of a large number of somatic mutations that occur in breast cancer. In the last 10 years, my clinical and laboratory efforts have focused on the development of a luminal (hormone receptor positive) breast cancer genome atlas to elucidate the complexity of the somatic changes in the breast cancer genome responsible for tumors resistant to current therapies. During these efforts we established a body of work on the practice of treating postmenopausal women with large palpable hormone receptor-rich tumors with four months of an aromatase inhibitor. The ultimate scientific goal of these efforts is to create specimen banks and biomarker data from thousands of patients to create sufficient statistical power to robustly link genomic screens to clinical outcomes so we can eventually focus our basic science efforts on the most lethal genetic events.

Over the last year, we have undertaken a comprehensive analysis of the tumor samples accrued, including "whole genome" gene expression chips, high resolution array comparative hybridization analysis and candidate gene sequencing. The gene lists we are currently generating, particularly those from the marriage of expression profiling and array comparative hybridization, suggest a host of new therapeutic targets are ready to be exploited. Functional characterization of these genes has begun, and this effort is a major focus in the laboratory. Elective students will focus on projects that relate to individual oncogene candidates. The scope of the project will be commensurate with elective time commitment but participation may include interpretation of genomic data, confirmatory studies on gene over-expression in cell lines and tissues, and functional studies using gene transfer, gene knock-down and pharmacological targeting to verify the identity of bona fide therapeutic targets for further investigation. Attendance at weekly lab meetings is expected.

Bradley Evanoff, MD, MPH
Phone: 314-454-8638

Occupational medicine epidemiology and intervention research. My research involves the use of epidemiology methods to characterize associations between diseases and work-related exposures. I am also doing workplace intervention studies to prevent injuries and illnesses, and to improve healthy diet and physical activity among working populations. During an elective in occupational medicine epidemiology research, students will learn how to use epidemiologic methods to investigate disease processes by working on a mutually agreed-on topic of interest related to occupational diseases. Other activities can include work site visits and intervention projects, as well as involvement with work site health promotion and policy making. Elective length is variable depending on individual circumstances. Please contact Dr. Evanoff to discuss this research.

Gregory I. Goldberg, PhD
Wohl Clinic, 4th Floor
Phone: 314-362-8172

Role of secreted extracellular matrix metalloproteases in tissue remodeling. Structure and function of the metalloproteases.

Richard W. Gross, MD, PhD
4525 Scott Avenue, East Building
Phone: 314-362-2690

Lipid mediators of signal transduction in the cardiovascular system. Characterization of regulatory mechanisms responsible for the liberation of lipid second messengers during cellular activation. The roles of phospholipases in mediating the metabolic syndrome and end-organ tissue damage.

Stacey House, MD, PhD
Phone: 314-362-8070
Email: houses@wustl.edu
or Lisa Hayes
Phone: 314-362-4362
Email: hayesli@wusm.wustl.edu

Emergency Medicine Clinical Research. Emergency medicine clinical research involves the gamut of research designs ranging from retrospective cohort studies ("The Use of B Hydroxy Butyrate Point-of-Care Testing in Diabetic Ketoacidosis"), to prospective clinical trials ("Biomarkers in Traumatic Brain Injury"), to the evaluation of health care systems and Emergency Department processes ("Effects of a Triage Process Conversion on the Triage of High Risk Presentations"), to analyzing health policy issues ("Rate of Follow-up to a Primary Care Clinic and Subsequent Emergency Department Utilization among an Urban ED Population"). Students will learn the basic clinical research designs and will be able to articulate the benefits and drawbacks of each. They will be involved in hypothesis generation and study design for projects that are at that stage. For ongoing projects, they will learn about the informed consent process and be involved in screening for study subjects and subject selection and enrollment. They will be allowed to consent for studies judged to be minimal risk. Students will be taught important rules regarding data acquisition and entry, particularly as it relates to standards that have been set forth in the medical literature. They will learn about bias and inter-rater reliability. Students will participate in data entry, data analysis, and subsequent abstract/manuscript preparation based on their level of interest and ability for time commitment. Students will meet weekly with one of the course masters to discuss study progress and to identify any roadblocks to study completion. These meetings will also serve as a forum for one-on-one education of the student regarding study methodology, ethical issues in research, and various resources available to the clinical researcher at Washington University.

Keith A. Hruska, MD
McDonnell Pediatric Research Building, 5th Floor
Phone: 314-286-2772

Our laboratory's focus is on two aspects of kidney diseases: the progression of chronic kidney disease (CKD), and the syndrome of the CKD-mineral bone disorder (CKD-MBD). The latter is an important cause of mortality associated with CKD. We have discovered the pathogenesis of the CKD-MBD in early stage 2 CKD. We have ongoing studies of CKD stimulated vascular calcification in which we have discovered the mechanism of atherosclerotic palque calcification stimulated by phosphorus. We are analyzing phosphorus as a cardiovascular risk factor, and new therapies for chronic kidney disease, the CKD-MBD, and vascular calcification.

Stuart A. Kornfeld, MD
Clinical Sciences Research Building, 8th Floor
Phone: 314-362-8803

Synthesis, processing and sorting of glycoproteins, including lysosomal enzymes. Intracellular protein trafficking.

Sandor J. Kovacs, MD, PhD
9965 Clinical Sciences Research Building
Phone: 314-362-8901

For students with math, physics and engineering background. Cardiovascular biophysics research elective concentrates on physiologic modeling and comparison of model predictions to in vivo human data. Minimum of eight weeks of elective time.

Jack Ladenson, PhD
Phone: 314-454-8436

Development of monoclonal and single-chain antibodies for use in research and in diagnostic testing.

Marc S. Levin, MD, and Deborah C. Rubin, MD
922/924 Clinical Sciences Research Building
Phone: 314-362-8933, 314-362-8935

Students will be members of a collaborative research team headed by Drs. Levin and Rubin (Department of Medicine) investigating the mechanisms underlying the intestinal adaptive response that occurs to compensate for loss of functional small intestine. A second project focuses on epithelial-mesenchymal interactions and their role in regulating gut epithelial proliferation carcinogenesis and the normal and cancer stem cell niche. Specific mechanisms under investigation include the function of an immediate early gene Tis7 on gut adaptation following resection or injury. The role of myofibroblast protein epimorphin in regulating cell proliferation and colon carcinogenesis is being explored. The student will have the opportunity to learn basic molecular biology and physiology as it relates to small intestinal growth and function. Examples of techniques that are used in these studies include small animal surgery and colitis and cancer models (mice and rats), molecular biological techniques including PCR, Northern blotting, vector construction for production of transgenic and knockout mouse models, in situ hybridization and immunohistochemistry.

Jeffrey D. Milbrandt, MD, PhD
101 Biotechnology Center
Phone: 314-362-4650

We have several ongoing projects in our laboratory that focus on peripheral neuropathy and neurodegenerative diseases. (1) Using high throughput screening methods to dissect the molecular program responsible for dismantling injured and/or unhealthy axons with the goal of identifying drugs to treat neurological disorders. (2) Using genetics and metabolomics to understand how metabolic deficits in glia lead to neuropathy and axon breakdown. (3) Developing new genetic tools for in vivo and in vitro assays aimed at characterizing the role of non-myelinating Schwann cells in acquired peripheral neuropathies such as diabetic neuropathy. (4) Implementing novel, high-throughput genome engineering technologies in induced pluripotent stem cell-derived neurons to perform functional genomic screens for pathways involved in axon regeneration.

