Welcome to the Medicine Clerkship. The next eight weeks of your medical school career will be both challenging and immensely rewarding. By immersing yourself in the care of acutely ill patients, with the guidance of expert faculty and resident educators, you will emerge after these short weeks with the core skills that will make you a successful resident and future physician. And, we hope that we can show you the excitement of a life as an internist.
The focus of the Medicine Clerkship is the care of hospitalized 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. The clerkship is composed of two 4-week components at two sites: NMH and the Jesse Brown VA. Every student will spend at least four weeks at NMH; some will go to the VA for a month while others will be at NMH for two months (on two separate teams).
We consider our students to be integral parts of the ward team. Year in and year out, students say (and we agree) that the best learning experience is to take an H&P one-on-one with a patient, develop an independent assessment and plan, and get feedback from your teachers. Thus, the majority of your time will be spent on the wards, caring for patients. To supplement this core aspect of your teaching, we have a number of additional requirements, including weekly conferences, physical examination rounds, and meetings with your Site Director faculty liaison to discuss your performance.
In addition to the above activities, students will be responsible for completing and actively maintain their online clerkship log to ensure they are completing the clinical requirements of the clerkship; they will also take the end of rotation Objective Structured Clinical Examination (OSCE) and the NBME Subject Examination at the end of the clerkship.
The Phase 2 Medicine Clerkship will provide the foundation of knowledge and skills which you will need in caring for sick patients, regardless of the specialty you decide to enter. During this eight-week clerkship, we will assist you in achieving the following important objectives. We do not expect mastery of all objectives listed but through efficient use of your time good progress will be made in attaining these objectives.
Download the complete Goals and Objectives document.
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.
Medicine Grading Breakdown
- 50% Clinical Evaluations (proportional to the time spent at each site)
- 17% NBME Shelf Exam
- 15% OSCE
- 8% EPA-Based Assessments
- 5% Notes Assessments
- 5% Timely completion of clerkship requirements
Professionalism & Initiative
Issues related to professionalism and initiative may also affect your grade. These include:
- Responding appropriately to emails from program coordinator Bridget Murdoch
- 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
- Learning Objectives
The max score is 100, and the typical range is 70-90. Honors cut-off is 85.5; high pass cut-off is 80.5.
If a student receives a clinical performance score below expectations (<4) in any category from either site, they may require additional time to complete the clinical requirements of the clerkship. Additional time on the clerkship can be required based on one low score, but a pattern of performance will more likely trigger this. A student may also be required to complete additional time on the clerkship if the student’s total score is <72 and the site directors believe that extra clerkship time will improve the student’s clinical performance. The final decision about extra time will be made at the quarterly site directors’ meeting that occurs soon after each rotation is completed.
The grading for the NBME shelf exam will be Pass/Fail. The clerkship will use the published Hofstee Recommended Standard from the most recent year as the Pass/Fail cut point. All students who achieve a score of Pass on the shelf will receive full points towards their final grade.
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.
For Faculty & Residents
- Safe and Healthy Learning Environment
- Medical Student Supervision and Level of Responsibility Policy
- Duty Hours Policy
- Assessment and Health Providers Policy
- Non-Discrimination Statement
- Non-Retaliation Policy
- Assessment Policy for Clerkships & Electives (Phases 2 and 3)
- Visiting Resident Policy
- Phases 2 and 3 Attendance Policy and Procedure
- Patient Caregiver Preferences and Refusal of Care by Caregivers Policy
- Performing Sensitive Physical Exams Policy
- Needle Stick and Other Blood-Borne, Body Fluid and or Respiratory Pathogen Exposure Policy