Guidelines

1. Length:  twelve weeks.
2. Site:  in-hospital medical wards and out-patient facilities. Students may also rotate through  nursing  homes, subacute  nursing  facilities or other similar places where  
   healthcare is delivered.
3. Orientation   at the   start   of   the clerkship:   this   should    include a   discussion of  the expectations  and   responsibilities  of  the clerk,  the   general   department      
   and student schedule and the assignment to residency teams and preceptors.  The 
   SGU  Clerkship   Director  in  Medicine  and   preceptors  are  responsible  to review  
   and discuss the educational goals and objectives of the clerkship   set  forth  in  this  
   manual before each rotation. Students must review the clerkship’s web-based introduction and orientation before starting the clerkship and/or the first day of the clerkship at the hospital.
4. Schedule:  all  day Monday  through  Friday; night, weekend  and  holiday  call with   assigned residency teams.
5. Attending  rounds  for  house  staff  and  students   at  least  three times per  week.
6. A   full  schedule  of   teaching   conferences  including  grand  rounds,  subspecialty  conferences and didactic sessions pertinent  to the needs of the students.
7. Preceptor sessions at  least four hours per week to  include   case  presentation  by    students and  beside rounds. These sessions  should include  a  teaching   physician  
   and students only.
8. A minimum of twelve clinical write-ups per student based on a detailed history and physical examination of patients. In  these write-ups students should  review write-  
   ups students should review relevant laboratory  and  imaging  data  and  include   a 
   complete  data  base  and  problem  list;  diagnostic,  therapeutic  and   educational     
   plans;  and  an  assessment   on each aspect of  the  case.   This   assessment should    
   require    considerable    supplementary    reading.   The  preceptor  must  read and  
   critique these write-ups and return them to the student in a timely fashion.
   
9. A mid-term evaluation of each student’s  performance  by a  preceptor or clerkship director which includes a review of the student’s electronic patient log.
10. An oral examination at the end of the clerkship based on the diagnostic entities   the student has seen and entered  into   the electronic patient log which   each student must keep current.  This  log  is  a  summation  of the  patient-studies  mentioned in Item 8 as well as any other patient with whom the student has had significant involvement.  These logs may be inspected by the dean and/or chair of medicine during site visits to assure a reasonable case mix. 
11. All students must take the NBME Clinical Subject Examination in Internal Medicine or the schools written exam. The school sends the grades on these exams to the hospital for incorporation into the final evaluation.

Core Topics & Patients

The core topics that provide the foundation of knowledge for internal medicine are those found in any number of standard text books. Students should choose a text book that can be read in its entirety during the 12 week medicine of clerkship. Examples of such textbooks are “Cecil Essentials of Medicine”, as well as Medicine Text by Kumar & Clark and Davidson. The end of clerkship oral exam and the internal medicine part of USMLE Step 2 CK is based on the content of such a book.

Students should make every effort to see patients with conditions listed below. This list is based on “Training Problems” published by the Clerkship Directors of Internal Medicine. In thinking about patients this list separates patients as follows:

Patients with a symptom, sign or abnormal laboratory value

1. Abdominal pain
2. Altered mental status
3. Anemia
4. Back pain
5. Chest pain
6. Cough
7. Cronic pain
8. Dyspepsia
9. Dyspnea
10. Dysuria
11. Fever
12. Fluid, electrolyte, and acid-base disorders
13. GI bleeding
14. Hemoptysis
    
15. Irritable bowel
16. Jaundice
17. Knee pain
18. Rash
19. Upper respiratory complaints
20. Weight loss

Patients presenting with a known medical condition.

1.  Acute MI
2.  Acute renal failure and chronic kidney disease
3.  Asthma
4.  Common cancers
5.  COPD
6.  Diabetes mellitus
7.  Dyslipidemia
8.  CHF
9.  HIV
10.  Hypertension
11.  Inflammatory bowel disease
12.  Liver disease
13.  Nosocomial infection
14.  Obesity
15.  Peptic ulcer disease
16.  Pneumonia
17.  Skin and soft tissue infections
18.  Substance abuse
19.  Thyroid disease
20.   Venous thromboembolism

Educational Objectives

The twelve-week core clerkship in internal medicine is based in acute care medical centers. The curriculum is designed to provide students with the formal instruction and patient care experience so as to enable them to develop the knowledge, skills and behavior necessary to begin mastering the following clinical competencies essential to becoming a knowledgeable, well-rounded, caring physician.

