Transcript Introduction

Wayne State University
School of Medicine
Department of Internal Medicine
Clerkship Orientation
2005
The Organization
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Two month
Inpatient clerkship
Single site assignment
The Learning Experience
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Students function as an integral
member of the health care team
The learning experience is based on
– direct patient care
– clinical teaching
– conferences
– personal reading
Overall Goal
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To help students understand and
obtain practical experience in the
– recognition
– evaluation
– diagnosis and management
of adult patients with
acute non-surgical illnesses
Specific Goals
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To be able to evaluate and manage
sick hospitalized patients.
To develop familiarity with common
problems seen by internists
To understand the role of the internist
in providing care and coordinating care
Learning Objectives:
Core Problems
Learning Objective:
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To develop familiarity with the core problems in Medicine
Measurement:
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This objective may be satisfied by either caring for a
patient with one of the identified core problems or
by completing a “Medcase” for that problem.
Students must document patient encounters and the
corresponding problem on Campus Mobility.
Medcases profiles must be submitted to clerkship
director, all Medcases must be completed XXXX before
the conclusion of the rotation.
Core Problems
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Anemia 588
Arrhythmias
– Atrial fibrillation
Arthralgas/arthrits 480
Chest pain
– CAD/ACS 451
Common cancers
– Breast 265-s
– Colon 588
– Lung 501
Cough and Dyspnea
– Asthma/COPD 416
– Heart Failure 445
– Pneumonia 472
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Diabetes 549
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Gastrointestinal Ds
– Abdominal pain 359-s 319-s
– Diarrhea 607
– GI bleeding
Geriatric syndromes
– Dementia 464
– Syncope 554
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Hepatitis 494
HIV/AIDS 450
Hypertension 773, 397
Kidney Disease
– Kidney failure 402
– UTI
Substance Abuse
Thromboembolism 489, 460
Learning Objective:
The H&P
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Learning Objective:
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To obtain an accurate medical history and
perform a thorough physical examination in an
efficient and timely manner
Measurement:
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Successful completion and logging of a
minimum of 12 H&Ps.
Satisfactory evaluation of one H&P by site
director
Learning Objective:
The SOAP Note
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Learning Objective:
– To compose an accurate and complete
SOAP note documenting the patient’s
daily progress
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Measurement:
– Satisfactory evaluation of SOAP note by
site director
– Satisfactory evaluation of SOAP note on
the end-of-rotation OSCE
Learning Objective:
Decision Making and the ddx
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Learning Objective:
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To develop diagnostic decision-making skills
that incorporate probability-based thinking
Measurement:
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Successful completion of the assessment and
plan portion of H&P and SOAP notes
documenting
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well ranked differential diagnoses and
clinical rationale for the proposed diagnostic work-up
Learning Objective:
Interpretation of basic labs
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Learning Objective:
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To accurately interpret the results of basic
tests and properly determine how the results
should influence patient management including
analysis of
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acid base and electrolyte disturbances
renal function
peripheral smears and complete blood counts
liver function tests
basic electrocardiograms
chest radiographs
Learning Objective:
Interpretation of basic labs
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Measurement:
– Students will complete the “Interpreting
Diagnostic Tests” Examination on
Blackboard scoring a minimum of 80%
correct.
Learning Objective:
Therapy
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Learning Objective:
– To develop therapeutic decision-making
skills that incorporate pathophysiologic
reasoning and evidence-based
knowledge
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Measurement:
– Satisfactory completion the plan portion
of the H&P and SOAP note.
Learning Objective:
Good Presentation Skills
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Learning Objective:
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To develop facility with different types of case
presentation: written and oral, new pt and
follow-up
Measurement:
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Satisfactory clinical evaluations from their
attending and resident physicians
Satisfactory completion of the presentation
component of the end-of-rotation OSCE
Learning Objective:
RESPECT
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Learning Objective:
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To recognize ethical dilemmas and respect
different perceptions of health, illness, and
health care held by patients of various
religious, cultural and ethnic backgrounds.
Measurement:
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Students will be evaluated on their
participation in the small group discussion
addressing these issues during the
reorientation session
Learning Objective:
Communication Skills
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Learning Objective:
– Students will develop proficiency in
communication and interpersonal skills with
patients and colleagues with attention to how
diversities of age, gender, race, culture,
socioeconomic class, personality, and intellect
require sensitivity and flexibility
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Measurement:
– Satisfactory completion the end of clerkship
Internal Medicine OSCE
Learning Objective:
Collaboration
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Learning Objective:
– To work in collaboration with other
professionals to ensure optimal patient
care.
