Goals and Objectives

The following three categories of broad goals for the clerkship are not meant to be limiting you to other goals that you may want to focus on but are intended to clearly outline what we expect for you to achieve by the end of the eight-week Internal Medicine Clerkship. Herein you can review objectives linked to three main goals:

Professionalism

Demonstrate commitment to excellence, honesty, respect for others, integrity and altruism in patient care.

Objectives

  • Treat all patients, staff, and colleagues with respect, which includes maintaining a professional demeanor in speech and dress
  • Strive for excellence
  • Place the care of your patients above competing interests
  • By the end of the clerkship the student will be able to demonstrate effective communication strategies and professional behaviors with patients, families, and all members of the healthcare team (including physicians and non-physician health professionals).

Learning Activity

Professionalism should imbue all aspects of your performance and cannot really be taught in isolation. However, there are weekly sessions throughout the eight-week block taught by core senior faculty about important issues of professionalism including:

  • Navigating the wards- your role in the team, working with mid-level and ancillary providers, etc.
  • Approaching medical errors
  • Palliative Care
  • Communicating difficult news

Evaluation

Formative and summative feedback will be obtained from the ward team using a structured evaluation instrument. The clerkship director will evaluate portfolio submissions and your interactions with them as well (including timeliness, attitude, initiative). How you treat staff, nurses, and all members of the health care team can play a role in this evaluation, though the clerkship does not specifically seek out formal feedback from these individuals.

Patient Care

Evaluate and manage patients hospitalized with acute illness.

Objectives

Objective

Obtain and record a patient’s history in a logical, organized, and thorough manner.

Learning Activity

Interview, examine and write an H&P for each new patient assigned to you (even if there is already a note).

Evaluation

H&Ps are submitted to the attending is primarily who is primarily responsible for evaluating these. The resident will give ongoing feedback as well. The four best H&Ps are included in the final portfolio for additional evaluation by the Clerkship Director.

Objective

Perform and record a complete physical examination in a logical, organized, and thorough manner for new patients and an appropriately focused physical examination for follow up patients. Specific physical examination skill we expect students to master by the end of the third year medicine clerkship includes:
  1. Abnormal lung sounds. Be able to identify pulmonary crackles and wheezes
  2. Abnormal heart sounds. Be able to identify extra heart sounds (S3, S4, pericardial friction rubs), systolic vs. diastolic murmurs, and specifically aortic stenosis and mitral regurgitation
  3. Abnormalities related to liver disease. Be able to recognize and describe stigmata of liver disease including findings consistent with ascites, spider angiomata, palmar erythema, jaundice/scleral icterus

Learning Activity

Each student should be observed performing a complete physical examination and/or targeted portions to the exam. Physical finding rounds will be offered to supplement students’ skills.

Evaluation

House staff and faculty will observe students perform physical examinations in the course of patient care. Formative assessment and feedback will be periodically documented on EPA website platform and submitted as part of portfolio.

Objective

Obtain and understand important supplemental information, including CBC, serum chemistries, ABG, coagulation studies, ECG, chest x-ray and urinalysis.

Learning Activity

  1. Lab Studies. Students will have a two-hour session the first Monday of each block (four hours total) in the Laboratory Medicine Section. These sessions consist of rotations through six different areas of the clinical lab where students are presented with illustrative cases and guided through the appropriate use and interpretation of laboratory tests with an emphasis on how to use the lab and Laboratory Medicine staff as resources.
  2. ECG Studies. Students will also participate in an eight-week (eight hours total) ECG conference run entirely by experienced attending-level cardiologists. The course covers a systematic approach to reading ECGs (beginning with rate, rhythm, axis, intervals progressing through heart block and ventricular and atrial arrhythmias) supplemented by small group discussion.
  3. Radiologic Studies. Students will participate in an eight-week (eight hours total) progressive radiology course that instructs students on the basics of reading plain radiographs (chest, abdomen) beginning with normal studies and progressing through abnormal studies (pulmonary infiltrates, edema, pneumothorax, effusion etc) and introduces students to CT scanning, ultrasonography, and magnetic resonance imaging. Images are presented both in a disease-specific orientation as well as in a problem-based setting (i.e. how to choose and interpret radiographic studies for the patient with hematuria; headache; abdominal pain etc).

Evaluation

Students’ understanding of these tests will be assessed in small group discussions on rounds and on the Exam Master knowledge assessment.

Objective

Formulate and document an assessment that includes the relevant differential diagnoses based on data gathered to guide initial diagnostic evaluation and disease management.

