Internal Medicine
Medical Clerkship » Course Description
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Course Description Overview»
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General Guidelines
Duration.
The clerkship in Internal Medicine at the Texas Tech University Health Sciences Center - Lubbock, is a 12-week experience. There will be 8 weeks of "ward" inpatient general medicine, and 4 weeks of a subspecialty or ambulatory elective experience.
back to topInpatient Ward Rotations
Team Assignment.
There will be two to four week blocks when you are assigned to an inpatient team. Each "team" is typically composed of a faculty attending, one senior medical resident (PGY-2), one or two interns (PGY-1), and two medical students - a total of six or seven persons. The student is a member of the team and participates actively in the care of assigned patients and may assist with the care of other team patients as needed.
Ward Activities.
While on ward rotations, specific responsibilities and educational activities include Attending Rounds and Work Rounds. Work rounds typically take place between 8:00 and 9:00 a.m. daily at University Medical Center Hospital. Teaching attending rounds are usually scheduled in the morning from 9:30 a.m. to 11:30 noon either daily, but this may vary according to the schedule of the attending physician. Bedside rounds tend to be management focused and patient oriented. This time should be used to develop effective doctor-patient and doctor-doctor communication skills. Longer academic discussions that do not require the patient's participation can will be held in one of the conference rooms.
Call.
During ward rotations, you will not be required to do overnight call. If your patient evaluations and ward duties are completed you may leave at 10:00 pm.
Patient Evaluation.
You are expected to "work-up" 3-5 new patients each week (1-2 patients each call day). In general, you should average at least three patients per week. Thus, you will be able to evaluate 30 or more patients during a 12-week medicine clerkship. You should write a full history and physical examination, and record the initial database. You should define the problem list for each patient, starting with the presenting problem and include a differential diagnosis for each problem. A plan of action for each problem should be devised and recorded.
See your patients as soon as possible after they are assigned to you. Your completed evaluation should then be written up and, if time permits, reviewed with your resident or intern before presenting to your attending physician on rounds. The write-up should be given to your attending for evaluation.
Generally, the student should do a complete workup of one patient every time on call on the wards (every fourth day). The write-up should be completed and on the chart by morning rounds. The write-up should usually be 2-4 pages and should include differential diagnosis with discussion of pathophysiology, therapeutics of the case based on readings of a large medicine text and/or current literature. Xerox a copy and give it to your attending and keep a copy to review. Keep your log current. You should write progress notes on all of your patients daily.
Use the problem-oriented format, e.g., SOAP notes, to provide a concise and informative style of documentation, rather than simply transcribe sets of laboratory values. Progress and procedure notes can be written under the supervision of the house staff.
You may write orders relative to the work-up and therapy of your patients if done under the direct supervision of your residents. These orders must be co-signed by the resident at the time they are written
Log Book.
You should list all patients on whom you have done a complete H&P, including those seen in the ambulatory setting and on consultation services on your "log". The log provides a means of monitoring the scope and diversity of your learning experience. Periodically you will be asked to submit your log to permit a review of your patient experience. If you find that you are not seeing a wide variety of patients, show your log to your attending and ask to be assigned different types of patients. Procedures completed are to be noted in the back of the Log Book.
Information Access.
When you read about your patient you will likely find yourself challenged by the immense and continuously growing literature relevant to providing high quality care. You should become familiar with the key sources for obtaining updated information on issues relevant to the medical management of adult patients. I recommend that you obtain one of the standard textbooks of internal medicine as your basic resource for reading about patients whom you evaluate. The more abbreviated study guides and books can also be used for study materials. They are particularly useful in providing an overview of subject areas before lectures and when reviewing for exams. You may find it helpful as you scan your knowledge base to determine specific subject areas for more in-depth study. Finally, don’t forget to regularly scan some of the key journals such as The New England Journal of Medicine, The Journal of the American Medical Association, Annals of Internal Medicine, Archives of Internal Medicine, Lancet, etc. I recommend you perform a computerized literature search to find articles pertinent to a specific clinical question at least once a week.
Scheduled conferences.
Core lectures are usually scheduled at 7:15 am. Check your student lecture schedule for topics, time and location. Noon conferences are listed in the Department of Internal Medicine Conference Schedule that is published weekly and are posted on the Student Bulleting Board across from the Coordinator's office.
Attendance.
Attendance is required at morning report, medical student core curriculum lectures, and noon conferences.
Absences.
If you find you will be late or absent from any clerkship duties, call Lesa Rollison, the Clerkship Coordinator at 743-3155 ext. 223 as soon as possible (by 8:30 am preferably). In addition to notifying Lesa, please notify your Ward Attending AND Senior Resident if you are on a Ward rotation. And please don’t forget, the guidelines for years 3 and 4 (see your TTUHSC School of Medicine Student Handbook) require there be no unexcused absences during clerkships. Any absence must be reported to the Clerkship Director and a Student Absence Form filled out.
Clerkship Student Interview and Examination Exercise.
At some point during the clerkship you will be scheduled to interview and examine a patient while being observed by a faculty member. The faculty member will then provide feedback on your performance and complete an evaluation form for signature by both you and the faculty member. The primary emphasis of this exercise is to provide constructive feedback as you develop and improve your techniques for interview and examination
Elective Rotations.
Electives are designed to gain further experience with adult internal medicine patients. Electives may be done on Infectious Diseases, Nephrology, Cardiology, Gastroenterology, Allergy Rheumatology, Hematology/Oncology, Pulmonology, Endocrinology, or the Intensive Care Unit, depending on availability and scheduling demand. In most cases, your duties will be very similar to those on the general medicine wards and will entail obtaining histories, performing physical exams, and performing the usual reporter, interpreter, and manager functions of the clinical clerk.
back to topGrading Policy
You will be evaluated on your performance during ward and clinic rotations. Your grade will be based on three sources of information:
The National Board of Medical Education (NBME) part II Medicine subtest will constitute 40% of the grade. Evaluations by faculty physicians and house staff will constitute the remaining 60% of the grade. Points will be added to your final grade for online evaluations and attendance requirements.
Mid-way through the clerkship you will be given an evaluation document to complete, by the Clerkship Coordinator. An appointment will be made with the Clerkship Director for review of this document, and feedback about your performance. You should bring the completed mid-rotation evaluation form, your patient log, and your Clinical Examination Exercise form with you to the meeting. This mid-rotation evaluation is not graded and is for your information about your strengths and weaknesses.
