MEDICAL STUDENT EXPECTATIONS
AIMMC-DEPARTMENT OF INTERNAL MEDICINE
- Monthly Schedules/Days off: The senior resident is charged with preparing a monthly calendar which will provide one day off per week for each team member, including students. On the “day off”, students are not expected to come in at all, regardless of whether there are team or student activities scheduled for that day. Obviously, every effort should be made to schedule days off on weekends where they won’t interfere with scheduled teaching sessions. Fourth year students may take one additional day off for interviews. No additional days off are allowed including time off for family functions, interviews, vacations, etc. Religious holidays are covered by the individual medical school’s policy.
- Student Conferences and Workshops: Medical students are expected to attend all student-specific conferences (see the student activities section). Student-specific activities take priority over team activities with the exception of attending rounds. If any problems are encountered by the student, he or she is to bring this to the attention of Dr. Dunphy immediately.
The third year student: is expected to attend noon conference daily and grand rounds weekly. A sign-in sheet is provided. 60% attendance is expected and, if not achieved, will adversely impact the final clinical grade assigned by the site director.
The fourth year student: is strongly encouraged to attend noon conference and grand rounds. Morning report is also highly encouraged if floor responsibilities have been taken care of. However, fourth year students are not required to sign-in at any of the conferences and there is no minimum attendance required.
- Students and Patient Care Issues: Students need extra time and need to be allowed independence when first evaluating new admissions. Ideally, medical students should see the patient before the housestaff and then present the patient to the resident so that a joint plan can be developed. A resident is expected to review the plan with the student, including all orders which are to be co-signed. Students may be assigned to either private or service patients based on the educational value of the patient.
The third year medical student: is encouraged to function as their patient’s primary interface with the medical team. Whenever possible, the student should enter all orders and be actively involved in discussions with the attending and consultants.
Call is every fourth night. Third year students are expected to stay until approximately 10 pm. If a patient is admitted late, the student is expected to stay until the patient’s admission note and orders are completed and the patient is stable. Third year students should admit 1-2 patients per call night and carry from 2-4 patients.
The fourth year medical student: is expectedto function as their patient’s primary interface with the medical team. When deemed appropriate by their senior resident, the fourth year student should be calling the attending and medical consultants as well as entering all orders in the computer.
Call is every fourth night. Subinterns are expected to stay until approximately 10 pm. If a patient is admitted late, the student is expected to stay until the patient’s admission note and orders are completed and the patient is stable. Subinterns should admit 2-3 patients per call night and carry 4-6 patients.
Subinterns on the Senior Service (aka “Day Float”) have no call. They will admit patients daily up to their teams “cap”. Subinterns on the Senior Service should aim to carry 4-6 patients.
4.Patient Write-ups: Students are expected to write a complete history and physical examination database on every patient that they admit. Each H & P should include a complete problem list as well as a differential diagnosis and diagnostic and therapeutic plan. It is expected that the resident working with the student reviews and provides feedback on the write-up. Progress notes should be written daily on every patient being followed by the student. Students should follow the “SOAPE” format (with the “E” for education of the patient).
Students are to write their notes in the Care Connection system.
Advocate Illinois Masonic has a “zero tolerance policy” against cutting and pasting from previous progress notes! It promotes sloppiness, is not accepted by payers, and may be a liability issue so get in the habit of documenting well and do not cut and paste.
5.Evaluations: Both the third and fourth year medical students are required to inform the student coordinator which resident and attending physicians will be filling out evaluations for their rotation. All medical students are expected to perform at a high level. As such, an “average” evaluation is indicative of a good performance. Our residents and attendings are strongly encouraged to provide a realistic evaluation of your performance including areas of strength and areas for improvement. You are encouraged to sit down with your team at the end of the month and review your performance with them.
The University of Illinois (UIC) students use paper evaluations and are responsible for assuring that all evaluations are turned into our office within two weeks of the end of the rotation. At that time, the final grade will be determined based on the evaluations present in your file. No grade changes will be made based on late evaluations.
The Chicago Medical School (CMS) students use an online evaluation system. Both our office and the medical school must be notified of which physicians will be evaluating your performance and be given the physicians’ email addresses.
6.Feedback: Feedback is the cornerstone of medical education. Most feedback is given informally on a daily basis by your team by comments to you on your write-ups, presentations, etc. You should elicit more formal comments on your performance from your team (residents and attending) two weeks after you start with them. At the end of the calendar month, the teams will change and you should receive a critique from the residents and attending on your performance.
7.Patient Sign-Outs: Signing out patients is an important part of the care of each patient and a source for potentially serious errors. Sign-outs should be reviewed with your resident prior to calling the on-call team.
The third year medical student: should review with his or her PGY-1 resident the sign-out information for any patient the student is following.
The fourth year medical student: should generate and participate in the sign-outs for his or her patients with the assistance of the senior resident.
- Conflict Resolution: Should conflicts arise between a physician and student, all efforts should be made to work these out individually. If that process fails, the student should seek assistance from the Director of Medical Student Programs (Dr. Dunphy) immediately. Alternatively, the chief residents are a source for conflict resolution. Either way, the conflict must be resolved as quickly as possible. Indeed, the active solving of these complex interrelationships is an important learning experience and worth the extra time of both parties.
