Internal Medicine Clerkship Activities

CLERKSHIP ACTIVITIES

During the ten-week Internal Medicine Clerkship you will participate in many activities, briefly described below.

General Medicine Ward Services

ST. JOHN’S HOSPITAL/MEMORIAL MEDICAL CENTER
You will spend three weeks on a general internal medicine ward. You may request a fourth, contiguous week of wards, using one of the weeks allotted for subspecialty selectives. During this time you will be assigned to a first-year resident, who in turn will provide you with patients during your rotation for you to work-up and follow. A complete write-up of your history and physical examination should be in the chart within 24 hours. Please provide a copy of your write-up for review by the senior medical resident. You should follow your patient cases carefully and participate actively in their evaluation and treatment. You should write daily orders and progress notes in the chart which reflect your understanding of the patient’s progress, and details of further evaluation and management. You should be prepared at any time to present each of your patients to residents, attendings, or your colleagues. You should read extensively about each of your patients in major general internal medicine textbooks, subspecialty textbooks, or other medical literature.

Nephrology
You will spend two weeks assigned to the Nephrology service. During this time you will be assigned to a resident and/or attending physician. You will participate in the evaluation and management of patients as you would on the wards.

Subspecialty Preceptorships
Each student will rotate on at least two subspecialty services. Your activities and the patients you see will be determined by your preceptor, as will your work schedule. You should play an active role in the evaluation and management of patients both in clinic and in the hospital.

Please consult the written guidelines on the Clerkship website for each specific subspecialty for details regarding curriculum, call expectations, and time-off policy. Call your subspecialty preceptor the Thursday or Friday before you start your new rotation.

General Internal Medicine Continuity Care Clinic
One half-day each week you will attend an ambulatory clinic with a general internist. There is a weekly ambulatory report (Monday mornings) that focuses on ambulatory topics commonly seen in these clinics. Please review the Ambulatory Objectives at the end of the syllabus.

Conferences and Rounds

GRAND ROUNDS
Grand Rounds are the premier weekly educational conference of the Department of Medicine. They are held in the Wedeberg Conference Center at Memorial Medical Center and televised to St. John's Hospital every Tuesday at 8:00 a.m. Plan to arrive a little early – these sessions start promptly at 8:00 a.m. Food and coffee are provided. Attendance is required and a sign-in sheet will be provided.

STUDENT SEMINARS
With few exceptions, student seminars are held on Monday, Tuesday, Wednesday and Thursday, at Noon. You will need to check your weekly calendar for locations. These sessions are designed for clerkship students and address core topics deemed important by Department of Medicine faculty. You should prepare for seminars in advance by reviewing the specific objectives, reading the suggested resources and answering the study questions. Core Curriculum Problems with objectives and references are posted on the Clerkship Website. Attendance is required.

A seminar evaluation form will be placed in your mailbox. Please complete as soon as possible.

CLINICAL MANAGEMENT
Dr. Constance, Dr. Varney or another Internal Medicine faculty member will meet with all clerkship students on Fridays at Noon, to discuss clinical cases and common practical problems in internal medicine. Attendance is required.

CHAIRMAN’S REPORT
Dr. Steward, or another Internal Medicine faculty attending will meet with all students on the wards weekly on Mondays or Thursdays, at 1:00 p.m. unless otherwise scheduled, to discuss clinical cases evaluated on the wards. One or two cases will be presented by ward students and discussed at each session, and every student is responsible for one presentation during his/her ward rotation. The case presentation should be concise yet complete, and about 7 to 10 minutes in length. The presenting student should expect detailed questions from the attending and the audience regarding the patient’s condition, work-up and management. A Ward Report Presentation sheet should be completed by the student responsible for the case presentation and copied for all attendees. Students are required to personally discuss any pertinent imaging studies related to their case with a radiologist. Students are encouraged to bring an article from the medical literature pertinent to their case and any imaging studies, EKGs or other data relevant to the patient’s problem. Attendance is required for students assigned to wards. Click here to view the Guidelines for Chairman’s Ward Report.

AMBULATORY REPORT
Faculty from the Division of General Internal Medicine will meet with all clerkship students on Monday mornings at 7:00 a.m., to discuss an ambulatory topic seen by students in their General Internal Medicine longitudinal clinic. At these sessions, two students will deliver a ten- to fifteen-minute oral discussion of a topic pertinent to ambulatory care. Patient cases seen in GIM clinics will also be discussed. Attendance is required.

Please review the ambulatory content objectives at the end of the syllabus.

