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Third Year Clerkship

Required rotation

This required rotation of no less than four (4) weeks in an internal medicine clerkship is intended to be a structured clinical experience under direct supervision. In a short time, all of internal medicine cannot possibly be covered; therefore, this must be considered an introductory experience. This rotation is a time to build a foundation in clinical problem-solving and decision-making; a time to build clinical experience and acumen on a foundation of didactic information.

The internal medicine department administers a post-rotation examination when the student has completed the required medicine rotation.

For more information on clinical rotations please visit theĀ Clinical Affairs page.

Purpose

Clinical experiences are intended to assist the student’s transition from didactic to integrated clinical evaluation and patient management. In addition to gaining specific skills, the student should also develop skill in systematic medical problem-solving and patient management abilities; establish or reinforce patterns of independent learning and self-evaluation; and improve skills in communication and medical record keeping. Under supervision, students are expected to assist in the management of acute and chronic problems. The student should also develop fundamental psychomotor skills by performing routine basic procedures under direct supervision.

Course objectives

The student should be able to:

  • Elicit a record of an appropriately complete, cogent and organized medical history.
  • Conduct and record an appropriately complete and accurate physical examination.
  • Communicate in a facilitative, effective, efficient and educational manner with patients and their families.
  • Identify the social and psychological components of patients’ medical problems.
  • Use knowledge of the pathophysiology of signs and symptoms to establish clinical correlation with disease processes.
  • Develop an accurate and complete problem list.
  • Formulate a reasoned differential diagnosis for each problem.
  • Formulate an appropriate plan for confirming the diagnosis.
  • Use knowledge of the indications and limitations of clinical sources such as laboratory and roentgenographic studies, consults, family input and old records to request and interpret data pertinent to problem-solving.
  • Use information from texts, syllabi and journals to study general topics related to patient’s problems.
  • Observe, review, reassess and revise clinical management daily; record patient progress in the medical record; and make a verbal report to the health care team.
  • Communicate clearly and succinctly to colleagues and other members of the health care team.
  • Apply those technical skills commonly employed on a medical service.
  • Formulate an appropriate initial treatment program taking into account the urgency of the patient’s problems.
  • Formulate an appropriate ongoing health care plan for patients within their socio-economic situation.

Technical and interpretational skills

Students are expected to acquire certain technical skills and interpretation that are commonly employed in medical care. Wherever possible, appropriate students are encouraged to participate in procedures under adequate supervision.

The student should be able to:

  • Record and interpret an ECG
  • Perform venipuncture for blood specimens or intravenous therapy
  • Test for the presence of blood (e.g. by hemoccult) in stool
  • Interpret cardiac enzymes
  • Interpret a complete blood count
  • Interpret results of a urinalysis.
  • Interpret Gram stain results of body fluids
  • Interpret bedside tests of pulmonary function
  • Interpret chest x-ray findings
  • Interpret arterial blood gas measurements
  • Interpret serum electrolyte measurements
  • Interpret common chemistry measurements (e.g. CMP)
  • Interpret results of body fluid analysis including joint, pleural, peritoneal, spinal