SYLLABUS
College of Medicine
AY 2015-2016
Course title and number
Term (e.g., Fall 200X)
Meeting times and location
IMED 866-00T Clinical Nutrition
Offered Year Round – 2 or 4 weeks
Report at 7:30 to Sid Richardson Auditorium or Doctors Conference Room
for Internal Medicine Morning Report. Following morning Report go to
Desk 3B, third floor of the clinic and ask for Dr. Pfanner.
Course Description and Prerequisites
The Faculty will strive to:
1. An introduction to clinical malnutrition in the adult patient with emphasis on the clinical
syndromes of kwashiorkor and marasmus.
2. An understanding of alterations in nutrition which occur as a result of adult illnesses including
the clinical recognition and management of resulting disorders of nutrition.
3. A familiarity to the student of the proper evaluation and utilization of specific lab tests in the
diagnosis of malnutrition in the hospitalized adult patient.
4. A familiarity to the students of the indications and usage of enteral nutrition in the support of the
hospitalized adult patient.
5. A familiarity to the student of the utilization of peripheral protein sparing alimentation in the adult
hospitalized patient.
6. A familiarity to the student of proper utilization of central alimentation (Total Parenteral Nutrition)
in the hospitalized adult patient.
Instructor Information
Elective Director
Timothy Pfanner
Name
254-724-3098
Telephone number
tpfanner@sw.org
Email address
By appointment
Office hours
Office location
Coordinator
Martha Chandler
Name
254-724-2607
Telephone number
mschandler@sw.org
Email address
By appointment
Office hours
6th floor Brindley
Office location
Circles, Room 640
Learning Outcomes & Objectives
(COM Competency Based Learning Objectives: http://medicine.tamhsc.edu/academicaffairs/curriculum/objectives/
Date Created/Revised: _____ By: _____
Course Objective:
1. Recognize the clinical
syndromes of malnutrition in
the adult patient
2. Recognize the signs and
symptoms and etiologies of
malnutrition in the adult
patient.
Date Created/Revised: _____ By: _____
COM Competency
Based Learning
Objectives
(CBLO):
PC8: Demonstrate
an understanding
of the principles
involved in the care
of patients across
the spectrum of the
human life cycle
MK1: Demonstrate
knowledge of
normal human
structure and
function at the
organ-system,
tissue, cellular and
molecular level;
and of the
interaction of
human systems in
maintaining
homeostasis
MK2: Describe the
basic mechanisms
involved in the
causation of human
disease and their
influence on clinical
presentation and
therapy
MK3: Demonstrate
an understanding
of how healthy
lifestyles,
psychosocial
factors, and
behavioral factors
influence heath
MK4: Apply
evidenced-based
methods to clinical
problem solving
MK5: Demonstrate
an understanding
of the epidemiology
of common
diseases within a
population and the
approaches which
are useful in
reducing their
incidence and
prevalence
PC8: Demonstrate
an understanding
of the principles
involved in the care
Taught (T)
and/or
Evaluated (E):
Evaluation:
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
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Evaluation Form
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Evaluated
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Evaluation Form
3. Be familiar with the
pathophysiology of stress in
the development of
malnutrition in the adult
patient.
4. Discuss the indications for
enteral and parenteral
nutritional support.
Date Created/Revised: _____ By: _____
of patients across
the spectrum of the
human life cycle
MK1: Demonstrate
knowledge of
normal human
structure and
function at the
organ-system,
tissue, cellular and
molecular level;
and of the
interaction of
human systems in
maintaining
homeostasis
MK2: Describe the
basic mechanisms
involved in the
causation of human
disease and their
influence on clinical
presentation and
therapy
MK3: Demonstrate
an understanding
of how healthy
lifestyles,
psychosocial
factors, and
behavioral factors
influence heath
MK4: Apply
evidenced-based
methods to clinical
problem solving
MK5: Demonstrate
an understanding
of the epidemiology
of common
diseases within a
population and the
approaches which
are useful in
reducing their
incidence and
prevalence
PC8: Demonstrate
an understanding
of the principles
involved in the care
of patients across
the spectrum of the
human life cycle
MK1: Demonstrate
knowledge of
normal human
structure and
function at the
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
organ-system,
tissue, cellular and
molecular level;
and of the
interaction of
human systems in
maintaining
homeostasis
MK2: Describe the
basic mechanisms
involved in the
causation of human
disease and their
influence on clinical
presentation and
therapy
MK3: Demonstrate
an understanding
of how healthy
lifestyles,
psychosocial
factors, and
behavioral factors
influence heath
MK4: Apply
evidenced-based
methods to clinical
problem solving
MK5: Demonstrate
an understanding
of the epidemiology
of common
diseases within a
population and the
approaches which
are useful in
reducing their
incidence and
prevalence
PC1: Obtain both
complete and
system-focused
medical histories
that include
psychosocial and
behavioral
determinants of
health
PC2: Perform both
complete and
system-focused
physical
examinations
PC3: Develop
appropriate
differential
diagnoses by
integrating
Date Created/Revised: _____ By: _____
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
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Evaluated
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Evaluation Form
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Evaluated
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Evaluation Form
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Evaluated
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Evaluation Form
5.
