The Department of Medicine brings together faculty members with diverse backgrounds and experiences who share a concern for the teaching and practice of clinical medicine. The fundamental goal of Internal medicine courses is to provide students with a comprehensive core of the clinical medicine knowledge necessary to become a competent physician. The faculty strive to motivate students and provide them with experience adequate to define and redefine their interests, whether these direct the student to practice clinical medicine or to pursue other disciplines.

The department presently includes 160 full-time and 360 part-time faculty members and 160 house staff, all of whom are utilized as instructors to give the student a broad range of learning opportunities. The department incorporates the medical services of the three major affiliated institutions: the Buffalo General Hospital, Erie County Medical Center, and Veterans Affairs Medical Center, and employs the resources of Roswell Park Cancer Institute, Sisters of Charity Hospital, Mercy Hospital of Buffalo, and Millard Fillmore Hospital.

New programs, utilizing other institutions, have been developed to further increase the range of education offered to students by the department. For example, Consultation Medicine, which emphasizes the areas of adolescent and maternal medicine, is offered through the Buffalo Children's Hospital. Several programs are also in place which focus on the teaching of patient care in various ambulatory clinics and rural practices.

MED-521 MEDICAL HUMANITIES: CULTURAL AND SOCIAL DIMENSIONS OF THE PHYSICIAN-PATIENT RELATIONSHIP 2 credits; spring semester. Dr. J. Bono. Number of students: 15. Prerequisite-Medical student.

This course is a blend of literature, philosophy, anthropology, and the history of medicine. The purpose is to address themes and issues in the thinking and behavior of physicians and patients not usually addressed in other medical school courses.

The principal experience of the course is reading great literature and critically viewing great films, often in association with papers from medical sources. Classes meet to discuss readings, films, and the issues they raise regarding the social, cultural and humanistic dimensions of medicine. Readings vary in obvious relevance to medicine. Some, like stories by William Carlos Williams or Tolstoy, are explicitly medical in content. Others, like Flannery O’Connor’s, “The Lame Shall Enter First”, represent non-medical settings but have themes related to the passions, powers, and responsibilities of physicians. Examples of non-fictional readings from medical sources are Eric Cassell’s “The Nature of Suffering and the Goals of Medicine” and David Hilfiker’s “Healing the Wounds: A Physician Looks at His Work”. The course will be divided into two units: (1) “Problems of Knowledge and Power: The Physician-Patient Relationship and the Social and Cultural Contexts of Healing” and (2) “Constructing Narratives of Illness: patients’ Stories and the Meanings of Illness, Aging, Death, and Dying”. One or more films will be used to illustrate themes in the course.

At the conclusion of the course, students should have a greater understanding of the personal dilemmas faced by physicians and patients, and of the attributes and values necessary to each. Students should also have the ability to observe, recognize, and respond in appropriate ways to the meanings and life-problems associated with illness for individual patients. A goal of this course is to facilitate thoughtful and lively discussion concerning the non-medical aspects of medicine essential to the ideal physician’s practice.

*MED-700 INTERNAL MEDICINE CLERKSHIP 8 credits. Contact departmental office for site location before registering. Prerequisite-Junior medical student. Dr. Susan Gallagher, Program Director; Drs. Saltzman, Schwartz, Noyes,Lippes, Freer, O’Donnell,Raab and staff.

Clinical clerkship in Medicine is intended to enable the student to understand the clinical correlation of basic science knowledge and to acquire further medical information and clinical skills necessary for understanding and management of commonly encountered medical problems and diseases of adult patients. Six hospitals and numerous ambulatory sites participate in the clerkship program. The course is composed of both inpatient and outpatient experiences.

For the inpatient rotations, the students are arranged into groups of two or three who work as members of a medical ward team that also includes an attending physician and two or three house officers. In addition to their daily work, they take night and weekend duties. Each student is expected to perform initial evaluation and close follow-up of a limited number of patients. During the early part of the clerkship, the emphasis is placed on patient interview, physical examination, problem identification, write-ups, and case presentations. More direct involvement with patient management and decision making, as well as familiarization with common bedside and lab procedures, is progressively added to their clinical clerkship activities. With diverse roles, the attending physician and house staff actively participate in student teaching.

The ambulatory portion of the clerkship is done under the supervision of a preceptor. Students will be expected to perform directed histories and physicals and to write up and discuss the cases seen with the preceptor.

At the outset of the course, each student is provided with a course syllabus describing the objectives, expectations, student's responsibilities, and outline of the core curriculum with pagination of a most updated medical textbook and other references. Although the students will have ample learning opportunities through their participation in patient workup, daily rounds, case presentations and discussions, teaching conferences, lectures and seminars, their self-learning through reading and effective use of the medical libraries and learning resource centers will be stressed throughout the clerkship. The eventual goal is to develop the skills that will allow each student to continue independent learning and problem solving.

MED-800 SUBINTERNSHIP IN MEDICINE 4 credits. Modules L-M. Contact departmental office for site location before registering. Prerequisite-Successful completion of MED-802. Dr. Susan Gallagher, Course Director; Drs. Saltzman, Schwartz, Ellis, and staff. Number of students: 2.