Jason C. Mills, MD, PhD
Clinical Sciences Research Building, North Tower, Room 1030
Phone: 314-362-4213

We investigate the differentiation of epithelial stem cells in the upper GI tract. We study how genes regulate differentiation in mouse models and in vitro in tissue culture, and we correlate our findings with human tissue specimens. Specific projects include: (1) understanding how inflammation leads to aberrant differentiation (metaplasia), which is a precursor for cancer; (2) elucidating how master regulatory transcription factors like Xbp1 and Mist1 coordinate the massive cytoskeletal and organellar expansion of specialized secretory cells as they differentiate from stem cells; and (3) understanding mechanisms regulating how differentiated cells can be reprogrammed into stem cells in GI organs like stomach and pancreas.

Stanley Misler, MD, PhD
815 Yalem Building, Barnes-Jewish Hospital
Phone: 314-454-7719

Stimulus-secretion coupling in endocrine cells (B-islet cells and adrenal chromaffin cells) examined using single-cell assays of secretion (capacitance measurements, amperometery).

Ginger E. Nicol, MD
4412 Renard Building
Phone: 314-362-5939

Clinical research concerning substrate (glucose and lipid) metabolism and the regulation of weight and body composition in persons with mental illness, particularly concerning the effect of psychotropic medications. This elective offers the student a broad exposure to clinical research protocols, including protocols in adults and children. Students will have an opportunity to focus on a particular project of interest.

Amit Noheria, MBBS, SM
Northwest Tower, 13th Floor
Phone: 314-249-7352

Clinical Outcomes in Patients with Cardiac Implantable Electronic Devices: Clinical research to evaluate outcomes in patients with cardiac implantable electronic devices (CIEDs).

  1. Risk of stroke in patients with patent foramen ovale and CIEDs.
  2. Predictors of hemodynamically unstable ventricular arrhythmias in patients with left ventricular assist devices (LVADs).

Richard E. Ostlund, MD
8804 Wohl Hospital
Phone: 314-362-8286

Our laboratory focuses on the prevention and treatment of coronary heart disease by studying cholesterol absorption, detoxification and elimination from the body. Direct patient studies that use new stable isotopic cholesterol tracers and mass spectrometry techniques complement in vitro work on the biochemistry of cholesterol transport in cultured cells.

Russell Pachynski, MD
BJC Institute of Health, 7th Floor
Phone: 314-286-2341

My lab focuses on several aspects of tumor immunology and translational immunotherapy. We utilize mouse tumor models, human tissues and samples, and advanced molecular and immunologic techniques to study leukocyte trafficking in the setting of tumor development and progression. We also have projects focusing on developing novel immunotherapeutics aimed at augmenting the recruitment of beneficial leukocyte subsets into the tumor microenvironment in order to suppress tumor growth. We are utilizing several approaches such as nanoparticles, fusion proteins and viruses.

Katherine Ponder, MD
8818 Cancer Science Research Building
Phone: 314-362-5188
Email: kponder@wustl.edu

Gene Therapy for Lysosomal Storage Diseases. Our laboratory is interested in using gene therapy to treat lysosomal storage diseases such as mucopolysaccharidosis (MPS). We have developed a retroviral vector that can be efficiently delivered to the liver of mice and dogs, and results in expression that is sufficient to reduce many of the clinical manifestations of these genetic diseases. Current studies focus upon assessing the therapeutic effect of gene therapy on sites that are affected in MPS such as the heart, aorta, bones and joints, and developing vectors that might be translated into human patients. In addition, we are evaluating the pathogenesis of disease in MPS, which appears to involve the upregulation of destructive proteases in the aorta and possibly other sites. A better understanding of the pathogenesis of disease might result in additional therapies for MPS.

Clay F. Semenkovich, MD
Southwest Tower, 8th Floor
Phone: 314-362-4454

Fatty acid metabolism and its role in atherosclerosis, diabetes, hypertension and obesity. The modulation of respiratory uncoupling for the treatment of aging, obesity and vascular disease.

Phyllis K. Stein, PhD
Northwest Tower, Room 13116
Phone: 314-286-1350
Email: pstein@wustl.edu

Clinical Significance of Heart Rate Variability and ECG-Derived Waveform Parameters Obtained from Continuous Ambulatory Monitoring. This elective affords the opportunity to perform research in heart rate variability or in other measurements, like QT variability or T-wave alternans that can be derived from continuous ECG monitoring from Holter recordings or polysomnography recordings in the sleep lab. One area of active research is the identification of heart rate patterns associated with obstructive and central sleep apneas and hypopneas and the relationship of previously unappreciated cycling heart rate patterns and outcomes. Data are also available from mice. Many possible projects are available using our many large existing datasets, using the thousands of stored studies in the sleep lab, or involving de novo data collection in a clinical or animal population and in infants. Also, many possible directions for this research are available from applying traditional and nonlinear HRV to different populations, developing methods to quantify ultradian heart rate variability patterns, to developing novel ECG analysis techniques, etc. Also, we are involved with the Cardiovascular Health Study (CHS), a large population-based longitudinal study of risk factors for heart disease and stroke among community-dwelling people >65 years old. There is a subset of this population who had Holter recordings (~1400 at baseline, ~800 of the same people five years later, and ~370 minority subjects recorded at the same time as the second CHS recording). These recordings have already been analyzed by us so there is a large amount of heart rate variability and heart rate pattern data available. There are also subsets of the CHS and of another study (EPHESUS) who are known to have died suddenly, and we have developed a matched control group in order to examine ECG-based differences in those who died suddenly. We also have electronic sleep studies at two time points for about 300 of the CHS Holter participants who also participated in the Sleep Heart Health Study. We have analyzed an additional ~1500 sleep studies from CHS participants who did not have Holter recordings. Thus, there is also an opportunity in the CHS dataset for studies on the relationship of heart rate variability and changes in heart rate variability over time and a huge number of clinical and demographic factors among the elderly. We also have data on the relationship of Holter-based HRV and sleep apnea patterns to the development of atrial fibrillation post-cardiac surgery and data from a study of treatment of depression in treatment-resistant depressed post-MI patients, a study of sickle cell patients, and one of heart rate variability and echo parameters in elderly African Americans. Currently we are also analyzing HRV in both premature infants as they mature and also HRV as a predictor of response to treatment in babies in the NICU and PICU, using stored 24-hour bedside ECGs.

Heart Rate Variability and Clinical Outcomes: The student will be learning about HRV Methods and will investigate the relationship of HRV and outcomes in one of our datasets. Because we have clinical and demographic data on about 20,000 subjects for whom continuous ECGs from Holter recordings, sleep studies, and ICU studies are available, and also some mouse data, the student will be able to choose a project leading to a publishable result in an area of interest. The HRV Lab has enough computers and software to accommodate the needs of any interested students.

John Turk, MD, PhD
Southwest Tower, 8th Floor
Phone: 314-362-8190

Phospholipid signaling mechanisms in pancreatic islets. Experience in mass spectrometric analysis of complex lipids is available.

H.J. Wedner, MD
5002 Steinberg Pavilion, Barnes-Jewish Hospital, North Campus
Phone: 314-454-7937 or 314-454-7377

  1. Asthma Care in the Inner City: Students will participate in ongoing studies of the delivery of asthma care to inner-city children and adults. The emphasis will be on direct contact between the asthmatic patients and the student, along with an asthma counselor.
  2. Biology of Pollen and Fungal Allergens: Our laboratory has been characterizing the important allergenic proteins from molds and pollen. The allergens are identified using skin test sensitive individuals, and the proteins are isolated and characterized by a combination of physiochemical and molecular biological techniques. These studies should lead to better forms of allergy immunotherapy. Students will participate in the isolation, characterization and modification of major allergens from a number of molds including Stachybotrysatra, Epicoccum nigrum, and several pollens including those from white oak and Parthenium hysterophoros, a newly recognized allergen.