Learning Activity

This will be discussed on daily rounds with the teams and the clinical reasoning process is explicitly taught in weekly Student Report led by a core faculty member.

Evaluation

This is assessed by the teams on daily round interactions and review of progress notes. This is also assessed formally in the portfolio with the H&Ps. Full development of this skill is a crucial component and goal of this clerkship. Formative assessment and feedback on clinical reasoning will be periodically documented on EPA mobile platform and submitted as part of student portfolio.

Objective

Orally present a new patient’s history and physical examination clearly and with appropriate detail.

Learning Activity

This is typically performed with the attending or resident one-on-one and feedback is given at that time, though this can occur as part of rounds.

Evaluation

Attending and residents who directly observe presentations will provide formative and summative feedback. Formative assessment and feedback will be periodically documented on EPA mobile platform and submitted as part of student portfolio.

Objective

Orally present a follow-up patient’s case (including those with more than one problem) in a focused manner, including diagnostic and therapeutic plans.

Learning Activity

This is practiced on daily rounds with the whole team present.

Evaluation

Attending and residents who directly observe presentations will provide formative and summative feedback. Formative assessment and feedback will be periodically documented on EPA mobile platform and submitted as part of student portfolio.

Objective

Write cogent, clear progress notes documenting working diagnosis and status of diagnostic evaluation and therapeutic plans.

Learning Activity

Students practice this by writing daily progress notes on all their patients. These should be on the chart in a timely manner (ideally before noon conference) if feedback is to be given.

Evaluation

The house staff and attending primarily evaluate progress notes. However, students also have the option of submitting them in the portfolio for additional feedback by the clerkship director.

Requirements

Students are strongly encouraged to complete eight full H&Ps in Med 1 and 14 in Med 2. Formative assessment and feedback on full H&Ps and progress notes will be periodically documented in EPA mobile platform and submitted as part of student portfolio.

Medical Knowledge

Demonstrate understanding of the clinical presentation, basic physiology, key physical findings, evaluation and management of diseases frequently encountered in an inpatient medicine setting.

Objectives

  • Be able to use clinical reasoning to synthesize data into a prioritized differential diagnosis, working diagnosis, and plan.
  • Review the pathophysiology and be able to recognize and initiate evaluation and management plans for the following disease states/clinical presentations:
    • Acute Coronary Syndromes*
    • Congestive Heart Failure
    • Pneumonia
    • Pulmonary Embolism*
    • Community Acquired Bacterial Meningitis
    • Acute kidney injury
    • Acid base disturbance*
    • Ascites
    • Gastrointestinal bleeding*
    • Anemia
    • Back Pain*
    • Syncope*
    • HIV and OIs
    • Acute mental status change/delirium*
    • Diabetes
    • Abdominal Pain*
  • By the end of the clerkship, the student will be able to review the scope and prevalence of medical error in our current health care system. The student will be able to learn the causes for error (communication, latent and active errors, etc) and methods to report and improve patient safety.
  • By the end of the clerkship, the student will be able to improve patient safety and clinical care through consistent and effective handoffs and signouts.
  • By the end of the clerkship, the student will be able to demonstrate knowledge of, and utilize, effective methods of acquiring and exercising evidence based practice through articulating foreground questions and gain practice at answering these questions through the use of vetted systematic reviews.

Learning Activities

Sixteen core topics will be covered in small interactive cases conference or assigned as computer-based learning. A clerkship sites cover same eight topics in Med 1 and eight topics in Med 2 but may differ in which topics are covered in case conferences or assigned Aquifer cases. Many topics are also frequently covered in the interactive “Student Report” teaching sessions. Expert faculty will meet with students for interactive problem solving sessions to reinforce many of the concepts taught in the Aquifer cases and of course students will actively care for patients with many of these medical problems. The above list also is intended to help guide students’ reading. Students are strongly encouraged to learn about all of their patients’ past medical problems in addition to the acute problems to further enhance their medical knowledge. Weekly Student Report sessions and Case Conferences will explicitly teach the clinical reasoning process using a highly interactive, case-based format.

Requirements

Students must provide evidence patients’ diagnoses by using the patient logs. A total of 16 core topics will be required either through Aquifer case completion, case conference attendance or Simulation.

Assessment Methods

ExamSoft (multiple choice) in internal medicine (at week seven of eight-week inpatient rotation, end of Ambulatory Block); team evaluations (based on observation) at end of four weeks, and assessment of the four required patient write-ups.