9.Contact Information:
Dr. Dunphy:Phone61-7704
Pager 0923
Deb Anderson:Phone61-7079
THIRD-YEAR INTERNAL MEDICINE CLERKSHIP STUDENT ACTIVITIES
ADVOCATEILLINOISMASONICMEDICALCENTER
M3 LECTURE SERIES
Internal medicine covers a broad range of topics. Even with an 8 to 12 week rotation, it is impossible to cover all of the areas that internal medicine touches upon. Instead, the lecture series here at AdvocateIllinoisMasonicMedicalCenter focuses on the more common subjects that you are most likely to encounter during your clerkship.
You will receive a monthly calendar with a schedule of the lecture topics. Approximately once per week, all of the third year students will convene in the Department of Internal Medicine conference room for the M3 lecture. Each lecture will usually cover several articles. You are expected to have read each article and be prepared to discuss its content at the lecture. Questions pertaining to each article are presented in a case-based format. Students are called upon individually to answer the questions; however, open discussions amongst the students to address more difficult questions are encouraged. Of note, the article binder that you receive during your orientation contains more articles than we will cover during the lecture series. These extra articles are included to provide a useful reference for important topics that could not be covered in a formal didactic environment.
The M3 Lecture Series does not substitute for reading an internal medicine textbook during your clerkship. The lectures provide emphasis on important aspects of medicine but, by no means, do they cover all of the material you will need to gain a basic foundation in internal medicine. Reading about your patients’ problems in review articles and reference textbooks is a tremendous way to not only learn internal medicine, but to provide better patient care. For studying the many topics in which you have not had a patient, a review textbook for internal medicine should be obtained.
STUDENT MKSAP SESSIONS
Once weekly, all M3 students will meet to review questions from the Medical Knowledge Self-Assessment Program (MKSAP for Students). Each student will be assigned a subject (or subjects) from the book and a date for the session for which they will be moderator. The student will be responsible for copying the questions for the topic(s) assigned and making them available to their fellow students. The answers for the questions should be distributed at the end of the session. As you progress through your medical training, you will be expected to take on a greater role in the teaching others. The purpose of this student-led activity is to provide experience in the position of educator and discover the benefits and challenges that come with this duty.
MINI-CEX
Both medical schools require their students to do mini-CEXs as part of the clerkship experience. These should ideally be completed before the mid-clerkship evaluation. An attending or senior resident should conduct the mini-CEX.
PATIENT LOG
Students should keep a log of all patient diagnoses that they’ve experienced as per the requirements of their respective medical schools. The patient logs should be periodically reviewed with your team to ensure that you see a broad range of patients during your internal medicine rotation.
ADDITIONAL CLERKSHIP REQUIREMENTS
Every week, each student is required to turn in the list of patients that they have admitted and/or followed for the week (unless they were on the ambulatory portion of the rotation). Failure to do so will adversely affect your clerkship grade. Dr. Dunphy will use the list to periodically check your progress notes and H&Ps.
Attendance at ALL (i.e. 100%) of the student specific activities (M3 lecture series, MKSAP sessions, EKG workshops) is mandatory. Any absences must be approved by Dr. Dunphy. Attendance at noon conferences and grand rounds is also mandatory. An attendance rate of 60% or greater is required. Sign-in sheets will be present-be sure to sign them! Failure to do so will adversely affect your clerkship grade.
Clerkship information, including a monthly calendar of student activities, can be found on the internet at:
INFORMATION FOR CMS STUDENTS ONLY
CMS REMINDERS
Complete one Mini-CEX (turn in to site director at mid-clerkship meeting)
Complete self-evaluation on D2L (turn in printout at mid-clerkship meeting)
Print out copy of your patient log to review at mid-clerkship meeting
Complete patient log (turn in printout to site coordinator at week 7 of rotation)
INFORMATION FOR UIC STUDENTS ONLY
AMBULATORY MEDICINE
For students whose medical school requires a portion of their clerkship to include ambulatory medicine, we have the Internal Medicine Associates (IMA). The IMA is a Resident-Faculty practice whose patient population includes a broad diversity of ethnic and socioeconomic backgrounds.
Students generally spend four days per week seeing patients in the office. There are no weekend hours for students. A typical day in your ambulatory month starts with attending morning report. Then, the first session at the IMA runs from 9:30-11:30 am. A break is given for lunch and noon conference. The next session is 1:00-3:00 pm. From 3:00-5:00 pm is the last session for seeing patients. There will be times in which you will have a student lecture during the IMA office hours. You are expected to attend student lectures and workshops and then return to the IMA when those sessions are over. One afternoon per week is set aside for shelf exam study time.
Ideally, the student should see the patient first and perform a focused history and physical exam. If it is a resident’s patient, the student should then present the patient to the resident who can confirm the student’s findings. Then, the student should present the case to the supervising attending with the resident present to support and clarify the student’s presentation.
The student should be prepared to not only present the history, physical and lab data, but also to generate a differential diagnosis as well as a diagnostic and therapeutic plan of action. Routine health maintenance needs and patient education are important aspects of every patient visit and should be addressed as well. Because of the importance of staying on schedule in a busy practice, students will not always be able to fully assess each patient on their own. However, every effort is made to allow for this.
While many attributes are evaluated during your four weeks, one of the most important is your educational initiative. Enthusiasm and hard work will allow you to see more patients and consequently learn more ambulatory medicine.
UIC REMINDERS
Patient Log Form (Turn in to Veronica Guzman)
Blackboard Evaluation of the course at the end of the rotation
Simple Cases- complete at least 7 of the 10 assigned cases (2,9,10,13,14,15,16,28,33,35)
MiniCEX- complete 4 and turn in to your site Director