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A. Ward Activities
The medical student spends all eight weeks of the rotation on the Internal Medicine "University Service" at DCH Regional Medical Center. The student is a member of a team consisting of the attending physician, a senior resident, a junior resident, and two or three medical students. The attending physician is a full-time or part-time faculty member, with a major commitment to teaching.
Each medical student is assigned up to two patients per call night and follows two to four patients in the hospital. The medical student will, therefore, study about 20 "new" patients. The student will take the history and perform a complete physical examination, unless there is a valid reason for omitting a part of one or more of these procedures. The information obtained, a problem list, and initial plans are written and received by the attending physician. [See V. Patient Write-Up (Suggested Outline)].
The problem-oriented record is followed in the initial workup and in the progress notes. Medical students record progress notes each day on each of the patients assigned to them. These notes are read and countersigned by the attending physician, and, on occasion, by the resident as well.
Medical students make rounds with the residents and with the attending physician. In addition, medical students are expected to visit assigned patients alone. The medical
progress of the patient will be followed very carefully. The student will attempt to establish rapport with the patient and the patient's family and to consider the patient's problems, perhaps more closely and with more understanding than anybody else on the team. The medical student is the individual who has fewest patients and who, therefore, has the best opportunity to know these patients.
Making rounds once or twice daily with the resident and/or attending physician, the medical student will have many opportunities to observe the patients of other medical students on the service. While the contact is less intimate, these patients are very likely to have a positive effect on the student's retention of clinical information concerning the observed illnesses.
During the course of patient care, work and teaching rounds, as well as through consultations and other cross-departmental interactions, medical students should become aware of the various relationships among those involved in the care of the patient. If x-rays are checked out for discussion in morning report by a medical student, that student is to return them promptly to the x-ray department.
We expect that the medical student will learn a great deal of Internal Medicine during the eight-week clerkship. The body and scope of information in Internal Medicine are so vast, however, that we recognize it is unreasonable to expect a medical student (on any level) to grasp the field in its entirety.
We believe the relationship of the medical student to a particular patient is a very strong stimulus toward permanent learning, i.e., learning that will persist in years following this rotation. It is very important that the student read in textbooks and medical literature about the illnesses affecting assigned patients. We hope medical students will become well-based in the illnesses observed. Students will be considered to be the local experts in some aspects of the illnesses that have affected their patients.
B. Outpatient Activity
Medical students will spend a half-day once each week in the Internal Medicine clinic of the University Medical Center under direct faculty supervision. There is a copy of the clinic schedule online.
C. Problem-Based Learning Sessions
The centerpiece of learning is the patient. The PBL format encourages individual and group exploration of issues relevant to the patients. As cases are explored students learn about related clinical problems (a ripple effect). For example, an actual case of meningitis may not be encountered, but several with headache and fever will. From these, an exploration of meningitis and its management will emerge. The study of pathophysiology, clinical epidemiology and clinical pharmacology constitute much of the cement for such cross-linkage in understanding. Students should leave clinic to attend the PBL lectures, which are usually, though not always, scheduled on Wednesdays and Fridays at 11:00.
In addition, didactic learning sessions on a variety of core Internal Medicine curriculum will be provided as outlined on the lecture schedule.
D. CME Conferences
Medical students are encouraged to attend the noontime CME Conferences when they are related to Internal Medicine. These have the purpose of review and gap-filling and are most effective if related to patients you have encountered.
E. Night Call
Medical students will be on call every fourth night on average. This duty exposes them to nocturnal problems that arise, e.g., emergency admissions, crises involving inpatients, etc. This also provides an opportunity to observe the natural course of illness over a 24-hour period.
F. Manual Skills
The medical student will be encouraged to perform manual procedures such as venipuncture, arterial puncture, lumbar puncture, etc., whenever the opportunity presents itself. Other procedures may be experienced, but they depend on chance opportunities. Appropriate supervision should be requested and provided.
G. Laboratory Procedures
It is intended that the medical student will personally examine blood smears, the urine sediment and the sputum (if indicated) with bacterial stains, on some patients. Laboratory, personnel have been extremely helpful in assisting students.
H. Supporting Systems
Medical students should learn about various support systems during the Internal Medicine rotation:
1. Nursing services.
2. Electrocardiography laboratory, including EKG, echocardiogram, graded exercise tests, and
other special procedures.
3. Pulmonary support systems and respiratory
therapy.
4. Social services.
5. Dietetics.
6. Pharmacy and supply.
- Priority of Student Work Activities:
- PBL, Lectures, and Physical Diagnosis
- Clinic
- Morning Report
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