Internal Medicine

This elective offers experience in a busy MICU at Y-NHH. Students are on call every fourth day with an intern and resident pair (there are NO overnight responsibilities), assisting them in the admission of patients. Students follow patients in the MICU, are expected to present during rounds, and assist in patient care with their intern and resident. This elective provides the opportunity for participating in the acute management of common medical emergencies. Although students will be exposed to a variety of ICU based procedures, there will be limited "hands-on" opportunity.

Length of Rotation: 2 or 4 weeks (maximum-2 students)

Scheduling Restriction: Not offered 06/30/14-07/11/14, 11/29/14-01/09/15, 05/04/15-05/29/15 

Student's Class Level: 4th, 5th year, will take 3rd year by special application if medicine rotation completed with Honors

Prerequisite: Internal Medicine Clerkship 

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the Medical ICU history and complete a history in the medical record for at least 5 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of shock on at least 3 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common adult medical critical care conditions.
  4. Attitude: Demonstrate professionalism, and take on responsibility while working as a team member with other members of the adult medical ICU care team, patients and families.
  5. Career/context: Know the training/career pathway for pulmonary and critical care medicine.
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Students electing this course will attend the Allergy & Immunology Clinic for Adults held at the Yale Allergy & Immunology Center, 6 Devine Street, North Haven.  Clinics are held Mondays all day, Tuesday mornings, Wednesdays and all day Thursday afternoons. In addition, students will attend the Allergy & Immunology Pediatric Clinic on Thursdays and Fridays, located at Long Wharf, New Haven. It is recommended that they attend the Journal Club held on Tuesdays from 1:00 - 2:00pm, as well as the Allergy Seminar held on Friday mornings at 8:00am. Students may also join in consultations with the Allergy & Immunology service at YNHH.

Length of Rotation: 2 or 4 weeks (maximum-2 students)

Scheduling Restriction: Not offered 06/30/14 – 09/05/14 

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: Immunobiology course

Accept Visiting Students: yes - departmental approval

Learning Objectives:

1. History skills:  Gather the important information that is needed for the general allergy history and complete a history in the medical record for at least 10 patients. 

2. Physical examination skills: Complete a physical examination for the evaluation of allergic rhinitis on at least 3 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident. 

3. Knowledge/diagnostic and treatment skills: Know the pathophysiology and common clinical presentation and treatment approach of the following  allergy and immunobiology conditions. 

4. Attitude:  Demonstrate professional responsibility in working as a team member with all members of the multidisciplinary care team, patients and families. 

5. Career/context:  Know the training/career pathway for allergy/immunobiology.

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The rotation emphasizes a rigorous history and physical exam to develop a differential diagnosis to guide the care of patients in the hospital and clinic. Supplementary reading on topics arising from the management of the patients is an important component of the experience. Interested students should discuss their goals prior to the rotation. A maximum of one student can spend a minimum of two weeks on this rotation and share time between a private practice in New Haven, Connecticut and Yale-New Haven Hospital.  

Length of Rotation: 2 to 4 weeks (maximum-1 student)

Scheduling Restriction: Not offered 06/16/14-07/11/14, 09/08/14-09/19/14, 10/06/14-10/17/14, 11/03/14-11/28/14, 11/29/14-01/09/15 

Student's Class Level: 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes - departmental approval

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The student will participate in the daily activities of the inpatient cardiology consult service, including rounds and new consultations under the supervision of a fellow and attending.  Students will be participating in clinical case conferences and gain exposure to procedures such as cardiac catheterization, stress testing, echocardiography, nuclear imaging, and electrocardiography. The training experience will emphasize the physiologic basis for clinical manifestations and therapy of cardiovascular diseases.  A collection of pertinent review articles will be provided.

Length of Rotation: 2 or 4 weeks (maximum-1 students)

Scheduling Restriction: N/A

Student's Class Level: 4th, 5th year

Prerequisite: Internal Medicine Clerkship

Accept Visiting Students: yes, with departmental approval.  International visiting students must be approved by Yale and VA for direct patient care; this is not an observership.