Primary Care Summer Preceptorships

Since 1996 the school has sponsored a primary care preceptorship program for students during the summer between their first and second years of classes. Students select a preceptor in internal medicine, pediatrics or family practice and spend up to eight weeks observing that physician's clinical practice. A stipend is provided to the student. Although many of the preceptors are in St. Louis, others, particularly alumni, are located in cities throughout the country.

Visit online course listings to view offerings for M25 Medicine.


M25 Medicine 507 Practice of Medicine I

The practice of medicine requires that physicians integrate a diverse array of knowledge. Clinicians must interview and examine a patient, understand that patient's experience of illness, develop an evidence-based differential diagnosis, and engage patients in their treatment plan, all the while attending to the ethical dimensions of clinical medicine. Physicians must understand how to promote the health of populations as well as that of individual patients. Physicians must also master skills for lifelong learning to remain competent professionals. The Practice of Medicine I (TPM I) is the first part of a three-year course about the interfaces between patient, doctor and society. The course is organized around the Content Areas described below. In addition, regular Integrative Case Sessions will highlight the interrelationships of the TPM Content Areas. Primary Care Preceptor sessions will provide each student with an introductory experience in outpatient medicine. Content Areas:

  • The Experience of Illness, Stephen S. Lefrak, MD. The practice of medicine reflects the tension between the unique story of individual patients and the generalized scientific understanding of disease. Physicians must learn to understand and resolve this tension as much as possible. The Experience of Illness is intended to help the student become aware of those areas that determine this unique response to biological processes. In addition to readings and small group discussions, students will write both a personal illness narrative and a patient-centered narrative following a home visit to a patient.
  • Health Promotion/Disease Prevention, Bradley Evanoff, MD, MPH. This overview of public health and preventive medicine will combine theory and application to allow students to interpret the scientific literature, to approach clinical medicine with an emphasis on prevention, and to understand aspects of the social, economic, and political environments which affect health and health care. We will focus on methods of primary and secondary prevention, and on nutritional, environmental, and behavioral factors that impact health. Discussions will include immunization, screening for chronic diseases, and effects of toxic exposures.
  • Scientific Method of Clinical Medicine and Research, Jay F. Piccirillo, MD. Students will learn the central role of clinical epidemiology and medical statistics in the care of patients, the critical review the published literature, and the conduct of clinical research. Students will also learn to use computerized statistics and spreadsheet programs, as well as how to measure and improve the quality of care.
  • Clinical Skills, Yoon Kang, MD. Students will perform a complete physical exam (excluding neurologic and mental status exams). Additionally, students will learn how to summarize the exam findings in a written form, both in the context of a complete history and physical note and a daily progress note (i.e., SOAP note).
  • Doctor-Patient Communication, Elliot E. Abbey, MD. This section begins development of physician-patient communication skills through several mechanisms. Students will observe their small group instructors taking medical histories from hospitalized patients. Subsequently, the instructors will observe student-patient interaction in the same setting. Lectures regarding the standard components of the history will coincide with the instructor role-modeling segment. Finally, videotapes illustrating examples of positive and negative aspects of communication will be utilized.
  • The Ethics and Context of Medicine, Rebecca Dresser, JD. This content area introduces students to ethical, social, and legal issues arising in the practice of medicine. Topics to be covered include: the responsibilities of medical professionals; the doctor-patient relationship; and the organization and financing of health care. Issues in resource allocation, clinical research and genetics will also be addressed.

Credit 198.5 units.


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M25 Medicine 605A Infectious Diseases

The infectious diseases course now includes a basic discussion of medical microbiology previously taught in the first year. The infectious disease portion emphasizes both organism-specific and organ-specific approaches to disease caused by microbes. The course aims to expand upon the material presented in the first year concerning bacteria, viruses, fungi and parasites and their involvement in causation of human disease. Educational methods include lecture and clinical case discussions in small groups.

Credit 51 units.


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M25 Medicine 606A Rheumatology

The rheumatology pathophysiology course begins with an overview of the structure, function and physiology of the normal joint. The pathophysiology of both localized joint disorders such as osteoarthritis and infectious arthritis are then presented, along with systemic inflammatory disorders including rheumatoid arthritis, lupus and vasculitis. Diagnosis, pharmacologic management and rehabilitation of these conditions are included. In small group sessions, students interview patients and observe the characteristic physical findings of these disorders.

Credit 17 units.


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M25 Medicine 607 Practice of Medicine II

The goal of The Practice of Medicine (TPM) is to provide students with a set of knowledge, skills and attitudes essential to patient care regardless of specialty. TPM II is a continuation of TPM I and will build on concepts introduced during TPM I. TPM II will continue to address various interfaces between patients, physicians and society and will also introduce approaches to clinical thinking and decision-making in the context of today's socioeconomic and cultural environment. The sections of TPM II include Advanced Physical Examination, Case Development, Communication, Ethics and Health Policy, Health Promotion/Disease Prevention, Interpreting Illness, Ophthalmology, Patient Sessions, Radiology, and Scientific Methods. The learning objectives for each section of TPM II emphasize topics and skills utilized in all fields of medicine, and the majority of the course work for TPM II will be taught in small groups or through clinical experiences.

Credit 99 units.


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M25 Medicine 611B Cardiovascular Disease

The purpose of this course is to consider the mechanisms and manifestations of acquired and congenital cardiovascular disorders as well as their pharmacologic treatment. Lectures and group discussions are provided which emphasize the major areas of cardiac pathophysiology and pharmacology.

Credit 30 units.


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M25 Medicine 612B Pulmonary Diseases

The objectives of the pulmonary pathophysiology course include to review normal pulmonary physiology as related to specific pulmonary disease states. The focus of the course will largely be upon presentations in lectures concerning pathophysiologic principles of abnormal lung structure and function. In addition, case study problems will be discussed.

Credit 22.5 units.


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M25 Medicine 613B Renal & Genitourinary Diseases

After a review of normal renal physiology and structure, the course focuses upon renal disease states including glomerulonephritis, secondary glomerulo diseases, diabetic and tubulointerstitial nephropathies, disorders of fluid volume and osmolality, electrolyte and acid/base disturbances, hypertension, renal infection, nephrolithiasis, as well as acute and chronic renal failure. Teaching of renal pathophysiology is integrated with the renal segment of the pathology course. Lectures are supplemented by clinical case discussions in small groups.

Credit 38 units.


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M25 Medicine 614 Dermatology

The dermatology second-year course is designed to teach medical students how to describe skin lesions and the pathophysiologic basis and clinical characteristics of major dermatologic diseases. Major categories of clinical skin diseases and their most prominent constituents will be discussed, including papulosquamous diseases, blistering diseases, infectious diseases, and benign and malignant neoplasms.

Credit 8 units.


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M25 Medicine 615A Endocrinology and Metabolism

The endocrine pathophysiology course aims to provide an understanding of the pathophysiology and clinical manifestations of common endocrine disorders. Emphasis is placed upon relevant clinical history and physical examination as well as the interpretation of investigations for endocrine disorders. Basic principles of treatment of endocrine disorders will also be discussed. Lectures are supplemented by organ-specific clinical case discussions.

Credit 31 units.