Outline the clinical
evaluation, treatment, and
on-going management of the
patient requiring enteral and
parenteral nutrition.
Date Created/Revised: _____ By: _____
collected clinical
information
PC6: Recognize
common
immediately lifethreatening
conditions and
initiate therapy
PC7: Formulate an
initial management
plan for critically ill
patients
PC9: Perform
technical
procedures
including:
venipuncture and
arterial puncture;
insertion of
intravenous, central
venous, and
urethral catheters;
insertion of a
nasogastric tube;
lumbar puncture;
basic suturing; and
basic airway
management
PC14: Properly
utilize clinical,
laboratory,
radiologic, and
pathologic
examinations to
diagnose and treat
common maladies
PC1: Obtain both
complete and
system-focused
medical histories
that include
psychosocial and
behavioral
determinants of
health
PC2: Perform both
complete and
system-focused
physical
examinations
PC3: Develop
appropriate
differential
diagnoses by
integrating
collected clinical
information
PC14: Properly
utilize clinical,
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
Clinical
Evaluation Form
Taught and
Evaluated
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Evaluation Form
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Evaluated
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Evaluation Form
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Evaluated
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Evaluation Form
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Evaluated
Taught and
Evaluated
Clinical
Evaluation Form
Clinical
Evaluation Form
laboratory,
radiologic, and
pathologic
examinations to
diagnose and treat
common maladies
PC6: Recognize
common
immediately lifethreatening
conditions and
initiate therapy
PC7: Formulate an
initial management
plan for critically ill
patients
PC9: Perform
technical
procedures
including:
venipuncture and
arterial puncture;
insertion of
intravenous, central
venous, and
urethral catheters;
insertion of a
nasogastric tube;
lumbar puncture;
basic suturing; and
basic airway
management
PC14: Properly
utilize clinical,
laboratory,
radiologic, and
pathologic
examinations to
diagnose and treat
common maladies
MK4: Apply
evidenced-based
methods to clinical
problem solving
ICS3:
Communicate
effectively with
patients, patients'
family members,
peers, and other
members of the
health care team
ICS4: Educate
patients, patients'
family members,
peers, and other
members of the
health care team at
an appropriate level
Date Created/Revised: _____ By: _____
Taught and
Evaluated
Clinical
Evaluation Form
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Evaluation Form
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Evaluated
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using appropriate
technologies
ICS5: Maintain
accurate medical
records
6. Be familiar with and able to
properly use enteral and
parenteral nutrition in the
nutritional support of the
hospitalized patient
Date Created/Revised: _____ By: _____
PC2: Perform both
complete and
system-focused
physical
examinations
PC3: Develop
appropriate
differential
diagnoses by
integrating
collected clinical
information
PC5: Interpret the
results of
commonly used
laboratory and
radiologic studies
PC6: Recognize
common
immediately lifethreatening
conditions and
initiate therapy
MK4: Apply
evidenced-based
methods to clinical
problem solving
ICS2: Discuss
diagnostic and
treatment options in
a manner
comprehensible to
the patient
ICS3:
Communicate
effectively with
patients, patients'
family members,
peers, and other
members of the
health care team
ICS5: Maintain
accurate medical
records
PROF2: Display
honesty, integrity
and ethical
behavior
PROF3: Act in the
patient's best
interest and serve
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Evaluated
Clinical
Evaluation Form
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as a patient
advocate
PROF4: Treat
patients and
patients' family
members
respectfully and
compassionately,
regardless of age,
disability, gender,
race, ethnicity,
culture, religion,
sexual preference,
and socioeconomic status
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Clinical
Evaluation Form
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Textbook and/or Resource Material
1.
2.
3.
4.
‘Enteral and Tube Feedings, by Rombeau and Caldwell, Volume One.
Parenteral Nutrition, edited by Rombeau and Caldwell, Volume Two.
Course syllabus
Manual of Nutritional Therapeutics, by J. Alpert.
Grading Policies
GRADING SCALE
Satisfactory
70-100
Unsatisfactory
69 and below
Should the course director determine remediation is required, the remediation plan will be at the
discretion of the course director and on a case by case basis depending on the issues involved.
Remediation plans could entail some (or all) of the following examples: Additional clinical shifts,
research papers, presentations, article reviews, exams, directed reading, web-based modules, etc. If the
student performance results in a failure of the elective, it will be recommended that the elective be taken
again in its entirety.
