Welcome to the Advanced Clerkship in Medicine

on the Osler, Nelson/Baker, and Polk services!

WARD ASSIGNMENTS

You can locate your Ward Assignment on the "ASSIGNMENTS" page of this website. 

 
ORIENTATION and DIDACTIC/CASE PRESENTATION DATES

Orientation and weekly Didactic/Case Presentation dates are located on the "CALENDAR" page of  this website.  Please check this site before you are scheduled to start to confirm your orientation time and place.  The Medicine Sub-I elective is scheduled on a MONTHLY BASIS but does follow the academic/quarterly calendar.  

PROVIDER ORDER ENTRY (POE) TRAINING

It is the student's responsibility to schedule Provider Order Entry (POE) Training BEFORE the start of the Sub-I elective.  If you have already completed POE training during your Basic Medicine Clerkship rotation you WILL NOT need to return for POE again.  POE Training is offered on the first Tuesday and the last Tuesday of each month.  To schedule your POE Training Session, call 4-0958.  (POE has

replaced OrderNet effective June 1, 2004). 

Learning Objectives for the Advanced Clerkship in Medicine

Clerkship students are active members of the ward team and assume responsibilities for patient care as close as possible to that of an intern.  The directors of the clerkship have determined the following objectives for the experience.:

1.        To enhance communication skills with patients and colleagues

2.        To hone history taking and physical examination skills

3.        To utilize diagnostic reasoning skills and hypothesis to develop differential diagnoses and cogent plans of action

4.        To enhance oral and written presentation skills

5.        To build on your knowledge base of adult internal medicine problems through readings related to your patients and other patients on your team

By the end of the rotation it is our hope that you havedeveloedp a systematic approach to common inpatient problems including:

- Fever

- Hypotension

- Dyspnea

- Chest Pain

- Abdominal Pain

- GI bleeding

- Altered Mental Status

It is expected that, throughout the clerkship, you will demonstrate the following professional attributes

- Accept personal responsibility for learning; seek out additional resources, expert help

- Accept limitations of competence, that is, ask for help when needed. 

- This is particularly important in the writing/entering of orders.  You are allowed to transcribe verbal orders received from an intern or resident.  This conversation should be specific, that is: drug name, dose, route and frequency.  If not, it is your responsibility to clarify with the prescribing physician by stating specifically what you intend to write, and receive their specific approval, which constitutes their verbal order.

- Assume responsibility for patients under your care.

- Approach the practice of medicine with the highest ethical and professional standards, respectful of patients, families and colleagues.

By the end of the rotation, you should be able to

- Succinctly communicate the patient history and objective findings to colleagues:  the oral case presentation.

- Competently perform the basic physical examination of the patient; seek out and develop expertise in expanded clinical examination maneuvers.

- Completely document the appropriate findings in the medical record.

Learning Resources 

While the subinternship is an active clinical experience, it is expected that you will be reading nightly on the case material encountered during the day.  We recommend a good textbook in Internal Medicine or online resource similar to what was expected during the Basic Medicine Clerkship.  Additionally, we expect further inquiry into the evidence-basis of disease diagnosis and treatment as it pertains to your patients.  PubMed searches for primary data and thorough evidence-base reviews are encouraged.

Evaluation

Your residents, interns, and attending will complete their evaluation of you utilizing the on-line evaluation program called E*Value.  The Department of Medicine will use the following system for assigning final grades for the Advanced Clerkship in Medicine:  “Fail”  “Pass” “High Pass”, and “Honors” grades will be assigned based on feedback from E*Value.  Keep in mind that there are currently no shelf examinations or standard patient examinations mandated as part of the grading scheme. 
 
 

THINGS TO REMEMBER

1)  ALL orders MUST be countersigned within 24 hours. This is a legal requirement of the hospital and a part of the By-Laws.  An Unsigned order may receive delayed attention, which can jeopardize your patient, and be frustrating to everyone involved.

2)    You are on your honor to discuss all medication orders with a supervising provider prior to entering them as a verbal order.  The acceptance of verbal orders is a privilege for a subintern that assumes this conversation has occurred.  Failure to follow this procedure will result in loss of that privilege.

3)  You are not permitted to write orders (including verbal borders) in the intermediate or intensive care areas in the Department of Medicine:  CCU, CCP, MICU.  If your patient is transferred to those areas, the care of the patient will be reassigned to an intern.

4)  IDENTIFY yourself to nursing staff as a "Acting Intern".  This is done best by wearing your white coat with a name tag.  This is particularly important for dealing with patients/nursing staff on other floors.  Remember that you are only passing through a nursing unit but the permanent staff members have many continuing obligations to your patients and many others.  It will help everyone (especially your patients) if the lines of communication remain open.  

5)  VERBAL ORDERS must be transcribed verbatim, e.g. “Digoxin 0.125 mg p.o. bid per Dr. XYZ.” 

6)  WHITE COATS are available in the Hospital Laundry room, Carnegie basement.

7)  COMMUNICATE with the attending physicians.