This rotation has been developed to encourage the assumption by the student, under the appropriate faculty supervision, of responsibility for diagnostic evaluation and management of inpatients on the general medical wards of the affiliated hospitals. The objective is approached through the following mechanisms: refining of skills of the student in physical diagnosis and case presentation; review of principles of pathophysiology, particularly the interaction between different organ systems; review of principles of pharmacokinetics; fostering in the students of cost-effective behavior in the diagnosis of medical problems; introduction of the students to principles of effective patient preparation for discharge, such as utilization of resources in rehabilitation, ambulatory care, pharmacy and social services.

The student will be responsible for obtaining the admission history and performing the admission physical examination on one to three patients each admitting day (= every fourth day). The student has one day off per week. On nonadmitting days the student will regularly evaluate all of the patients for which he or she is responsible and adjust each diagnostic and therapeutic program under the guidance of ward resident physicians and attending physician. The student will also be expected to be able to discuss and justify the diagnostic and therapeutic measures instituted for each of his or her patients. The student will be expected to attend the conferences and rounds held in conjunction with the house officer, namely, morning work rounds with the ward resident physician, attending physician rounds, city-wide medical grand rounds, and the departmental conferences held in each of the three hospitals.

Upon completion of this rotation, students should have developed an understanding of the overall concern of evaluation and management of the patient with general medical problems. Students desiring this course should indicate the hospital of their choice (BGH, ECMC, VAMC, MFH, SOCH, MHOB), and a letter to this effect should be sent to Dr. Susan Gallagher at the Buffalo General Hospital. We will try to make every effort to assign you to one of the services of the affiliated hospitals of your choice. Because the annual house staff schedule at the affiliated hospitals is designed after the receipt of the data from the "computer match" for fourth-year students, no student will be permitted to withdraw from this course except under the most unusual circumstances and with specific permission of Dr. Gallagher and Dr. Klocke.

*MED-802 ADVANCED CLERKSHIP IN MEDICINE 4 credits. Modules B-K. Contact departmental office for site location before registering. Prerequisite-Senior medical student or permission of OME and instructor. Dr. Susan Gallagher, Program Director, Drs., Ellis, Saltzman, Schwartz and staff. Number of students: 16.

Advanced Clerkship in Medicine is a four-week rotation that will give students an inpatient experience aimed at developing expertise in managing acute illness in the hospital setting. It will stress normal and abnormal physiology, management of fluid and electrolytes, and highlight some of those conditions that are commonly treated by practicing internists. The rotation will be structured around a work team consisting of resident and intern, a fourth-year clerk, and a third-year clerk. There will be daily participation in morning report and in scheduled didactic conferences. In addition, there will be a didactic portion specifically geared to the fourth year clerk.

By the end of the rotation the student should feel comfortable with responding quickly to acute medical problems and should be able to develop a reasonable pertinent differential diagnosis for presenting problem and begin to discuss appropriate management. The student will thus be prepared to handle not only acute medical problems, but complications that may result from surgery or that may be seen in patients that are commonly seen within other specialties.

Due to limited number of sites available each module, no student will be permitted to withdraw from this course except under the most unusual circumstances and with the specific permission of Dr. Gallagher.

MED-803 PRIMARY CARE INTERNAL MEDICINE 4 credits. Modules C-L. NOTE: A "G" after the module in the Class Schedule indicates the Buffalo General Hospital as the site. Prerequisites-Senior medical student or permission of OME and instructor. Successful completion of MED 802 Advanced Medicine Clerkship; and approval by either Drs. Susan Gallagher or Richard Schifeling. Number of students: 1.

The student will be provided experience in ambulatory medicine which approximates that of a practicing academic general internist. The activities of the rotation will include making daily and weekend rounds on the service inpatients; evaluating scheduled and unscheduled ("walk-in") patients in the primary care clinic; researching medical issues arising from the care of these patients; coordinating patient care with nursing staff, patients, and their families; and teaching third-year medical students in the outpatient setting.

Upon completion of this rotation, the student should have gained insight and experience in the routine of an academic general internist, improved physical diagnosis and patient management skills, provided continuity of care for patients going from the outpatient to inpatient service as well as outpatient follow up after hospital discharge.

MED-804 CARDIOLOGY 4 credits. Modules A-M. NOTE: A "G" after the module in the Class Schedule indicates the Buffalo General Hospital as the site. Prerequisite-Senior medical student or permission of OME and instructor. Drs.Graham, Schwartz, Sullivan, and Paris. Number of students: 1.

Students will see patients for whom cardiac consultation has been requested and will make daily rounds with the attending, Cardiology fellow, and resident. The student will also attend the Adult Congenital Cardiology Clinic and our general Cardiology Clinic. There will be exposure to stress testing, nuclear cardiology, Holter monitoring, echocardiography, and cardiac catheterization. There will be opportunities to observe cardiac catheterizations and open-heart surgery. The student will attend weekly scheduled conferences, including echocardiography and catheterization conferences. In this way the student will develop an understanding of the pathophysiology, diagnosis, and treatment of a wide variety of cardiac conditions.

MED-804 CARDIOLOGY 4 credits. Modules B-L. NOTE: A "E" after the module in the Class Schedule indicates the Erie County Medical Center as the site. Prerequisite-Senior medical student or permission of OME and instructor. Drs.Dashkoff, Wadhwani, Zizzi, Sr., Zizzi, Jr., Forte, and Gunawardane. Number of students: 1.

