Medicine Clerkship

PREREQUISITES AND PLACEMENT IN THE CURRICULUM:

Completion of M2 Year; Year Three

PURPOSE:

The basic Internal Medicine clerkship is designed to expose students to the comprehensive approach to adult patients with nonsurgical disease. The emphasis is on perfecting the fundamental skills of data collection, clinical reasoning, and understanding of pathophysiological processes. The experience is patient-centered, supplemented with didactic presentations and student readings appropriate to the care of their own patients. In their first exposure to Internal Medicine as a discipline, students simulate the role of a trained internist under the close supervision of resident trainees and faculty members.

GOALS AND OBJECTIVES

GOALS

The Department of Internal Medicine will provide an educational experience for clinical clerks offering graduated supervised responsibility for patient care in the area of general internal medicine.  During the clerkship each student will gain an awareness of the knowledge, skills, values and attitudes that internists strive to acquire and maintain throughout their professional lives. Students will have graduated, supervised responsibility for patient care, learning to integrate clinical knowledge with practical experience. During the course of the clerkship, the students will gain competencies in 8 core areas: Patient care, medical knowledge, interpersonal and communication skills, professionalism, practice based learning and improvement and systems based practice, interprofessional collaboration and personal and professional development.

OBJECTIVES

At the end of the clerkship, the student should be able to demonstrate competencies in each of the competency domains as outlined below:

Medical Knowledge:

• Explain the pathophysiology of each of the diagnoses or clinical conditions as outlined by the AAIM Core Medicine Clerkship Curriculum Guide: https://uofi.box.com/s/gs53o1v589jw3j71aelu8tn14esoi6my
• Describe how biomedical, ethical, and psychosocial-behavioral factors apply to the clinical presentation of the disease in their patients
• List the indications, contraindications and benefits of the following common procedures: ABGs, thoracentesis, paracentesis, and lumbar puncture
• Describe the indications for the following tests: complete blood count, comprehensive metabolic panel, coagulation studies, chest Xray, abdominal x-rays, EKG, PFTs, and interpret results of these tests for their patients

Patient Care:

• Obtain an accurate, pertinent history from all appropriate available sources, perform a thorough and accurate physical examination, and record all findings in a complete and well-organized manner. (EPA: 1 and 5)
• Perform and record a thorough physical examination, and review the physical findings with the faculty
• Based on history and physical examination findings as well as any laboratory or diagnostic tests done, develop an appropriately prioritized and detailed problem list for each patient
• Utilize clinical reasoning to develop appropriate differential diagnoses to assess the patients’ problems. (EPA 2)
• Select a working diagnosis and formulate a diagnostic and therapeutic plan for their patient(s) based on gathered clinical information and laboratory data. (EPA: 2 and 3)

Interpersonal and Communication Skills:

• Document and deliver oral case presentations on new admissions (full H&P) and document and present daily progress notes (SOAP notes) that are generally accurate, concise, organized, and complete. (EPA: 5 and 6)
• Communicate with patients and their families in a clear, respectful manner, responding to verbal and non-verbal cues.
• Demonstrate respect and courtesy when communicating with all members of the health care team, including staff, nurses, residents and faculty
• Describe the key components of informed consent, and when, applicable, participate in obtaining informed consent prior to performing procedures in their patients. (EPA 11)
• Demonstrate ability to actively engage with patients, families and other members of the health care team to coordinate care. (EPA 9)
• Demonstrate ability to discuss management plan with their patient and explain pathophysiology to them without using medical jargon

Professionalism:

• Discuss how psychosocial, educational, economic and religious backgrounds of patients may underlie their diverse belief systems, and demonstrate this understanding in the approach to the management of individual patients
• Demonstrate sensitivity to, and an understanding of, the ethical dimensions of patient care, and demonstrate this sensitivity in the approach to the management of individual patients
• Develop professional relationship based on trust, mutual-respect, empathy and conscientiousness with patients, peers and other health care members at all times
• Demonstrate ability to work hard, accept patient responsibility and respond appropriately to feedback provided
• Demonstrate respect, compassion, integrity, and honesty at all times

Practice Based Learning and Improvement:

• Develop and research clinical questions that arise during patient care and management, using evidence-based resources. (EPA 7)
• Demonstrate critical reading skills by analyzing selected journal articles, and identify characteristics of effective medical articles. (EPA 7)
• Choose pertinent issues related to the care of their patients and research them independently. (EPA 7)

System Based Practice:

• Participate, whenever possible, in coordination of care and in the provision of continuity of care including transfer and discharge.
• With supervision, students should begin to learn how to identify system failures and contribute to a culture of safety and improvement (EPA13)

Interprofessional Collaboration:

• Describe the roles of other health care professionals in the care of patients in internal medicine.
• Collaborate with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust. (EPA-9)

Personal and Professional Development:

• Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors
• Demonstrate healthy coping mechanisms to respond to stress
• Manage conflict between personal and professional responsibilities
• Practice flexibility and maturity in adjusting to change with the capacity to alter one’s behavior
• Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients
• Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty

