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At the end of the second year, the student is well-founded in basic sciences,
has reviewed and learned the pathological changes associated with many diseases
and knows a good deal about anatomy, microbiology, physiology, biochemistry,
etc.
Following the third year, the student progresses somewhat independently in
clinical medicine with the various requirements and electives of the fourth year,
prior to beginning residency training. The third year, therefore, is critical
for the transition from basic scientist to clinician. Fundamental clinical skills
should be learned this year and developed and refined in subsequent years.
Internal Medicine is an important part of the transition. It is a discipline
based on careful history-taking and equally careful focused physical examination.
Students need this training as the basis for their clinical futures. One of the
functions of the third-year course in medicine is to provide this training as
thoroughly as possible.
Internal Medicine emphasizes the techniques of patient evaluation and planning.
It embraces almost all of human pathophysiology, clinical epidemiology and clinical
pharmacology. Internal Medicine is well-suited to help the student acquire a
foundation upon which to base future clinical development and life-long learning.
The information from the history and physical examination needs to be ordered
logically. It should be used to direct diagnostic and therapeutic procedures.
The assessment and plans should be well-organized and the student should learn
to present them clearly, both orally and in writing.
Simultaneously with technical training, the student should be learning about
the personal relationships involved in patient care, not only relationships between
doctor and patient, but also with various other individuals involved (families,
other physicians, nurses, technicians, etc.).
In summary, the student should begin the life-long process of learning the
skills of data acquisition and interpretation, diagnostic and therapeutic planning,
counseling and follow- up.
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