Introduction to Clinical Clerkships

Susan M. Kies, Ed.D.

University of Illinois at Urbana-Champaign

Brief Description of the Course: A two-week experience for new M-3 students, starting immediately before the core clerkship schedule begins. The course is designed to acclimate the students to the clinical program and give each clinical department time to orient students to materials before they enter core clerkships and reinforce clinical issues introduced during the M-2.

GOALS AND OBJECTIVES:

  1. Communication: Students will learn to communicate appropriately in different clinical settings, understanding the appropriate breadth and depth of the communication, with diverse health care professionals in both written and oral formats.
  2. Hospital Environments: Students will learn the institutional expectations and appropriate behaviors associated with each clinical teaching site. These may include procedures, administrative components and procedures, building upon the knowledge base learned in the second year.
  3. Survival Skills: Students will learn general facts, procedures and behaviors that will aid them in success during their clerkship training. Topics specifically addressed include: professionalism; wardsmanship; and, interaction with attendings, peers and other allied health professionals.
  4. Emergent Conditions by Specialty: Students will learn the most common emergent patient presentations within each clinical specialty, understanding how each discipline approaches patient problems and discuss their role, as students, in each patient’s care.
  5. Advanced Topics: Students will expand their knowledge of specific topics previously identified as anxiety producing for new clerks.

Development of the Course:

During the planning phase of this course, initial meetings were held with individual department heads and clerkship directors to determine the elements contained in each department’s orientation to their clerkship. These were outlined and discussed in the larger curriculum committee meeting. The committee reviewed areas of the clinical curriculum that overlapped and considered them for placement into this course.

Further meetings were held to determine additional skills that would be appropriate to include in the course. Both faculty and students gave input at these meetings. The following Critical Skills Checklist outlines these skills. The faculty adopted the list to form the foundation of the Introduction to Clinical Clerkships course.

Delivery of the Course:

During the M-2 curriculum, students are encouraged to hone independent learning strategies. This is reinforced in the Introduction to Clinical Clerkships (ICC.) A major feature of the course is the interaction of the student with inpatients. The first day of the course, students are instructed to identify a hospitalized patient, from a pre-assigned service. Students are assigned to either adult medicine, pediatrics, obstetrics and gynecology, family medicine or surgery.

After the student makes contact with the assigned service, the hospital site coordinator assists them in finding a patient. The student then completes a history and physical examination in the same format utilized during their M-2 curriculum. Over the period of the two-week course, students must complete a comprehensive written (typed) admission evaluation, including a problem list, impression list, plans, admitting orders, day one progress note, off service note and a brief discharge note. In addition, they write a prescription for one or more medications for care at home. They obtain a copy of the patient’s EKG or, if unavailable, another EKG for further discussion with their small group. All rules related to HIPAA apply to patient records.

During the small group (four to five students) component of the ICC, students work with a variety of clinical preceptors and each other to discuss their patients and the documentation gleaned from the examination of those patients. Through these discussions, students learn to and reinforce learning on the various kinds of chart documentation necessary to care for hospitalized patients. Specifically, they learn what to write in charts, how to write it and when to write it. They discuss each others’ patients and the documentation that must be written to care for the inpatient. When the two weeks are complete, students will have presented, discussed and written those documents listed above.

Evaluation of the Course:

Students are evaluated on a pass/fail basis by their clinical preceptors. At the end of the two-week course, students are individually interviewed regarding their experiences during the two-week course. A follow up survey is given to students after they complete three months of core clerkships and then again after six months. Clerkship directors are also surveyed for their comments on student preparation at three and six months.

Critical Skills Checklist:

  1. Wardsmanship

Seek information regarding patient care

Explain what occurs on rounds

Display proper behavior on rounds

Discuss different types of presentations to faculty

The following can be accomplished using one case in a small group setting with attending physician acting as group facilitator:

Develop a case presentation

Present a case to an attending physician on morning rounds, then discuss feedback from peers and group facilitator

Present a thumbnail case to an attending physician for a specific question or problem and discuss feedback

Present a brief case over the telephone to attending physician

Write a problem list and relate the list to the written student history and physical examination

Write orders

Write soap note based upon problem list

Write discharge summary

Determine how to ask for and accept feedback

Determine how presentations change among clinical sites

Understand what to write in the patient chart

  1. Emergencies

Determine student role in a variety of frightening or stressful situations

Determine where to go for help in the clinic or hospital setting

Determine how to call a code

Determine the role of student during a code

Utilize the equipment in the hospital room

  1. Survival Skills (Student-to-Student Input)

Determine successful strategies for students on clerkships

Determine how to organize clerkship skills

Perform history and physical examination

Present three-minute presentation

Determine how to assess ‘trivial’ patient problems

Determine how to utilize common machines (CPAP machine, EKG monitor, automated blood pressure)

Develop confidence in

  • Examining wounds
  • Conducting rectal examinations
  • Moving patients
  • Reading EKG reports

Discuss with a senior student the relationship with resident physicians

Determine how to deal with attending physicians who make inappropriate comments to students

Discuss ‘best advice’ with senior student:

  • Punctuality
  • Understand the sequence of daily notes written in patient charts and the role of student, resident and attending physician
  • Presenting current patients’ status to attending physicians
  • Determine how to ask questions
  • Determine how to ask for help

Sample calendar

UICOM-UC

Introduction to Clinical Clerkships

Monday, June 28-Friday, July 9, 2004

Week

One

/ Monday
June 28 / Tuesday
June 29 / Wednesday
June 30 / Thursday
July 1 / Friday
July 2
8:00 - 9:50 / Introduction to ICC
Patient Assignments and workups / Intro
To
Clinical
Teaching
Hospitals / Small
Group
Sessions / Large Group Sessions:
Advanced EKG
Sessions:
Basic Dysrhythmia / ECG Review
Small Groups:
Case Presentation Skills
(5-7 minutes)
Student Facilitators / Intro
To
Clinical
Teaching
Hospitals / Small
Group
Sessions
10:00 – 11:50 / Wisdom from the Wards
12:00 – 1:00
Afternoon / Overview of ICC*
The Wards
An Introduction to Clinical Clerkships
Student Facilitators Panel / Emergent Conditions:
Surgery
Small Groups:
Case Presentation Skills
(10 minutes)
Student Facilitators / Emergent Conditions:
ED/Family Medicine
Case Presentation Skills
Student Facilitator / Case Presentation Skills
Student Facilitators
Emergent Conditions Lecture
OB/GYN / Advanced Rounds Observations
(Small Group Discussions)

*Each session is for all Groups unless noted otherwise.

All sessions are mandatory.

Week

Two

/ Monday
July 5 / Tuesday
July 6 / Wednesday
July 7 / Thursday
July 8 / Friday
July 9
8:00 - 9:50 / University
Holiday / ICU Group Tours
One Group per hour
8:00 Group 5
9:00Group 4
10:00Group 3
11:00Group 2
12:00Group 1 / Breakfast
And
Wrapping
Up the
ICC
10:00 – 11:50 / Case Presentation Skills
Student Facilitator / PDA Pearls
12:00 – 1:00
Afternoon / Case Presentation Skills
Student Facilitators
Emergent Conditions: Pediatrics / Clinical Faculty Advisor Strategies
Imaging