The major objective of this rotation is to familiarize the students with consultative cardiology through a broad exposure of diagnostic and therapeutic modalities.

Students will participate in daily consult rounds with the Cardiology attending, resident, and staff; receive individual teaching in the interpretation of electrocardiograms; and participate in the performance of noninvasive procedures including phonocardiography, external pulse recording, echocardiography, and treadmill exercise testing. In addition, patients will be followed through special procedures including fluoroscopy, cardiac catheterization and angiography, and, in certain cases, open-heart surgery. Students will also attend cardiac clinics, weekly cardiac conferences, journal club once a month, and occasionally visit the Coronary Care Unit.

This rotation is designed to improve the students' physical diagnostic skills and to enhance their knowledge of cardiac pathophysiology.

MED-804 CLINICAL CARDIOLOGY 4 credits. Modules B-L. NOTE: A "V" after the module in the Class Schedule indicates the Veterans Administration Medical Center as the site. Prerequisite-Senior medical student or permission of OME and instructor. Drs. Canty, Ellis,Fallavollita, Rana, Manja, Young and staff. Number of students: 2.

The purpose of this elective is to provide fourth-year medical students with a comprehensive introduction to clinical cardiology. The intent is for students to become adept in cardiac history taking and physical examination, in the management of patients with acute and chronic cardiac disease, and in the interpretation of various diagnostic modalities.

Students will see patients with cardiologic problems and will make daily consultation rounds with the attending. The intent is for students to become familiar with a variety of cardiac diseases including ischemic heart disease, valvular heart disease, pericardial disease, brady- and tachyarrhythmias, and primary and secondary cardiomyopathies.

The use and interpretation of various invasive and noninvasive diagnostic modalities will also be emphasized. Students will read electrocardiograms on a daily basis and will be introduced to echocardiography, Holter monitoring, stress testing, and angiography. In addition to scheduled weekly University-wide conferences, informal didactic sessions will be arranged so that timely topics can be discussed.

MED-807 UNIVERSITY PROGRAM IN PULMONARY DISEASES 4 credits. Modules A-M. Contact departmental office for site location before registering. Prerequisite-Senior medical student or permission of OME and instructor. Dr. Alan R. Saltzman, Course Director. Drs. Aquilina, Campbell, Rabadi, Sethi, Grant, Loewen, Lwebuga-Mukasa, Schwartz, Ten Brock,Mador and Gibbons. Number of students: 3.

The objective of this rotation is to teach the clinical and laboratory techniques necessary for diagnosis and management of patients with pulmonary diseases.

Students will actively participate in evaluation of patients seen by the pulmonary disease services at the ECMC, the VAMC, and the BGH. This will include pulmonary consultation and critical care evaluation and management. In addition, daily learning lab sessions are conducted, covering such fields as pulmonary function interpretation, X-ray diagnosis, and selected clinical topics. Exposure to sleep apnea and bronchoscopy is also available at all hospitals.

At the end of this rotation, the students should be able to outline a diagnostic and therapeutic program for a patient with pulmonary disease. They should have thorough understanding of pulmonary function studies and be experienced in the interpretation of chest X-rays.

MED-808 RENAL DISEASES 4 credits. Modules A-M. NOTE: A "E" after the module in the Class Schedule indicates the Erie County Medical Center as the site. Prerequisite-Senior medical student or permission of OME and instructor. Drs. Cunningham, Venuto, Murray, Hom, Tienzo, and Ranjan. Number of students: 2.

This rotation is designed to afford students the opportunity to acquire necessary skills for the evaluation of patients with renal disease, fluid and electrolyte abnormalities, and hypertension.

The students will be expected to evaluate and follow one to three new inpatients per week. The patient mix will be comprised of those with acute and chronic renal failure, others who are postrenal transplant, and patients referred by other services for a variety of hypertensive of fluid or electrolyte abnormalities. Rounds will be made regularly with an attending physician, the Renal fellow, and house officers assigned to the renal service. The students will attend the Renal Hypertension Clinic, which meets weekly. This will afford the students the opportunity to examine and follow outpatients with renal disease and/or hypertension. The Renal Transplant Clinic meets weekly, and students can have the opportunity to evaluate stable patients who have successfully undergone renal transplant.

Conferences: The students are encouraged to attend morning, report and mortality/morbidity conference at C, the ECMC. Monthly renal biopsy conferences are held on Tuesday afternoons at the ECMC. This meeting is attended by members of the Departments of Pathology and Pediatrics, as well as the members of the University wide nephrology community. The clinical aspects of each biopsy are presented and discussed. A series of lectures are held weekly which review many basic areas of nephrology.

Seminars: Each hospital arranges a schedule under the direction of the Renal fellow and attending physician of a group of topics to be presented and discussed. This affords the student an opportunity to prepare an in-depth review of at least one topic on nephrology during the course of the elective.

At the conclusion of this rotation, students should know the basic approach to evaluation and treatment of the patient with renal disease or hypertension and fundamentals of renal pathophysiology.

MED-808 RENAL DISEASES 4 credits. Modules C-G. NOTE: A "F" after the module in the Class Schedule indicates the Millard Fillmore Suburban as the site. Prerequisite-Senior medical student or permission of OME and instructor. Dr. George Marinides. Number of students: 1.