Learning Objectives:

  1. History skills. Gather the important information that is needed for the cardiovascular history and complete a history in the medical record for at least 20 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of chest pain and shortness of breath on at least 10 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or fellow.
  3. Knowledge/diagnostic and treatment skills: Know about common cardiovascular conditions including acute coronary syndromes, congestive heart failure, and atrial fibrillation and how to evaluate and treat patients with these diagnoses. Students are expected to give a presentation on a topic in clinical cardiology.
  4. Procedural skills: Students will understand the indications for and principles of transesophageal echocardiography, direct-current cardioversion, right and left heart catheterization, coronary angioplasty and stenting, pacemaker/ICD implantation, and pericardiocentesis. Students will have the opportunity to observe these procedures being performed but will not be directly involved in performing any invasive procedures. Students will be expected to perform and interpret 12-lead ECGs on their patients.
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the inpatient cardiology consult service, as well as patients and families and all other medical staff members
  6. Career/context: Know the training/career pathway for Cardiovascular Medicine.
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The student will participate in the daily activities of the cardiology service, including rounds, consultations, conferences, and special procedures such as cardiac catheterization, echocardiography and electrocardiography. The training experience will emphasize the physiologic basis for clinical manifestations and therapy of cardiovascular diseases.

Length of Rotation: 4 weeks (maximum-1 student)

Scheduling Restriction: Not offered 06/16/14-09/05/14 

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the Cardiology Consult history and complete a history in the medical record for at least 5 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of cardiovascular system distress on at least 10 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common critical care conditions.
  4. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Cardiology Consult care team, patients and families.
  5. Career/context: Know the training/career pathway for Cardiovascular Medicine.
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This is an opportunity for students to see a wide variety of gastrointestinal problems and patients, with an opportunity for discussion and review. The student will be an integral part of the inpatient GI consult service, primarily working in an inpatient setting

Length of Rotation: 2 or 4 weeks (maximum-2 students)

Scheduling Restriction: Not offered 06/30/14-09/05/14

Student's Class Level: 4th year only

Prerequisite: N/A

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the common gastrointestinal complaints and complete a history in the medical record for at least 5 patients
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of common gastrointestinal problems. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common pediatric critical care conditions.
  4. Attitude: Demonstrate professional responsibility in working as a team member with other members of the gastroenterology care team, patients and families.
  5. Career/context: Know the training/career pathway for gastroenterology.
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This is an opportunity for students to see a wide variety of gastrointestinal problems and patients, with an opportunity for discussion and review.  The student will be an integral part of the inpatient GI consult service, primarily working in an inpatient setting.

Length of Rotation: 2 or 4 weeks (maximum-2 students)

Scheduling Restriction: Not offered 06/30/14-09/05/14

Student's Class Level: 4th year only

Prerequisite: N/A

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the common gastrointestinal complaints and complete a history in the medical record for at least 5 patients
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of common gastrointestinal problems. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common pediatric critical care conditions.
  4. Attitude: Demonstrate professional responsibility in working as a team member with other members of the gastroenterology care team, patients and families.
  5. Career/context: Know the training/career pathway for gastroenterology.
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This is an opportunity for students to see a wide variety of liver problems and patients, with an opportunity for discussion and review. The student will be an integral part of the inpatient liver service, primarily working in an inpatient setting.

Length of Rotation: 2 or 4 weeks (maximum-2 students)

Scheduling Restriction: Not offered 06/30/14- 09/05/14

Student's Class Level: 4th year only

Prerequisite: N/A

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for a history focused on liver diseases and complete a history in the medical record for at least 8 patients.
  2. Physical examination skills. Complete a pertinent physical examination on at least 8 patients with liver diseases (preferably with cirrhosis), focused on abdominal examination. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or fellow.
  3. Knowledge/diagnostic and treatment skills: Know about common hepatology conditions.
  4. Procedural skills. Perform paracentesis on at least 3 patients. Present in pathology rounds at least 3 patients and discuss findings on liver biopsy
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the hepatology team, patients and families.
  6. Career/context: Know the training/career pathway for clinical hepatology.
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This is an opportunity for senior students to participate in critical care medicine activities in the medical intensive care unit (MICU).  The emphasis will be on evaluation and acute management of respiratory failure, shock and sepsis and use of invasive monitoring.  The physiological basis of disease and rationale for therapeutic interventions will also be emphasized.

