| The focus of junior medicine is the care of patients with complex medical and psychosocial problems. You will take a complete history, conduct a thorough and accurate physical exam, take into consideration complex psycho-social issues, formulate a problem list, construct a relevant differential diagnosis, and along with your team begin to manage the daily details of the care of your patients. At the completion of the 12-week medicine clerkship, every student will have achieved the following. For selected items, there are relevant links.
1) Skills/Activities/Experiences ● | Conduct a complete History and Physical write up | 16 patients | ● | Present new patient formally to team/specialist | 20 patients | ● | Write relevant and thoughtful progress notes | 150 | ● | Participate in the care of and gradually take increasing responsibility for the management of patients, including concise and relevant oral presentations | 30 patients | ● | Write Admission orders | 8 patients | ● | Observe or participate in a difficult conversation-breaking bad news or end of life discussion | 2 patients | ● | Personally read and interpret | | | ABG | 1 | | CXR | 10 | | EKG | 10 | | PFT | 1 | | | | | | | ● | Examine Patients with the following physical exam findings | | | Ascites | 1 | | Crackles | 1 | | Joint –abnormal | 2 | | JVD | 2 | | Liver-palpable | 1 | | Lymph nodes – palpable | 1 | | Pleural effusion | 1 | | Skin-abnormal (eg allergic reaction, petechia, telengietesias) | 3 | | Systolic murmurs | 4 | | Thyroid-palpable | 1 | | Wheezing | 1 |
2) Knowledge During the 12 week medicine clerkship, the student will encounter patients with the following medical conditions or symptoms. Depending on the specific disease/symptom, the student will learn to describe the common causes of the condition and/or the relevant differential diagnosis, and/or a logical diagnostic plan and/or the appropriate initial management. For selected topics, there are relevant links that either provide the most important learning objectives for the particular disease/condition or most relevant differential diagnoses for the symptom. There are 2-3 case conferences a day that will provide adjunctive learning for many of these topics. However, the primary method of learning on junior medicine is caring directly for patients.
Specific diseases/conditions ● | Acid-base disorder | 1 | ● | Alcoholism and Substance abuse | 2 | ● | Anemia | 5 | ● | Atrial fibrillation | 1 | ● | Cancer | 4 | ● | Congestive heart failure | 3 | ● | Coronary heart disease | 4 | ● | Diabetes | 5 | ● | Electrolyte disorder | 5 | ● | HIV | 1 | ● | HTN | 8 | ● | Liver function abnormal | 2 | ● | Pain management | 3 | ● | Pneumonia | 1 | ● | Psychosocial issues | 6 | ● | Renal impairment | 4 | ● | Rheumatologic | 2 | ● | Thromboembolism | 1 | ● | Thyroid | 1 | ● | Urinary tract infection | 2 |
Symptoms: ● | Abdominal pain | 3 | ● | Altered mental status | 2 | ● | Chest Pain | 4 | ● | Diarrhea | 1 | ● | Dyspnea | 4 | ● | Fever | 4 | ● | GI Bleeding | 1 | ● | Syncope | 1 | ● | Weight loss | 1 |
3) Additional Objectives:
In addition to the specific knowledge and skills objectives listed above, students are expected to demonstrate competence and ongoing growth in the following areas: Self-Directed Learning. Each student should be able to - Describe key sources for obtaining updated information on issues relevant to the management of adult patients.
- Describe key questions to ask in critically appraising articles on diagnostic tests or therapeutic maneuvers.
- Perform a computerized literature search to find articles pertinent to a clinical question.
Professional and Ethical Aspects of Care. As evidence of the presence of attitudes, perspectives, and commitment appropriate to the practicing physician, each student will - Demonstrate a commitment to caring for all patients, regardless of gender, race, socioeconomic status, intellect, sexual orientation, or ability to pay.
- Demonstrate honesty and truthfulness, including accuracy in communication of clinical information.
- Take initiative in caring for your patients, ie. go beyond just doing what is asked of you; begin to think independently about your patients’ needs.
- Be punctual, dependable, and appropriately dedicated to clerkship activities.
- Maintain an appearance consistent with the tradition of the profession and the expectations of patients.
- Be tolerant of the opinions of others, able to receive constructive criticism gracefully, and adaptable to changing situations and expectations.
4) Specialty Medicine Learn how to be an effective consultant. Understand the management of chronic conditions and symptoms Learn how to take a focused history and physical Gain exposure to different aspects of medicine (inpatient, outpatient, procedural) Develop a more detailed approach and knowledge base regarding specific aspects of medicine
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