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Directors:
Kendalle Cobb, M.D. – Basic Core I Director, CC Discipline Leader, Family Medicine
Seema Baranwal, M.D. – CC Discipline Leader, Internal Medicine
Matthew Walsh, M.D. – CC Discipline Leader, General Surgery
For additional information, please Dr. Kendalle Cobb (e-mail:cobbk@ccf.org)
Goals:
- Build on skills developed during Years I and II
- Provide clinical and didactic experiences in ambulatory and inpatient settings for students to gain knowledge and skills in Medicine and Surgery
- Prepare students for related, subsequent Advanced Clinical experiences
Overview:
Basic Core I at The Cleveland Clinic is a 16 week clerkship designed to integrate the disciplines of Family Medicine, Internal Medicine, and Surgery. The 16-week Block is comprised of:
- 1 week outpatient Surgery (rotating through selected Surgical Subspecialties during which students will identify patients for whom they will “scrub in” during their surgery in subsequent weeks)
- 4 weeks inpatient Surgery (working with a general surgeon in clinic, in the OR, and on the wards)
- 3 weeks outpatient Internal Medicine (rotating through General Medicine and selected Medicine Subspecialties)
- 5 weeks inpatient Internal Medicine Each student will spend one three-week block on a general medicine service (Kimball or Tucker). The other two-week block can either be general medicine, cardiology, or GI. These will be assigned to each student.
- 3 weeks outpatient Family Medicine.
- Basic and Clinical Science Rounds every Friday Morning.
- No clinical responsibilities after 5 pm on the Wednesday of week 16.
Basic Core I Master Schedule
(Students are assigned to 1 of the 6 templates)
Weeks
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Patient-Based Experiences:
Family Medicine
Family Medicine will be a 3 week experience at one of the Cleveland Clinic Family Health Centers (Beachwood, Brunswick, Chagrin Falls, Fairview, Solon, Strongsville, or Westlake).
Internal Medicine
Each student will spend one three-week block on a general medicine service (Kimball or Tucker). The other two-week block can either be general medicine, cardiology, or GI. These will be assigned to each student. Inpatient Internal Medicine will occur at Main Campus.
Outpatient Internal Medicine will be a combination of general medicine and subspecialty clinics and will occur at both Main Campus and Cleveland Clinic Family Health Centers.
Surgery
Surgery will have 1 week of outpatient clinics in various specialties (ex: general surgery, colorectal, orthopedics, urology) and the students will then follow patients longitudinally into the OR for the subsequent 4 weeks. After the first week of outpatient surgery clinics, students will be assigned to an inpatient team and will learn to manage patients on service while also participating in the care of their longitudinal patients.
Location: All Surgery experiences will be conducted at the Cleveland Clinic Main Campus
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On-Call Experiences:
Internal Medicine
Call is overnight on every 4th night, with a maximum of 8 calls in the entire 5 weeks. This applies to all General Internal Medicine, Teaching Cardiology, and GI (Green) services. Exceptions: “Short” call on Thursday nights, until 10 p.m. This is to accommodate Friday conferences.
You are expected to do a thorough work-up on 1 patient admitted on each of your team’s "call days" and "short admission" days. You should complete at least 8 patient work-ups per 3-week block. You are expected to present all new patients to your attending and to submit a copy of your write-up as well (you will receive a laminated card with a template for student write-ups). Generally, you will receive feedback from the attending on your oral presentation the same day that you present. If you don’t receive specific feedback about your write-ups from your attending, be sure to ask for this.
Surgery
Students will take in-house call during the week and on weekends. A rotation schedule of every 4th night call to 11 p.m. will be arranged. Twelve hour shifts will be part of the schedule on weekends. Students are expected to contact the resident team on call, which is a night float team during the week.
The goal is to assess new patients for emergency consultations and assist the residents in evaluating ward patients. The students are expected to be physically close at hand with the surgical residents on call to get the most experience. Patient encounters should be assessed by email to the resident involved. TOP
Didactic Experiences:
Morning Report: Fridays, 7:00 a.m. - 9:00 a.m.
(weeks 1, 2, 3, 4, 5, 7, 9, 10, 11, 12, 13, 14)
This will be a Friday morning conference focusing on student presentations and clinical reasoning. There will be 3 groups of 8-10 students. The faculty for each small group will include a Family physician, Internist and Surgeon (the three of whom will also form the Block Assessment Team for their small group of students). Each conference will each be facilitated by one of the three faculty members. Two students will present at each morning report (surgery case from 7-8, FM/IM case from 8-9). The faculty member(s) will facilitate discussion of differential diagnosis. At the end of each conference, the student group will discuss potential questions for review, and the student presenter of the week will research this question, using Evidence Based Medicine Techniques. This student will report his/her findings to the group during the first few minutes of the following week’s conference.
Point/Counterpoint: Fridays, 8:00 a.m. - 9:00 a.m.
(weeks 6, 8, 15)
All students will participate in this Friday morning session. Four students will lead the discussion each week. Two of the four students will focus on the basic science aspect of the clinical problem; these two should choose a review article for their colleagues to review. The other two will present an overall argument, supported by the literature; these two should choose an article to support their side of the argument. Each of the four students must select an article to support their side of the argument and have it approved by the staff in charge. The articles are to be submitted to the staff, at least two weeks prior to the session, so the articles can be approved and uploaded to the portal. All students on the core are to have read the articles in order to fully participate in the debate. The two students who are presenting the main argument will have 15 minutes each to present their argument. The two students who are presenting the basic science will have ten minutes each. The topics for debate will be predetermined, and the students will have to gather data to support their position and make reasonable arguments in support of that position. Fellow students and faculty mentors can critique the arguments and data selected and vote as to the most persuasive argument.
Clinical Rounds: Fridays, 9:15 a.m. – 11:30 a.m.
These weekly sessions will consist of a multi-specialty approach to the clinical topics for that week. All students, in a large group format, will work through 2-4 cases that will require specific reading prior to the session. (A reading syllabus for both surgery and medicine will be provided). In addition to the reading, students are expected to draw on their clinical experiences from both the surgery and medicine rotations. The students will be given brief clinical scenarios and have to work through the history, physical exam, diagnostic work-up, assessment, and treatment plan for each case. The goal is to allow for student participation similar to a session in problem based learning and provide the Block Assessment Team another way to assess clinical reasoning. While presence and participation are expected, the sole purpose of clinical rounds is to create a safe learning environment, in which students can explore common problems. Students are not graded on Clinical Rounds.
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Student Assessment:
Student reports of clinical encounters and assessments from faculty and resident observations, written and oral presentations, an oral examination in surgery, and a progressive NBME examination will be used to assess student performance. The Discipline Leaders will review student assessments frequently to:
- Oversee students’ accumulation of assessment data.
- Ensure that students are getting adequate patient interactions in each
specialty.
- Assure that students have assessment data from faculty that will
provide the necessary information to make accurate assessment decisions.
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