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M25 Medicine 620A Gastroenterology and Liver Diseases/Nutrition

This course discusses the pathophysiological mechanisms involved in producing disease of the gastrointestinal tract including esophagus, stomach, small and large intestines, liver, gall bladder and pancreas. A series of lectures related to nutrition and the impact of nutritional disorders on health and disease are also included. Lectures are supplemented by group seminars that include clinical case presentations.

Credit 32 units.


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M25 Medicine 625A Hematology and Oncology

The hematology pathophysiology course exposes students to common hematologic disorders and hematologic malignancies. The course utilizes lectures, clinical case discussions and practical sessions involving microscopy.

Credit 39 units.


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M25 Medicine 707 Practice of Medicine III

Objectives: 1. To review challenges and dilemmas relevant to the practice of clinical medicine. 2. To examine clinical experiences from a variety of perspectives. In this course, themes and topics relevant to students in their clinical stage of training are discussed. Session formats include lecture, panel discussion and/or small group. As students exchange problematic scenarios and questions, the group develops potential solutions and management schemes. *Topics in the past have included: Session 1: Complementary and Alternative Medicine; Session 2: Safe and Quality Care at BJH; Session 3: Communicating Serious Adverse Events to Patients and Families; Session 4: Intimate Partner Violence; Session 5: Medical Malpractice/Tort Reform; Session 6: Health Care Financing; Session 7: Update on the Patient Protection and Affordable Care Act (PPACA); Session 8: Clinical Practice Management; Session 9: Recognizing Personal Biases; Session 10: Evaluation and Treatment of Patients with Disabilities. Attendance at eight out of 10 POM III sessions is required to pass this course. Student may use two absences for any reason and are recommended to save them for their ACES rotation, Labor & Deliver rotation, or an emergency. Sessions will be from 12-2 p.m. on the third Tuesday of every month except for November and December. (Please note that the first session is held on the fourth Tuesday of June).


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M25 Medicine 710 Medicine Clerkship

The Medicine clerkship provides supervised study of patients in both inpatient and ambulatory settings. For the inpatient rotations, students are assigned as clinical clerks to patients admitted to the general medical teaching services of Barnes-Jewish Hospital and Veterans Administration Medical Center. For the outpatient rotations, students rotate through the ambulatory general medicine clinics at Barnes-Jewish Hospital and a community-based internal medicine practice. Teaching is provided by the chief of service, attending physicians, house officers, consultants, chief residents and regularly scheduled conferences. Formal instructions is given regarding core internal medicine topics during the clerkship. A minimum of 12 weeks is required: three consecutive four-week rotations.

Credit 462 units.


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M25 Medicine 714 Ambulatory Clerkship: Emergency Medicine

The Urgent Care area (UCA) serves as our site for the WUSM III Ambulatory Care Rotation. Three students at a time are assigned to this four-week rotation. Students will spend their first day in an orientation session learning suturing, ECG interpretation and airway management (including intubation skills) in hands-on laboratories. They will also review pelvic examinations and view an education video on domestic violence. On day two, they begin primarily evaluating non-emergent patients in Urgent Care and report directly to an Emergency Medicine attending. There are four hours of conferences per week (8-10 a.m. on Tuesday and Wednesday mornings) — attendance is mandatory. Discussions are currently underway to allow students to participate in helicopter ride-alongs with ARCH Airmedical Services. Students can expect to gain a wide range of skills in evaluating uncomplicated upper respiratory infections, urinary tract infections, sexually transmitted diseases, lacerations, eye problems, rashes, simple extremity trauma — in general, "bread and butter" medical/surgical problems. Students do a case presentation (15 min.) at the close of the block.

Credit 154 units.


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M25 Medicine 730 Physical Medicine and Rehabilitation Clerkship

Clerkship in PM&R for third-year medical students provides an opportunity to gain basic knowledge and clinical skills in evaluation and management of a wide range of neurological and musculoskeletal diseases and conditions that require specialized rehabilitative medical and therapeutic care. Students spend two weeks on the Spinal Cord Injury Unit (SCI) and two weeks on the Brain Injury (BI) and Stroke Unit at The Rehabilitation Institute of St. Louis. Students are expected to be a part of the rehabilitation team, follow three to five patients, participate in daily morning rounds, participate in performing consults, and attend team meetings and family conferences. Students are required to attend several outpatient clinics such as SCI, BI, Amputee and Stroke. During the entire rotation, students work with PM&R residents and fellows, and under direct guidance of the NeuroRehabilitation faculty. The usual duty hours are 7:30 a.m. to 5 p.m. weekdays and 8 a.m. to noon on Saturdays. There is no night call. Students are required to attend all PM&R curriculum lectures and conferences. On the first day of rotation, students meet with the PM&R program director to go over goals, objectives and schedules. Upon completion of the rotation, students are required to fill out the evaluation form to provide feedback regarding rotation experience.

Credit 154 units.


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M25 Medicine 740 Dermatology Clerkship

The goal of the dermatology clerkship is to provide a guide for the student to appreciate dermatology within the broader perspectives of medicine and biology. The student will develop familiarity with dermatologic vocabulary, learn to recognize and initiate therapy of common dermatologic disorders and become cognizant of uncommon or complicated dermatologic problems that require specialty care. Emphasis will be placed on careful history taking and physical examination. Students will always work under the direction of the resident physician and the attending physicians in the clinic setting.

Credit 154 units.


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M25 Medicine 750 Geriatrics Clerkship

The primary goal of the four-week clerkship in Geriatrics is to provide an opportunity for students to gain proficiency in the principles of geriatric evaluation, including the medical, psychological, social, and functional assessments of older adults. Direct, hands-on experience with patients is a major feature of the clerkship. Students are expected to participate in the evaluation of three to five patients per week, in a variety of settings including the hospital Acute Care for the Elderly (ACE) unit on 3200 North Campus, the Older Adult Outpatient Assessment Program (Storz building), and the Long Term Care Setting (Barnes Extended Care in Clayton). Students attend hospice, geropsychiatry rounds, and the geriatric conferences while on the rotation. Students are assigned to a variety of attendings to enhance the experience. There is no night call or call on weekends. Participation on the hospital consult service will occur depending on volume. The day normally begins at 8:00 a.m. and is usually finished by 5. There will be time to read the detailed syllabus/bibliography. Students will be asked to present a brief topic of their choice at the end of the rotation and demonstrate knowledge of the geriatric screens and assessments.

Credit 154 units.


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M25 Medicine 801 Honors Medicine - General Medicine

The purpose of the Honors Medicine elective (sub-internship) is the development of expertise in the care of hospitalized patients in a well-supervised teaching environment. Sub-interns act as their patients' interns under the supervision of residents and attending physicians. Sub-interns have the same on-call and admitting schedules as the interns on their teams and are assigned up to two new patients on each admitting day. Sub-interns are not required to spend call nights in the hospital. Except in emergencies, sub-interns are the first individuals to evaluate patients admitted to medical service teams. A diagnostic and therapeutic approach to the patient is planned in consultation with the resident. Sub-interns assume primary responsibility for the daily care of their patients, under the supervision of resident and attending physicians. This includes evaluation on daily rounds, scheduling and obtaining results of diagnostic studies, planning therapy, making arrangements for care after discharge and communicating with patients and their families. Sub-interns attend the same conferences as the house staff.


