Internal Medicine Clerkship

The Medical Approach to the Patient (MAP) is a 12-week integrated clerkship block that is comprised of Internal Medicine and Neurology rotations. The course is structured to give clerkship students in-depth experience with the diagnosis and management of adult medical issues. Because of the significant clinical overlap between internal medicine and neurology, these two clerkships are combined to form the MAP experience. Students will rotate through eight weeks of internal medicine and four weeks of neurology during their MAP experience. In addition to rotation-specific didactics, students will attend the “Top Ten” series of didactics throughout their MAP clerkship, covering common chief complaints that encompass diagnoses specific to internal medicine and neurology.

The Internal Medicine clerkship is an immersive 8-week course which gives clerkship students extensive experience with the diagnosis and management of hospitalized adults. Divided into two 4-week blocks, the students are assigned to either the Yale New Haven Hospital Campus at York Street or one of three other inpatient facilities each of which bring their own unique perspective on inpatient internal medicine (West Haven VA, Saint Raphael’s Hospital Campus, or Bridgeport Hospital). In addition to general medicine teams, students have the option to select a subspecialty team for one of their 4-week blocks (oncology, liver disease, renal disease , etc) to explore careers within Internal Medicine. Students work as wholly integrated members of an inpatient team each working along an intern, senior resident, and attending. Through the processes of admitting new patients to the hospital and following them throughout their stay and through discharge, students have ample opportunities to hone their clinical skills.

In addition to the team-based clinical learning, clerkship student-specific didactics include an 8-week ECG interpretation course, longitudinal radiology sessions, core curriculum cases (delivered in small groups, our Top Ten format, and in the simulation center), exploration of laboratory medicine, and critical incidents debriefs.

Formative assessment structures are in place to ensure direct observation and real time feedback to help students improve over the course of the clerkship. At the conclusion of the MAP clerkship, students take a medical knowledge exam based on a mix of questions from USMLE and other sources as well as a clinical reasoning exam. Both assessments are used to equip the students with information about areas of relative strengths and weakness and neither are used to determine a clerkship grade.

• 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
• Demonstrate effective communication strategies and professional behaviors with patients, families, and all members of the healthcare team (including physicians and non-physician health professionals)

• Obtain and record a patient’s history in a logical, organized, and thorough manner
• 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
• Be able to identify abnormal lung sounds, abnormal heart sounds, and abnormalities related to liver disease
• Obtain and understand important supplemental information, including CBC, serum chemistries, ABG, coagulation studies, ECG, chest x-ray and urinalysis
• Formulate and document an assessment that includes the relevant differential diagnoses based on data gathered to guide initial diagnostic evaluation and disease management
• Orally present a new patient’s history and physical examination clearly and with appropriate detail
• Orally present a follow-up patient’s case in a focused manner, including diagnostic and therapeutic plans
• Write cogent, clear progress notes documenting working diagnosis and status of diagnostic evaluation and therapeutic plans

• 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 16 core topics listed in the next section
• Review the scope and prevalence of medical error in our current health care system and learn the causes for error and methods to report and improve patient safety
• Improve patient safety and clinical care through consistent and effective handoffs and signouts
• 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

Please note that students are required to complete an additional four EPA experiences selected from any of the five EPAs listed above

*alternative methods = didactics, simulations, case conferences, or Aquifer modules