Third Year Internal Medicine Clerkship
2015 - 2016
Syllabus
Department of Internal Medicine
Quillen College of Medicine
East Tennessee State University
Dr. Charles A. Stuart
Interim Chair, Department of Internal Medicine
Dr. Aaysha Kapila – Course Director
Dr. Rupal Shah – Co-Director
Yvette Font
Clerkship Coordinator
(rev. 9/22)
2015 – 2016 JUNIOR INTERNAL MEDICINE CLERKSHIP SYLLABUS
Contact Information / 3Welcome / 3
- Importance of clerkship
- Clerkship Goals
- Clerkship Objectives
Roles and Responsibilities / 5
- Assessment of Student
- Assessment of Faculty and Course
- Faculty Responsibilities
- Student Responsibilities
- Documentation of Required Experiences
- Clerkship Specific Procedures/Patient Log
- Professional Expectations for Students
- Social Networking
- Policy on HIPPA Training, Violations and Disciplinary Actions
- Medical Student Duty Hours
- Student Illness
- Student Absences
- Inclement Weather Policy
- Appropriate Dress
- Identification Badges
- Student Contact Phone Numbers
Schedules / 13
- Clerkship Site Assignments
- Student Education Conferences
- Quiz schedule
- Department of Medicine Grand Rounds
- Cardiac Rehabilitation
Assessments / 14
- Clerkship Grading
- Clerkship Grade Scale
- NBME Exam Policy
- Student Computer Usage During Electronically Administered Quizzes/Exams Policy
Tips for Learning / 16
- Top 10 Ways to Excel on the Internal Medicine Clerkship
Learning Resources / 16
- Textbooks for reading
- References and Materials (Optional)
- Student Procedures for Special Services (ADA)
- Tutoring
- Counseling
Appendices / 18
- History and Physical Template
- COM Intuitional Objectives
- Entrustable Professional Activities
Jr. Internal Medicine Clerkship
Dr. Aaysha Kapila: Course Director: 423-224-8425 (beeper)
Yvette Font: Clerkship Coordinator, 423-439-6381
Johnson City Medical Center / Ms. Tawana Holland / 423-431-6431VA Medical Center / Ms. Anetha Wright / 423-926-1171 ext. 7358
Holston Valley Medical Center / Ms. Rita Forrester / 423-224-5075
Bristol Regional Medical Center / Ms. Jane Lipscomb / 423-844-6650
Academic Affairs / Ms Cathy Peeples / 423-439-6311
WELCOME!
Welcome to the Junior Medicine Clerkship. We hope you will enjoy the time you share with us. We are proud of our reputation as dedicated medical educators and hope you enjoy the knowledge and experience you will gain while rotating with the Department of Internal Medicine.
The Junior Clerkship experience in Internal Medicine consists of six weeks of inpatient medicine divided into two three week rotations at two of our three sites: VA Medical Center, Johnson City Medical Center or Holston Valley Medical Center. This will provide you the opportunity to experience different hospital settings.
- Importance of this course
During this six-week clerkship, you will acquire fundamental skills, reinforce and expand your knowledge, and develop personally and professionally. We hope that this experience inspires you to learn and experience more of what Internal Medicine has to offer. Internists care for a broad spectrum of patients, ranging in age from adolescents to the ever-growing elderly population. While expanding your medical knowledge, you will also be solidifying basic clinical skills such as patient interviewing, physical examination, and communication through case presentations and written documentation. This time is also a major opportunity to improve more advanced skills such as physical diagnosis, clinical reasoning, and developing physician-patient relationships.
- Clerkship Goals
The Internal Medicine curriculum goals are to assist students in acquiring a foundation of knowledge regarding the practice of medicine, and assist students in mastering basic interpersonal skills relevant to the management of patients with medical illness.
- Student will develop a solid foundation of medical knowledge regarding the care and management of patients presenting with a variety of medical diseases. This will include formulating a diagnosis, patient care plan, medical diagnostic procedures, adherence to evidence-based guidelines and follow up care that includes both medical and psychological support.
- Students will effectively participate as team members while maintaining a professional demeanor that includes communication with fellow students, residents, attending physicians and patient’s family members.
