TTUHSC School of Medicine
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Ambulatory Rotation for 4th Year Students

Location:  Internal Medicine Clinic, TTUHSC

Duration:  4 weeks


To meet the objectives in increasing knowledge and skills and developing professional attitudes and behavior while caring for adult patients on Internal Medicine ambulatory service.



The student should

Demonstrate ability to evaluate and manage patients with the following chronic conditions such as

DM type I & II, HTN, CAD, CHF, Thyroid disorders, OSA, COPD, HIV etc.

And with acute conditions such as

respiratory illnesses, pain, common skin infections, drug side effects etc.

Learn and master the screening guidelines for colon/ cervical/ prostate/ breast cancers, osteoporosis, hyperlipidemia, hypothyroidism, and adult vaccination schedule.

Recognize alcohol and tobacco dependence problems with appropriate management and referral.

Learn to order labs in an appropriate manner.


The student should

Develop skills in performing an accurate history and physical with differential diagnosis and management plan with proper time management in a clinic setting.

Participate in procedures like I/D of abscess, joint injections, skin biopsies etc.

Develop the ability to interpret labs and ECGs.

Determine the clinical stability of the patient for appropriate disposition.


The student should

Establish trust with patient by effective communication skills (as referring patients by their names) and maintaining patient privacy and confidentiality.

Be sensitive to diverse factors affecting patients and their health care needs as race, culture, income and ethnicity.


The student should

Learn care coordination with nursing staff and other ancillary services.

Discuss ethical issues, including end of life care where appropriate.


The student will be rotating through general internal medicine and some subspeciality (Endocrine/ Infectious disease/ Pulmonary/ Nephrology) clinics as follows:

Day                          AM                                                                      PM

Monday                  Endocrine (Dr. Lado)                                    Study Time

Tuesday                 Pulmonary (Dr. Jumper)                                   Study Time

Wednesday            Infectious Disease (Dr.Winn)                         Study Time

Thursday                IM (Dr. McDonald)                                             Study Time

Friday                     Nephrology (Dr. Bello-Reuss)                           Ambulatory Exam

The student should

Care for approx. 3-4 adult patients per day with above described disease mix.

Present cases to the supervising attending with accurate history and physical and with a  differential diagnosis, assessment and plan.

Present a case at morning report once during the rotation.

Maintain patient log.

Attend morning reports, journal clubs and noon conferences.

Read core ambulatory articles.


End of rotation evaluation forms to be filled by faculty attending based on the presentations, patient care and literature review.

Student progress and satisfaction will be assessed weekly.


The student should

Manage patients under the supervision of senior resident or attending.

Demonstrate high standards of professionalism during patient care.


The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation form.