Inpatient/Outpatient US Clinical Experience in Cardiology in Los Angeles

Information about this clinical experience:

You will be under the supervision of a physician board-certified in internal medicine and cardiology. This physician holds a staff appointment at University of California Irvine Medical Center.  The attending is an Assistant Professor of Medicine at University of California Irvine School of Medicine. The preceptor is actively involved in the teaching of interventional cardiology fellows from the University of California Irvine. Rotators will split time between the inpatient and outpatient settings.

Outpatient

Rotators will see new and established patients in the preceptor’s outpatient practice. Prior to these encounters, students will review notes, test results (labs, echocardiograms, stress test, etc.) and other information in the EMR to gain the necessary background for the patient’s visit. New patients may present to the clinic with a range of symptoms or conditions, including chest pain, palpitations, shortness of breath, edema, and leg pain, providing rotators with the opportunity to develop evidence-based approaches to the evaluation of such patients. For established patients, the emphasis will be identifying any new or recurrent symptoms and assessing for any interval change in the patient’s condition. When EKGs are needed, students will learn how to perform and interpret these studies.

Several Saturdays per month, you will be able to observe the preceptor perform nuclear cardiac stress tests on patients. Through this aspect of the experience, you will gain an understanding of the various imaging modalities and their basis, indications and contraindications, protocols, and clinical applications. You will have the opportunity to acquire skills in the interpretation of these studies.

Every other week, for one half day, you will see patients at another clinic with the preceptor. This clinic is in a highly underserved area with patients who often delay care due to lack of access to physicians, financial hardship, or other barriers. At this clinic, you will learn how cardiologists tailor the care they deliver based on these types of situations.

Inpatient

Rotators will typically go to the hospital once per week to observe in the cardiac catheterization lab or join the attending for hospital rounds. On non-hospital days, you will continue to help out in the care of hospitalized patients by gathering relevant information from the hospital EMR (Epic and Cerner). You will present this information to the preceptor so that the team can begin drafting notes for these hospitalized patients. As you discuss these cases with the team, you will be asked to offer your thoughts on these cases, including an assessment and plan. This will be excellent preparation for your future as a resident when you will have to work up and manage hospitalized patients with cardiac conditions.

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision (please note that this experience remains within the regulations of California pertaining to the unlicensed practice of medicine):

• Taking patient histories under supervision.

• Performing physical exams under the physician's supervision.

• Presenting patients.

• Writing or entering clinic progress notes under supervision.

• Researching the literature to answer clinical  questions at the point of care.

• Educating patients under supervision.

• Delivering talks about important topics.

• Have opportunities to teach other team members.

• Learning about billing and coding.

The activities above will mostly take place in the outpatient setting. As a result of hospital policies, inpatient activities will be more observational.