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M25 Medicine 805 Rheumatology

Students will be involved in the diagnostic workup and management of patients with rheumatic illnesses including systemic lupus erythematosus, rheumatoid arthritis, vasculitis (polyarteritis, Wegener's, temporal arteritis), spondyloarthropathies (ankylosing spondylitis, reactive arthritis), osteoarthritis, gout and regional musculoskeletal problems. By working closely with a faculty member, fellows and medical residents, students become integral and active members of the rheumatology service for inpatient consultations and outpatient clinics at Barnes-Jewish Hospital. An emphasis is placed on the physical examination of joints and the musculoskeletal system, synovial fluid analysis, and interpretation of diagnostic tests and radiographs. Students attend two rheumatology conferences held weekly. A rotation limited to outpatient rheumatology is possible by prior arrangement with the course director.


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M25 Medicine 807 Honors Medicine - VA Hospital

The purpose of the Honors Medicine elective (sub-internship) at the VA Medical Center is to develop practical experience and expertise in the care of hospitalized patients on an internal medicine ward. With appropriate supervision by the attending and resident physicians, sub-interns will have similar responsibilities as interns. They have the same on-call/admitting schedules as the interns and participate in the same teaching conferences, but they do not take overnight call. Sub-interns should admit at least two patients per call day, and they should be the first to evaluate the patients admitted to the medical service, except in emergencies. A diagnostic and therapeutic approach to evaluating each patient is planned in consultation with the resident. While being supervised as listed above, sub-interns assume primary responsibility for the daily care of their patients, including evaluation on daily rounds, scheduling and obtaining results of diagnostic studies, calling consults, planning therapy, making arrangements for care after discharge, and communicating with patients and their families.


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M25 Medicine 810 Geriatric Medicine

The primary goal of this rotation is for students to gain proficiency in the principles of geriatric evaluation and management, including the medical, psychological, social, and functional assessments of older adults. Students are expected to participate in the evaluation of three to five patients per week, in a variety of settings including the outpatient Geriatric Assessment Clinic, inpatient Geriatric Consult service, Parc Provence nursing home, and the Rehabilitation Institute of St. Louis (TRISL). Students will also have the opportunity to participate in hospice and home care visits, interdisciplinary team meetings, and observe an assessment at the WU Alzheimer's Disease Research Center. Students are expected to attend weekly conferences while on the rotation. The day normally begins at 8:30 a.m. and is usually finished by 5:30 p.m. There is no night or weekend call. Time is provided to read the detailed syllabus/bibliography. Students will be expected to give an oral presentation on a topic of their choice once during the rotation.


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M25 Medicine 811 Clinical Internal Medicine - Hospitalist

This course allows the student to work one-on-one with hospitalist physicians on a patient care team. The student acts as the intern under the direct supervision of the attending physician. Daily responsibilities include admission history and physicals, daily notes and discharge summaries on assigned patients. They also will have the opportunity to perform indicated procedures on patients on this service. Students are encouraged to participate in Department of Medicine conferences.


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M25 Medicine 814 Clinical Emergency Medicine - Barnes-Jewish Hospital

This rotation offers practical experience in the evaluation and management of acutely sick and injured patients. Students will function as sub-interns, initially evaluating their assigned patients and developing a plan for further diagnostic studies and therapy. They will report to a senior-level resident or an attending physician. The student can expect to get an opportunity to perform a wide variety of procedural skills such as suturing, splinting, peripheral and central venous access, and cardiopulmonary resuscitation. Shifts will be eight hours, and students will rotate between day, evening and night shifts, including weekend shifts, in order to gain maximum exposure to all types of emergencies. A core content of lectures will be provided. Students will gain an understanding of prehospital care by doing a ride-along shift with the St. Louis Fire Department EMS. Students will also have a shift with the toxicology attendings and residents and will gain knowledge of the basics of ultrasound during their time in the department. Students interested in EM will be doing 1:1 shifts with a single attending during their last two weeks of the rotation. Students desiring a letter of recommendation from any EM attending should take this WUSM IV Emergency Medicine rotation. Students will be scheduled for required weekend and overnight shifts, and changes will not be allowed to the schedule unless approved prior to the start of the rotation by the course coordinator. Please be advised that there is a limit of days off while on this rotation during interview season; otherwise, students should arrange to take the elective at a different time during the year. Days off during the rest of the year will conform to university policy. Days off should be requested from the course coordinator at least two weeks prior to the beginning of the rotation for scheduling purposes.


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M25 Medicine 821 Inpatient Cardiology

Students will participate as members of the Barnes-Jewish Cardiology at Washington University Consultative Team. They will be part of a team composed of faculty members, fellows, residents, and nurse specialists that sees a large population of cardiac patients and follows them through all aspects of their in-hospital care. Emphasis will be placed on physical examination and the interpretation of modern cardiac diagnostic tests including electrocardiograms, echocardiograms and coronary angiograms and their role in clinical decision making.


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M25 Medicine 822 Honors Medicine - Cardiology

The structure and functioning of the Honors Medicine-Cardiology elective (sub-internship) is very similar to the general medicine sub-internship (M25 801). The basic purpose is to develop expertise in the care of hospitalized patients in a well-supervised teaching environment. The majority of patients admitted to the service will have a cardiology diagnosis as the main reason for admission. Some general medical problems will also be seen. All attendings on the service are cardiology subspecialists. Cardiology fellows act as the chief residents for the service on a monthly basis. Sub-interns act as their patients' interns under the supervision of residents and attending physicians. Sub-interns have the same on-call and admitting schedules as the interns on their teams and are assigned up to two new patients on each admitting day. Sub-interns are not required to spend call nights in the hospital. Except in emergencies, sub-interns are the first individuals to evaluate patients admitted to medical service teams. A diagnostic and therapeutic approach to the patient is planned in consultation with the resident. Sub-interns assume primary responsibility for the daily care of their patients, under the supervision of resident and attending physicians. This includes evaluation on daily rounds, scheduling and obtaining results of diagnostic studies, planning therapy, making arrangements for care after discharge, and communicating with patients and their families. Sub-interns attend the same conferences as the internal medicine house staff. There are also several conferences specific to the cardiology service.


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M25 Medicine 823 Clinical Cardiology

The major purpose of this elective in clinical cardiology at the John Cochran VA Hospital is to improve evaluation and management skills for diagnosis and treatment of important cardiovascular conditions such as coronary artery disease including acute myocardial infarction, congestive heart failure, hypertension, and valvular heart disease. The rotation is designed to be flexible enough to accommodate a wide variety of course objectives but includes the opportunity to participate in 1-3 outpatient clinics per week; 1-4 weeks of inpatient intensive care, telemetry, or cardiology consultation rounds; and ECG, stress testing, nuclear imaging, or echocardiographic reading sessions, cardiac catheterization and electrophysiologic procedures. The emphasis will be on improvement of the ability to diagnose and treat cardiovascular disease on the basis of information obtained from a thorough history and physical examination that is integrated with data from appropriate highly targeted laboratory studies in a manner that optimizes patient outcome and minimizes risk and costs.


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M25 Medicine 825 Cardiac Arrhythmias and Electrophysiology

This elective provides the student with exposure and teaching in the diagnosis and treatment of complex cardiac rhythm disturbances. Specifically, the student is expected to evaluate patients referred for evaluation and treatment of complex or life-threatening rhythm disturbances, unexplained syncope or sudden cardiac death. Rounds are made daily on hospitalized patients, and students are welcome to observe electrophysiology studies or implantation of pacemakers and defibrillators. This elective also provides an intensive opportunity to learn clinical electrocardiography and the systematic use of anti-arrhythmic drugs. Finally, since patients with chronic, complex rhythm disturbances frequently have organic heart disease, a broad-based exposure to general cardiology is also part of this elective.