The goal of this program is to familiarize the student with the current diagnosis and management of renal diseases including acute/chronic renal failure, fluid and electrolyte abnormalities, and acute/chronic hypertensive problems.

The student will become a part of a team consisting of attending and resident. This experience includes daily rounds on an active renal service with direct involvement in nephrology consults.

The student is expected to participate actively in the twice-weekly nephrology service conferences and twice monthly medical house staff conferences, renal radiology, and renal pathology. In addition, the student will be assigned selected readings from the nephrology library.

Opportunity is also available to participate in the various dialysis programs revolving around the eight-station hemodialysis facility serving both acute and chronic end-stage renal disease patients. This facility is complemented by self-care training programs in hemodialysis and continuous ambulatory peritonea] dialysis. Exposure to clinical research is available as a result of nephrology division's close association with the Departments of Pharmacokinetics and Neurology.

At the conclusion of this rotation, a student should know the basic approach for evaluation and treatment of the patient with renal disease or hypertension and the fundamentals of renal pathophysiology.

MED-808 RENAL DISEASES 4 credits. Modules A-M. NOTE: A "V" after the module in the Class Schedule indicates the Veterans Administration Medical Center as the site. Prerequisite-Senior medical student or permission of OME and instructor. Drs.Lohr and Arora. Number of students: 1.

This rotation is designed to afford the students the opportunity to acquire necessary skills for the evaluation of patients with renal disease, fluid and electrolyte abnormalities, and hypertension. The students will be expected to evaluate and follow one to three new consultations per week. The patient mix will be comprised of those with acute and chronic renal failure; others who are post-renal transplant patients referred by other services for a variety of hypertensive or fluid or electrolyte abnormalities. Rounds will be made regularly with an attending physician, the Renal fellow, and house officers assigned to the renal service. the students will attend the renal hypertension clinic, which meets weekly. This will afford the students the opportunity to examine and follow outpatients with renal disease and/or hypertension.

Conferences: The students are encouraged to attend morning report and mortality/morbidity conference at VA Medical Center. Monthly renal biopsy conferences are held on Tuesday afternoons at the ECMC. From Modules C through L, a series of lectures are held weekly which review many basic areas of nephrology. The students are urged to attend these conferences, which are usually held at the VA Medical Center. On Friday mornings, a clinical case conference is held where problem cases of the week and relevant journal articles are reviewed.

Combined Conferences: The students are encouraged to attend monthly grand rounds held at the University at Buffalo.

Seminars: Each hospital arranges a schedule under the direction of the Renal fellow and attending physician of a group of topics to be presented and discussed. This gives the student the opportunity to prepare an in-depth review of at least one topic on nephrology during the course of the elective.

At the conclusion of this rotation, students should know the basic approach to evaluation and treatment of the patient with renal disease or hypertension and fundamentals of renal pathology.

MED-809 ALLERGY-CLINICAL IMMUNOLOGY 4 credits. Modules B-L. Contact departmental office for site location before registering. Prerequisites-Senior medical student or permission of OME and instructor. Drs. Ballow, Ambrus, Jr. and Stanley Schwartz. Number of students: 1.

During this rotation students will learn about the diagnosis and management of allergic and immunologic diseases. Particular attention will be directed toward the common respiratory allergies, asthma, food and drug reactions, atopic dermatitis, urticaria, angioedema, hymenoptera sensitivity, autoimmune disorders, and primary and secondary immunodeficiency diseases. The student will attend two pediatric and one adult clinic each week and will also attend weekly teaching sessions, journal club, and research seminars.

Upon completion of this rotation, students will have learned to take a history for allergic and immunologic diseases and to perform appropriate physical examination, skin tests, and simple spirometry. They also will learn to formulate a therapeutic program of environmental control, pharmacotherapy including the use of intravenous gamma globulin, and immunotherapy. Additionally, students will become familiar with the cellular and molecular mechanisms underlying the pathogenesis and treatment of allergic and immunologic diseases.

MED-810 SLEEP MEDICINE 4 credits. Modules C-L. Contact departmental office for site location before registering. Prerequisites-Senior medical student. Dr. Tenbrock. Number of students: 1.

The fourth year clinical elective in Sleep Medicine will allow the student to become familiar with the various sleep problems people encounter. Such problems include sleep apnea, insomnia, periodic limb movements, parasomnias, and circadian rhythm disturbances. Over the course of four weeks, the student will be exposed to various diagnostic and therapeutic techniques used in the field of Sleep Medicine. The student will attend a few sleep medicine clinics a week. Additionally, instruction and exposure will be given regarding interpreting polysomnographic recordings as well as polysomnogram hookups. The student will attend and partake in multidisciplinary sleep medicine conferences as well as sleep medicine journal club. The medical student is given a sleep rotation schedule and will become familiar with sleep centers in Buffalo and the surrounding area as well as the sleep medicine attendings.

MED-811 UNIVERSITY PROGRAM IN ENDOCRINOLOGY 4 credits. Modules A-M. Contact departmental office for site location before registering. Prerequisite-Senior medical student or permission of OME and instructor. Drs. Ryan, Dandona, Kelijman, Lippes, O'Donnell, and Stephen Spaulding. Number of students: 2.