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Measurement:
– Students must have two professionalism
card completed by ancillary personal on
the internal medicine clerkship
Learning Objective:
Transition of care
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Learning Objective:
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To recognize the importance of ensuring
smooth transition of care from acceptance of
patients from the Emergency Department, to
transfer of patients to other services and finally
to discharge.
Measurement:
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Completion of three discharge progress notes
one of which must be selected and turned in
for evaluation by the Site Director
Learning Objective:
Recognizing systems
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Learning Objective:
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to recognize that systems are critical in
achieving high quality patient care. Students
will make use of systems thinking and
participate in the process of assessing current
practice.
Measurement:
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Completion of a 2-3 paragraph reflective essay
outlining the role the health care system
played in the outcome of one assigned patient.
This must be turned in to the Site Director
prior to completion of the rotation.
Learning Objective:
Life long learning
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Learning Objective:
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To develop and practice self-directed life-long
learning, including the ability to access and
utilize information systems and resources
efficiently.
Measurement:
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Student will be required to do one formal
presentation to their team including literature
review, identification of one review article and
one recent article. This will be evaluated by
the attending physician.
Attestation
I have received and reviewed the goals and objectives for the Junior
Clerkship in Internal Medicine. I am familiar with the expectations and
understand my role and responsibilities for this clerkship.
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Student signature
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Attending physician signature
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Resident signature
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Intern signature
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Intern signature
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Date
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Date
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Date
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Date
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Date
Procedures
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Venipuncture
Blood culture
Peripheral IV
catheter insertion
Arterial blood gas
Throat culture
Nasogastric tube
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Digital rectal
Urethral
catheterization
Place and interpret
a tuberculin skin
test (PPD)
Electrocardiogram
Procedures
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Indications
Contraindications
Risks
Benefits
Alternatives to a given procedure.
What the patient’s experience of the
procedure will be.
Student Expectations
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Attend Year III Internal Medicine Orientation
Attend Site Orientation
Follow Site Specific schedules
Attendance is mandatory; students are
excused for
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Weekly continuity clerkship session
ACLS
WSUSOM recognized holidays--MLK Day, not Valentines
Daily Schedules
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Arrive at the hospital early enough to see
and evaluate their patients prior to work
rounds
Attend work rounds and teaching rounds
with their team
Attend required conferences
Attend laboratory and x-ray rounds
Call
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Students will take call with their assigned
team.
The nature of call depends on the
assigned site; however, call will be no
more frequent than every fourth night.
Students may stay in the hospital all night
with their team or with the night float
team as required by their specific sites.
Student Duty Hours
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Students’ duty hours follow resident duty
hours as described under current RRC
guidelines.
– May not work more than 80 hours per week
– Must have an average of one day off in seven
averaged over four weeks.
– May not spend more than 30 hours in the
hospital at one time
– Must have a minimum of 10 hours between duty
shifts.
References and
Recommended Reading
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Read Dubin the first week
Read about your patients in a standard
text book
Do MKSAP 2 questions every night
Work through Medcases
Use a short internal medicine manual
eg Cecil's to read broadly
Evaluation and Grading
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Students will be evaluated by each
supervising resident and each attending
Intern evaluations are NOT used for grading
Midway through each month of the clerkship,
students must complete WSU formative
evaluation form and review with attending
physician. This will set the stage for
receiving meaningful feedback.
COMPETENCY
DESCRIPTOR(S)
1**.
Application of knowledge in the clinical setting
Application of knowledge to clinical problem solving,
integration of clinical data, development of differential
diagnoses
2.**
Taking a History
Skills in interview techniques, completeness of history,
appropriately focused, thorough, organized, accurate,
comprehensive
BELOW
EXPECTATIONS
SATISFACTORY
OUTSTANDING
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3**
Performing a Physical Exam or Mental Status
Exam
Technical competency and quality, completeness, follow
up, recognition of abnormal and normal findings, focus
and level of detail
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4.**
Communication and relationships with patients
and family
Sensitivity to patient’s feelings and/or needs, empathy,
compassion, rapport, respect, comfort w/ interactions,
putting patients at ease
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5.**
Professional attributes and responsibilities
Attendance, punctuality, commitment, reliability,
motivation, conscientiousness, dependability
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6.
Overall Knowledge Base
Breadth and depth of knowledge base at student’s level
of training
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7.
Written and oral case presentations
Organization, clarity, use of appropriate terminology,
focus of presentation, appropriateness of information
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8.
Record Keeping (Write-ups, Progress Notes,
etc.)
Timeliness of notes, clarity, organization, appropriate
inclusion and exclusion of information, accuracy and
completeness of information
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9.
Facility with Technical Skills and Procedures, if
applicable
Manual dexterity and competence in performing
procedures and/or tests
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10.