Attendance and Make-up Policies
The Department of Internal Medicine adheres to attendance policies and duty hours as set forth in the
College of Medicine Student Handbook, http://student-rules.tamu.edu/rule07 In the case of personal
illness, critical illness within your immediate family, family death, or other circumstances where you will
not be able to participate in required activities, you must contact the Internal Medicine Medical Education
Coordinator and contact the attending Faculty. Students who miss more than 20% of a 4 th year elective
for any reason (2 weekdays during a two-week rotation or 4 weekdays during a 4-week rotation), will
require a remediation plan. The Course Director will consider student attendance and remediation if the
student is requesting extended time off during interview season.
Date Created/Revised: _____ By: _____
Course Topics, Calendar of Activities, Major Assignment Dates
1. Participate in the hospital nutritional rounds on the hospitalized patients and to be the
primary nutritional consultant for these patients.
2. Attend the CORE Curriculum lectures given in the Division of Clinical Nutrition.
Participate in the home TPN and Patient Care Conferences of the division.
3. Work as an acting intern on the Hospital Nutrition Service, providing initial nutritional
consultation to hospitalized patients.
4. Work as an acting intern in the clinic evaluation of new patients and return patients in
making recommendations for diagnostic studies and the development of a
comprehensive therapeutic plan with recommendations as a consultant on the usage and
manipulations of enteral and parenteral feeding techniques.
Americans with Disabilities Act (ADA)
The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides
comprehensive civil rights protection for persons with disabilities. Among other things, this legislation
requires that all students with disabilities be guaranteed a learning environment that provides for
reasonable accommodation of their disabilities. If you believe you have a disability requiring an
accommodation, please contact Disability Services, in Cain Hall, Room B118, or call 845-1637. For
additional information visit http://disability.tamu.edu
Any student with a disability who needs accommodation should inform the instructor at the beginning of
the course.
Academic Integrity
For additional information please visit: http://aggiehonor.tamu.edu
“An Aggie does not lie, cheat, or steal, or tolerate those who do.”
College of Medicine
Professionalism and integrity Statement (Academic Honesty and Plagiarism)
All College of Medicine students are required to comply with the student code of conduct and the
academic integrity and honesty standards published in each component’s Student Handbook.
Disciplinary action will be taken in accordance with the policies of each component. Students found
guilty of Academic Dishonesty will receive an “F”/Unsatisfactory in the course. For a full list of actions
qualifying as academic dishonesty, please review the College of Medicine Student Handbook at
http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf.
According to the Aggie Honor System Office, plagiarism is defined as the appropriation of another
person's ideas, processes, results, or words without giving appropriate credit. Intentionally, knowingly, or
carelessly presenting the work of another as one’s own (i.e., without crediting the author or creator).
Plagiarism and other academic misconduct definitions can be viewed on the Aggie Honor System Office
website; http://aggiehonor.tamu.edu/RulesAndProcedures/HonorSystemRules.aspx#definitions.
Date Created/Revised: _____ By: _____
E-mail Access and FERPA
The College of Medicine is communicating all official information to students through the students’
TAMHSC e-mail accounts. Please check the account frequently during the semester for updates.
This course is supported with web-based and/or e-mail activities. In order to take advantage of these
additional resources and participate fully in the course, you have been assigned an e-mail address by
the Texas A&M Health Science Center. This e-mail address is for internal use only, so that faculty may
communicate with you and the entire class. By registering for this course, you are agreeing to allow
your classmates to have access to this e-mail address. Should you have any questions, please contact
the TAMU’s Office of the Registrar at 979-845-1031.
The Family Educational Rights and Privacy Act of 1974 (FERPA), which the HSC complies fully, is
intended to protect the privacy of education records, to establish the rights of students to inspect and
review their education records and to provide guidelines for the correction of inaccurate or misleading
data through informal and formal hearings. Students also have the right to file complaints with the Family
Educational Rights and Privacy Act Office of the Department of Education in Washington, D.C.,
concerning alleged failures by the HSC to comply with the act.
Mistreatment of Students
The College of Medicine is committed to providing a positive learning environment in which students can
meet their academic goals based on mutual respect in the teacher/learner relationship. Both parties
must be sensitive to the needs of others and differences in gender, race, sexual orientation, religion, age
or disability. As outlined in the Student Handbook under the section titled Standards of Conduct in the
Teacher-Learner Relationship, belittlement, intimidation and humiliation are unacceptable for effective
learning and undermine self-esteem. Breaches involving student mistreatment may result in a faculty or
staff member being sanctioned or the loss of faculty and/or staff appointment. These policies address
student mistreatment involving College of Medicine employees, residents, affiliate staff, or patients.
Mistreatment may be reported through the College of Medicine telephone hotline, 1(855)-397-9835 or
through an online form at http://medicine.tamhsc.edu/current/student-mistreatment-form.html. For a full
list of reporting avenues, please refer to the Student Handbook under the Mistreatment Policy.
Exposure and Occupational Hazard
The Needle Stick Policy and Bloodborne Pathogen Exposure information for Medical Students may be
accessed in the Student Handbook at: http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf
Note: More information is available on the aforementioned topics to all students on the College of
Medicine website.
Date Created/Revised: _____ By: _____
Date Created/Revised: _____ By: _____