This rotation will give the student a broad-based exposure to endocrine diseases, focusing on diagnosis, pathophysiology, and management. The students will participate in clinics and inpatient consult services. Approximately one third of the time will be spent in the ambulatory diabetes and general endocrinology clinics where new and established patients are evaluated. Hospital based consults are drawn from a variety of disciplines including Internal Medicine, Surgery, Psychiatry, and Ob-Gyn. Spending part of the rotation in a practitioner's office can be arranged.

The rational use of diagnostic methods and therapy will be stressed during the rotation in clinics, attending rounds, and at the weekly clinical conference. At the end of the experience, the student should have a general understanding of pathophysiology and diagnostic methods in endocrinology.

MED-812 RHEUMATOLOGY 4 credits. Modules A-M. Contact Department of Medicine (859-1262) for availability and registration. Prerequisite-Senior medical student or permission of OME and instructor. Drs. Ambrus, Silverberg, and Zaider. Number of students: 1

This course is a combined program at the Veterans Administration Medical Center and the Erie County Medical Center. Preferences, if any, for principal hospital base will be accommodated. The goal of this rotation is to expose the student to the fundamentals of arthritis and rheumatic diseases.

This course will include the supervised examination of outpatients and inpatients with a wide variety of rheumatic diseases, the participation in the management of such cases, presentation and discussion of cases, and special rounds and seminars. In addition, the student will explore the scope of the field of rheumatology and its interface with immunology, dermatology, physical medicine, orthopedics, and nephrology.

At the conclusion of the rotation, students should have acquired skills in the art of locomotion system examination, the procedure of joint aspiration, techniques of polarizing microscopy of crystals, and therapy and prognosis of acute and chronic rheumatic diseases.

MED-813 INFECTIOUS DISEASES 4 credits. Modules A-M. Contact departmental office for site location before registering. Prerequisite-Senior medical student or permission of OME and instructor. Drs. Berenson, Hewitt, Lesse, Murphy, Mylotte, Crane, Russo, Hsiao, Das,Sellick, and Segal. Number of students: 4.

This rotation provides a student with an intensive experience in clinical infectious diseases. Students will have the opportunity to evaluate patients initially and present them at daily consult rounds with the attending physician. The experience will include history taking, physical examination, review and interpretation of pertinent laboratory data, case presentation, and reading of pertinent information from the available literature. A syllabus of important original articles and reviews in infectious diseases is provided. Students will be assigned to the ECMC or the VAMC.

NOT CURRENTLY OFFERED
MED-815 PRECEPTORSHIP IN INTEGRATIVE MEDICINE 4 credits Modules C-L. Dr. Sanford Levy. Number of students: 0

This office rotation with an internist who practices Integrative Medicine will expose the student to a medical practice which is conventional in many ways, but also focuses on nutrition, vitamins, herbs, and other dietary supplements for prevention of health ailments as well as treatment of medical conditions. Patients of this practice are sometimes referred to local homeopaths, massage therapists, acupuncturists, chiropractors, or a variety of other types of complementary practitioners.

There will be three aspects to this rotation. First, the student will see 5-10 patients each day in the office, often seeing new patients to the practice and urgent resists prior to the Attending, and often seeing routine revisits with the Attending. Second, if desired, it will be arranged for the student to spend several hours in the office of practitioners such as chiropractors, acupuncturists, or others. Third, the student will choose a relevant small project such as gathering and compiling published data on select dietary supplements for presentation to a hospital pharmacy and therapeutics committee, or gathering specific data on cardiac rehabilitation programs which successfully incorporate stress reduction techniques for presentation to the medical director of a local cardiac rehabilitation program. The Attending will work closely with the student on any project chosen.

MED-817 Medical Oncology 4 credits. Modules B-M. NOTE: An "R" after the module in the Class Schedule indicates the Roswell Park Cancer Institute and an “E” indicates ECMC as the site. Number of Students: 6

RPCI Site
Number of students: 2. Prerequisite-Senior medical student or permission of OME and instructor, Drs. Baer, Wetzler, and Wang, and staff of Medical Oncology, RPCI. This is a four-week (one module) rotation for fourth-year medical students on the Leukemia service at Roswell Park Cancer Institute. Students will care for up to two patients receiving treatment on the inpatient service, will participate in daily inpatient rounds with the Leukemia team, and will participate in the evaluation and care of outpatients with leukemias and related disorders in the outpatient setting under the supervision of the attending physicians. In the inpatient setting, the student will become familiar with the evaluation and care of acute leukemia patients, management of neutropenic patients, transfusion therapy, evaluation of medical complications of leukemia patients and organization of high-acuity inpatient care. In the outpatient setting, the student will become familiar with evaluation of abnormal blood counts and management of chronic hematologic disorders including chronic myelogenous leukemia and myelodysplastic syndromes. In both settings, students will gain familiarity with diagnostic evaluation of the bone marrow, including bone marrow aspiration and biopsy, hematopathology, immunophenotyping, cytogenetics and molecular diagnostics.

ECMC Site
Number of Students: up to 2 fourth and 2 third year. Instructors Dr. Gerald Logue and Dr. Zale Bernstein, Chief of Hematology & Oncology: A broad introduction to clinical hematology and oncology. A wide variety of hematologic and oncologic clinical presentations, both in inpatient and outpatient, are encountered. Teaching and first hand clinical encounters are encouraged.

