Junior Medicine Clerkship

The focus of junior medicine is the care of patients with complex medical and psychosocial problems.  During the 8 weeks of inpatient medicine, 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.

During the 4 weeks of specialty medicine, you will learn how to take a focused history and physical, manage chronic conditions and symptoms, and develop a more detailed approach and knowledge base regarding two specialty areas of internal medicine.

Inpatient blocks

• The student is considered to be an integral part of the ward team, and is to be given progressive levels of responsibilities based on the student’s individual capacity.  In other words, the more initiative you take, the more responsibility you will get.

• The student should try to conduct the initial history and physical alone at least ½ the time.  This may mean taking a “less interesting patient”, but being alone with your patient is a unique experience. The “easiest” thing to do is participate in a group interview with your intern and resident. In general this is less educational for the student. 

• The student should learn to write orders.

• The student should read about his/her patient’s problems and related disorders.  Ideally, this should be done prior to writing your assessment plan and before presenting the patient the following morning.  Reading about clinical medicine when it directly pertains to your patient is the most fun way to learn medicine as well as the best way to remember it.

The inpatient component of junior medicine is composed of two 4-week components. There are three sites-NMH, Evanston and the VA. Every student will spend at least 4 weeks at NMH.

Each hospital has its own schedule of clinical rounds, teaching attending rounds, and conferences.  The clerkship is designed to take maximal advantage of the activities of the medical service at each site, while providing a number of common features and activities at all sites to ensure an appropriate degree of comparability in the education experience and to promote continuity between your first and second six weeks’ experience.  These common features include:

1) Eleven core topics will be presented throughout the rotation.

First month:

EKG
CXR
Chest pain
Antibiotics/common infections

Second month:

CHF
Acute renal failure
Fluid/electrolytes
Pulmonary Embolism

Third month:

HIV
ABG/acid base
COPD/asthma

2) Regular conferences with clerkship site directors.  The clerkship directors are responsible for overseeing your experiences during the clerkship, and through regular meetings with each group of students, usually utilizing a case conference format, they are charged with ensuring that your progress in the clerkship is appropriate.

3) There will be additional educational conferences unique to each site.

4) Formal faculty review of at least one written H&P at each site.

 5) A meeting with the site director at the end of the 4 weeks to discuss your clinical performance.

6) The clinical performance from each inpatient site contributes equally to the calculation of your final grade.

Specialty Block

After a 3 year internal medicine residency, a physician can elect to pursue a fellowship in a particular area - e.g. cardiology, gastroenterology, nephrology, pulmonary, etc.  These specialists often serve as consultants to the inpatient medicine teams.  The specialty medicine rotation component of the third year internal medicine clerkship is designed to ensure some student exposure to the medicine specialties.

 The general goals of the rotation are:

• 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.

Specific learning objectives will be defined for each specialty. For example, a student on rheumatology will be expected to master eliciting a rheumatological history and the joint exam, while a student on nephrology should become familiar with urine microscopy.

We hope that more “in depth” knowledge will give you a foothold of expertise (and hopefully, comfort) as you approach the rest of your rotation.

The one month long rotation will be divided into two 2 week blocks.  Students will select from a list of choices and we will try to match students to their top choices, although due to variability in student interest at different times of the year, we can only guarantee placement in a one of the top four choices.

Based on where the student is assigned, the rotation will likely vary widely.  Most students can learn something from “shadowing,” although acting as independently as possible is encouraged.  If possible, try to see patients on your own, then present to your preceptor (either by the patient’s side or out of the room).  You have to be considerate of the preceptor and patient’s time – an important aspect of outpatient clinic is being able to see all the patients, answer their questions, and stay on schedule.  We will try to provide you with a template of a standard note, with relevant history and physical exam features highlighted. 

Evaluation of the student will be a composite of the feedback from the attendings you worked with and the weekly small group sessions.