Director Rita Charon and faculty of the Program in Narrative Medicine are offering a month-long intensive fourth-year elective in Narrative Medicine in March of 2009. Close reading, writing fiction, and reflective writing develop narrative and literary skills that end up adding to one’s clinical effectiveness. In our Narrative Medicine Immersion month over the past several years, we have gathered twelve fourth-year students from P&S and from visiting medical schools for intensive craft and interpretive training, with the conceptual framework in mind that strengthening the skills of representation is a powerful means toward strengthening the skills of attention in clinical work. On the basis of student evaluations, the quality of written work produced, and projects that students undertake in the years following the intensive narrative training, the elective has demonstrated a capacity to target and improve these specific narrative competencies toward attentive and effective patient care.
The elective will include the following:

1. Graduate-level training in close reading of contemporary fiction, not limited to fictions about illness or medicine but rather attending to the complexities of the act of reading. Critical and theoretical approaches will be introduced alongside the literary texts. We will read a novel a week, including works of William Maxwell, Per Petterson, Pat Barker, and John Banville. One 2-hour meeting per week. Weekly reader-response writings assigned.
2. Seminar on illness narratives, including first-person accounts of illness written by patients or family members of patients and works offering theoretical frameworks of such autobiographical materials. One 2-hour meeting per week.
3. Writing workshop directed by Columbia University Writing Division faculty and advanced MFA students. Students will read and workshop one other’s work, read established writers focusing on craft and technique, and do in-class writing exercises to help generate new writing. By the end of the month, students will have written new stories or poems, revised old ones, and learned methods to critique their own work. Two 2-hour meetings per week.

To obtain more information, contact Dr. Charon at rac5@columbia.edu

To learn more about Narrative Medicine, visit the program web site at www.narrativemedicine.org

Objective: This course will emphasize principles in the care of in-patients with malignancies, especially management of complications of cancer and its treatment as well as oncologic emergencies such as cord compression, SVC syndrome, and hypercalcemia.
Learning Experience: Students will evaluate and follow selected admissions under the direct supervision of a resident, fellow and an attending oncologist. Optimal patient care provided using a team approach to patient evaluation, diagnosis and projected therapy.
Feedback: Continuous throughout the elective.  In addition feedback from students is useful and should be in the form of a letter to the course director. 
Evaluation: Students will be evaluated by their attending physician that month and senior residents. 
Faculty: Oncology staff.

First weekday of the month, 7:40 AM Room 2-095 Hospitalist Office

The Section of Hospital Medicine at Allen Pavilion offers a UNIQUE, challenging experience for 4th year medical students.  Students will work directly with 2 attending physicians on a 24 hour/7 day per week medicine service (15-30 patients).  As no interns, residents, or 3rd year students are on the team, students will take an active role and will receive one-on-one attention from attendings continuously throughout the day on the wards.
Objective: Students become competent in evaluation and management of patients with a broad range of medical conditions.
Learning Experience: Experience can be tailored to student’s interest.  Primarily, the student will function as a subintern under direct supervision of 2 attending physicians on a 4 week block, including over night call  roughly 6 times during the four weeks.  Call is optional for those students taking the clerkship as an elective.  Other activities could include teaching rounds with med consult, the Allen ICU overnight physician, or independent research. The student is expected to attend teaching rounds and attend the daily teaching conferences held by the Department of Medicine.
Feedback: Occurs on a continuous basis.
Evaluation: No exam.  Based on consensus of all faculty and staff involved in student’s experiences.  Student will be asked to provide a written assessment of the elective.

• Improved and streamlined skills of history taking, physical examination, and written and oral presentation.
• Improved ability to synthesize and integrate data into a clear list of problems.
• Efficiently used diagnostic and therapeutic resources for patient management.
• Identified and utilized available resources to provide an efficient and well-organized transition from the hospital to home environment.

This elective is designed to provide the student with experience in the care of critically ill patients in the Intensive Care Unit.
Objectives: The student will become familiar with the pathophysiology of critical illness; develop proficiency at the systems approach to the evaluation and management of critically-ill patients; become familiar with the proper utilization and interpretation of hemodynamic monitoring and with the indications for and management of a patients receiving mechanical ventilation; function as an integral member of the critical care team. Learning Experience: The student will participate in daily rounds as a member of the ICU team under direct supervision of the medical resident and attending Intensivist. Patients will include those with medical and cardiac problems. The student will be on overnight call approximately every third night, with the ICU resident.

• In conjunction with rounds, there will be a daily didactic session focusing on various topics in critical care medicine.
• Instruction in invasive and non-invasive ventilator management will occur on a daily basis.
• Students will be given an opportunity to develop familiarity with clinical procedures such as placement of arterial lines, central venous and pulmonary artery catheters under guidance of the attending intensivist.
• Students will be exposed to acute cardiac problems including myocardial infarction, cardiac failure, arrhythmias, and the principles of advanced cardiac life support.
• Students will be encouraged to develop a systematic approach to shock, acute respiratory failure, acute multi-organ and single-system failure, and to become proficient in the analysis of arterial blood gases, electrolyte and acid-base disturbances. Clinical applications and use of enteral and parenteral nutrition will also be emphasized.
• Ample handouts, references and other readings will be given, and students will be encouraged to use the library facilities to pursue more complete understanding of clinical problems.

Please note that students MUST contact the course director to make an appointment prior to the first day to select the course site.

For the student interested in the clinical care of elderly patients, in the health care system as it relates to a rapidly aging population. 
Objective: This elective can be tailored to meet the interests of the student.
Learning Experience: Possible sites of experience include the inpatient Geriatric Acute Care, the Geriatric Associates faculty practice, the Geriatric Clinic, the Isabella Geriatric Center (subacute rehabilitation and long term), the Physician Home Visit program,  in-patient Geriatric Consultation, (including Palliative Care and Hospice Care),  depending on the student’s interest.  A student may elect to work on an ongoing research project within the Division of Geriatric Medicine, or to design and execute a limited study under the supervision of an attending in the Division of Geriatric Medicine.  There are weekly conferences for the Division of Geriatric Medicine focusing on core Geriatric topics, including Geriatric syndromes; U.S. Healthcare System – Medicare, Medicaid, Managed Care; Preparing for Practice (documentation, coding, and billing); End-of-Life Care. 
Feedback: Continuous throughout the elective. 
Evaluation: Will be based on a consensus of all faculty members involved in the student's education in this course.