Students gain these and the additional skills outlined below by functioning as integral members of the patient care team, participating in resident work rounds and teaching attending bedside rounds every weekday and admitting patients when on-call and following them until discharge under the continuous supervision of the residents. Additional activities include meetings with their preceptors at least four hours per week (conferences for students only), attendance at  daily didactic conferences an independent learning including completing web-based education assignments. An orientation at the start of the clerkship outlines the educational goals and objectives of the clerkship as well as the responsibilities of the third year clerk, and his or her assignments and schedules.  Clerks are provided feedback on their progress during both mid-course and final summative reviews with their preceptor or clerkship director.

MEDICAL KNOWLEDGE

Demonstrate knowledge of the  principal  syndromes   and  illnesses in Internal Medicine, their pathophysiologies and the various  diagnostic and therapeutic options.      

Demonstrate knowledge of the indications for and the ability to interpret standard diagnostic tests, e.g., CBC, chemistries, chest x-rays, urinalysis, EKG’s.

Demonstrate knowledge of the indications for various levels of care post-discharge, e.g., short and long term rehabilitation, long-term skilled nursing facility care, hospice, home care, etc.

Demonstrate knowledge of, and concern for, advance directives, informed consent, patient confidentiality, and palliative and end of life issues.

CLINICAL SKILLS

Take a comprehensive history and perform a complete physical exam; formulate a differential diagnosis and therapeutic plan, employing concern for risks, benefits, and costs. Document proficiently.

Demonstrate  facility in  communication  with patients, families and other care – givers in a culturally competent manner

Analyze and document additional clinical information, lab tests  and changes  in patients’ clinical status; note changes in the differential diagnosis or in the diagnostic or therapeutic plans.

Demonstrate  proficiency  in basic  procedures,  such  as  venipuncture, insertion of intravenous lines, urinary bladder catheterization, etc.

PROFESSIONAL BEHAVIOR

Demonstrate a regimen of independent learning through the reading of suggested basic texts,  
research via the Internet and through other electronic resources, e.g., Up-To-Date,
maintenance of the patient encounter log and completion of the web-based educational
program requirements.

Demonstrate a commitment to quality, patient safety and self-directed improvement.

Demonstrate competency and comfort in dealing with people of varying racial, cultural, and
religious backgrounds

Demonstrate a commitment to treating everyone – patients, families and other caregivers –
 with respect.

Participate fully with the patient care team and fulfilling all responsibilities in a timely fashion. 
Maintain a professional appearance and demeanor.

Demonstrate  facility  in  working   in  concert  with  other  caregivers,  nutritionists  and   social
workers/discharge  planners  to obtain  optimal, seamless  multidisciplinary  care  for   their
patients, both during the hospitalization and after discharge.

Reading

Reading should proceed on four levels, each with a different goal.

1. Reading about your patients in order to “learn from your patients” and to develop a deeper understanding of patient care.
2. A systematic and thorough reading about the overall field of internal medicine in order to prepare for the end of clerkship shelf exam and the Step 2 CK.
3. Detailed in depth reading about specific topics of interest and for assignments.
4. A review of basic science and relevant research in order to reinforce the fundamental principals of clinical medicine and understand advances in patient care.

Students can choose from a large number of comprehensive texts book of medicine, medical sub-specialty texts, journal review articles and internet resources to read as outlined above.

Web Based Educational Assignments

1. Students are encouraged to utilize SIMPLE (Simulated Internal Medicine Patient Learning Experiences).  This is a series of clinical exercises developed by the clerkship directors of internal medicine. Students can access this program by going to www.med-u.org=> “register” at  the  top  right-hand  corner =>  Institutional  Subscribers.  The    iInTime Virtual Patient Cases – Registration page opens. Provide your personal information in the prompts. Important: use your SGU email address.
2. On   the   University’s    website    in   “MY SGU”   the   university   has   made   available   the Epocrates MedSearch tool. This resource allows you to instantly access clinical information on more than 3,300 drugs and hundreds of diseases.