Internal Medicine Clerkship
The Third Year Clerkship in Medicine represents the major clinical educational experience in the Internal Medicine Department in the Medical School. The general purpose of the third year clerkship is to provide the student with the environment and the opportunity to develop and refine the following:
- Skills and proficiency in performing a medical interview and a physical examination.
- Formulate differential diagnoses to identify appropriate steps that need to be taken to evaluate and/or treat the patient.
- Proficiency in presenting histories, physical examinations, assessments, and plans in verbal and written form.
- For students wishing to pursue a career in Internal Medicine (or an Internal Medicine sub-specialty), preparedness to continue their medical training.
- For students who plan to seek careers outside Internal Medicine, the beginning of acquisition of medical knowledge to recognize when patients they see need evaluation and treatment by an internist.
- Familiarity with general principles of preventive medicine for all patients as well as principles applicable to specific diseases.
- Interpersonal skills of communication, compassion, sensitivity, and awareness necessary to take optimal care of patients.
- Sensitivity and responsiveness to the behavioral, interpersonal, psychological, political, social, and economic issues of illness and medical care.
- Desire and skills to continue life-long learning in medicine.
- Knowledge and understanding of the pathophysiologic principles underlying medical illnesses and the specific pathophysiologic abnormalities causing common important medical disorders.
- Knowledge and understanding of the general principles of medical therapeutics and the specific treatment approaches to common important medical disorders.
- Understanding of the importance of patient education, as well as the acquisition of skills and knowledge to provide patient education.
- Awareness and knowledge of the ethical underpinnings of medical practice.
The Internal Medicine Clerkship is a 10-week clerkship, combined with the Neurology clerkship to make up the Care of Adults Thematic Section. The Medicine Clerkship is composed of both inpatient and outpatient experiences. The students spend eight weeks in the inpatient medicine setting and two weeks in the ambulatory care setting.
Each student is assigned to a Medicine ward team during his/her inpatient experience. The students are an integral part of the ward team. They are responsible for admitting at least two to three patients per week and for writing the complete history and physical on that patient. The students are responsible for writing daily progress notes on the patients they are following directly as well as performing indicated procedures for their patients. The students take call with the ward team one evening per week but are not required to stay overnight. The students are active participants in teaching attending rounds and will be called upon to present cases or give follow-up on the cases which have been previously presented.
Students work in small groups with a Longitudinal Preceptor in Medicine for the length of the clerkship. Students meet with their LPM’s at least 10 times at weekly intervals during the clerkship, and are expected to have studied on-line lectures and cases covering a broad range of topics in Medicine in preparation for each session. Additional lectures occur at the teaching hospitals include case management conferences, bedside teaching rounds, an EKG lecture series, Chiefs' Rounds, Teaching Attending Rounds, and Radiology conferences. This formal lecture series is in addition to the learning accomplished with patient interactions, work rounds with the housestaff, ward and work rounds with housestaff and attending physicians, and during their ambulatory block.
The ambulatory experience is two weeks in duration. In this block, the student spends two weeks with one or two primary care internists in the office setting. Students see patients independently and are precepted by the office internist. They participate in all aspects of the physician's daily routine and practice. They have exposure to office management issues in addition to patient care. There is an ambulatory-oriented lecture series and students participate in ambulatory case presentations.
Students interact with standardized patient instructors twice during their twelve-week clerkship. The first time is at the beginning of the clerkship where they are required to perform a complete physical exam on a patient instructor and are given feedback about the completeness of that physical exam. The second interaction, called an O.S.C.E. (Observed Structured Clinical Evaluation) is toward the end of the clerkship. They progress through six stations in which standardized patients portray patients with common medical problems. They are asked to take an appropriate history, perform an appropriate physical examination, and to then formulate a differential diagnosis and plan for each patient. The students are again given feedback about their performance and the completeness of their evaluation by the patient instructors and have a wrap-up session at the end with a faculty member.
Student grades are determined by a combination of clinical evaluations, participation in Longitudinal Preceptor sessions, OSCE performance and written NBME subject exam performance.