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Inpatient Internal Medicine Clerkship (IM:8301)

ICON LogoThe third year Internal Medicine Inpatient Clerkship is a 6-week rotation with the over-arching goal of acquainting students to the evaluation and treatment of adults hospitalized with acute medical illness.

Clerkship Description

The third year Internal Medicine Inpatient Clerkship is a 6-week rotation with the over-arching goal of acquainting students to the evaluation and treatment of adults hospitalized with acute medical illness. Emphasis is placed on developing the skills to diagnose common clinical conditions and to recognize clinical presentations of common diseases. This is facilitated by enhancing the skills used in taking a patient history, performing a comprehensive physical exam and formulating problem lists with appropriate differential diagnosis.

Teaching and learning in the context of patient care is vastly different from learning in the classroom. On the inpatient service the questions to be answered are posed by the patients and the healthcare team. Answering such questions is an excellent way to learn about the patient while also solidifying the students’ knowledge base by learning the scientific and clinical material. Students will participate in the evaluation of a diversity of patients as part of a team of residents and students under the supervision of an internal medicine faculty member.

The clerkship will also provide students with opportunities to enhance their knowledge of core training problems and to develop basic clinical skills (such as EKG and CXR interpretation, physical diagnosis skills) through scheduled structured teaching sessions. These sessions are facilitated by a Teaching Resident, a third-year Internal Medicine resident specifically selected to teach M3 and M4 students on Internal Medicine. Students are encouraged to use these structured teaching sessions to guide their learning and to use the variety of patients encountered to enrich their knowledge base through hands-on experience and targeted reading.

The learning experiences on inpatient internal medicine follow the continuum of self-directed learning established in the first 2 years of medical school. This type of learning is crucial in a field which like internal medicine is not static. Developing patient based learning patterns will allow students to adapt to the changing body of knowledge and will help students become effective, efficient clinicians.

As Sir William Osler said, “The important thing is to make the lesson of each case tell on your education.” It is important to learn something from every patient by identifying one question that is not understood. By going to textbooks, journals and peers to find the answer, students learn and are able to apply this knowledge in the clinical setting. The retained images of patients will not only serve as the ‘outline, lecture notes and laboratory’ wrapped into one, but their many wonderful stories will also serve as a rich resource for student reflection.

Inpatient Clerkship Goals and Objectives


The student will demonstrate commitment to scholarly excellence with continued self-assessment and growth of knowledge and skills, and dedication to patient care treating others with mutual respect and dignity.


  1. Demonstrates a commitment to personal excellence (timeliness, attitude, initiative) and professional development (initiative, self-reflection, and seeking constructive feedback).
  2. Demonstrate sensitivity and competence in working with others of diverse backgrounds, anticipating the influence of culture on illness and health decisions.
  3. Demonstrates honesty and integrity in accurately conveying information and in documentation.

Patient Care

The student will be able to evaluate and manage adults hospitalized with acute illness and convey this information facilely on patient care rounds.


  1. Obtains, records, and communicates an accurate history and physical exam.
  2. Utilizes supplemental laboratory and diagnostic studies to support the most likely diagnoses.
  3. Interprets the clinical information by prioritizing a problem list
  4. Begins to demonstrate reasoned therapeutic decision-making for basic core problems.
  5. Presents patients in the context of daily care rounds (abbreviated presentations) and new patient presentations (comprehensive).
  6. Documents clear and accurate admission and progress notes on each patient.

Medical Knowledge

The student will demonstrate understanding of the clinical presentation, basic physiology, evaluation, and management of diseases frequently encountered in the inpatient internal medicine setting.


  1. Initiates an assessment and management plan on the following diseases/clinical presentations:< >Acute myocardial infarction/coronary syndromeHeart failureAcute kidney injuryChronic kidney diseaseAltered mental status (delirium)DyspneaFeverFluids and electrolytes< >hyper/hypokalemiahyper/hyponatremiabasics of fluid managementGastrointestinal bleedingLiver diseaseNosocomial infectionPneumoniaVenous thromboembolism/pulmonary embolismDemonstrates a basic approach to interpretation of EKGs, CXRs, and acid-base problems.
  2. Demonstrates an understanding of the indications, techniques, and complications of basic procedures.

Practice-based Learning and Improvement

The student will develop life-long learning skills used for improving patient care and fostering continued professional growth and development.


  1. Based on a self-assessment, creates a set of personal goals for the clerkship and reflects on personal progress, modifying as necessary.
  2. Demonstrates an initiative in seeking and applying new knowledge in the clinical setting.
  3. Applies an evidence-based medicine approach to addressing questions that arise in the clinical setting.
  4. Develops a reading/study plan that will work in the clinical setting.
  5. Responds to constructive feedback and suggestions for improvement over the course of the clerkship.

Interpersonal and Communication Skills

The student will continue to develop effective interpersonal and communication skills needed to establish and maintain professional relationships with patients, families, colleagues and other members of the health care team.