SUMMARY OF ATTENDANCE REQUIREMENTS
Attendance is mandatory at:

Grand Rounds (8:00 a.m., Tuesdays)
Seminars (Mondays, Tuesdays, Wednesdays, and Thursdays at Noon)
Clinical Management Conferences (Fridays at Noon)
Chairman’s Report (Mondays and Thursdays 1:00 p.m.) – WARD STUDENTS ONLY
Ambulatory Report (Mondays, 7:00 a.m., as shown on schedule)

Other Clerkship Activities

MENTORS
Each student will be assigned to a faculty member who will serve as your mentor for the entire clerkship. You will meet with your mentor at least six (6) times during the clerkship. Activities may include case presentations, problem solving exercises, topic discussions, order writing assignments, participation in rounds or clinics or an observed history and physical. For greater detail read Expectations of the Mentor Experience.

CLINICAL SKILLS AND ASSESSMENT WEEK
During the last week of the clerkship a clinical skills exercise will be conducted at the Professional Development Laboratory at 801 North Rutledge, on the third floor. You will be observed by faculty or residents as you interview and/or examine four patients. Other clinical skills will also be assessed. Immediate feedback will be provided and your performance will be evaluated to assess your clinical skills.

Also, during this week there will be critical incident teaching experiences which include two interactive scenarios. Attendance is required.

LOG BOOK
Your logbook is a record of the patients you have seen during the clerkship. Every complete history and physical examination or initial consultation that you perform should be recorded in the appropriate place in your logbook. In addition, ambulatory patient encounters should be recorded and procedures, such as venipuncture, bladder catheterization, and others should be recorded in the appropriate place in your log. The Medicine Clerkship Logbook is available on the web and on your PDAs. Please keep your logs up to date – once the patients are gone it will be very difficult for you to describe them accurately.

MID-CLERKSHIP EXAMINATION
During the fifth or sixth week of the clerkship a departmentally-authored multiple choice test will be administered. This test will not count for your grade – rather, it is a self-evaluation which will give you an idea of how you are progressing with your reading. The exam will be taken at a computer station, and immediately after completion answers and explanations will follow for the items marked incorrectly. A hard copy of the exam with answers and rationales will be kept in the Clerkship office for further review.

WEEKLY SCHEDULES
A schedule of the following week’s activities will be available in the Clerkship office and on the Clerkship website by Wednesday afternoon of the current week. Because of the many conferences, rounds, guest speakers, and other activities sponsored by the department, and because you are scheduled irregularly to some activities, you will need to consult this weekly schedule to be informed of activities and the locations of these activities.

HOLIDAYS AND WEEKENDS
The Medicine Clerkship operates seven days a week, twenty-four hours a day. Your work schedule will depend on your assignment, but in general you should assume that you will have one weekend day off (usually Sunday) each week except during the Ward Rotation. One three-day weekend off duty is provided during the clerkship; the specific weekend provided will be announced during clerkship orientation. In most cases, each student is also assigned one Saturday and one Sunday off during the ward rotation.

STUDENT FILES
You may review your file at any time. However, you must ask for permission to see your file and you must look at it in the presence of someone from the Department of Medicine. Your file may not leave the clerkship office. Please do not search for your file, test papers, evaluations, or other materials on your own. There are important considerations for confidentiality and respect for your fellow student’s privacy involved.

QUESTIONS OR PROBLEMS
If you have questions about your activities or assignments or are having problems with any part of the clerkship, please ask for help from the clerkship office, Dr. Hingle, Dr. Kovach or Dr. Kapitan. Problems, questions or misunderstandings are usually easily handled if they are brought to our attention.

CLERKSHIP DIRECTOR MEETINGS
Once at the midpoint of the clerkship, and again at the end of the clerkship, Dr. Hingle will meet with you to discuss your evaluations, advise you about your progress, review your logbook entries, and answer other questions and concerns that you might have. These meetings will be scheduled by the clerkship office, and will be on your weekly calendar. Please be on time for these meetings.

ILLNESS AND OFF-CAMPUS ABSENCES
If you are ill or have an emergency, notify your ward team or your preceptor, and the Clerkship office (545-3900 or 545-8933).

The Clerkship Director and the Associate Dean of Student Affairs will be notified of all absences in accordance with the official school absence policy.

DRESS CODE
Appropriate attire must be worn during school activities. This includes all clerkship responsibilities such as conferences, Clerkship seminars, and rounds. White coats must be worn during all patient encounters including standardized patient visits. Open toe shoes are not acceptable. Shoes must be worn with socks or hose/stockings. Scrubs are acceptable only after business hours when on overnight ward call.

STUDENT WORK HOURS
During the clerkship students will not spend on average more than eighty (80) hours per week in required clinical and educational activities.

Required activities include, but are not limited to, formal didactic teaching, hospital rounds and activities, out-patient clinic attendance, in-house and at home call, and attendance at examinations. Required activities do not include personal study time or optional educational experiences.

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