Third Year Medical Student Internal Medicine Clerkship
Clerkship Director: Saman Ratnayake, MD
Clerkship Coordinator: Guillermina Olvera
Contact: Guillermina Olvera
Welcome to the Internal Medicine Clerkship.
The faculty and resident staff of the Department of Medicine at Kern Medical are dedicated to the education of our medical students and look forward to working with you. We hope that the time you spend with our enthusiastic and committed faculty and residents will demonstrate the richness and excitement of life in Internal Medicine.
No matter what specialty you ultimately enter upon graduation from medical school, the experiences you have and the skills you develop during this clerkship will form a foundation for your life as a physician.
This 12-week core rotation will introduce the student to the various tenants of internal medicine. Yet, we do not expect students to master all of internal medicine by the end of the clerkship. The emphasis of the clerkship is the acquisition of the knowledge, skills, attitudes and behaviors that form the core of inpatient and ambulatory internal medicine. By the end of the clerkship, students should be well on the way to developing a rational, evidence-based approach to the evaluation and care of hospitalized adult medical patients and patients encountered in ambulatory settings.
The 12-week core clerkship in medicine is comprised of both ambulatory and inpatient settings. All students rotate through both educational environments.
An orientation to the clerkship is held at 9 a.m. on the first Monday of each rotation start date. An overview of the clerkship, including the educational objectives, student clinical assignments, and the grading process will be reviewed during this time.
Students are then assigned to eight weeks of inpatient ward service and four weeks of outpatient subspecialty ambulatory care. Though there is no formal call schedule, students are expected to be present on the weekends when their ward team is on call. Otherwise, students should use their time off during the clerkship to read and expand their knowledge about the various patient diseases and pathologies they encounter.
Each week, students will participate in a mandatory didactic session with the Clerkship Director on predetermined topics. Students should read about each topic before it is reviewed and be prepared to answer questions when called upon.
At the six-week midpoint of the clerkship, all students will receive a mid-clerkship evaluation from the Clerkship Director that will highlight the student’s strengths and weaknesses. This in turn will provide the student sufficient time to improve any deficiencies during the latter half of the rotation.
At the rotation’s conclusion, all students will take a computerized clerkship final exam that will be similar in focus and style to the National Board of Medical Examiners (NBME) Subject Exam.
Your grade will therefore depend on your performance and evaluations by the faculty staff obtained during each of the two four-week inpatient ward experiences and the four-week ambulatory setting (80 percent of the clerkship grade) combined with your clerkship final exam grade (20 percent of the clerkship grade). The grade you receive from Kern Medical will then be combined with your performance on the shelf exam to produce your final grade from the medical school.
Throughout the clerkship students are expected to:
- Take responsibility for their own education (including reading extensively, attending conferences, and participating in patient care activities)
- Interact in a professional and caring manner with patients, families, staff and colleagues
- Be person-centered physicians attentive to the ethical, economic, and political aspects of patient care, in addition to the biological and psychosocial aspects
- Act nonjudgmentally when dealing with patients with unhealthy behaviors, alternative lifestyles, or culturally diverse backgrounds
- Assume as much responsibility as possible for the care of their patients
- Communicate early and effectively with patients and colleagues
- Practice evidence-based medicine
- Think for themselves
Goals and Learning Objectives
By the conclusion of the 12-week rotation, students should able to:
- Perform a thorough history and physical examination and develop a concise differential diagnosis on any patient admitted to the Internal Medicine service. The student will demonstrate proficiency in the interpretation of historical factors, physical exam findings, laboratory values, electrocardiogram findings and radiographic findings in preparing the assessments of patients.
- Master the didactic material introduced and reviewed during the didactic lectures.
- Acquire an understanding of the importance of ancillary medical services (social work, nutrition, physical therapy etc.) in the total care of the adult patient.
- Develop an appreciation for the unique psychosocial factors (psychiatric illness, family support, cognitive skills, financial status, etc.) that directly influence the plan of care for hospitalized patients.
- Develop the communications skills necessary to be an effective medical practitioner. This applies to both effective patient communication and interactions with faculty, house staff, nurses, and hospital workers.
- Acquire procedural skills to effectively perform the following: Phlebotomy, intravenous line insertion, nasogastric tube insertion, arterial puncture for blood gas assay, performing and interpreting EKG’s. Students are expected to complete a log documenting the completion of these procedures.
- Gain familiarity with the indications, techniques, and potential complications for the following procedures through observation: abdominal paracentesis, thoracentesis, insertion of a central vein catheter, lumbar puncture, and arthrocentesis of the major joints.
Required Reading and Didactics
All students are expected to read continually about their patients. In addition, students should read and be prepared for weekly didactic sessions with the Clerkship Director.
All students should be familiar with the following topics, some of which will be discussed during the mandatory clerkship lectures.
- Abdominal pain
- Altered mental status
- Back pain
- Chest pain
- Fluid, electrolyte, and acid-base disorders
- Gastrointestinal bleeding
- Knee pain
- Upper respiratory complaints
- Training problems: patients presenting with a known condition
- Acute myocardial infarction
- Acute renal failure and chronic kidney disease
- Common cancers
- COPD/obstructive airways disease
- Diabetes mellitus
- Heart failure
- HIV infection
- Liver disease
- Major depression
- Nosocomial infections
- Rheumatologic problems
- Smoking cessation
- Substance abuse
- Venous thromboembolism
Absences –If you become ill or must be absent from your duties for any reason, even for one day, please notify your faculty and house staff preceptors, as well as the Department of Medical Education. In the event of extended absences, you must consult with the Clerkship Director. An absence of three days or longer during a four-week rotation will result in an incomplete grade unless the absence is approved ahead of time by the Clerkship Director. Personal illness and family emergencies are examples of legitimate reasons for being absent. Weddings, visits to family and friends, and prepurchased airline tickets are examples of unacceptable reasons for being absent from a rotation.
Professional Conduct –As you become an integral member of the health care team, your degree of interaction with patients will often equal or even exceed that of the more senior members of your team. Accordingly, you are expected to meet certain standards of professional decorum. You are expected to be present and on time for all rounds, conferences and other scheduled activities unless patient care activities are more pressing. Moreover, you must always interact with patients, families, staff and colleagues in a professional and caring manner. Difficulties with appropriate professional conduct can and will be reflected in your final grade.