  1. Speaks with patients and their families using terminology that they understand.
  2. Exhibits communication that is compassionate and sensitive when interacting with people from a variety of cultures and backgrounds.
  3. Communicates in a facilitative, effective and efficient manner with members of the health care team.
  4. Educates colleagues as appropriate.
  5. Provides accurate and complete verbal presentations for assigned patients.
  6. Develops well organized and accurate patient notes.

Systems-based Practice

The student will develop an understanding of how health care is delivered in a hospital setting as well as resources available and the limitations encountered when caring for patients.


  1. Works as an effective member of the health care team, demonstrating reliability, initiative, organization, and helpfulness.
  2. Gains an understanding of interdisciplinary coordination and planning required when transitioning patients from the inpatient to outpatient setting.
  3.  Acts as the patient’s advocate.

Student Expectations

Responsibility for Learning: The process of learning involves integrating new knowledge with prior experiences and information to create a broader understanding. It requires reflection, planning and self-assessment.

Medical knowledge, skills in gathering and organizing data and excellent judgment are components of behavior that describe an outstanding student. Yet, perhaps the most important behavior is attitude. Students who create opportunities for their own learning, take pleasure in learning and who are willing to teach others are highly regarded by other team members.

It is a satisfying experience for students to carry forward the knowledge and skills developed in the first two years of medical school, as well as in their clerkships preceding the Inpatient Internal Medicine Clerkship, and see the integration of multiple disciplines in providing patient care. Medical knowledge from the basic science courses and Foundations of Clinical Practice, as well as concepts from Biomedical Ethics and Health Law, have particular relevance when dealing with patients hospitalized with acute illness. We hope that students will develop a solid foundation of skills and knowledge that will be applicable across the continuum of their training not only in internal medicine, but across all specialties.

Professionalism: The Department of Internal Medicine emphasizes the importance of this competency in the clerkship because it is the framework of all we do and who we are. It is a lifelong commitment to personal excellence and continued professional development. It is a standard of conduct towards our patients, as well as healthcare colleagues, and demands we aspire with each encounter to achieve the following expectations:

  • Show respect for time, both for clinical experiences and learning opportunities
  • Show respect towards others
  • Dress professionally
  • Demonstrate appropriate behavior under stress
  • Deliver the best possible care to each individual patient, regardless of race, age or ethnic differences
  • Conduct oneself in an ethical manner
  • Take responsibility for learning
  • Maintain patient confidentiality and discuss patient information only with those involved in the patient's care

Clinical Experience: Students are considered to be important members of the inpatient team assigned to the internal medical service for the care of patients. As part of the teams, students should expect to work with residents, attending staff, specialty consulting physicians and other healthcare personnel. The clerkship emphasizes the importance and rewards of experiential learning. Through direct patient contact and increasing responsibility for patient care, by observing the skills of residents and staff and by ongoing self-directed learning, students will acquire the clinical knowledge and skills necessary to care for patients. Both written and oral communication skills are emphasized. Students will learn to elicit an accurate history, perform a focused physical exam, formulate a reasoned differential diagnosis for each patient problem and begin to develop appropriate treatment plans for these problems. In addition, students will learn to synthesize this information into a concise presentation and to communicate medical information through comprehensive, well-developed medical documentation. Students make invaluable contributions to patient care and are encouraged the students to learn and experience as much as they can during the rotation.

Conferences: There is great breadth to internal medicine and while it will not be possible to teach students all of the body of knowledge during the six-week clerkship, there are a number of scheduled conferences that are available to students to supplement the clinical experiences.

Case-based Learning (CBL): During the clerkship interactive teaching sessions dedicated to internal medicine core topics are offered. The Teaching Resident facilitates this learning experience.

Internal Medicine Grand Rounds: Each Thursday afternoon at 1:00 pm in Med Alumni Auditorium (E331 GH) the Department of Internal Medicine presents Grand rounds. Students are expected to attend two (2) Grand Rounds during the six-week rotation.

Resident Core Conference: Monday through Friday residents come together for educational sessions. Students are invited to join their teams at these sessions.

Community Time: The Department of Internal Medicine feels it is important that students remain connected to their Learning Community and that they continue to promote and support the vertical integration of student life and medical education, two key goals of the Learning Communities. Every Tuesday from 12:30 PM to 1:30 PM is designated on the schedules as "Community Time." During this time students are encouraged to return to their community space in the MERF to check mail, meet friends or make new friends over lunch, and engage in conversation with M-1's and M-2's who are anxious to learn what students are experiencing in the clinical years. Please take advantage of this opportunity to share knowledge of the third year with the first and second year students who are anxious to know what might be in store for them as they progress through the curriculum and move from the basic science years to the clinical years.

For questions, please contact the Internal Medicine Education Center:

Lisa M. Antes, MD
Internal Medicine Clerkship Co-Director
Phone: 319-384-6437
Email: lisa-antes@uiowa.edu

Lee Sanders, MD, PhD
Internal Medicine Clerkship Co-Director
Phone: 319-384-8927
Email: marion-sanders@uiowa.edu