MEL 8318: Esophageal and Swallowing Disorders

Drs. Joel Richter and David Estores

This course will familiarize and engage the senior medical student in the basic principles and management of complex patients who are referred to a tertiary care center. This course should provide an invaluable clinical experience particularly for those who wish to pursue further training in the fields of ENT (otorhinolaryngology), allergy and immunology, gastrointestinal surgery (laparoscopic esophageal surgery), gastroenterology, internal medicine, radiology or neurology. The student will be involved in the different aspects of patient care including: history taking and physical examination; diagnostic approach and planning for therapy; observation and participation in oropharyngeal, voice and esophageal function testing and basic interpretation of the studies. The senior medical student will be given ample time for observing specialized procedures (including endoscopy and radiographic examinations) and will be provided the opportunity to longitudinally follow patients they have initially seen for evaluation. They will be involved in a “team” together with the nurses, patient care coordinators, speech pathologist, and physician members. Clinical activities are mainly based at the fully equipped Esophageal, Swallowing and Voice Function Laboratory at the USF Health North campus with endoscopic procedures performed at the Endoscopy Units at the Morsani Center for Advanced Health Care and the Moffitt Cancer Center.

 Objectives

1. Review and apply basic scientific principles, pathophysiology, clinical laboratory methods, radiology examinations and cognitive skills as they relate to the diagnosis and treatment of esophageal and swallowing disorders
2. Familiarize the senior medical student with certain procedures most commonly performed during the evaluation and therapy for these disorders which include: Fiberoptic Endoscopic Evaluation of Swallowing (FEES), Dynamic Video Esophagram (DVE), videostroboscopy, barium esophagram with meal challenges, upper endoscopy or esophagogastroduodenoscopy (EGD), esophageal manometry, combined manometry-fluoroscopy (manofluoroscopy),and 24 ambulatory esophageal pH studiesReinforce a critical approach to the medical literature
   1. Observation of the actual procedure being performed
   2. Discussion of the basic interpretation of these procedures
   3. Observe and participate in the discussions about the impact of test results on the therapeutic plan
3. Expose the senior medical student to evaluation and management of a wide variety of esophageal and swallowing disorders including basic evaluation and treatment of oropharyngeal dysfunction
4. Expose the senior medical student to evaluaton of neurologic conditions (i.e. ALS, Parkinson disease, Hungton Chorea), patient conditions after surgery (anti-reflux procedures, bariatric procedures esophagectomy, laparoscopic surgery) and treatment for head and neck cancer (radiation, chemo-or surgical therapy)
5. Familiarize the medical student with a multi-disciplinary approach to evaluation and management of complex esophageal and swallowing disorders (“center” model)

Learning Outcomes

At the end of the rotation the senior medical student is expected to:

1.  Become familiar with the anatomic, radiographic, endoscopic and physiologic, aspects of swallowing, esophageal and voice functions
2. Become familiar with the different aspects of abnormal or pathologic function for swallowing, esophageal and voice related disorders
3. Become familiar with the diagnostic approach and treatment options for dysphagia, voice disorders and gastroesophageal reflux diseases
4. Follow several patients from initial evaluation until they have received therapy or completed the diagnostic work-up
5. Become familiar with certain procedures commonly performed during evaluation and therapy for oropharyngeal, and esophageal swallowing disorders
6. Become familiar with a “center” approach to complex but focused medical problems and understand the interaction between the different members of the team

Evaluation

1. Periodic (at least once a week) feedback sessions will be provided to the student. 
2. The medical student will receive a written evaluation at the end of the month. This will be reviewed with the student by the faculty evaluator.
3. Faculty performance will be evaluated by the medical student (anonymously submitted to the center director).
4. Credit will be given for exceptional performance.

Any student interested in this rotation is encouraged to contact Dr. Estores (destores@health.usf.edu).