Internal Medicine

Welcome to the Junior Clinical Clerkship in Medicine! The objective of this course is to provide the student with the opportunity to apply what has been learned in the Foundations in Medicine Course both to inpatients and outpatients and their problems. It is the expectation of the department that the student should become comfortable with his/her ability to approach a patient with a medical problem, elicit a useful history, perform a thorough physical examination, appreciate pertinent abnormal symptoms and signs, and to organize such information in a concise and knowledgeable manner so that rational management and evaluation may be undertaken. Students should become familiar with the pattern of clinical presentations of common medical diseases. At the end of this rotation students should:

• Be able to obtain an accurate, thorough, pertinent, and organized history from the patient, the family, and/or the medical record.
• Be able to perform a comprehensive physical examination, with the ability to "target in" on the major systems involved.
• Demonstrate basic skills of interpretation of chest x-rays, EKGs and blood smears.
• Be able to synthesize the patient data [i.e., H&P, X-rays, EKG, appropriate laboratory studies] to formulate a problem list for each patient.
• Be able to formulate a differential diagnosis for each problem.
• Demonstrate the ability to record a patient's written history and physical in a concise, logical, thorough and efficient manner.
• Demonstrate self-directed, independent study of learning issues including computerized literature searches with retrieval of pertinent recent journal articles.
• Be able to demonstrate knowledge of the fundamentals of patient management [diagnostic, therapeutic, and follow-up plans] for common medical problems.
• Be able to perform clinical problem solving using the large fund of knowledge acquired the first several years of medical school, and using that database to solve the problems of each patient.
• Develop a broad fund of knowledge from the field of internal medicine concentrating on common presentations of common diseases, and a detailed understanding of the disease states of their individual patients.
• Demonstrate utmost professionalism.

Quantified criteria for the minimum acceptable clinical experience have been developed based on the training problems developed by the Clerkship Directors in Internal Medicine/Society for General Internal Medicine. The students have been encouraged, in past academic years, to review the CDIM/SGIM http://www.im.org/CDIM/ core curriculum, but no logbooks were required of them to document the types and numbers of patient contacts. For the 2004-2005 academic year, students on the Medicine rotation will be required to keep a log of the number of meaningful exposures which fulfill the CDIM/SGIM learning objectives. It is expected that students document at least one exposure [write-ups, morning report, bedside rounds] for each of the symptoms, lab tests, illnesses, etc. listed. Because the clerkship cannot ensure that every student will see the same patients, any gaps in the students' exposures will be filled by the use of standardized/simulated patients, Teaching Resident bedside rounds and case presentations. An informal poll of students at the end of the 2003-2004 academic year indicated that although some types of patients are overrepresented [e.g., heart failure] each student has had at least one meaningful exposure to patients whose symptoms or illnesses reflect all of the CDIM/SGIM core content. Additionally, it is expected that students will perform the procedures at least once under the supervision of an experienced provider.

CDIM/SGIM Core Training Problems:

• Abdominal Pain
• Acid-Base, Fluid, Electrolyte Disorder
• Acute Renal Failure
• Altered Mental Status
• Anemia
• Back pain
• Cancer
• Chest Pain
• Congestive Heart Failure
• Chronic Obstructive Pulmonary Disease
• Cough
• Depression
• Diabetes Mellitus
• Deep Venous Thrombosis
• Dyspnea
• Dysuria
• Gastrointestinal Bleeding
• The Healthy Patient
• HIV Disease
• Hypertension
• Joint Disease
• Lipid Disorders
• Liver Disorders
• Myocardial Infarction
• Nosocomial Infection
• Pneumonia
• Smoking
• Substance Abuse

Procedures:

• Insertion of a Foley Catheter
• Venipuncture
• Insertion of a Nasogastric Tube