Wayne State University School of Medicine

1. Department of Internal Medicine Clerkship Orientation 2005 Wayne State UniversitySchool of Medicine

2. The Organization • Two month • Inpatient clerkship • Single site assignment

3. The Learning Experience • Students function as an integral member of the health care team • The learning experience is based on • direct patient care • clinical teaching • conferences • personal reading

4. Overall Goal • To help students understand and obtain practical experience in the • recognition • evaluation • diagnosis and management of adult patients with acute non-surgical illnesses

5. Specific Goals • To be able to evaluate and manage sick hospitalized patients. • To develop familiarity with common problems seen by internists • To understand the role of the internist in providing care and coordinating care

6. Learning Objectives:Core Problems • Learning Objective: • To develop familiarity with the core problems in Medicine • Measurement: • This objective may be satisfied by either caring for a patient with one of the identified core problems or • by completing a “Medcase” for that problem. • Students must document patient encounters and the corresponding problem on Campus Mobility. • Medcases profiles must be submitted to clerkship director, all Medcases must be completed XXXX before the conclusion of the rotation.

7. Anemia 588 Arrhythmias Atrial fibrillation Arthralgas/arthrits 480 Chest pain CAD/ACS 451 Common cancers Breast 265-s Colon 588 Lung 501 Cough and Dyspnea Asthma/COPD 416 Heart Failure 445 Pneumonia 472 Diabetes 549 Gastrointestinal Ds Abdominal pain 359-s 319-s Diarrhea 607 GI bleeding Geriatric syndromes Dementia 464 Syncope 554 Hepatitis 494 HIV/AIDS 450 Hypertension 773, 397 Kidney Disease Kidney failure 402 UTI Substance Abuse Thromboembolism 489, 460 Core Problems

8. Learning Objective:The H&P • Learning Objective: • To obtain an accurate medical history and perform a thorough physical examination in an efficient and timely manner • Measurement: • Successful completion and logging of a minimum of 12 H&Ps. • Satisfactory evaluation of one H&P by site director

9. Learning Objective:The SOAP Note • Learning Objective: • To compose an accurate and complete SOAP note documenting the patient’s daily progress • Measurement: • Satisfactory evaluation of SOAP note by site director • Satisfactory evaluation of SOAP note on the end-of-rotation OSCE

10. Learning Objective:Decision Making and the ddx • Learning Objective: • To develop diagnostic decision-making skills that incorporate probability-based thinking • Measurement: • Successful completion of the assessment and plan portion of H&P and SOAP notes documenting • well ranked differential diagnoses and • clinical rationale for the proposed diagnostic work-up

11. Learning Objective:Interpretation of basic labs • Learning Objective: • To accurately interpret the results of basic tests and properly determine how the results should influence patient management including analysis of • acid base and electrolyte disturbances • renal function • peripheral smears and complete blood counts • liver function tests • basic electrocardiograms • chest radiographs

12. Learning Objective:Interpretation of basic labs • Measurement: • Students will complete the “Interpreting Diagnostic Tests” Examination on Blackboard scoring a minimum of 80% correct.

13. Learning Objective:Therapy • Learning Objective: • To develop therapeutic decision-making skills that incorporate pathophysiologic reasoning and evidence-based knowledge • Measurement: • Satisfactory completion the plan portion of the H&P and SOAP note.

14. Learning Objective:Good Presentation Skills • Learning Objective: • To develop facility with different types of case presentation: written and oral, new pt and follow-up • Measurement: • Satisfactory clinical evaluations from their attending and resident physicians • Satisfactory completion of the presentation component of the end-of-rotation OSCE

15. Learning Objective:R E S P E C T • Learning Objective: • To recognize ethical dilemmas and respect different perceptions of health, illness, and health care held by patients of various religious, cultural and ethnic backgrounds. • Measurement: • Students will be evaluated on their participation in the small group discussion addressing these issues during the reorientation session

16. Learning Objective:Communication Skills • Learning Objective: • Students will develop proficiency in communication and interpersonal skills with patients and colleagues with attention to how diversities of age, gender, race, culture, socioeconomic class, personality, and intellect require sensitivity and flexibility • Measurement: • Satisfactory completion the end of clerkship Internal Medicine OSCE