Length of Rotation: 2 or 4 weeks (maximum - 1 student)

Scheduling Restriction: Not offered 06/16/14-08/08/14, 11/29/14-12/28/14, 06/01/15-06/12/15

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: no

Learning Objectives:

  1. History skills. Gather the important information that is needed for the care of the critically ill patient and complete a history in the medical record for at least 5 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of the critically ill patient on at least 5 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common critical care conditions.
  4. Procedural skills. Perform bedside procedures as available (ABG, nasogastric tube…).
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the critical care care team, patients and families. 6. Career/context: Know the training/career pathway for critical care medicine.
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The student will participate as an active member of the endocrine training program, making daily rounds with the endocrine fellows and residents and attending physicians. He or she will work primarily on the inpatient consult service at Yale-New Haven Hospital and, as time allows, will have the opportunity to attend selected endocrine clinics at YNHH and the VA.  The  student will also participate in the regularly scheduled metabolism-endocrine conferences throughout the week. This is a full-time assignment.

Length of Rotation: 4 weeks (maximum-1 student)

Scheduling Restriction: N/A

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: Must have a strong command of English

Accept Visiting Students: yes 

Learning Objectives:

  1. History skills. Gather the important information that is needed for the Endocrinology & Metabolism history and complete a history in the medical record for at least 8 patients.
  2. Physical examination skills. Complete a pertinent Endocrinology & Metabolism physical examination on at least 8 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or fellow.
  3. Knowledge/diagnostic and treatment skills: Know about common endocrine and metabolic conditions.
  4. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Endocrinology & Metabolism care team, patients and families.
  5. Career/context: Know the training/career pathway for Endocrinology & Metabolism.
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The General Medicine Consult Team provides consultative services to all non-internal medicine services throughout Yale-New Haven Hospital and Yale-New Haven Psychiatric Hospital. The team consists of one attending and one PA or APRN from the Hospitalist Service.  The team performs preoperative evaluations, general medicine consultation and co-management and evaluates patients for possible transfer to the internal medicine service. Students are responsible for their own patients and perform independent evaluations of all types of consults, with supervision by the Attending MD and/or the PA/APRN. Didactic teaching sessions are held with the attending and/or the assigned PA or APRN.   The rotation is Monday through Friday.

Length of Rotation: 2 or 4 weeks (maximum-1 student)

Scheduling Restriction: Not offered 06/16/14-07/11/14, 07/14/14-08/08/14

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: Internal Medicine Clerkship

Accept Visiting Students: yes 

Learning Objectives:

  1. History skills. Gather the important information that is needed for the general medical consult history and complete a history in the medical record for at least 20 patients.
  2. Physical examination skills. Complete a physical examination for the evaluation of delirium on at least 3 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common medical conditions requiring inpatient consults and the general principles of how to manage such conditions. These include anticoagulation, antibiotic prophylaxis, DVT prophylaxis and treatment, blood transfusions, and diabetes management.
  4. Attitude: Demonstrate professional responsibility in working as a team member with all members of the multidisciplinary care team, patients and families.
  5. Career/context: Know the training/career pathway for Hospitalist medicine
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This is an opportunity to diagnose and manage geriatric syndromes in a variety of settings.  Sites include inpatient consultation service, outpatient geriatric assessment clinic, and nursing homes. Students will have the opportunity to work up and follow patients and participate in weekly team conferences.

