WR2 Curriculum

Internal Medicine 3rd Year Clerkship

Cleveland Clinic Lerner College of Medicine of Case Western University

LEARNING OBJECTIVES

OVERALL OBJECTIVES  ▪  OVERALL EXPECTATIONS  ▪  STRUCTURE OF THE BLOCK

1. To learn how to function as a physician (professionalization) in an Internal Medicine context including:

   1. Obtaining the necessary level of responsibility and commitment to patient care

   2. Developing a compassionate approach to patient care

   3. Working effectively in a health care team

   4. Obtaining physical diagnosis, procedural, and communication skill

2. To develop a successful approach to solving patient based problems in Internal Medicine
    

3. To acquire Knowledge, Skills, and Attitudes in the evaluation and management of the following (but not limited to) Core Problems in Internal Medicine: 
   
   abdominal pain, chest pain, dyspnea, cough, dysuria, joint pain, back pain, weight loss, altered mental status, anemia, fluids/electrolytes/acid-base disorders, congestive heart failure, COPD, depression, diabetes/obesity, dyslipidemia, hypertension, renal failure, thyroid/parathyroid disease, claudication/PVD, venous thromboembolism, common cancers, preventive care, smoking cessation, substance abuse
   

4. To learn of opportunities associated with a career in Internal Medicine

When third-year medical students begin to work on the hospital wards and in outpatient clinics, they begin to assume not only the rights but also the responsibilities of physicians. Among these important new responsibilities are professionalism, altruism, and high ethical standards. 
 

Third Year Clerks are Expected to Be

• Attendant – You are expected to attend all assigned clinics, lectures, seminars, and rounds. If absence is due to illness, family emergency, or other legitimate cause, you should make every effort to contact the clinic/ward preceptor and clerkship coordinator, if possible in advance.

• Accountable – Inform your preceptors if you need to attend a surgery/surgical appointment for one of your longitudinal patients.

• Accessible – Please answer all pages and emails promptly.  This is especially important for scheduling your surgical cases and any conference logistics.

• Active – Self-learning is an important skill for every physician to develop.  Your patients should guide your educational efforts.  We do recommend that you read thoroughly about all of your patient’s problems.
   

Structure of the Block

IMI = Internal Medicine Inpatient

IMO = Internal Medicine Outpatient

FM = Family Medicine Outpatient

Students will be assigned to one of four tracks for their Block I Clerkship:

There will be an administrative orientation on the first day of the block with Gwendolyn Dove (216-445-7435) at the Cleveland Clinic Lerner College of Medicine office.  She will review Cleveland Clinic procedures and your schedules with you. For CWRU students, Ms. Dove will also assist you in getting pagers, ID badges, parking assignments, and instructions for EpicCare (our electronic medical record) orientation.  You need to report to the CCLCM office at (details on location, time, parking, etc).
 

Friday conferences: Each Friday during the block, Science of Assessment and Reflection (7-8 am), and Basic Science and Clinical Science Rounds (8-11 am)
 

Inpatient Internal Medicine - (2) 3-week blocks
 

Student Role/Responsibilities:

1. Each student will spend one three-week block on a general medicine service (Kimball or Tucker). The other three-week block can either be general medicine, cardiology, GI, or nephrology.  These will be assigned to each student.

2. You are expected to do a thorough work-up on 1 patient admitted on your team’s call days and short admission days.  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).

3. Call is overnight on every 4th night, with a maximum of 4 calls per three-week block.
   
   Exceptions: “Short” call on Thursday nights, until 10 pm.  This is to accommodate Friday conferences.  Also, there is no overnight call on the nephrology rotation.

4. You will be excused from IM inpatient, Monday-Thursday, for the following reasons: attend a surgery for one of your longitudinal surgery patients, round on a post-op surgical patient, or attend an outpatient follow-up visit for a post-op surgical patient.  Please note that Friday conferences take priority over surgical care.

5. You will be expected to fill out an electronic patient log on each patient that you see, to be used as evidence that you are meeting the goals and objectives of Block I. Your preceptor will review at least _____ of these logs during the three-week block, and provide you written feedback. 

6. Clinical medicine is best learned by active involvement in patient care with as much responsibility to patient care as your level of training allows.  We urge you to participate in the decision making process that relates to your patients.

Outpatient Internal Medicine – (1) 3-week block

This 3-week block will either be at CCF main campus, or at one of the Regional Medical Practices.  At main campus, there will be a mixture of General Internal Medicine (GIM) Clinics + Subspecialty Clinics, at Regional Medical Practices, it will be all GIM.

For every IMO rotation, 4 students on main campus, 3 - 4 in Regional Medical Practice

For main campus Internal Medicine Outpatient Students, each week:

(Mornings in GIM clinics, afternoons in subspecialty clinics – this is just an example, check your schedule for exact combination of days)

Student Responsibilities:

1. You are expected to attend clinic sessions with your preceptor from 8 am until 5 pm Monday-Thursday (occasionally the preceptor will start later, or may have extended hours, and may want you to come in for a staggered shift).  You should between 2-4 patients per half day during IMO.

2. Goals for each encounter in order to maximize your learning: develop a differential diagnosis, come up with a learning agenda, and read about your patient problems. Discuss these problems with your preceptor the next day, or later in the week.  This case-directed learning is often some of the most lasting.

3. You will be excused from IM outpatient, Monday-Thursday, for the following reasons: attend a surgery for one of your longitudinal surgery patients, round on a post-op surgical patient, or attend an outpatient follow-up visit for a post-op surgical patient.  Please note that Friday conferences take priority over surgical care.

4. You will be trained to use EpicCare (electronic medical record) and are expected to write SOAP notes in the chart, which are to be reviewed and co-signed by your preceptor.

5. You will be expected to fill out an electronic patient log on each patient that you see, to be used as evidence that you are meeting the goals and objectives of Block I. Your preceptor will review at least _____ of these logs during the three-week block, and provide you written feedback. 

Assessment:

1. The DAT will oversee the student’s portfolio and ensure that the student is getting adequate exposure to the symptoms and diagnoses that are core to the Internal Medicine Clerkship.

2. Assessment will be based on patient logs, basic science/clinical science presentations, oral presentation reviews, simulation center exercises, etc, as entered into the portfolio.

3. The DAT will also have the responsibility of determining the goals and objectives of the six ACGME competencies (patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and improvement, systems-based practice).

Contacts:

Linda Krencik
IM Clerkship Coordinator
IM Residency Office (Room NA2-15)
Cleveland Clinic, 9500 Euclid Ave., NA21
Cleveland, OH 44195
216-444-2336
e-mail: krencil@ccf.org

Gwen Dove
CCLCM Office (Room NA2-97)
Cleveland Clinic, 9500 Euclid Ave., NA24
Cleveland, OH 44195
216-445-7435
e-mail: doveg@ccf.org