- Clerkship Objectives:
Course / Clerkship Objectives:
At the conclusion of this rotation the student will be able to: / Meets EPA-see appendix B / Educational Method(s) / Assessment Method(s)
gather a history and perform a physical examination incorporating ethical, social, and diversity perspectives to provide culturally competent health care. / EPA 1 / Clinical Experience-inpatient / -Clinical Documentation Review;
-Participation
prioritize a differential diagnosis following a clinical encounter for common conditions seen in Internal Medicine. / EPA 2 / Clinical Experience-inpatient / -Clinical Documentation Review;
-Exam-Institutionally Developed-writtem;
-Exam-Nationally Normed/Subject
recommend and interpret common diagnostic and screening tests for conditions frequently seen in Internal Medicine. / EPA 3 / -Clinical Experience-inpatient;
- Conference / -Clinical Documentation Review;
-Exam-Institutionally Developed-writtem;
-Exam-Nationally Normed/Subject
document and discuss orders for common conditions seen in Internal Medicine. / EPA 4 / Clinical Experience-inpatient / -Clinical Documentation Review
appropriately write prescriptions by recognizing and avoiding errors utilizing information resources to place the correct order/perscription and maximize therapeutic benefit and safety for patients / EPA 4 / Clinical Experience-inpatient / Clinical Documentation Review
document a clinical encounter in the patient record (electronic or written format) / EPA 5 / Clinical Experience-inpatient / Clinical Documentation Review
provide an accurate and concise oral presentation of a clinical encounter of a patient in the inpatient setting / EPA 6 / Clinical Experience-inpatient / Oral Patient Presentation
form clinical questions and retrieve evidence to advance patient care / EPA 7 / -Clinical Experience-inpatient;
-Self-directed learning / -Clinical Documentation Review;
-Oral Patient Presentation
give or receive a patient handover to transition care responsibility in an inpatient setting / EPA 8 / Clinical Experience-inpatient / Participation
demonstrate the ability to collaborate as a member of an interprofessional team in an inpatient setting / EPA 9 / Clinical Experience-inpatient / Participation
recognize a patient requiring urgent or emergent care / EPA 10 / -Clinical Experience-inpatient;
-Conference / -Participation;
-Exam-Nationally Normed/Subject
demonstrate knowledge of the elements necessary for informed consent for tests and procedures and impact on patient/family / EPA 11 / Clinical Experience-inpatient / -Participation;
- Exam-Nationally Normed/Subject
perform required Clerkship and College of Medicine procedures under direct supervision. / EPA 12 / -Demonstration;
-Preceptorship / -Participation;
-Clinical Performance Checklist
demonstrate an understanding of system based practice and the students role in a culture of patient safety and continuous quality improvement / EPA 13 / Clinical Experience-inpatient / -Participation;
-Exam-Nationally Normed/Subject
2.Roles and Responsibilities in Learning
- COM: ASSESSMENT OF STUDENT
The clerkship director and coordinator manage the assessment process for all the clerkship students. QCOM uses an on-line assessment system, New Innovations (NI), to assess each student’s performance. Individual faculty assessment of each student will be combined into the Clerkship Director’s final composite assessment form for each student. The final composite will contain faculty comments and the final course grade. Students will be notified when their final assessment is available in NI to view. This should be approximately 3 weeks following the conclusion of the clerkship. Final grades will be posted into the ETSU Banner system and become the official grade for the student’s transcript.
An integral part of the assessment process is the Mid-clerkship Review with the clerkship director which all students will have. It is the student’s responsibility to complete their portion of the Mid-Clerkship Review form and to arrange for a faculty member they have worked closely with during the clerkship to review and complete the faculty portion of the form prior to the Mid-Clerkship Review. During the Mid-clerkship Review the clerkship director will review and discuss the completed form with the student. The completed form will remain with the Clerkship throughout the rotation. The Mid-Clerkship Review form can be found in the Administrative Forms folder in New Innovations under my Favorites/Department Manuals or it may be provided to the student by the clerkship coordinator. The Mid-Clerkship Review form can be found in the Administrative Forms folder in New Innovations under Intranet or it may be provided to the student by the clerkship coordinator.
- COM: EVALUATION OF FACULTY AND COURSE
The on-line system is also used for the students to evaluate the faculty and the course. This evaluation tool is used to provide information to the clerkship administration about the teaching/learning process with the intent of improving learning. Student feedback is essential for curriculum planning. Students will be notified electronically when these required evaluations are available to complete. Timely completion of evaluations is required. Individual clerkships may also request students to evaluate its’ Resident Physicians using the on-line system, also with the intent of improving learning.
