Goals & Objectives
Goal of the Clerkship
During the Internal Medicine Clerkship, students will acquire the clinical skills, knowledge, and professional behaviors necessary to evaluate and care for adult patients with growing independence guided by careful and consistent supervision from residents and attending physicians.
CLINICAL SKILLS: During the clerkship, the students will acquire and be able to demonstrate the clinical skills necessary to independently evaluate (with appropriate supervision) and care for adult patients with common medical problems. Specifically, the student will be able to do the following:
- Obtain from a patient an accurate focused or complete medical history based on the presenting complaint and appropriate to the clinical setting.
- Perform an accurate focused or complete physical examination appropriate to the clinical setting.
- Prioritize patients’ problems, formulate appropriate differential diagnoses, and develop plans for diagnosis and management.
- Prepare and maintain in an accepted format the medical record of the evaluation and care of inpatients and outpatients, including written or electronic entry of a complete history and physical examination, progress notes, procedure notes, clinic visit notes, physician’s orders, and prescriptions for medications.
- Communicate orally with other members of the health care team regarding the evaluation and care of a patient. This includes giving case presentations to ward teams, attending physicians, and consultants, and verbal instructions to ancillary health care personnel.
- Communicate to patients, families and caregivers the diagnosis, prognosis and treatment plan for their condition, and educate them about beneficial lifestyle behaviors and preventive health measures.
- Become familiar with routine procedures commonly required for the evaluation and care of patients, including venipuncture, bladder catheterization, arterial puncture, insertion of peripheral intravenous catheters, fecal occult blood tests, electrocardiograms, insertion of nasogastric tubes, use of sterile technique, and use of universal precautions.
KNOWLEDGE: During the clerkship students will acquire and demonstrate knowledge of the basic and clinical science of medical problems of adult patients listed in the following core curriculum problems. Appropriate knowledge includes:
- Background knowledge such as anatomy, physiology, biochemistry, genetics, pharmacology, pathology, microbiology.
- Clinical knowledge such as pathophysiology, epidemiology, clinical decision making, use and interpretation of diagnostic tests, pharmacology, medical ethics, and medicolegal issues.
- Develop an appreciation of how one builds and advances his/her medical knowledge base.
- Begin to develop the knowledge to intellectually extend a patient care interaction in order to explore the questions that will improve patient care for similar cases.
- Begin to develop the ability to assess and critique research related to clinical question.
Click on each core problem for detailed objectives and resources.
Students are expected to continue the process of lifelong learning and demonstrate knowledge that they know how to use the medical literature to research questions and further their understanding of the above problems.
To assist in meeting the above knowledge objectives, the following conditions are those for which students are expected to evaluate and care for during the clerkship with guidance from faculty and residents.
- Abdominal Pain (at least 2 inpatient or outpatient)
- Abnormal ECG (at least 4 inpatient or outpatient)
- Acid Base and Electrolyte problems (at least 2 inpatient)
- Acute and Chronic Renal Failure (at least 4 inpatient)
- Anemia (at least 2 inpatient or outpatient)
- Cancer (at least 2 inpatient or outpatient)
- Chronic Obstructive Lung Disease, including Asthma (at least 2 inpatient and 2 outpatient)
- Congestive Heart Failure (at least 1 inpatient and 1 outpatient)
- Coronary Artery Disease (at least 2 inpatient and 2 outpatient)
- Depression (at least 1 inpatient or outpatient)
- Diabetes Mellitus (at least 2 inpatient and 4 outpatient)
- Dyslipidemia (at least 4 outpatient)
- HIV infection (at least 1 inpatient or outpatient)
- Hypertension (at least 4 outpatient)
- Joint Pain (at least 2 outpatient)
- Low Back Pain (at least 2 outpatient)
- Peptic Ulcer Disease/GERD (at least 1 outpatient)
- Upper Respiratory Infection (at least 2 outpatient)
- Urinary Tract Infection (at least 1 inpatient and 1 outpatient)
From the following list of problems, students in the clerkship are expected to evaluate and care for at least three.
- Fever/Sepsis (1 inpatient or outpatient)
- Gastrointestinal Bleeding (1 inpatient or outpatient)
- Liver Disease – acute or chronic (1 inpatient or outpatient)
- Pneumonia (at least 1 inpatient)
- Shock/Hypotension (1 inpatient)
- Thromboembolic Disease -- Pulmonary embolism or deep vein thrombosis (1 inpatient)
- Tuberculosis (1 inpatient or outpatient)
Students in the clerkship must also see the following categories of patients.
- New acute condition of an undifferentiated problem, with emphasis on diagnosis (at least 4 inpatient or outpatient)
- Chronic condition with emphasis on management (at least 2 outpatient)
- Exacerbation of a chronic condition with emphasis on management (at least 1 inpatient and 1 outpatient)
- Asymptomatic patient with emphasis on preventive care and screening (at least 1 outpatient)
- Patient with limited access to care (at least 2 inpatient or outpatient)
In all patient encounters students should:
- Recognize the importance of patient preferences when selecting among diagnostic and therapeutic options
- Appreciate the impact of the patient’s illness on his/her quality of life, well being, ability to work, and the family
- Recognize the importance of and demonstrate a commitment to the utilization of other healthcare professions in providing care
PROFESSIONAL BEHAVIOR: Students must understand and be able to demonstrate the attitudes and behaviors necessary to provide patient evaluation and care. Specifically, students must understand the importance of and display the following attitudes and behaviors.
- Independent, self-directed learning
- Integrity, honesty, altruism
- Compassion, tolerance
- Respect for patient privacy and confidentiality
- Respect for the patient’s rights
- A professional image in manner, dress and grooming
- Recognition of personal limitations in knowledge and skills and willingness to improve them
- Provision of patient care without interference by personal biases
- Advocacy for improving care of under-served populations
- Respect for the roles of other health care professionals
- Obligation of physicians to improve the health of all members of society and the public at large
- Understand the importance of being inquisitive, life-long learners
- Understand the importance of teamwork in patient care and how to function well on a clinical care team