Length of Rotation: 2 or 4 weeks (maximum-1 student)

Scheduling Restriction: Not offered 06/16/14-08/08/14, 11/29/14-12/28/14, 06/01/15-06/12/15

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: Internal Medicine Clerkships 1 & 2

Accept Visiting Students: no

Learning Objectives:

  1. History skills. Gather the important information that is needed for the geriatric history and complete a history in the medical record for at least 8-15 (2 or 4 week) patients
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of function and cognition as well as a focused geriatrics examaintion on at least 8-15 (2 or 4 wk elective) patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common geriatric syndromes.
  4. Procedural skills: Discussion of Goals of Care
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Home Care and Nursing Home Care teams, patients and families.
  6. Career/context: Know the training/career pathway for geriatrician
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This is an opportunity to diagnose and manage geriatric syndromes in a variety of settings. Sites include inpatient consultation service, outpatient geriatric assessment clinic, and nursing homes. Students will have the opportunity to work up and follow patients and participate in weekly team conferences.

Length of Rotation: 2 or 4 weeks (maximum-2 students)

Scheduling Restriction: Not offered 06/30/14-08/22/14, 11/3/14-11/28/14, 05/18/15-06/12/15

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes - departmental approval

Learning Objectives:

  1. History skills: Gather the important information that is needed for the geriatric history and complete a history in the medical record for at least ten patients.
  2. Physical examination skills: Complete a pertinent physical examination for the evaluation of common geriatric conditions on at least ten patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common geriatric conditions.
  4. Attitude: Demonstrate professional responsibility in working as a team member with other members of the geriatric care team, patients and families.
  5. Career/context: Know the training/career pathway for geriatrics.
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This elective is designed to provide intensive exposure to clinical hematology by direct participation in the activities of a regular clinical hematology service. Students will work up new patients and consults in rotation with the fellows and residents and will attend outpatient clinics. They will participate in daily hematology ward rounds and bone marrow readings and weekly inpatient/outpatient clinical reviews and clinical research conferences.

Length of Rotation: 2 weeks (maximum-1 student)

Scheduling Restriction: Not offered 12/29/14- 01/23/15

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the medical history and complete a history in the medical record for at least 2 patients/week.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of the patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Procedural skills. Read peripheral smears and marrows on patients.
  4. Attitude: Demonstrate professional responsibility in working as a team member with other members of the hematology care team, patients and families.
  5. Career/context: Know the training/career pathway for hematology
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The elective offers a robust learning experience to medical student rotators in general infectious diseases including the diagnostic evaluation and management of common community acquired and nosocomial infections in a diverse patient population, as well as infections in the immunocompromised patient. There are opportunities for learning in subspecialty areas such as medical microbiology, transplant ID, HIV/AIDS, hospital infection control, antimicrobial stewardship and sexually transmitted diseases. Students will function as active members of the consultation and training program in Infectious Diseases at Yale-New Haven Hospital; and will be expected to attend and participate in daily attending rounds, microbiology rounds four times a week, weekly clinical case conferences and monthly journal clubs. Clinical settings for training are Yale-New Haven Hospital including Saint Raphael’s campus and the West Haven Veterans Affairs Hospital.  Evaluations of students by faculty and fellows would be primarily based on performance in clinical case presentations on the consult service.

Length of Rotation: 4 weeks (maximum-1 student); only Yale students may elect to participate in a 2-week rotation

Scheduling Restriction: Not offered 06/30/14-07/11/14

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes - departmental approval

Learning Objectives:

  1. History skills. Gather the important information that is needed for the Infectious Diseases history and complete a history in the medical record for at least 8 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of nuchal rigidity, the heart, lung, abdomen, extremities and skin on at least 10 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending, fellow or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common adult infectious disease conditions and attend scheduled conferences/rounds.
  4. Attitude: Demonstrate professional responsibility in working as a team member with other members of the infectious diseases care team, patients and families.
  5. Career/context: Know the training/career pathway for infectious diseases
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This elective in clinical nephrology offers the student an opportunity for in-depth learning regarding problems in fluid and electrolyte disturbances, acute renal failure, chronic renal failure, and hypertension. Emphasis is placed on problem recognition, pathophysiologic diagnosis, evidence-based clinical judgment, and management based on pathophysiologic principles. The primary activity involves the inpatient consultation service in which the student works up and follows several patients per week, and participates in daily rounds with the attending physicians, postdoctoral fellows, and residents on service. An introduction to hemodialysis, peritoneal dialysis, renal transplantation, and renal biopsy histology is also provided.

