Participation in Undergraduate Medical Education

Medicine Clerkship

The Medicine Clerkship consists of:

• An eight-week experience that provides students with the opportunity to work directly with Internal Medicine attendings and residents, evaluating and caring for patients, with acute and chronic medical conditions, who have been admitted to the inpatient care-setting.
• Students learn to conduct complete history, physical exam, make decisions on clinical testing, formulate differential diagnosis, develop management plans, learn to document patient’s encounters and present data in a cohesive and efficient manner.
• In addition, students are encouraged to exercise self-directed learning, use information technology to support patient care decision making, appraise medical literature and recognize the barriers to health care systems.
• Students will also share in effective communication among the teams that demonstrate professional interaction, respect, compassion and integrity.
• The students rotate for four weeks at two hospital sites.  (SUNY Downstate Medical Center, NYC Health + Hospitals/Kings County, Maimonides Medical Center, Lenox Hill Hospital, Brooklyn Veterans Administration Medical Center, Brookdale Medical Center and North Shore LIJ).

Medicine Clerkship Competency-Based Goals and Objectives:

The goals and objectives of the Medicine Clerkship are centered upon acquiring the basic competencies that students need to demonstrate to go on to residency training and to become independent physicians.

1. Patient care domain:
   • Learn to conduct complete and focused histories appropriate to the clinical presentation
   • Learn to conduct complete, relevant and focused physical examination on adult patients.
   • Make informed decisions on clinical testing based on clinical information gathered as well as up-to-date scientific evidence.
   • Formulate differential diagnosis based on the use of patterns of diagnostic reasoning.
   • Develop and carry out a management plan that includes, based on patient information and preferences, preventive, therapeutic and palliative interventions.
   • Learn to document patient encounters and present data in a cohesive, efficient and concise manner.
2. Medical knowledge domain:
   • Understand the pathophysiologic bases and the mechanisms for diseases processes and being able to apply such knowledge to the bedside.
   • Understand and apply the principles of pharmacology and therapeutics, and the processes of therapeutic decision-making and disease management.
   • Understand and apply the principles of diagnosis and management of system-specific and cross system diseases and disorders.
   • Appreciate the limitations of the current knowledge and the need for scientific investigation to further knowledge.
3. Practice based learning and improvement domain:
   • Use patient care experience to continually improve ability to care for patients through ongoing self-directed learning and self-reflection.
   • Use information technology to access and manage on-line medical information to support patient care decision making.
   • Critically appraise the biomedical literature and make informed decisions about diagnostic and therapeutic interventions based on best evidence.
4. System based practice domain:
   • Recognize the impact of the various factors on the ability of patients to participate in their health care including financial, organizational, social and linguistic barriers.
   • Provide a rational for the appropriate behaviors of a physician for the regulatory and financial environment of hospitals and other practice settings.
   • Incorporate fundamental principles of patient safety into clinical care.
5. Domain of professionalism:
   • Demonstrate commitment to excellence in personal/professional development; demonstrate respect, compassion, integrity and altruism; accountability to patients, society, and the profession.
   • Demonstrate sensitivity and responsiveness to patients' culture, age, gender, socioeconomic status, education level, sexual orientation and disabilities, among other elements of diversity
6. Domain of interpersonal and communication skills:
   • Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
   • Use effective verbal communication with colleagues to exchange information for patient care.
   • Work effectively with others as a member or leader of a health care team or other professional group.

In Medicine Clerkship, specific clinical conditions are selected as vehicles to teach our students with the aim of achieving the goals of each of the six domains of competency.

These core conditions include:

• Anemia
• Asthma/ Chronic Obstructive Pulmonary Disease (COPD)
• Atherosclerosis
• Cancer
• Diabetes mellitus
• Dyspnea: diagnostic work-up
• Fever: diagnostic work-up
• Human immunodeficiency virus
• Congestive heart failure
• Hypertension
• Liver disease
• Pneumonia
• Renal disease
• Venous thromboembolic disease.

Medicine Sub-Internship

The Medicine Sub-Internship (MS4) consists of:

• A four-week experience that provides students with the opportunity to work directly with Internal Medicine attendings and residents, evaluating and caring for patients, with acute and chronic medical conditions, who have been admitted to the inpatient care-setting.
• Students get real world experience in providing direct care to patients. Students can substitute a Sub-internship in Pediatrics or Surgery. Responsibilities include but are not limited to patient interview and gathering a history, physical exam of the patient, daily evaluation and follow-up, transmitting and sharing information with other members of the health care team, writing daily notes, transfer notes, discharge summaries, obtaining, talking to and assessing consult information, recognizing critical clinical situations and promptly seeking help and any other aspect of daily clinical care. They are presumed to be PGY-1s but with a smaller clinical load and somewhat more indirect supervision.

Internal medicine as a specialty demands a very large set of skills, knowledge and attitudes. All of these skills are taught throughout the 4 years of medical school. During this time students should avail themselves as much as possible of the opportunity to consciously observe others going about their daily work on the wards. They should seek to ask questions, model good behavior when you see it, develop good habits, identify your own strengths and seek or build on them while concurrently working to improve areas of care that present challenges. Students are expected to attend all scheduled meetings, rounds, conferences, interact with consultants, other services, etc.

Clerkship Competency-Based Goals/Objectives/Core content and skills

Being a house officer and caring for patients requires the integration and mastery of many skills. Learning them from peers, residents, attendings and self-directed requires a cognitive awareness of these integrated skills and how best to observe and master them. The goals, objectives and core skills for the Sub-I are defined and described in Internal Medicine Sub-Internship Curriculum which is available upon request at the internal medicine clerkship office.

The 5 core skills are:

1. Patient evaluation skills
2. Time management skills
3. Communicating Effectively within healthcare teams
4. Knowing when and how to ask for help
5. Medical student/resident wellness

The curriculum was created by the Association of Program Directors in Internal Medicine (APDIM) and the Clerkship Directors in Internal Medicine (CDIM). These skills integrate the 6 LCME competencies and the 13 ACGME entrustable professional activities (EPAs).

Examples of some of these items 2 and 3 of these skills are:

Time management skills:

• Organize a patient care task list in a structured and systematic fashion
• Prioritize daily patient care tasks list according to importance/urgency
• Prioritize patients’ clinical problems according to importance /urgency

Communicating effectively within the healthcare team skills are:

• Writing a transfer/acceptance note
• Writing a useful and complete discharge summary
• Giving and receiving patient handoffs during transitions of patient responsibility
• Provide an oral presentation tailored to the specific context
• Communicate effectively with nursing/pharmacy/case manager/social worker, etc.

All of the skills and their integration with the competencies and EPAs are presented in detail within  the Curriculum document.