General expectations for ALL students
I. Organizational structure:
- First day of service – please report to 6RC work rooms (Team A, B and C)
- Provide residents and faculty with your contact information
- Introduce yourself to the 6RCE and 6RCW clerks on the first day
- Day off: core students Sunday; subinterns either Saturday or Sunday
- Core students: Sundays; Clerkship directors must approve any other day off in advance
- Subinterns: either Saturday or Sunday to coincide with senior residents day off
- Daily Admissions: 8:00 AM until a team cap, based on admission schedule
- Night call is not expected. For the subinterns only, ONE night call may be taken during your General IM rotation on 6RC
- Make every effort to learn as much as possible during this rotation and demonstrate your interest in learning to the team
II. Patient care:
- Round daily in the morning with the Internal Medicine teaching team
- Present patients in SOAP format on daily care rounds
- Work up at least one new patient daily and present to the attending
- Stay up-to-date with normal and abnormal test results
- Always make sure your patients are aware of the plan
III. Educational responsibilities:
- Each week identify at least 3 skills you would like to work on while on this service, share them with the team and work to achieve your educational goals
- As early as possible, let your attending know of specific cardiac procedures or tests that you wish to observe
- Attend educational sessions:
- Clerkship specific teaching sessions
- Resident Core Conferences
- Internal Medicine Grand Rounds
IV. Communication:
- Documentation:
- Write admission notes and daily progress notes in electronic medical record – please discuss details with your Senior Resident
- Write/pend orders and immediately notify the senior resident of availability to sign in EPIC
- Contribute to discharge summaries (work with 6RC nurse navigators, social workers, pharmacists, interns, and residents on discharge planning)
- Write and practice patient hand-off
- Attendance/observation at one goals of care discussion is strongly recommended
Student Expectations based on level of training
Core Clerkship Students (M2/M3) |
Advanced Clerkship/Subinterns (M3/M4) |
| 1. Supervision | 1. Supervision |
| Function under supervision of the team (interns, residents and attending) | Function semi-independently with a level of responsibility and supervision similar to a first year resident. Supervision is by attending and senior residents |
| Learn through a process of observation and controlled participation in patient care. Admit patients in the presence of your team members. | Independently interview and examine patients, formulate clinical reasoning, differential diagnosis, and share your final assessment and plan with your senior resident and attending. |
| Interns and senior residents remain the primary point of contact for all your patients. |
As soon as you admit the patient, put your name and a pager number in EPIC as ‘Primary contact person’, so that floor clerks and nurses can communicate with your directly: -- click on ‘Attending’ name >> ‘Open Treatment Team’ >> ‘Add me’, chose relationship ‘1st Contact or Resident >> Accept. Let the subinternship program director know if you are not being directly contacted by the nursing staff regarding your patient matters despite your efforts to improve such communication. |
| Learn as much as you can from every patient you come across. | Learn as much as you can from every patient you come across. It is strongly recommended that you engage yourself in any interesting patient cases or clinical concepts, review literature and share it with the team. |
| 2. Number of patients | 2. Number of patients |
| Follow 1 or 2 patients | Follow at least 2 or 3 patients. Discuss a total number of patients that you wish to manage beyond this expectation with your team |
| 3. Communication | 3. Communication |
|
Observe and practice doctor-patient communication skills with all patients |
Practice doctor-patient communication skills, using the PEEER Model and complete self-evaluation for at least 2 patients (Week1 & Week 4) |
| Make every effort to attend weekly clinical case presentations by during ‘tea time’ (6RC) and actively participate in small group discussions. | Once during your subinternship, during a ‘Wards 101’ (6RC) you will be required to present one of your patients for students, interns, residents , chief residents and staff. |
| 4. Patient notes | 4. Patient notes |
|
Sign your final note in EPIC (no cosign) Request verbal feedback on each Admission and Progress note from staff and residents |
Sign your final note in EPIC (no cosign) Each week, print at least one Admission Note and at least one Progress Note to allow for verbal feedback from residents and staff. Also use a rubric self-assessment tool downloaded from ICON/Canvas each week to document progress in effective note-writing skills |
| 5. Evaluations | 5. Evaluations |
|
At the end of the 1week, initiate evaluations to Interns, senior residents and attending |
At the end of the 2 weeks, initiate evaluations to attending and senior residents. |
Expectations for Internal Medicine Faculty and Residents
- Review expectations with student as well as Goals and Objectives on first day
- Serve as a role model [research studies have shown that clinical skills, personality and teaching abilities were the most important characteristics making physicians excellent role models in the eyes of their students; Wright S. et al, The impact of Role Models on Medical Students. J Gen Intern Med 1997;12:53.
- Encourage student participation on rounds and highlight aspects of patient care from all patients on the service.
Note, clerkship students and subinterns are currently not ACLS certified - Emphasize student’s clinical decision-making skills and development of management plans
- Highlight aspects of the evaluation and management of the patient with cardiovascular disease.
Make sure that students, especially subinterns, are exposed to a variety of different cases during their rotation. The following are common cardiac conditions that students should be exposed to: Acute kidney injury, acid base, electrolyte imbalance, chest pain, heart failure, pneumonia, UTI, altered mental status, DVT/PE, abdominal pain, liver disease, and many others. - Focus part of teaching to level of student; spend time each day reviewing a topic with the student
- Give verbal feedback to students on both written documentation and oral presentations
- Be supportive of students’ educational venues
- Encourage students, especially subinterns, to review the literature relevant to aspects of patient care and share with the team. Consider mentoring student to present interesting cases at local ACP Chapter Clinical Vignette competition
- Provide opportunity for students to observe goals of care discussion
- At the end of the rotation, students will send you an e-mail with a link to electronic Evaluation. Complete the online evaluation within one week as any delay in completion of your evaluations will lead to delays in final grade completion and may require Dean’s approval (refer to the attached evaluation anchors). Comments regarding student’s skills as well as specific examples of the student’s contributions to patient care should be provided, including mini-literature searches and leading discussions.
Learning/Curriculum
- The emphasis on this service will be on learning to:
- take a good history
- perform a good physical exam
- order and interpret appropriate imaging/testing
- learn how to present the case in an organized fashion
- clinical reasoning, explanation and planning
- organized and appropriate documentation
- Core topics required on inpatient internal medicine core clerkship include:
- Approach do patient with hypo-/hyperglycemia
- Altered mental status
- Fever workup
- EKG interpretation
- Additional topics
- Assessment of the patient with shortness of breath
- Appropriate management of patients with acute kidney injury
- EPIC rounding tips: rounding reports