MED-821 GASTROENTEROLOGY-LIVER 4 credits. Modules B-L. Contact departmental office for site location before registering. Prerequisite-Senior medical student or permission of OME and instructor. Drs. Novak, Miqdadi, Ullah, Mahl, Scheig,and Burkard. Number of students: 2.

This course is designed to provide an in-depth experience in gastroenterology and hepatology oriented toward gaining an understanding of the pathophysiology and molecular pathology of diseases and an exposure to the current research in the field.

The student will become part of a team of physicians responsible for the consultation and clinic services. The student will be expected to evaluate new patients, present to an attending physician, and to provide a review of the patient literature. He will have the opportunity to observe diagnostic procedures such as endos-copy, colonoscopy, sigmoidoscopy, esophogeal motility, liver and small-bowel biopsies. The student may also participate in GI grand rounds, journal club, research seminars, endoscopy conferences, GI pathology, and GI pathophysiology conferences. All four major teaching hospitals (ECMC, VAMC, BGH, and RPCI) are part of this course. Hospital choice on a first-come-first-served basis.

The student, upon completion of this course, should have gained an appreciation of the pathophysiology and clinical characteristics of the diseases of the GI tract and the liver most commonly encountered in the geographic area. In addition, it is hoped the student will have a better idea of the value and limitations of the diagnostic procedures and therapeutic regimen used in this medical subspecialty.

NOT CURRENTLY OFFERED
MED-823C CONSULTATIVE OBSTETRIC MEDICINE AT SISTERS HOSPITAL 4 credits.Drs. Lee, Hall and Lippes from Medicine. Drs. Ray, Schmidt, Pivarunas from Obstetrics. Prerequisites: Senior medical student and interviews with Dr. Lee and his staff. NOTE: Some of the rotation takes place at our practice offices in Williamsville, at Windsong Medical Park. Number of students: 1.

Availability depends upon the assignment of house staff and students for general medicine and ambulatory medicine rotations. The goal of this rotation is to provide students with an educational experience concerning internal medicine problems in pregnancy. The students will participate in rounds on the maternal floor. They will be actively involved in consultations for a variety of medical problems on the maternity service such as diabetes mellitus, hypertension, anemia, cardiopulmonary disease, and renal disease. The students will also be involved in outpatient consultations relative to high-risk pregnancies and metabolic problems. All of these experiences will be closely supervised by one of the medical attendings, and there will be adequate opportunity for case-oriented discussions. Since this is done in a unique setting, there will be particular areas in which the students should gain new factual knowledge: adolescent diseases, maternal problems (the effect of illness on pregnancy and the effect of pregnancy on medical illness), and the importance of being aware of fetal risks in treating medical illness.

MED 850 PULMONARY DISEASE ACUTE CARE/CRITICAL CARE MEDICINE 4 credits. Modules B-L. NOTE: A "Y" after the module in the Class Schedule indicates the Mercy Hospital as the site. Prerequisite-Successful completion of MED-802 and subject to Dr. Buscaglia’s availability. He must be attending when students are doing rotation. Number of students: 1.

The objective is to give a structured education and clinical experience in Critical Care Medicine in preparation for Residency training in Primary Care, Internal Medicine, Surgery, or Anesthesia. The Critical Care Elective consists of a Monday to Friday, four week rotation in the Intensive Care Unit of Mercy Hospital. Supervision will be given by the Senior Medical Resident and the ICU Attending Physician. The Student will be assigned a maximum of 5 patients at any given time and will share an equal opportunity with the Senior Resident to develop technical skills in procedures.

MED-851 PULMONARY DISEASES-MICU ROTATION 4 credits. Most modules. NOTE: A "G" after the module in the Class Schedule indicates the Buffalo General Hospital as the site. Prerequisite-Received an Honors grade in MED-700, successful completion of MED 802, and approval of Dr. Susan Gallagher. Drs. E. Ten Brock, S. Schwartz, L Campbell, W. Gibbons, and J. Lwebuga-Mukasa. Number of students: 1.

The MICU rotation will provide students with direct experience in caring for critically ill patients in the Medical intensive Care Unit. The student will be an active participant in the MICU and have primary patient care responsibility with supervision given by the MICU resident and attending staff regarding daily care of patients in the MICU. A limited caseload will be assigned and daily work rounds and attending rounds with the house staff and MICU attending physicians will be expected. Presentations of recently admitted and existing patients will be performed on a daily basis. Exposure to critical care procedures such as CVP'S, arterial lines, and Swan Ganz catheterizations will be available. A limited MICU lecture series and MICU manual will be provided.

Upon completion of the rotation, the student should have a basic understanding of the needs of critically ill patients. A rudimentary knowledge of mechanical ventilation and the types of pharmacologic intervention required in an ICU setting is also expected.

MED-860 GERIATRIC MEDICINE 4 credits. Modules C-L. Contact departmental office for site location. Prerequisite-Senior medical student or permission of OME and instructor. Drs. Naughton,Ippolito,Garbarino,Ramadan, and Vijayasekaran. Number of students: 1.

