The curriculum includes clinical instruction in general internal medicine, clinical instruction in subspecialty practice, and classroom exercises. Clinical instruction will occur in a variety of sites including hospital clinics, private practices, federally-qualified community health centers, and health maintenance organizations. Because students are likely to have quite different experiences in each clinical site, we have designed a classroom program to assure that every student learns about key topics and illnesses.
The Steering Committee elected for several reasons to emphasize general medicine in the clinical portion of the curriculum. There are several reasons for this emphasis. First, more internists in the United States practice general medicine than any single subspecialty. The committee wanted the curriculum to reflect this. Second, general medicine has traditionally emphasized concepts included in the specific aims: primary care, health maintenance, etc. Third, only in general medicine are students likely to see the broad spectrum of symptoms and illnesses which bring patients to physicians. Fourth, general medicine practices may be more suitable than subspecialty practices for teaching basic skills including physical examination, interviewing, charting, and referral.
Specific Components of the Curriculum
1. General Medicine Practice
In most clinical sites, students will practice with an attending physician and will see the physician's personal patients. At some participating hospital clinics, students will be supervised in the care of patients who do not have a personal doctor.
Physicians at all clinical sites will encourage students to become actively involved in the care of patients. Under close supervision, students will take primary responsibility for at least two patients per half-day session by seeing the patient before other providers, writing the visit note, and following-up on tests. Whenever possible, the student will see patients in return visits.
In addition to active learning, students will also observe senior clinicians at work. The purpose of this observation is to acquaint students with the attitudes, interviewing skills, and examination skills of accomplished internists.
With the guidance of the preceptor, each student will be expected to consult library resources to answer important clinical questions on specific patients.
2. Subspecialty Practice
In most subspecialty sites, students will have direct responsibility in patient care just as for general medicine sites. In some subspecialty sites, however, students will have an observational role, having no direct responsibility for patient care.
Through participation in subspecialty practice and discussion with physicians, students will have an opportunity to learn behavior required for effective consultation. Students will also learn how to make an effective subspecialty referral by receiving them.
3. Classroom Exercises
During the four week rotation, students will meet twice a week to discuss six cases or case sets. The cases illustrate fundamental principles in the diagnosis, management, and outcome of common medical conditions. Every general internist should know how to care for these patients. The cases are:
|Case #||Topic||Session Coordinator|
|2||Infectious Diseases||Andre Sofair|
|3||Abdominal Pain||Anil Nagar|
|6||Low Back Pain||Walter Kernan|
The format for these case conferences is a group discussion led by an informed faculty member. Students will be asked to read the case and specific literature before the conference.
Once during the rotation, each student will design and lead an educational exercise for his or her peers (student is the “faculty” member). The duration of each students' exercise will be one-half hour, depending on the number of students in the rotation. The exercise will be based on a patient seen by the student at one of his or her clinical sites. The aims for these rounds are: 1) to help students learn techniques for effective small-group learning, and 2) to assure that students broaden their knowledge of medicine. A faculty member will attend each session.
During the last three weeks of the rotation, students will meet with an attending to review patients encountered at clinical sites. Students will be notified in advance that they will be asked to present a patient; each student will present at least once per rotation. The format will be a traditional report.
4. Practice-Based Exercises
Skill Certifications: The learning objectives for this clerkship include competencies in communication and physical examination. As part of an effort to assure students achieve these competencies, we have adopted a certification program. In this program preceptors will observe students performing selected skills and using a standard form, record their findings. Students who demonstrate competency in the skill will be considered “certified.”