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M25 Medicine 827 Heart Failure/Cardiac Transplantation

This rotation is intended to provide trainees with a comprehensive experience managing patients with advanced heart failure. In addition to daily rounds, trainees are invited to attend both heart failure and transplant clinics. Further, the curriculum is supplemented by a comprehensive syllabus that contains the critical literature pertinent to this patient population. The trainees will also have experience with the evaluation of patients for operative heart failure therapies and will have the opportunity to observe these surgical procedures.


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M25 Medicine 830 Dermatology

The aim of this elective is to provide a guide for students so they are able to appreciate dermatology within the broader perspectives of medicine and biology. Emphasis will be placed on the dermatologic variations encountered in a normal physical examination of the skin, the identification of common skin diseases, dermatologic clues to systemic disease, as well as those dermatologic conditions that are life threatening. Students will participate in outpatient care in the Barnes-Jewish Hospital and affiliated clinics. Students will attend all clinical teaching rounds and conferences in addition to the basic science and cutaneous histopathology conferences.


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M25 Medicine 831 Pediatric Dermatology

This clinical rotation will be available to students interested in dermatology, pediatrics or both. Students will follow the dermatology rotation (M25 830) with an emphasis on pediatric dermatology by attending pediatric dermatology clinics, seeing consults, etc. Enthusiastic students will have an opportunity to write up a case report if they wish, but need to notify the instructor before the course.


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M25 Medicine 834 Clinical Mentoring

This elective is designed to develop the teaching and mentoring skills of our fourth-year medical students through structured hospital sessions with first-year medical students and supervised sessions with clinical faculty. The primary format of the elective is observation of the first-year students during hospital sessions where the first-years perform the H&P and the fourth-year mentors offer constructive feedback. Each H&P write-up is also thoroughly reviewed and critiqued by the mentor. Supervisory sessions also occur with clinical faculty who give feedback on both the performance of the first-year students as well as the mentoring skills of the fourth-year.


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M25 Medicine 836 Clinical Gastroenterology and Hepatology

The GI Hepatology elective is integrated into a very active inpatient/outpatient and endoscopy service at Barnes-Jewish Hospital. Students will participate in the evaluation of inpatients and outpatients with a spectrum of gut and liver disorders, will make patient rounds with the faculty and fellows, and have responsibility for patients on whom consultations have been requested. In addition, they will observe biopsy, endoscopic, and intubation techniques and participate in outpatient clinic and GI conferences.


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M25 Medicine 838 Medicine Consult Service

The focus of the Medicine Consult Service elective is the evaluation and management of medically complex patients admitted to the hospital on non-medicine services. The issues involved with perioperative management are particularly stressed. The student will function as a member of the consult service team. Duties will include performing initial consultations and follow-up care under the supervision of a Hospital Medicine attending and a senior medical resident. Attendance at Department of Medicine and division conferences is encouraged.


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M25 Medicine 842 Introduction To Wilderness Medicine

The purpose of this course is to introduce medical students to common medical problems both emergent and nonemergent seen in various wilderness settings. After taking this course the student should have a basic understanding of the pathophysiology and management of these problems in an environment with limited access to medical aid. The course will involve four days of four-hour lectures each week along with one 1-2 day required overnight camping trip. Requirements to pass this course include completing a presentation on a topic of their choosing that is approved by the course director as well as a skills and written test.


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M25 Medicine 843 Medical Toxicology

This rotation offers practical experience in the evaluation and management of the acutely ill poisoned patient. Students will function as sub-interns and either report to the senior resident, fellow, or directly to the toxicology attending. Students will gain familiarity and experience evaluating and treating patients who have intentionally and unintentionally overdosed on medications or illicit drugs, been envenomated (such as by spiders, snakes, or other reptiles), or been exposed to toxic substances or chemicals. Students will also gain experience in administering antidotes and learning to properly decontaminate someone after an ingestion or exposure. There are no overnight or weekend shifts. Daily activities start in the morning and are generally concluded by the early afternoon. A core content of lectures will be provided. The students will also be assigned small projects during their rotation that will enhance their experience particularly in environmental and occupational toxicology. Opportunities to increase their experience with occupational toxicology also exist during this rotation; those with this interest can ask for further information during their rotation. Students will also have the opportunity to go to the Missouri Poison Center and evaluate patients in the outpatient toxicology clinic. Students desiring a letter of recommendation from one of the toxicology attendings (who are also Emergency Medicine and Internal Medicine attendings) or interested in Emergency Medicine or Medical Toxicology should take this elective. Also, students considering other specialties such as Pediatrics or Internal Medicine should consider this rotation as they will be responsible for evaluating these patients as part of their inpatient or outpatient practice. Please be advised that there is a limit of days off while on this rotation during interview season; otherwise, students should arrange to take the elective at a different time during the year. Days off should be requested from the course coordinator at least two weeks prior to the beginning of the rotation for scheduling purposes. Students should receive a course guide just prior to their rotation. However if they do not, they can page the toxicology pager at 314-672-0284 to determine when and where to meet for rounds.


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M25 Medicine 844 Hematology and Hemostasis

Activities planned include workup of patients at Barnes-Jewish Hospital under the supervision of the hematology fellow and his staff consultant; attendance at clinical rounds three to five hours weekly; participation in outpatient clinics; experience in various procedures, especially blood and bone marrow morphology and in interpretation of coagulation tests. Daily student rounds with a senior staff person.


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M25 Medicine 847 Bone and Mineral Diseases

The course is designed to acquaint the student with the clinical, radiological and pathological manifestations and treatment of disorders of bone and mineral metabolism, including osteoporosis, Paget's disease of bone, hyperparathyroidism, osteomalacia, and more rare disorders of bone development and homeostasis. The student will rotate through clinics of the Division of Bone and Mineral Diseases, and see patients at Barnes-Jewish Hospital, Barnes-Jewish West County Hospital and Shriners Hospital for Children. Acquired and heritable bone diseases will be studied in the context of derangements of mineral homeostasis with emphasis on vitamin D and peptide hormone metabolism and skeletal formation and remodeling. The role of noninvasive methods for measuring bone mass in the diagnosis and management of skeletal diseases also will be stressed. Faculty and medical students will present interesting cases for discussion or the students can present a pertinent topic related to bone metabolism they have researched during their rotation.


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M25 Medicine 853 Bone and Joint Infectious Disease Consult

Study of infectious diseases of the bones and joints, including infections in both native and prosthetic joints. The elective is designed to teach students the fundamentals of evaluating clinical orthopedic infections and formulating plans for workup and therapy. Students see consultations in infectious diseases in every part of Barnes-Jewish Hospital under the supervision of a faculty member who rounds with them every day. They work closely with the infectious diseases attending and nurse practitioner, follow their own patients and play an important role in their management. They are expected to read the literature about their patients and participate in clinical conferences. They attend teaching rounds and conferences and lectures in infectious diseases. They also learn appropriate use of antibiotics and antifungal agents. The role of surgical and medical management is discussed, and the students will interact with surgical staff in understanding the risks and outcomes of these common infections. Two weeks of General Infectious Disease are a prerequisite to this course.


