Department of Medicine

Required Clinical Experiences

To help learners achieve the educational course objectives, requirements for both patient type (diagnostic category) and students’ level of involvement have been established. These clinical experiences will be complimented by faculty-directed small group sessions, resident-directed clinical discussions, and web-based interactive self-study (Aquifer Internal Medicine Cases).

Patient type

During this clerkship, students are required to recognize symptoms that may signify disease in eight categories. They need to distinguish normal from abnormal findings on physical exam, formulate a differential diagnosis based on signs and symptoms use and interpret common tests used in diagnosing disease and develop a systematic approach to management of these common diseases. This provides the core of the internal medicine experience. All categories are required and considered essential as part of an introduction to internal medicine. The minimum number of patients in each category is defined. Patients are seen in both inpatient and outpatient settings. All students complete 6 weeks of Medicine inpatient service. Students are required to evaluate at least 16 inpatients over the 6- week experience. The level of involvement for each patient must include:

1. Independently gathered history information
2. Independently performed physical exam
3. Presented patient case
4. Wrote patient note
5. Opportunity to discuss laboratory or test results
6. Opportunity to offer and discuss differential diagnosis
7. Opportunity to offer and discuss management options

In addition to participating in Medicine inpatient service, students spend 2 weeks in a variety of ambulatory/outpatient sites. Students are required to assess at least 8 outpatients during this experience. The level of involvement for each patient must include:

1. Observed or performed patient interview
2. Observed or performed physical exam
3. Opportunity to discuss laboratory or test results
4. Opportunity to offer and discuss differential diagnosis
5. Opportunity to offer and discuss management options

Diagnostic Category: Cardiovascular Disease
Minimum Number of Patients: 2 (at least one patient with CAD and one patient with HTN)
Comments/Explanation: Includes CHF, ischemic heart disease, arrhythmia, hypertension, or peripheral vascular disease. 

Diagnostic Category: Endocrinology Disease
Minimum Number of Patients: 2 (at least one patient with Diabetes Mellitus)
Comments/Explanation: Includes hyper/hypothyroidism, diabetes mellitus, or adrenal disease

Diagnostic Category: Pulmonary Disease
Minimum Number of Patients: 2 (at least one patient with obstructive lung disease)
Comments/Explanation: Includes COPD, asthma, interstitial lung disease

Diagnostic Category: Hematologic/Oncologic Disease  
Minimum Number of Patients: 2 (at least one patient with anemia)
Comments/Explanation: Includes anemia, hematologic malignancy, or solid organ malignancy

Diagnostic Category: Infectious Disease
Minimum Number of Patients: 2 (at least one patient with pneumonia)
Comments/Explanation: Includes sepsis, endocarditis pneumonia, meningitis, urinary infection or HIV

Diagnostic Category: Rheumatologic Disease
Minimum Number of Patients: 2 (at least one patient with arthritis)
Comments/Explanation: Included rheumatoid arthritis, degenerative arthritis, or SLE

Diagnostic Category: Gastroenterology Disease  
Minimum Number of Patients: 2 (at least one patient with gastrointestinal bleeding)
Comments/Explanation: Include peptic ulcer disease, esophagitis, cirrhosis or inflammatory bowel disease

Diagnostic Category: Nephrology Disease
Minimum Number of Patients: 2 (at least one patient with renal failure)
Comments/Explanation: Includes renal failure, electrolyte disturbance, acidbased disturbance, nephritic syndrome, or renal calculi

Level of involvement

In addition to seeing patients in the diagnostic categories listed above, how the students are engaged in the encounter is also an important factor in helping students achieve the objectives for this clerkship. Level of involvement is likely to include various types of interaction with patients and the health care team and should be monitored to ensure a complete experience. Levels of involvement will be indicated for logged patient encounters so log accurately! The logs will be reviewed around the middle of the clerkship to ensure that students have a range of experiences in both inpatient and/or outpatient settings.

Level of involvement during patient encounters will be logged using the following categories:

• Independently gathered history information
• Observed patient interview
• Independently performed physical exam
• Observed physical exam
• Presented patient case
• Wrote patient note
• Opportunity to discuss laboratory or test results

Other Clerkship Experiences

In addition to required clinical experiences (patient type and level of involvement), successful completion of the clerkship requires student participation in a variety of additional experiences. These experiences are coordinated through the Department of Internal Medicine and include lecture/discussions and presentations.