Length of Rotation: 2 or 4 weeks (maximum-1 student)

Scheduling Restriction: Not offered 06/16/14-08/08/14

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the Nephrology history and complete a write up for at least 8 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of the nephrology consult patient. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common Nephrology conditions.
  4. Procedural skills. Perform Urine microscopy on every consult.
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Nephrology care team, patients and families.
  6. Career/context: Know the training/career pathway for Nephrology.
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The goal of this elective is to reinforce students' clinical skills following their time away from clinical medicine.  The emphasis will be made on history, physical examination skills, interpretation of data, morning presentation, medical terminology, patient communication and coordination of care.  Students will be assigned to a team that consists of one intern, one resident, and one attending.  He or she will admit his or her own patients and be responsible, with supervision, for the care of their patients during hospitalization.  The student will present daily on rounds and history, physical diagnosis and laboratory interpretation skills will be emphasized.

Length of Rotation: 2 or 4 weeks (maximum - 1 student)

Scheduling Restriction: Not offered 06/16/14-08/08/14, 06/01/15-06/12/15

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Learning Objectives:

  1. History skills. Gather the important information that is needed for the internal medicine history and complete a history in the medical record for at least 5 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of internal medicine on at least 5 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common internal medicine conditions.
  4. Procedural skills. Perform bedside procedures as available.
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the internal medicine care team, patients and families.
  6. Career/context: Know the training/career pathway for internal medicine.
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Opportunity for senior students to manage acute medical problems such as chest pain, shortness of breath, acute renal failure, hyperkalemia, diabetic ketoacidosis and GI bleeding in a unit. Students will be the primary providers under the supervision of a resident and clinician educator. Responsibilities include writing orders, doing procedures, arranging consults and family meetings and hospital follow up of patients with the same clinician educator. Students will develop and receive feedback on clinical skills. No overnight call.

Length of Rotation: 4 weeks (maximum - 1 student)

Scheduling Restriction: Not offered 06/16/14-07/11/14, 11/29/14-12/28/14, 06/01/15-06/12/15

Student's Class Level: 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: no

Learning Objectives:

  1. History skills. Gather the important information that is needed for the internal medicine history and complete a history in the medical record for at least 5 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of internal medicine on at least 5 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common internal medicine conditions.
  4. Procedural skills. Perform bedside procedures as available.
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the internal medicine care team, patients and families.
  6. Career/context: Know the training/career pathway for internal medicine.
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The Internal Medicine subinternship offers medical students the opportunity to function in the role of an 

intern on an Internal Medicine inpatient team. Subinternship opportunities are available throughout the 

academic year at Yale-New Haven Hospital (York Street Campus), the West Haven VA, and at Waterbury 

Hospital. Subinterns will join a team consisting of an upper year medical resident and attending and will 

be responsible for admitting patients, writing admission and daily progress notes, presenting cases on 

rounds, communicating with consultants, ordering medications and tests, and serving as the front line 

physician for patients admitted to the hospital. Students will be responsible for managing approximately 

half the number of patients typically managed by an Internal Medicine intern. The Internal Medicine 

Subinternship offers medical students an outstanding opportunity to prepare for internship, whether the 

student intends to pursue a career in Internal Medicine or another specialty.

To qualify for an Internal Medicine Subinternship, students must have successfully completed their 

3rd year Internal Medicine Clerkships. 

Length of Rotation: 4 weeks  

Scheduling Restriction: Not offered during Winter Break (11/29/2014 – 12/28/2014)

Student's Class Level: 4th, 5th year

Prerequisite: Completion of two inpatient Internal Medicine Clerkships (Med 1 & Med 2) required. 