The course is designed to provide a clinical experience in internal medicine focused specifically on the older patient and an understanding of certain aspects of medical practice which are essential in the care of older patients. Examples include clinical pharmacology of the elderly, functional assessment, modalities of rehabilitation designed to preserve functional capacity, and nutrition. Special attention is given to formulating a plan for evaluation and management of patients with multiple problems and guidelines in the development of a plan of action for the patient who is "getting nowhere." The rotation includes experience in conducting a home visit and a visit to a nursing home.

Course Activities/Experience: Teaching conferences and "core topic presentations" on topics of special relevance to geriatrics and long-term care are held weekly and provide the student and Geriatric fellows with an opportunity to extend their knowledge into various aspects of geriatrics. Presentations are given by Geriatric faculty and fellows and, occasionally, student/subintern. Faculty from other medical specialities concerned with the care of geriatric patients are invited to present conferences on special topics. Students will attend a geriatric journal club weekly. Students will also join Dr. Chang or Dr. Garbarino in the geriatric referral clinic (Senior Plan) held at the Erie County Medical Center and the geriatric clinic at the Buffalo VA Medical Center.

Home care experience is provided in association with the Hospital-Based Home Care Program under the direction of Dr. Steinberg. This provides an opportunity to see and follow patients in the home setting, working with a team of health professionals experienced in this form of patient care.

Nursing home experience may be provided at a variety of hospital and community based sites, and experience with a multidisciplinary approach to demented patients and their families is available at the Alzheimer's Disease Assistance Center with Dr. Edwards.

The course objectives include an understanding of the unique physiologic, pharmacologic, psychologic, and sociologic problems faced by older persons and the gaining of a perspective which will assist the student in providing good care for those patients, and enjoying it.

MED-861 CLINICAL PHARMACOLOGY 4 credits. Modules Limited. NOTE: A "F" after the module in the Class Schedule indicates the Millard Fillmore Hospital as the site. Prerequisite-Senior medical student or permission of OME and instructor. J.L. Izzo, Jr., M.D.; J. Schentag, Pharm.D.; R. Blum, Pharm. D.; D. Nix, Pharm.D.; J.R. Carr, Pharm. D.; and M. Birmingham, Pharm. D. Number of students: 0.

The goal of this rotation is to provide students with instruction and experience in the rational use of drugs in clinical medicine. This includes application of pharmacokinetics to the selection and dosing of drugs. Emphasis will be placed on cardiovascular drugs, antibiotics, and problems of polypharmacy.

Students will participate in an active clinical pharmacology consultation service dedicated to the optimization of drug therapy in acutely ill patients. Students will be involved in review of drug utilization, computer simulations, patient assessment, and routine provision of consultative advice under appropriate guidance. They will work with fellows, residents, and faculty who are part of a federally funded training program in clinical pharmacology.

MED-862 MEDICAL ONCOLOGY 4 credits. Modules A-M. NOTE: An "R" after the module in the Class Schedule indicates the Roswell Park Cancer Institute as the site. Prerequisite-Senior medical student or permission of OME and instructor, Dr. Levine, and staff of Medical Oncology, RPCI. Number of students: 2.

This program is an intensive experience directed at learning the natural history, definitive management, and supportive care of outpatients with malignant disease at an internationally renowned cancer institute. The prognostic influence of morphology, immunological and molecular genetic markers, cytogenetics, and patient characteristics will be shared. The student will work with the Medical Oncology fellows and faculty on specific case management of hematologic and solid tumors in the various outpatient clinics and inpatient units of the RPCI. Students will spend two weeks on a solid tumor service and two weeks on a hematology service. The student will complete initial histories and physicals on patients new to the Institute and follow up his or her patients during the four-week rotation. Students will also have the opportunity to see patients who are known to the Medical Oncology staff who present to clinic with acute or emergent conditions. The student will, in addition to his clinic responsibilities, attend patient management conferences, Medical Oncology grand rounds, and the resident/fellow teaching seminar, all of which are held at Roswell Park . Evaluation of clinical performances and intellectual activity during clinics and conferences will be made by the Medical Oncology senior staff. Upon completion of this rotation, students should have gained an overview of the manifestations of a number of tumors and will have the opportunity to read about and discuss in detail the characteristics of the natural history of some of the more common cancers. They should have learned to develop logical approaches to the diagnosis of cancer. They will also have had an opportunity to learn about the available and appropriate forms of management provided by the modalities of surgery, radiotherapy, chemotherapy, and biomodulation. No night call will be required, but Saturday and/or Sunday coverage may be involved.

MED-870 INTERNATIONAL HEALTH 4 credits. Modules A-M. Contact departmental office for site location before registering. Prerequisites-Senior medical student; and interviews with Drs. Lee, DiMaggio, and staff of the Division of Geographic Medicine. Drs. Lee, DiMaggio, Lippes, Ambrus, Sillman, and Professor Cohen. Number of students: unlimited.

Students interested in overseas work in developing countries during their fourth year should begin planning their experience no later than the beginning of the third year. The Division of Geographic Medicine has contacts in Africa, Asia, and South America which students should discuss with the staff. Many other opportunities exist. In order to obtain credit for this elective, students must plan their program with the University at Buffalo staff. Correspondence between supervisory staff at the field site and the faculty of the Division of Geographic Medicine, including evaluation of the student's performance, is mandatory.

Field sites should offer the following:
supervision by physicians medically qualified or approved by the country;
stable patient care base (outpatient clinic, hospital, mobile outpatient unit);
adequate subsistence, safety, and housing.

