Essentials for Students - What to Expect at your Clinical Sites
General Internal Medicine Site
Your general internal medicine site is where you will have your principal clinical experience. At every site there is a "site coordinator" who is overseeing your clinical activity to assure you have the opportunity to achieve the goals of the clerkship. At solo practices, the site coordinator is the preceptor. At group practices, health maintenance organizations, and hospital clinics the coordinator may be a physician other than your preceptor.
In general, here is what you can expect at your site:
- An orientation to the practice and discussion of goals for your clinical activity. This discussion is key to getting you off to the right start. Ask your preceptor about when you will start seeing patients alone, writing notes, expectations for your interaction with office staff, hospital rounds, and the clinic schedule. Find out when you should arrive for each clinic session. Expect to hear about planned mechanisms for giving you feedback on your performance. Be sure to find out how to use available computers and receive test results.
- Active participation in patient care
Your preceptors understand that, at this phase in your education, you need to be responsible for patient care. They also know that you are not ready to practice on your own and that lots of coaching and supervision is warranted. You will not be left on your own.
Usually after an initial brief period of passively observing your preceptor, you may expect to see at least four patients per day (8 hours) on your own with the understanding that you will be supervised in providing all aspects of care from the initial interview to negotiation of treatment. Your preceptor will usually brief you about the patient beforehand and set goals for your interaction with the patient. Always, your preceptor will see the patient with you at the conclusion of your independent evaluation.
For an additional number of patients, your preceptor may ask you to see them on your own, but not to assume responsibility for total care. For example, you may be asked to briefly see a patient to obtain a focused history, review medications, or make a preliminary diagnosis.
The most important feature of your clinical experience is the opportunity to initially evaluate patients on your own and independently solve problems related to patient interviewing, physical examination, differential diagnosis, and treatment. While passive observation of your preceptor will be an important adjunct to your clinical instruction, it should not constitute the majority of your time with patients.
There will be many opportunities during your ambulatory clerkship for formative feedback on your performance in patient interviewing, physical examination, clinical reasoning, and professional communication. Formative feedback is any reflection on your performance that comes with explicit recommendations for improvement. Some feedback will come serendipitously during regular clinical work from your own observations, comments of your patients, and remarks by your preceptor.
You may expect regular feedback, however, from your preceptor or site coordinator who will meet with you weekly. Make plans for these meetings at the beginning of your rotation.
By the end of this ambulatory clerkship, you should be able to write a concise, well-organized visit note. Instructions for writing an outpatient note and a sample note are provided in this prospectus. Expect your preceptor to ask you to write a note on every patient for whom you are the principal provider. At most clinical sites, your note will be included in the patient's official record, countersigned by your preceptor.
- Integration into the practice
General medicine preceptors have been asked to actively involve you in all aspects of their practice including hospital rounds and consultations, emergency room care, and practice management.
Most students will spend only one or two 1/2 days per week with their subspecialty preceptor. This schedule will not always permit a full integration of the student into the practice. At some subspecialty sites where no separate room is available for student use, students may not have direct responsibility in patient care. Expectations for feedback and charting are the same as for general medicine practice.