Accept Visiting Students: US - yes; International - no

Learning Objectives:

  1. History skills: Students are allowed to do this rotation only if they have completed their Internal Medicine clerkship rotations both in the inpatient and outpatient arenas. Thus, by the time they begin the Subinternship there will be an expectation by supervising residents and Attending Physicians that students have acquired substantial skills in data gathering and in the writing of medical histories using accepted formats. Thus, the focus will be more on how the subintern is able to summarize the history succinctly during oral presentations, and is able to advance to the next phase from being a data gatherer to a data analyzer.
  2. Physical examination skills. Students are allowed to do this rotation only if they have completed their Internal Medicine clerkship rotations both in the inpatient and outpatient arenas. Thus, by the time they begin the Subinternship there will be an expectation by supervising residents and Attending Physicians that students have acquired the rudiments of skills in physical diagnosis. Every patient whom the subintern examines is also examined by both the supervising resident and the Attending Physician, and therefore all discrepancies in physical findings are used as teaching opportunities at the bedside. Furthermore, Attending Physicians will also ensure that subinterns are shown physical findings of interest on patients who are not their own but those of other interns or residents on the medical team
  3. Knowledge/diagnostic and treatment skills: It is our firm belief that the summum bonum of the Internal Medicine Subinternship is that the bulk of knowledge acquired will be learned at the bedside attending to the needs of patients admitted by the subintern and during call nights also from covering for the patients of colleagues on the medical team. Therefore, it being impossible to predict what kinds of patients will be admitted in a given month on the inpatient team on which the subintern serves, there is no strict qualitative definition of an exact mass of knowledge that should or needs to be acquired during this rotation. That having been said, based on the average experience acquired on a 4-week ward rotation at our Subinternship sites, the subintern would have acquired the following skills in the approach to the diagnosis and management of: patients presenting with or having as a part of their illness
  4. Procedural skills. To anticipate a subintern to memorize the indications and risks of every procedure would be an unreasonable expectation and if required would be worthless expenditure of mental energy. Hence we do not very deliberately provide such a list. Instead, the indications, risks and individual benefits of procedures to patients will be discussed with the subintern as and when a patient to whom that subintern is providing care requires that procedure. In each case the subintern will also be tutored about informed consent. The types of procedures involved include diagnostic thoracenteses and paracenteses, joint aspirations, and lumbar puncture. The subintern may be taught to do such a procedure by a certified resident if it be a procedure such as the drawing blood for arterial blood gasses.
  5. Professionalism and Interpersonal Communication: Demonstrate professional responsibility in working as a team member with other members of the Internal Medicine Team, Care Coordinators, Social Workers, Nurses and Consultants. Provide patient centered care. Learn the skill so important to a medical resident, (which is what the Subinternship prepares a student for), and that is the skill of interpersonal communication.
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This rotation is designed to provide senior medical students (and PA and nursing students) with an introduction to the principals and practice of occupational and environmental medicine, including exposure, assessment and evaluation of disease causality. Students will learn how to evaluate workplace and environmental exposures, and assess the contribution of such exposures to patients’ diseases. The experience is centered on the YOEMP diagnostic clinic at 135 College St, New Haven, CT, VA Connecticut Healthcare System, and YNHH Employee Health. In addition, students will have the opportunity to participate in ongoing didactic and research conferences, workplace surveillance programs, and visit workplaces and other environmental sites that are being evaluated for their role in disease causation. Students will be exposed to the varied opportunities for careers in this discipline.

Length of Rotation: 2 or 4 weeks (maximum-1 student)

Scheduling Restriction: Not offered 06/30/2014-09/05/2014, 11/29/2014-01/09/2015

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the Occupational and Environmental Medicine history and complete a history in the medical record for at least 5 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of occupational asthma on at least 5 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common occupational and environmental medicine conditions.
  4. Procedural skills. Perform spirometry on at least 5 patients.
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Occupational and Environmental Medicine care team, patients and families.
  6. Career/context: Know the training/career pathway for Occupational and Environmental Medicine
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This is an advanced elective offered to students who have completed their 3rd year Internal Medicine clerkship. This elective is designed to expose students to all aspects of clinical medical oncology by direct participation in the daily disease-specific out-patient oncology clinics at Yale Cancer Center. Students will have the opportunity to work-up patients with new cancer diagnoses and to participate in the on-going care of patients with diverse cancer diagnoses working closely with the medical oncology fellows and attending physicians. Students will participate as an active member of the medical oncology training program, attending the regularly scheduled daily clinical conferences as well as weekly disease-specific multi-disciplinary tumor boards and medical oncology fellow education conferences. Although the emphasis of the elective is on out-patient oncology in disease-specific units, students can also opt to work with the in-patient oncology team at Yale-New Haven Hospital. Rotations based at the VA Cancer Center can be arranged as well.

