- 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 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 two sites-NMH and the Jesse Brown 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.
Goals & Objectives
Detailed Goals and Objectives
Download the complete Goals and Objectives document.
Grading & Evaluation
You will receive ongoing feedback from your interns, residents and teaching attendings. Ask for their feedback often. Immediate feedback is usually more specific and more likely to help you improve.
All written comments from your residents and attendings will be available to you on the medical school portal. You should be able to read most of them before your site director meeting at the end of each month. Therefore, it’s rare for a student to hear of a failing performance only at the end of the rotation unless the student’s performance deteriorates very late in a four-week inpatient block. At the end of every block, overall feedback will be summarized by your site director in a written evaluation that will be used to calculate your grade.
Calculated based on feedback as follows = (scholar x 2) + (clinician x 2) + (communicator x 2) + collaborator + professional)
|National Board of Medical Examiners exam:||25%|
|Objective Structured Clinical Exam:||10%|
Issues related to professionalism and initiative may also affect your grade. These include:
- Responding appropriately to emails from program coordinator Anna-Kate Trubilowicz
- Completing VA processing in a timely fashion
- Submitting conflicts of interest
- Completing clerk log in a timely fashion
- Seeing as many patients as you can and writing H&Ps
- Completing clerkship evaluations in a timely fashion
The max score is 100, and the typical range is 70-90. Honors cut-off is 86.5 and a score on the final exam; high pass cut-off is 82.5 and a score on the exam.
The final decision about grading, failure and remediation will be made at the quarterly site directors’ meeting that occurs soon after each rotation is completed. A student’s final grade will only be lowered at this meeting if a student has received a marginal form, a professionalism form or received a clinical performance score below expectations (less than 4) in any category from any site.
Your final grade and evaluation will be available about five weeks from the end of the clerkship. If you have a question about your clerkships grade, please contact the clerkship director directly.
Tools and Readings
- Harrison's - will provide as much depth most of your needs
- Paauw's Guide to Internal Medicine, Mosby - is written by the University of Washington's clerkship director for medicine students. It is more accessible and briefer than Harrison's.
- Clinician's Guide to Laboratory Medicine - is written by two former NMH Chief Medical residents - Dr. Desai and Dr. Isa-Pratt. It provides an excellent practical approach to abnormal labs.
- Pocket Medicine - Mass General Handbook of Internal Medicine - a pocket sized book that many NU students have liked.
During the junior clerkship, journals are best used sources of review articles about topics currently under discussion on your service or in the junior conferences and original articles describing concepts or new studies of therapies that will assist in the care of your patients. If you are interested in pursuing a career in internal medicine, you would be well advised to begin browsing the following journals on a regular basis as a means of becoming familiar with current trends and controversies:
- The Annals of Internal Medicine is the official journal of the American College of Physicians, and home to some of the best original literature in general internal medicine and its subspecialties. The American College of Physician web site (http//www.acponline.org) posts the table of contents of recent issues and the text of some articles.
- In addition to publishing many of the most important original investigative literature of general interest, the New England Journal of Medicine offers its weekly clinicopathologic conferences (CPC) - the Case Records of the Massachusetts General Hospital - and other features such as the regular series in clinical decision making.
- JAMA, the Journal of the American Medical Association, is probably well known to you all by now. In addition, the AMA publishes a number of specialty journals, including the Archives of Internal Medicine.
- The American Journal of Medicine (the "Green Journal") is published by the Association of Professors of Medicine (the organization of chairs at US medical schools). It often contains excellent review articles. The clinicopathologic conferences of the Washington University School of Medicine are also published in AJM.
Frequently Asked Questions
What are the daily expectations for a M3 on this clerkship?
Students spend most of the day working with a team, directly caring for patients. On average, there is one hour required conference per weekday and two hours optional conference per weekday.
What is the typical schedule (number of days worked/hours per day) for this clerkship?
6 days a week, 7 to 5:30 a.m. most weekdays
What is pre-rounding? Rounding? Note writing expectations for this particular clerkship?
Pre-rounding is seeing your patients before rounds-about 15 to 30 minutes. Rounding is usually seeing all of your team’s patients – 2 to 2 1/2 hours.
You will write a progress note on your patients every day.
What does “Call” mean on this particular clerkship?
Call is every four to six days, which means you are at hospital until 10 to 11 p.m.
What do I do if I have a question about my clerkship grade?
If you have a question about your clerkships grade you should discuss this directly with the clerkship director.
What do I do if I have experienced or witnessed Student Mistreatment during this clerkship?
If you have experienced or witnessed student mistreatment there are many avenues to report this. You can discuss this with the clerkships director, mentor, any of the deans or Lisa Rone, MD, the ombudsperson.
What do I do if I feel burnt out or overwhelmed during this clerkship?
If you feel burnt out or overwhelmed during a clerkship there are a number of people you can speak with. The clerkship director, your mentor or anyone in the dean’s office are available to talk. CAPS can also be extremely helpful in this situation. You can contact CAPS at 847-491-2151.
Who do I contact if I am sick or have a personal appointment?
Personal appointment -tell your resident. Sick- tell your resident and let your site director know.
Any required equipment?
Stethoscope, reflex hammer, and light.
David Neely, MD