- Faculty Responsibilities:
- Observe each student perform components of a history and physical exam on a patient some time during their inpatient rotation. During the inpatient rotation a strong emphasis on the development of clinical skills is a necessity.
- Review student’s histories and physical exams to include assessments and plans.
- Review the written record and assess that the student is able to present each case succinctly. (Students at the VA will write notes in Word Document so that the notes can be cut and pasted if needed by residents or attendings to insert into the patient record.)
- Submit an assessment via New Innovations of each student after the completion of the ward rotation.
- Student Responsibilities:
- Attend Orientation at 8 a.m. on first Monday of the clerkship. This is a live interactive orientation conducted by one of the co-clerkship directors and coordinator, which is designed to outline the course and expectations as well as tips on how to succeed. Included in the orientation will be a discussion regarding professionalism and its vitality in medicine.
- Admit at least 12 patients during the 6 week ward service. Perform a complete history and physical exam on these patients. Assist the PGY-1 with entering admission orders into the hospital order entry system. Leave history, physical exam and assessment on patients chart to be countersigned by the attendings. Copies of the H&P should be made and submitted to the attending for critique. An H&P template will be emailed to you for assistance with structure and content. In addition, one formal H&P will be submitted to the clerkship office for review and evaluation. It will be counted as 10% of your total grade.
- Write daily progress (SOAP) notes on patients you are covering to be co-signed by attendings. Each student will be responsible for two patients while on rotation during any one given time.
- Attend morning report and/or attending rounds daily and be prepared for patient presentations or admission H&P’s from the previous night.
- Take Overnight call – no more than 1 in 7 days (average over 6 weeks) If you are assigned to the VAMC you will be expected to take one week of night float. Students should be aware that night float begins on Sunday night at 7 p.m. and ends Friday morning at 7 a.m. STUDENTS MAY WEAR SCRUBS DURING THE WEEK OF NIGHT FLOAT AT WELL AS NIGHTS ON CALL AT JCMCH OR HOLSTON VALLEY. STUDENTS AT ALL SITES MAY STOP TAKING FLOOR CALLS AND ADMISSIONS AT MIDNIGHT ON NIGHTS PRIOR TO QUIZ DATES. PLEASE COMMUNICATE WITH YOUR ATTENDINGS AND SENIOR RESIDENTS.
- Maintain a professional demeanor that includes communication with fellow students, residents, faculty, staff and patient’s family members.
- Attend Student Education Conference each Thursday afternoon from 1-5 p.m. in VAMC, Bldg 1.
- Complete a comprehensive patient interview followed by a case presentation with their assigned attending who will assess a grade. Grading forms will be distributed at orientation and can also be obtained online in New Innovations. This grade will count as 15% of their overall clerkship grade.
- Complete a patient log (hard copy) as well as enter in New Innovations. At mid-rotation the student must review the log with his or her attending to make sure the requirements are being met. Any deficiencies must be noted and completed by the end of the rotation.
- Complete a Mid-Clerkship Self-Assessment. During the Mid-clerkship Review the clerkship director will review and discuss the completed form, accomplishment and documentation of required procedures and/or patient types, and duty hours issues with the student. The Mid-Clerkship Review form can be found in the Administrative Forms folder in New Innovations under Intranet or it may be provided to the student by the clerkship coordinator.
- Complete an assessment of the faculty and clerkship at the end of the rotation. Student input is instrumental to creating a positive experience for students. Student responses are taken into consideration by each department.
- Access:
The prerecorded lectures can also be retrieved by accessing the Department of Internal Medicine website – “clerkships” – “junior medicine” – “student lecture series”
- COM: DOCUMENTATION OF REQUIRED EXPERIENCES
Required College of Medicine Procedures and Clerkship Specific Procedures and/or Patient TypesLCME Accreditation standard ED-2 requires that core clinical requirements are identified for all students to accomplish. This has been done at both the clerkship level and the College of Medicine level. Students are expected to demonstrate performance (not observing or assisting) the following procedures by the end their M3 year in order to graduate from the Quillen College of Medicine.