Students will be expected to keep a log of their clinical activities and to present their experience to students.

MED-871 GEOGRAPHIC MEDICINE: GEOGRAPHIC AND CULTURAL ASPECTS OF HEALTH CARE 4 credits. Module D (course runs from September through December). Prerequisite-Senior medical. Dr. Richard Lee. Number of students: 3.

An introduction to medical anthropology and geography and an intensive review of the communicable and nutritional diseases found in isolated populations, in developing countries, and among the disadvantaged. Intended for students planning to work overseas or among ethnic isolates in North America. The objectives of the course are to provide students with sufficient background in ethnography, anthropornetry, and geography to prepare for clinical work in urban ghettos, squatter settlements, rural communities, etc.

Faculty includes individuals from the Departments of Medicine, Social and Preventive Medicine and Anthropology.

Course work will consist of lectures and seminars, case presentations, field trips to rural and inner city sites, and laboratories.

Students will be expected to present selected topics In seminars and to write papers on assigned topics.

MED-880 PALLATIVE MEDICINE 4 credits. Prerequisite-Senior medical student or permission of OME and instructor. Drs. Freer and Milch. Number of students: 2.

This rotation is designed to provide the student with a broad-based experience in hospice and palliative medicine. It combines clinical teaching from a variety of sites to give the student an overview of symptomatic therapeutics and interdisciplinary care in a wide range of clinical settings.

The student will spend time at the Palliative Care Consultation Services at Millard Fillmore Hospital, and Buffalo General Hospital and the Medical Oncology and Chronic Pain Management Services at Roswell Park Cancer Institute. The student will also spend part of the rotation at the Center for Hospice and Palliative Care in team meetings, home visits, and the Center’s Palliative Care Unit on the Mitchell Campus in Cheektowaga. CD-ROMs, and other audiovisual resources will be available. Standardized patients will assist in teaching important communication skills.

1. developed important attitudes concerning appropriate timing of palliative care, based on accurate prognosis determination and rational goals of medicine,
2. gained a sound knowledge base in symptomatic management of patients with a variety of distressing symptoms, and
3. acquired clinical skills in effective but compassionate communication.

MED-890 COURSE AT OTHER UNIVERSITY 4 credits. Contact department before registering. Prerequisite-Senior medical student; approval by Dr. Susan Gallagher; and faculty member of other school. Number of students: unlimited.

This elective will offer the students an opportunity to expose themselves to other hospitals, universities, and their faculty outside of Buffalo in General Internal Medicine or a subspecialty of Internal Medicine. As a general rule, the maximum number of allowable out-of-town rotations in Medicine is two months. Exceptions can be developed for students desiring to pursue specific academic objectives, such as a research-oriented tract in some area of medicine not well represented in Buffalo at the present time. In order to arrange such an elective, a definite program must be set up with the appropriate faculty member of the other school and a letter sent to the student noting the approval along with the course description. The student must then fill out an "Out of Town Elective" card which may be obtained from OME at the Medical School. The card and letter must be submitted to Dr. Susan Gallagher for final approval. It is imperative to note that all Add and Drop Out-of-Town forms must be submitted to BGH, Room B663, for Dr. Susan Gallagher's approval and authorization.

MED-900 PRECEPTORSHIP IN MEDICINE 4 credits. Modules B-L. Contact department before registering. Prerequisites-Senior medical student; approval by Dr. Susan Gallagher; and the faculty member with whom the student chooses to work. Any faculty member, Department of Medicine. Students: unlimited.

This rotation will give the students a broader opportunity to arrange their own preceptorships with any members of the faculty of the Department of Medicine. However, all such programs must be approved by Dr. Susan Schwartz or Dr. Scheig, as well as the faculty member with whom the students choose to work.

Each student will have the opportunity to work closely with a preceptor and become acquainted with diagnostic and therapeutic aspects of patient management in the hospital or office setting either in General Internal Medicine or in one of the subspecialties of Internal Medicine. In addition, they are involved in the initiation of a diagnostic and management plan. They follow the patients throughout their hospital or office course.

These preceptorships include, but are not limited to, General Internal Medicine, Critical Care, Primary Ambulatory Care, Renal Disease, and Hepatology. The preceptorships cannot be used to satisfy specific Medical School requirements for Advanced Medicine 802 and/or experience in Primary Ambulatory Care. To fulfill the requirement as an ambulatory experience, prior approval must be obtained from Dr. S. Gallagher.

At the conclusion of the preceptorship, the students should have improved their technical skills in obtaining proper histories and doing sound physical examinations. They are also expected to have gained insight about diagnostic modalities rendered by the attending physician in General Internal Medicine or subspecialties. The student is required to obtain the approval of their selected preceptor before course registration.

MED-950 RESEARCH IN MEDICINE 4 credits. Modules A-M (by special arrangement with faculty preceptor). Contact department. Prerequisite-Senior medical student and permission of OME and instructor. All members of faculty. Number of students: unlimited.

Students may, by special arrangement, elect to undertake research experience with any member of the faculty. Rotations may extend for periods of one to several modules as long as the student's schedule will allow.

The value of the research, its goals, design, techniques, etc., are to be worked out by the student and his or her faculty preceptor.