M3 Role & Responsibilities

1. A) Patient Care Responsibilities (EPA: 1, 2, 3, 5, 6, 7, 9, 13)

• Obtain a thorough history and physical exam at the time of patient admission
• Write & present full H&P(s) on new admissions
• Write & present daily progress notes (SOAP notes) on the patients they are following
• Pre-round on assigned patients & follow-up on tests and consultation notes and updates
• If feasible, accompany patients to tests (e.g., colonoscopy, stress test, etc.)
• Participate in family meetings and multidisciplinary rounds
• Participate in sign-out rounds
• Actively practice EBM & Read and bring in articles or other educational materials related to your own or team patients.
• Assist interns and senior residents with the care of any patient with supervision commensurate with their level of training and particular skill i.e., calling a consultant about a case.
• Ask for feedback about write-ups, presentations, participation, etc. consistently and especially at midpoint
• Communicate collaboratively and effectively with nursing, pharmacy staff, social workers, patient’s outpatient physicians, inpatient consultants and other staff members to enhance patient care.
• Students may perform, under supervision, procedures on their patients commensurate with their level of training (e.g., BLS, EKG placement, venipuncture, insertion of an i.v.). (EPA 12)

1. B) Call Responsibilities:

• The students are expected to be on call with their team for the duration of the call.
• Students will work with their teams on weekends, and on average will get 1 day off per week (at the discretion of the team). These (off days) are typically weekend days, unless the team is on or post call. Days off for special circumstances must be requested in advance with the Clerkship Director and Coordinator. Days off may be required to be made up at the discretion of the Clerkship and Site Director.  The supervising resident, attending and team must also be notified in advance.
• Students should not exceed work hour rules set by UICOM:
  • https://chicago.medicine.uic.edu/wp-content/uploads/2016/11/StudentWork-Hrs04sept13_Final-approved-12feb14-1.pdf
• Students should respond to the blue alerts/Code Blue as part of the code team.

1. C) Floor Responsibilities:

• Students are expected to participate in pre-rounds and sign-outs and follow patients with their intern –M3s may admit 2-3 new patients a week (no >2 on a given call day) and follow 3-5 patients daily depending on complexity.
• Students are expected to pre-round on their patients and follow up on (and inform the team) all test results and consultant recommendations
• Students are expected to write daily notes (SOAP notes) on their assigned patients
• The students are expected to participate with the medical team in the “sign-out” of patients at the end of the day
• Students are not expected to write discharge summaries, but may practice if desired.
• Students should try to contact the PCP at discharge with the supervision of their residents to inform them of the follow-up plans.
• Students should try to participate in family meetings, end of life and code discussions, and emergent bedside management of their patients when needed and discharge planning.

1. D) Mandatory Requirements

• Students are expected to attend all mandatory student didactics/meetings as assigned by the Clerkship director
• Students must complete:
  • IM Patient Log form (BenWare)
  • 4 direct observation Forms (formerly Mini-CEX)
  • Assigned Aquifer Cases
  • Formative SP exam
  • Other assignments designated by the clerkship directors
• Students must complete a Mid-term Evaluation/Feedback meeting
• Students should complete Qualtrics surveys & Evaluation of Clerkship

UICOM Student Work Hour Policy

• The maximum number of required hours at clinical sites (hospital, clinic, nursing home, etc.) should not exceed 80 hours per week.
• There should be no required consecutive call.
• Night call should be assigned no more than an average of every fourth day (Q4) over the duration of the experience.
• Night call should not be required the day before administration of the end of clerkship examination.
• Students should have an average of at least one day (24 hours) each week free of clinical responsibilities (including lectures, seminars, clinic, and rounds).
• Any time off including getting off early on scheduled work days must be approved by the Clerkship office/Director.

The above restrictions do not include independent study time apart from clinical duties or optional activities in which the student voluntarily participates.

The Association of American Medical Colleges (AAMC) 13 Core EPAs

EPA 1	Gather a history and perform a physical examination
EPA 2	Prioritize a differential diagnosis following a clinical encounter
EPA 3	Recommend and interpret common diagnostic and screening tests
EPA 4	Enter and discuss orders and prescriptions
EPA 5	Document a clinical encounter in the patient record
EPA 6	Provide an oral presentation of a clinical encounter
EPA 7	Form clinical questions and retrieve evidence to advance patient care
EPA 8	Give or receive a patient handover to transition care responsibility
EPA 9	Collaborate as a member of an interprofessional team
EPA 10	Recognize a patient requiring urgent or emergent care and initiate evaluation and management
EPA 11	Obtain informed consent for tests and/or procedures
EPA 12	Perform general procedures of a physician
EPA 13	Identify system failures and contribute to a culture of safety and improvement

 IMPORTANT:

All students will be placed at our academic sites: UIH or VA for at least ½ the rotation.  Additionally, some students will be placed at our community sites (St. Francis Hospital, St. Joseph of Chicago Hospital, Weiss Memorial Hospital, Lutheran General Hospital, Advocate Christ Hospital, and Illinois Masonic Hospital) or on an IM subspecialty ward at UIH (cardiology or oncology).  Students will have call and weekend responsibilities. In general, students will get 1 day off per week at the discretion of their team (generally a Saturday or Sunday depending on the call schedule).

ASSESSMENT:

Written clinical evaluations from residents and attending physicians, and a clerkship examination given at the end of the rotation.

ADMINISTRATIVE INFORMATION:

Program Number: CLER 605

Location: Various Sites as Assigned

Program Director: Asra R. Khan, MD,  Nabeela Rabbani (Coordinator)

E-Mail: arkhan@uic.edu, nrabba2@uic.edu

Duration: 8 Weeks

Night Call: No

Weekends: Yes

Click here to link to the Office of Student Affairs Web Site to view the Reporting Instructions for the Medicine Clerkship.

Updated:  04/19/2022