Clerkship Director

Joseph J. Fins, MD
Chief, Division of Medical Ethics
Associate Professor of Medicine and Public Health
Associate Professor of Medicine in Psychiatry
Phone: 212-746-4246
Office: F-173
jjfins@mail.med.cornell.edu


Course Overview

A two-week course for third year students that will help to promote self-reflective and humanistic practice. The course will have a special focus on improving competency in end-of-life patient care.


Course Objectives

Knowledge

• Identify psychosocial and contextual factors that influence care.
  
  
• Identify ethical and legal issues at the end of life.
  
  
• Identify principles of pain and symptom management.
  
  
• Apply knowledge of pain and symptom management in palliative care.

Skills:

• Demonstrate an ability to apply ethical norms to patient care.
  
  
• Demonstrate an ability to relieve pain and suffering through the application of palliative care skills.
  
  
• Demonstrate an ability to communicate in an effective and humanistic manner with patients and their intimates.
  
  
• Demonstrate an ability to envision models of patient advocacy.

Attitudes:

• Foster professionalism in the care of patients throughout the life cycle.
  
  
• Assume responsibility for the development of competence in both the humanistic and scientific dimensions of patient care.
  
  
• Appreciate the importance of respecting cultural diversity and differing patient values

Methods:

• Participant Observation
  
  
• Rounds on Pain and Palliative Care Service at MSKCC
  
  
• Small Group Tutor Sessions
  
  
• Topical Seminars
  
  
• Visit to Calvary Hospice
  
  
• Meeting with Course Director
  
  
• Attend New York-Presbyterian Hospital Ethics Committee meeting
  
  
• Visit to Metropolitan Museum of Art
  
  
• Student Case Presentations

Patient Rounds: Student as Participant Observer

• Student will be a participant observer on rotations where they do not have direct patient care responsibilities.
  
  
• Student will spend one week on a rotation that is being considered for residency
  
  
• Student will observe patients and their intimates' responses to illness. Special attention will be paid to the ethical dimensions of: clinical practice, care of the dying, doctor/patient/family communication, issues of spiritually and issues of multiculturalism.
  
  
• Student will observe practices of fellow students, residents, nurses and attendings for the ability to integrate the technical and humanistic dimensions of care.
  
  
• Student will record observations and reflections in daily logs. These observations will be discussed in small group sessions.

Pain and Palliative Care Rounds

Pain and Palliative Care Service, MSKCC
Richard Payne, M.D., Chief of Service
Tutors: Jonathan Abrams, MD and Gil Schreier, MD

• Daily morning rounds with Pain and Palliative Care Service
  
  
• Morning Report
  
  
• Rounds with Pain and Palliative Care Fellow and/or Nurse
  
  
• Assigned Patient Experience:
  
  Each student will be assigned to a single patient at MSKCC. During their week there, the student will meet the patient and talk w him/her (and family when appropriate) about their illness, review the medical record for the palliative care issues and treatment responses, and speak with attendings/fellows/nurses/social workers etc about the patient.
  
  At the end of each week the student will present this patient to the entire class and submit a write up that addresses the palliative medicine management of that patient. These presentations will be made to a MSKCC Pain and Palliative Care Attending and all students must attend. The MSKCCC Attending will grade these papers and presentations and provide feedback at the session. The paper and presentation should include:
  
  
  1. The patient's medical history and physical, including psychosocial and narrative issues.
     
     
  2. Current palliative care issues.
     
     
  3. Diagnostic strategies to w/u pain and other complaints.
     
     
  4. In depth discussion of treatment strategies used to address symptoms including drug choices and dosing strategies, delivery systems, side effects, cause of adjuvant treatments, psychotherapy, etc.