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M25 Medicine 854 Transplant Infectious Disease

Study of infectious diseases in patients who have had bone marrow or solid organ transplants, or who have a hematologic malignancy. The elective is designed to teach students the fundamentals of evaluating clinical infections in these complex and interesting patients and formulating plans for workup and therapy. Students see consultations in every part of Barnes-Jewish Hospital under the supervision of a faculty member who rounds with them every day. They work closely with infectious disease fellows, follow their own patients and play an important role in their management. They are expected to read the literature about their patients and participate in clinical conferences. They attend teaching rounds and conferences and lectures in infectious diseases. They also learn appropriate use of antibiotics, antifungal and antiviral agents in this highly immune suppressed population. A wide distribution of infectious diseases is covered including management of neutropenic fever, invasive fungal infections in the transplant population, acute and chronic infections, infection prophylaxis and monitoring and interactions between immunosuppressive agents and antibiotics.


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M25 Medicine 858 Ambulatory Infectious Disease

The elective is designed to teach students the fundamentals of evaluating clinical infections in the outpatient setting. Students see patients under the supervision of a faculty member. Students will participate in the care of HIV-infected or otherwise immunosuppressed patients as well as general infectious disease and travel patients. The clinic is the primary provider for HIV-infected patients, and students will learn the pathogenesis of HIV, become familiar with most antiretroviral medications, and have the opportunity to learn about opportunistic infections and their prophylaxis. They will also have the opportunity to see patients with bone and joint infections, endovascular infections, endemic and opportunistic mycoses, sexually transmitted diseases and travel plans. Patients seen will have a wide range of acute and chronic infections with a heavy emphasis on HIV/AIDS, including indigent and insured patients, of both sexes and a wide range of ages. The students will play an important role in the management of these patients. They are expected to read the literature about their patients and participate in clinical conferences.


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M25 Medicine 859 General Inpatient Infectious Disease

Study of patients with infectious diseases, including inpatient care of HIV-infected patients and general infectious disease consults. The elective is designed to teach students the fundamentals of evaluating clinical problems in infection and formulating plans for workup and therapy. Students see consultations in infectious diseases in every part of Barnes-Jewish Hospital under the supervision of a faculty member who rounds with them every day. They work closely with medical residents and infectious disease fellows, follow their own patients and play an important role in their management. They are expected to read the literature about their patients and participate in clinical conferences. They attend teaching rounds and conferences and lectures in infectious diseases. They also learn appropriate use of antibiotics, antifungal and antiviral agents. A wide distribution of infectious diseases is covered including community-acquired acute and chronic infections, opportunistic infections in HIV-infected patients, hospital-acquired infections, and basic infection control practices. This is a four-week rotation. Two-week rotations are allowed, but must be done in conjunction with two weeks of Transplant Infectious Disease or Bone and Joint Infectious Disease.


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M25 Medicine 861 Oncology - Inpatient
Medical Oncology is a complex subspecialty that is undergoing a rapid evolution as a result of new systemic treatment approaches that stem from biological insights into the nature of cancer. During the course of the elective, medical students will be able to interact with attending physicians and patients for bedside teaching and attend tumor boards and lectures focused on the care of patients with solid tumors. At the end of the rotation the students will appreciate the principles of our approach to cancer patients and should have gained insights into the pharmacological basis for systemic cancer treatment. The ethical and medical challenges of caring for patients with advanced incurable malignancies will also be an important theme, as well as the conduct of clinical research in this patient population. Students will learn to care for hospitalized patients suffering from complications from their cancer or from toxicities due to treatments. Oncologic emergencies will be covered. Issues such as palliative care treatment options and end-of-life decision making will be explored as well.


M25 Medicine 862 Inpatient Internal Medicine/Oncology - Firm

Medical Oncology is a complex subspecialty that is undergoing a rapid evolution as a result of new systemic treatment approaches that stem from biological insights into the nature of cancer. During the course of the elective, medical students will be able to interact with attending physicians and patients for bedside teaching and attend tumor boards and lectures focused on the care of patients with solid tumors and lymphoma. At the end of the rotation the students will appreciate the principles of our approach to cancer patients and should have gained insights into the pharmacological basis for systemic cancer treatment. The ethical and medical challenges of caring for patients with advanced incurable malignancies will also be an important theme, as well as the conduct of clinical research in this patient population. Students will learn to care for hospitalized patients suffering from complications from their cancer or from toxicities due to treatments. Oncologic emergencies will be covered. Issues such as palliative care treatment options and end-of-life decision making will be explored as well. Major learning goals: (1) Become familiar with frequent complications of cancer treatment such as neutropenic fever, nausea/vomiting, diarrhea, infectious complications and their management. (2) Become familiar with oncologic emergencies (spinal cord compression, hypercalcemia, neutropenic sepsis) and their management. (3) Become more comfortable interacting with patients and families requiring difficult psychosocial and end-of-life discussions.


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M25 Medicine 863 Emergency Ultrasound

This rotation will focus on ultrasound and all of its many applications and uses in the Emergency Department. Students will participate in the performance of bedside ultrasound of patients in the Emergency Department. Common applications of emergency ultrasound include the FAST exam, pelvic ultrasound, Abdominal Aortic Aneurysm (AAA), vascular access, renal, gallbladder, and DVT. In general, the student will be in the Emergency Department during weekdays to perform these exams. Students will not be involved in direct patient care during this rotation. Students will have access to a lecture bank of the common applications. In addition, the student will meet with the ultrasound director 1-2 times/wk to review images and have direct hands-on instruction. At the end of the rotation the student should have gained the knowledge of basic emergency ultrasound including its indications and applications; as well as becoming more adept at the performance of ultrasound.


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M25 Medicine 865 Intensive Care Medicine

This elective in intensive care is offered in the Intensive Care Unit at Barnes-Jewish Hospital, South Campus. This unit has 16 intensive care beds providing intensive nursing care and life-support technology. The patients represent a mixture of patients with primarily medical problems. Patient care responsibility includes night call. In addition to patient responsibility, there are regularly scheduled conferences and attending rounds.


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M25 Medicine 867 Medical Intensive Care

This elective is offered as an opportunity to gain additional experience in acute, primary care medicine. The elective is an advanced course in patient care involving complex medical problems. Responsibilities involve working up new patients with the MICU team, case presentations and attendance at conferences. Conferences consist of attending rounds Monday through Saturday, radiology rounds Monday through Saturday, pulmonary conference and medical grand rounds on Thursday, and critical care conference once each month. Call schedule is every third night.


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M25 Medicine 869 Palliative Medicine

The Palliative Medicine elective will focus on the care of patients with life-threatening or debilitating illness throughout the course of their care. Skills in symptom management, communication, and interdisciplinary team-based care will be the focus. Students will spend the majority of their time on the BJH Palliative Care Service. Based on the individual student's interest, there may also be opportunities to work with the BJC Hospice Team and the St. Louis Children's Hospital Palliative Care Service. While in the hospital, students will be responsible for seeing patients upon initial assessment as well as delivering follow-up care with the team. Patients will be seen for both end-of-life care as well as symptom management. Students will learn to assess and treat refractory symptoms and participate in complicated advanced care planning. Students will attend interdisciplinary team meetings, and may participate in conversations about goals of care and coping with bad news. They may also make home visits with hospice care providers, if desired. Emphasis will be placed on observing and understanding the psychosocial and spiritual needs of the patients, as well as the impact of the burden on caregivers. In addition, students will be expected to lead biweekly presentations/group discussions on selected aspects of Palliative Medicine with the BJH Palliative Care team.