Length of Rotation: 2 or 4 weeks (maximum-3 students)

Scheduling Restriction: N/A

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes - departmental approval

Learning Objectives:

  1. History skills. Gather the important information that is needed for the oncology history and complete a history in the medical record for at least six patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of cancer and treatment side effects on at least six patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about syndromes causing oncology emergencies.
  4. Procedural skills. Observe the order entry of chemotherapy orders.
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Oncology care team, patients and families.
  6. Career/context: Know the training/career pathway for medical oncology.
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This 52-bed inpatient program at the nation's first hospice provides intensive palliative care for patients with terminal illness. The medical, psychological and spiritual needs of these patients and their families are met through the coordinated efforts of an Interdisciplinary Team (IDT) of physicians, nurses, social workers, pharmacists, clergy, art therapists and volunteers.

Students work one-on-one with an attending physician caring for patients approaching the end of life and their families. They participate fully in admissions, morning rounds, family conferences and IDT conferences. This elective offers students an opportunity to acquire advanced knowledge and skills in the management of symptoms (pain, anxiety, insomnia, etc.), which will benefit them in their future care of all patients, both those approaching the end of life as well as those who are acutely or chronically ill. It is the only elective in which symptom management receives a major focus.

The four-week rotation allows for optional time spent with allied services and/or home care. The goal of this rotation for students is to learn to provide optimal symptom management and, as members of the IDT, to learn to care for patients approaching the end of life and to give support to their families.

Length of Rotation: 2 or 4 weeks (maximum-2 students)

Scheduling Restriction: N/A

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: All students are required to provide a letter of good academic standing from the Registrar; a copy of their recent PPD; and acceptance or declination of Hepatitis B; documentation of no communicable diseases; evidence of private health insurance and evidence of professional liability from the Registrar; and a personal letter stating why the student wants to do a rotation in Palliative/Hospice Medicine. All documentation must be sent to Luis Gonzalez two weeks prior to the start of your rotation.

Accept Visiting Students: yes - departmental approval

Learning Objectives:

  1. History skills. Gather the important information that is needed for the adult/pediatric history and complete a history in the medical record for at least 10-15 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of presenting diagnosis and comorbidities on at least 15-20 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common adult/pediatric critical care conditions.
  4. Procedural skills. Participate in at least 4 Interdisciplinary Team(IDTs) meetings and 15-20 rounds
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the IDT care team, patients and families.
  6. Career/context: Know the training/career pathway for palliative/hospice medicine
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The Yale New Haven Medical Center (YNHH) consult elective in Pulmonary Medicine is designed to provide medical students an in-depth knowledge of respiratory diseases through consults on the patient care floors and through didactic sessions and directed reading. Students become an integral part of the Pulmonary and Critical Care (PCCM) Section consult service, working with the attending and PCCM fellow(s). From two to six new consults on average are seen daily. Formal didactic lectures are given on Wednesday afternoons at 2:30 p.m. at the Yale State Chest Conference and Friday afternoon at 3:00 p.m. at the Fitkin Amphitheater. Students are expected (1) to learn the differential diagnosis and treatment of respiratory disorders, (2) to learn to interpret pulmonary function tests and (3) to learn to read a chest radiograph and understand the essentials of a chest CT scan. Students work closely with faculty and staff in the pulmonary group and participate in daily consulting and rounds. Students assist in the examination and treatment of patients with various cardiopulmonary diseases, including tuberculosis, chronic obstructive airway disease, asthma, lung cancer, bacterial and fungal lung infection and other diagnostic problems. They will receive practical instruction in chest images and pulmonary function tests and their interpretation, clinical and laboratory methods in diagnosis and management, including intensive respiratory care and respiratory therapy, and an opportunity to observe fiberoptic bronchoscopy. Students receive didactic lectures in a number of areas relating to airway pharmacology, lung cell biology and lung immunology (respiratory cells, immunologic reactions, etc). A separate experience is available in intensive care medicine.