17. Learning Objective:Collaboration • Learning Objective: • To work in collaboration with other professionals to ensure optimal patient care. • Measurement: • Students must have two professionalism card completed by ancillary personal on the internal medicine clerkship

18. Learning Objective:Transition of care • Learning Objective: • To recognize the importance of ensuring smooth transition of care from acceptance of patients from the Emergency Department, to transfer of patients to other services and finally to discharge. • Measurement: • Completion of three discharge progress notes one of which must be selected and turned in for evaluation by the Site Director

19. Learning Objective:Recognizing systems • Learning Objective: • to recognize that systems are critical in achieving high quality patient care. Students will make use of systems thinking and participate in the process of assessing current practice. • Measurement: • Completion of a 2-3 paragraph reflective essay outlining the role the health care system played in the outcome of one assigned patient. This must be turned in to the Site Director prior to completion of the rotation.

20. Learning Objective:Life long learning • Learning Objective: • To develop and practice self-directed life-long learning, including the ability to access and utilize information systems and resources efficiently. • Measurement: • Student will be required to do one formal presentation to their team including literature review, identification of one review article and one recent article. This will be evaluated by the attending physician.

21. Attestation I have received and reviewed the goals and objectives for the Junior Clerkship in Internal Medicine. I am familiar with the expectations and understand my role and responsibilities for this clerkship. ____________________________ _______ Student signature Date ____________________________ _______ Attending physician signature Date ____________________________ _______ Resident signature Date ____________________________ _______ Intern signature Date ____________________________ _______ Intern signature Date

22. Venipuncture Blood culture Peripheral IV catheter insertion Arterial blood gas Throat culture Nasogastric tube Digital rectal Urethral catheterization Place and interpret a tuberculin skin test (PPD) Electrocardiogram Procedures

23. Procedures • Indications • Contraindications • Risks • Benefits • Alternatives to a given procedure. • What the patient’s experience of the procedure will be.

24. Student Expectations • Attend Year III Internal Medicine Orientation • Attend Site Orientation • Follow Site Specific schedules • Attendance is mandatory; students are excused for • Weekly continuity clerkship session • ACLS • WSUSOM recognized holidays--MLK Day, not Valentines

25. Daily Schedules • Arrive at the hospital early enough to see and evaluate their patients prior to work rounds • Attend work rounds and teaching rounds with their team • Attend required conferences • Attend laboratory and x-ray rounds

26. Call • Students will take call with their assigned team. • The nature of call depends on the assigned site; however, call will be no more frequent than every fourth night. • Students may stay in the hospital all night with their team or with the night float team as required by their specific sites.

27. Student Duty Hours • Students’ duty hours follow resident duty hours as described under current RRC guidelines. • May not work more than 80 hours per week • Must have an average of one day off in seven averaged over four weeks. • May not spend more than 30 hours in the hospital at one time • Must have a minimum of 10 hours between duty shifts.

28. References and Recommended Reading • Read Dubin the first week • Read about your patients in a standard text book • Do MKSAP 2 questions every night • Work through Medcases • Use a short internal medicine manual eg Cecil's to read broadly

29. Evaluation and Grading • Students will be evaluated by each supervising resident and each attending • Intern evaluations are NOT used for grading • Midway through each month of the clerkship, students must complete WSU formative evaluation form and review with attending physician. This will set the stage for receiving meaningful feedback.

30. To achieve an overall “Outstanding” clinical evaluation 7 out of 11 items must be in the exceeds expectations category

31. The Exam • NBME subject examination • 100 questions • 2 hours and 10 minutes • It is not enough time

32. Grading

33. Year III Grading Form

34. Grade Appeals • All appeals must be made in writing • Appeals will be presented to the Internal Medicine Medical Education Committee which is composed of Year III site directors. • At no time may students appeal their grade directly their resident or attending physicians or the site director. • The IM MEC will meet and make a determination regarding the student’s appeal. • Student may appeal the IM MEC finding to the Year III Clerkship Grading Committee

35. Turn in signed attestation Complete 12 work-ups Submit H&P, follow-up SOAP note and discharge note Give formal presentation with lit search and articles Complete reflective essay Complete WSU mid-rotation form, review with attending Complete OSCE Complete Blackboard lab interpretation exam Complete clinical rotation Log all cases and procedures on PDA Submit Medcase transcript Pass shelf exam Complete clerkship evaluation on PDA Checklist