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M25 Medicine 870 Endocrinology, Diabetes, and Metabolism

In general, the four-week rotation will be divided into two weeks of general endocrinology and two weeks of diabetes. Students taking this elective will perform consultations with fellows and faculty on the inpatient services at Barnes-Jewish Hospital and will also see patients with endocrine and metabolic diseases in the Outpatient Consultation. They will present these cases daily on teaching rounds. They will also participate in case conferences and seminars on a weekly basis. Extensive interaction with patients with diabetes and a diabetes education program are included, as is involvement with patients with thyroid, pituitary, adrenal, gonad, metabolic bone disease, and lipid disorders. Ample opportunities will be provided for discussions of patient problems with the members of the division. A variety of outpatient clinics are offered in the division, and interested students should speak with the fellows and faculty members to customize the learning experience to match their career goals. At the end of the rotation, it is expected that students will have the ability to initiate inpatient and outpatient management of diabetes including insulin dosing and glucose monitoring, as well as evaluate and treat of a variety of endocrine disorders including but not limited to thyroid, pituitary, and adrenal disease. Students will learn to perform effective inpatient and outpatient consultations.


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M25 Medicine 871 Oncology - Outpatient

Students will gain experience in the initial treatment of newly diagnosed malignancies and the outpatient management of oncology patients. Participation in multidisciplinary tumor conferences will stress a combined-modality approach to management, incorporating chemotherapy, radiotherapy and surgery. Students will see patients with a variety of malignancies, including lymphoma, myeloma, and tumors of the lung, breast and colon. Management of hypercalcemia and other paraneoplastic syndromes, as well as cancer pain management will be covered. Students will have the opportunity to see how most oncologists spend 90 percent of their workday. They will observe different styles that oncologists have in presenting news about prognosis, treatment options and other information to patients while they also learn about the molecular basis for cancer, the mechanisms of action for our therapies (particularly the newer agents which target specific molecular abnormalities) and the key studies that justify the use of therapies (e.g., randomized studies showing that after surgery, chemotherapy will reduce the risk of recurrence from a particular cancer with a particular regimen). By spending time with clinicians, students will learn how to identify hereditary syndromes, use drugs for symptom relief and also learn how radiographic and laboratory tests allow oncologists to care for patients.


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M25 Medicine 877 Intensive ECG Interpretation

The student, during the two-week elective, will read 20-25 ECGs obtained from the Barnes-Jewish Heart Station and then overread by an experienced electrocardiographer. There will also be didactic sessions covering infarction, ventricular hypertrophy, heart block, arrhythmias, and aberrant conduction.


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M25 Medicine 879 Pulmonary Clinic for the Underserved

Clinical setting: Outpatient clinic dedicated to providing pulmonary specialty care to patients who are predominantly uninsured or who rely upon public assistance such as Medicaid. Student role: Students independently interview and examine patients and present findings to the attending, tests and imaging are reviewed, and provider and attending develop plan. Common problems/diseases: Asthma, COPD, sarcoidosis, lung cancer, and obstructive sleep apnea are commonly seen. Also, patients are referred for evaluation of abnormal x-rays and for symptoms such as dyspnea. Primary learning objectives: to understand and practice important history and exam skills in pulmonary medicine: symptoms, smoking history, work and environmental exposures, and important pulmonary physical exam findings; to understand the basics of pulmonary function tests, chest imaging, and methods for tissue sampling; to understand the basis of treatment of common pulmonary disorders. Conferences: There is no conference associated with this clinic, but students may attend the usual Thursday morning Medicine Grand Rounds at 8:00 a.m. and the Pulmonary Grand Rounds at 11:00 a.m. if the subject matter is appropriate.


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M25 Medicine 880 Pulmonary Medicine - Barnes-Jewish Hospital

Students will acquire skills in the evaluation and management of patients with pulmonary diseases and in the interpretation of pulmonary function tests. They will gain experience in outpatient Lung Center and attend regular pulmonary and critical care medicine conferences.


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M25 Medicine 882 Pulmonary Medicine - VA Hospital

Students will participate in several ambulatory care activities of the Pulmonary Section, including outpatient consultations of common respiratory disorders such as COPD, obstructive sleep apnea, lung cancer and tuberculosis, and follow-up of primary care patients with pulmonary disease. In addition, students will round in medical intensive care units, interpret pulmonary function tests, participate in bronchoscopy and attend scheduled teaching conferences of the Pulmonary Division.


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M25 Medicine 884 Bone Marrow Transplantation and Stem Cell Biology

Intense four-week clinical rotation exposing interested fourth-year medical students to the clinical world of bone marrow transplantation and to the basic science of hematopoiesis, leukemia, and stem cell biology. Students will be primarily responsible for the care of autologous and allogeneic BMT recipients and those patients being treated for a variety of hematologic malignancies such as AML, ALL, multiple myeloma and non-Hodgkin's lymphoma. In addition they will be exposed to methods of stem cell harvest, cryopreservation and immunophenotyping. This rotation plans to provide motivated students with an ideal mix of clinical medicine and basic science.


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M25 Medicine 885 Occupational/Environmental Medicine

This elective is designed to introduce students to research and practice in the prevention of work-related injuries and illnesses, and prevention of health effects related to environmental exposures. Preventive activities will include work site visits and intervention projects, as well as involvement with work site health promotion and policy making. Research projects involve epidemiology and intervention projects in work-related injury and musculoskeletal disorders. Specific activities are flexible depending on the students' interests. Students may elect to participate in the Interdisciplinary Environmental Clinic at Washington University. Based in the law school, the clinic involves interdisciplinary teams of students (law, engineering, environmental science) taking principal responsibility, under faculty supervision, for cases and projects on behalf of environmental and community organizations. The medical student(s) assist clinic students by evaluating the human health impacts involved in one or more of the clinic's cases, and presenting such information to the client organization(s) and others. Among the cases on which medical students might participate are: (1) air pollution associated with factories in the St Louis metropolitan area; (2) lead poisoning of children and adults in St. Louis and surrounding towns; (3) air and water pollution caused by concentrated animal feeding operations (factory farms) in Missouri. Students choosing this option will work with the Environmental Clinic staff and with Dr. Evanoff to evaluate and present evaluations of human health impacts of environmental exposures.


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M25 Medicine 887 Clinical Cardiovascular Medicine

Clinical cardiology with some internal medicine in a rural setting. Inpatient and outpatient care. Diagnostic testing. Device implants and follow-up care. Cardiac catheterization. Peripheral vascular angiography and intervention.


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M25 Medicine 890 Clinical Nephrology

Students rotate through inpatient and outpatient experiences to gain exposure to all facets of nephrology. They will spend time the majority of their time on an inpatient consult service, gaining exposure to acute and chronic renal failure, glomerulonephritis, and electrolyte disorders. During this time, they will serve as a fully integrated member of the consult team, evaluating underlying causes of kidney disease, performing diagnostic procedures, formulating management plans, and engaging in decision-making discussions with primary services and families. In addition, students will have the opportunity to experience ICU nephrology, the transplant service, the various CKD clinics, and all modalities of dialysis, including in-center, home, and peritoneal dialysis.


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M25 Medicine 893 Adult Allergy and Clinical Immunology

Students will participate in the allergy consult service at Barnes-Jewish Hospital, North and South Campus. The student will serve as the primary allergy consult for inpatient and Emergency Room consultation and present each patient to the allergy fellows on call and the attending physician. Students will attend The Adult Allergy Clinic, Pediatric Allergy Clinic, and the outpatient clinics at The Asthma & Allergy Center at Barnes-Jewish West County Hospital. Conferences on selected topics in allergy and clinical immunology will be held with the attending staff two to three afternoons a week.


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M25 Medicine 900 Research Elective - Internal Medicine

Research opportunities may be available. If interested, please contact the Department of Internal Medicine.


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