Internal Medicine Component

Medical Approach to the Patient (MAP) is a 12-week integrated 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 disciplines 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 block, covering common chief complaints that encompass diagnoses specific to internal medicine and neurology.

Description, Pedagogy, and Objectives

The Internal Medicine component 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.

Pedagogy

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.

Assessment

Formative assessment structures are in place to ensure direct observation and real time feedback to help students improve over the course of the component. At the conclusion of the MAP block, 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.

Learning Objectives

Learn the clinical knowledge and apply basic science concepts to evaluate and treat common presentations and diagnoses in core required IM topics and clinical encounters.
Use clinical reasoning to synthesize data into a prioritized differential diagnosis and plan.
Demonstrate behaviors consistent with the highest standards of professionalism and medical ethics in all patient encounters and interactions with colleagues.
Participate in team-based care by contributing to team rounds and appropriately contributing to clinical activities.
Take individual responsibility for learning.
Prioritize patient care by responding to patient needs and communicating with care team when conflicts between personal and professional responsibility arise.
Demonstrate effective communication with patients, families, and all members of the healthcare team.
Obtain an accurate and appropriately detailed medical history in a logical and organized manner for a given clinical setting.
Complete an appropriate and accurate hypothesis-driven physical examination.
Identify abnormal lung sounds, abnormal heart sounds, and physical exam findings related to liver disease.
Deliver an effective oral and written presentation, appropriately tailored for a given clinical setting.
Recognize whether to obtain and how to interpret common diagnostic studies in medicine inpatient setting such as complete blood count (CBC), serum chemistries, arterial blood gas (ABG), coagulation studies, electrocardiogram (ECG), chest x-ray, and urinalysis.
Support patient safety and clinical care through consistent and effective handoffs and signouts.
Demonstrate sensitivity and responsiveness to diverse patient populations, including effective use of interpreters, when indicated.
Appreciate how patient health care needs are impacted by social and structural determinants of health.
Regularly solicit social determinants of health (SDH) that could impact patient care and outcomes.
Apply concepts of high value care including weighing benefits and harms, relative costs, and patient preference into management plans.
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.
Utilize effective methods of acquiring and applying evidence-based practices to guide diagnosis and treatment decisions.
Appreciate the overlapping skills, knowledge, and approach to patient care in internal medicine and neurology through shared learning activities.

Required Experiences Internal Medicine Logbook

The purpose of the logbook is to ensure that each student has fulfilled the required clinical experiences determined by the faculty to meet the objectives of the clerkship rotation. All students are responsible for logging required clinical experiences in the logbook. The logbook is reviewed by clerkship leadership and completion is documented and monitored centrally by the Office of Curriculum.

If you need accessibility assistance with the Logbook, please contact the Office of Curriculum.