Length of Rotation: 4 weeks (maximum-1 students)

Scheduling Restriction: Not offered 06/30/14-07/11/14, 11/29/14-01/09/15, 05/04/15-05/29/15

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the pulmonary medicine (specialty/service) history and complete a history in the medical record for at least 5-7 (patients/biopsies/radiographs etc.).
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of lungs on at least 5-7 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
  3. Knowledge/diagnostic and treatment skills: Know about common pulmonary critical care conditions.
  4. Procedural skills. Perform chest x-rays and pulmonary function tests on at least 10 (patients/radiographs/biopsy specimens etc.).
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the pulmonary service care team, patients and families.
  6. Career/context: Know the training/career pathway for pulmonary (specialty)
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Students will work closely with the faculty member and fellow assigned to the inpatient consultative service at both Yale-New Haven Hospital and the West Haven VA Medical Center. They are expected to attend rounds and evaluate patients with rheumatic conditions and other diseases with rheumatic manifestations. In addition they will participate in outpatient clinics including two VA Hospital arthritis clinics, and two general Rheumatology clinics at Yale-New Haven Hospital. They are expected to attend two weekly conferences sponsored by the Section of Rheumatology.

Length of Rotation: 2 or 4 weeks (maximum-1 student)

Scheduling Restriction: N/A

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the Rheumatology history and complete a history in the medical record for at least 15 patients.
  2. Physical examination skills. Complete a pertinent physical examination for the evaluation of the musculoskeletal system on at least 15 patients. The student should demonstrate the ability to perform a pertinent physical examination while being observed by at least one attending or resident/fellow.
  3. Knowledge/diagnostic and treatment skills: Know about common rheumatologic conditions.
  4. Procedural skills. Perform or assist with joint injection on at least 3 patients
  5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Rheumatology care team, patients and families.
  6. Career/context: Know the training/career pathway for Rheumatology
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The goals of this rotation are to convey to the student an awareness of the options for spiritual care and support within an acute care hospital setting and to give the student an opportunity to learn and practice spiritual care-giving skills appropriate to the physician's role. The Department of Religious Ministries has professionally certified chaplains of many faiths who will serve as faculty and spiritual care-giving mentors, sharing their practice via being 'shadowed' and their pastoral theological understandings. During the course of this elective the student will spend time with at least four different chaplains (of Jewish, Roman Catholic, Protestant and Pentecostal backgrounds) to observe their chaplaincy practices and to discuss with them the implications of both faith-specific and interfaith spiritual care. The student will also be instructed in various spiritual assessment models and be invited to conduct at least four assessments (a self assessment, a colleague assessment and two patient assessments). In addition to shadowing individual chaplains, the student will attend departmental morning reports, staff meetings and at least one Sunday's worship services. Topics such as Spiritual Self-Care will be discussed. The students will have a one-hour discussion weekly with Dr. Fortin. The students will prepare a brief essay at month's end, reflecting upon his/her experience. The student will receive a copy of relevant texts on Spirituality in Medicine.

Length of Rotation: 4 weeks (maximum-2 students)

Scheduling Restriction: Not offered 06/16/2014-09/05/2014;10/06/2014-12/28/14; 01/26/15-4/03/15

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: No

Learning Objectives:

  1. History skills. Gather the important information that is needed for the Spiritual assessment and complete such a assessment for at least 2 patients, as well as a colleague assessment and a self assessment.
  2. Knowledge/diagnostic and treatment skills: Know about methods of spiritual assessment.
  3. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Spiritual care team, patients and families.
  4. Career/context: Know the various roles and responsibilities of professionals providing spiritual care in the health care context.