Communication and relationships with health
care team
Integration into the team, sensitivity to needs, feelings
wishes and/or rights of others, interaction with team
members, function within team structure
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11.
Self-improvement and adaptability
Introspection, aware of own limitations, adaptability,
receptivity to and acceptance of criticism, motivation,
degree of effort, intellectual curiosity
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To achieve an overall “Outstanding” clinical evaluation
7 out of 11 items must be in the exceeds expectations category
The Exam
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NBME subject examination
100 questions
2 hours and 10 minutes
It is not enough time
Grading
Clinical
Grade
Exam Score
>1 SD
WSU Group mean
< 62
(62WSU Group Mean)
WSU
Group Mean
Outstanding
Repeat Exam
Pass
Commendation
Honors
Satisfactory
Repeat Exam
Pass
Pass
Commendation
Repeat
Clerkship
Repeat
Clerkship
Repeat
Clerkship
Repeat
Clerkship
Unsatisfactory
Year III Grading Form
COMPOSITE CLINICAL EVALUATION SUMMARY (N = ____4____)
CLINICAL COMPETENCY
DESCRIPTOR(S)
FAILS TO MEET COURSE
EXPECTATIONS
MEETS COURSE
EXPECTATIONS
EXCEEDS COURSE
EXPECTATIONS
1.** Application of
knowledge in the clinical
setting
Application of knowledge to clinical problem solving, integration of clinical
data, development of differential diagnoses
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2.** Taking a History
Skills in interview techniques, completeness of history, appropriately
focused, thorough, organized, accurate, comprehensive
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3.** Performing a Physical
Exam or Mental Status Exam
Technical competency and quality, completeness, follow up, recognition
of abnormal and normal findings, focus and level of detail
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4. ** Communication and
relationships with patients
and family
Sensitivity to patient’s feelings and/or needs, empathy, compassion,
rapport, respect, comfort w/ interactions, putting patients at ease
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5. ** Professional attributes
and responsibilities
Attendance, punctuality, commitment, reliability, motivation,
conscientiousness, dependability
6.Overall Knowledge Base
Breadth and depth of knowledge base at student’s level of training
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7. Written and oral case
presentations
Organization, clarity, use of appropriate terminology, focus of
presentation, appropriateness of information
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8. Record Keeping (Writeups, Progress Notes, etc.)
Timeliness of notes, clarity, organization, appropriate inclusion and
exclusion of information, accuracy and completeness of information
9. Facility with Technical
Skills and Procedures
Manual dexterity and competence in performing procedures and/or tests
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10. Communication and
relationships with health care
team
Integration into the team, sensitivity to needs, feelings wishes and/or
rights of others, interaction with team members, function within team
structure
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11. Self-improvement and
adaptability
Introspection, aware of own limitations, adaptability, receptivity to and
acceptance of criticism, motivation, degree of effort, intellectual curiosity
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FINAL CLINICAL
EVALUATION
“Exceeds” evaluations for competencies 1-5 (identified with **) and
“Exceeds” evaluations for at least three (3) other competencies are
minimal criteria for an Outstanding Final Clinical Evaluation.
UNSATISFACTORY
SATISFACTORY
OUTSTANDING
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YOUR GROUP MEAN _____________ SD __________
UNSATISFACTORY
SATISFACTORY
OUTSTANDING
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UNSATISFACTORY
SATISFACTORY
OUTSTANDING
SUMMARY OF CLERKSHIP GRADE COMPONENTS
WRITTEN EXAM
SCORE____________
MINIMUM WRITTEN EXAM PASSING SCORE ____62________
MINIMUM WRITTEN EXAM OUTSTANDING SCORE
OTHER ASSESSMENT
(SPECIFY)
FINAL COURSE GRADE
INCOMPLETE
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PENDING
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UNSATISFACTORY
SATISFACTORY
HONORS
Grade Appeals
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All appeals must be made in writing
Appeals will be presented to the Internal
Medicine Medical Education Committee which is
composed of Year III site directors.
At no time may students appeal their grade
directly their resident or attending physicians or
the site director.
The IM MEC will meet and make a determination
regarding the student’s appeal.
Student may appeal the IM MEC finding to the
Year III Clerkship Grading Committee
Checklist
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Turn in signed attestation
Complete 12 work-ups
Submit H&P, follow-up
SOAP note and discharge
note
Give formal presentation
with lit search and articles
Complete reflective essay
Complete WSU midrotation form, review with
attending
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Complete OSCE
Complete Blackboard lab
interpretation exam
Complete clinical rotation
Log all cases and
procedures on PDA
Submit Medcase transcript
Pass shelf exam
Complete clerkship
evaluation on PDA