Class of 2016 Required College of Medicine Procedures
2015-16Quillen College of Medicine Required Procedures
- QCOM: Arterial puncture - perform (also Surgery Clerkship requirement)
- QCOM: Aseptic technique-demonstrate (also Surgery Clerkship requirement)
- QCOM: Bacterial culture-collect, perform and interpret results (also Surgery Clerkship requirement)
- QCOM: EKG-perform
- QCOM: Foley catheter- perform insertion (also Surgery Clerkship requirement)
- QCOM: Glucose test finger stick-perform and interpret (also Community Medicine & RPCT Clerkship requirement)
- QCOM: Injection-intramuscular -perform (also Family Medicine & RPCT Clerkship requirement)
- QCOM: Injections-subcutaneous - perform
- QCOM: KOH Prep-perform (OB Clerkship requirement)
- QCOM: Nasogastric tube insertion - perform (also Surgery Clerkship requirement)
- QCOM: Pap smear-perform (also OB Clerkship requirement)
- QCOM: Prostate Exam-perform
- QCOM: Spirometry-perform and interpret results (also Community Medicine & RPCT Clerkship requirement)
- QCOM: Stool guaiac testing-perform
- QCOM: Suturing-successfully demonstrate (also Surgery & OB Clerkship requirements)
- QCOM: Tube Thoracotomy (live or in sim lab) (also Surgery Clerkship requirement)
- QCOM: Urine clean catch - instruct patient and obtain (also Community Medicine & RPCT clerkship requirement)
- QCOM: Urine dipstick test-perform & interpret results (also Community Medicine & RPCT clerkship requirement)
- QCOM: Venipuncture - perform (also Surgery Clerkship requirement)
- QCOM: Wet mount-perform (Wet prep, GBS, FFN requirement for OB clerkship)
The above procedures can to be performed any time during the M3 year and documented into New Innovations under the Global setting in the Case Logger, however please note some are also Clerkship requirements and must be accomplished during that specific clerkship.
- Clerkship Specific Procedures Patient Log
Each clerkship has also identified required and/or suggested procedures to be performed and/or patient types for all students to experience during the clerkship. Clerkship specific procedures/patient types are also to be documented in New Innovations, indicating if they observed, assisted or performed a skill and where the experience occurred. Required procedures must be “performed”. Only those procedures documented as “performed,” not observed or assisted, will count toward meeting the requirements.
Students are to document all clerkship identified experiences in the Case Logger module of New Innovations by the end of the clerkship. Only the electronic log will be accepted as evidence of meeting the requirements. The ability to log diagnosis or procedures into New Innovations closes at midnight the last Friday of the clerkship rotation. Those students who do not document in New Innovation accomplishing all clerkship specific required procedures/patient types by the end of the clerkship will have their final numeric grade lowered by 5%.
2015-16 Internal Medicine Required Procedures / # RequiredInterpret a Gram stain / 1
Interpret an EKG / 1
Interpret and report urinalysis results / 1
Perform a complete history and physical / 12
Read and interpret a peripheral blood smear / 1
Encouraged Diagnosis
Abdominal Pain / Alcohol/ Drug Related Problem
Anemia / Arthritis
Bleeding Disorder / COPD/Asthma
Coronary Artery Disease / CVA
Diabetes / Electrolyte Abnormality
Gastrointestinal Bleeding / Heart Failure
Hepatitis / HIV
Hypertension / Lung Nodule/Mass
Neuromuscular Disease / Pancreatitis
Pleural Effusion / Pneumonia
Renal Failure / Syncope/Arrhythmia
Thyroid Disorder / Urinary Tract Infection
Vasculitis
Clerkships must provide students with adequate exposure to a variety of learning opportunities. If a student is having difficulty in securing an opportunity to perform a required procedure or see a required patient type they should request assistance from the clerkship director, preceptors, residents or fellow students in identifying opportunities. If the student is still not able to secure a required procedure experience they should inform the clerkship director and request tocomplete in a simulated environment. It is the student’s responsibility to be proactive in seeking out the identifiedrequired educationalexperiences. A clerkship may provide the student a paper copy of the required experiences specific to that clerkship and require that each accomplished experience be validated by the observing faculty. This documentation assures the requirements of the clerkship are met by each student and builds the student’s portfolio. A single observer cannot validate all of a student’s documentation. Students are expected to enter their documentation at least weekly into New Innovations and document at least 1/3 of the required clerkship procedures/patient types by the clerkship midpoint. Students’ progress will be monitored by the Clerkship Director and Coordinator in addition to Academic Affairs.