Welcome to the Junior Medicine Clerkship. We hope you will enjoy the time you share with us. We are proud of our reputation as dedicated medical educators and hope you enjoy the knowledge and experience you will gain while rotating with the Department of Internal Medicine. While on the rotation you will learn much more regarding basic patient care than you might expect.
The Junior Clerkship experience in Internal Medicine consists of six weeks of ward medicine divided into two three week rotations. These rotations will be at two different locations which may include The VA Medical Center, Johnson City Medical Center and Holston Valley Medical Center. This will give the student a different hospital setting to experience. This is dependent on the period of their Medicine clerkship
INTERNAL MEDICINE WARD ROTATION GOALS:
1. Develop a solid foundation of medical knowledge regarding the care of patients presenting with medical maladies. This will include practical and critical thinking, diagnosis, patient care, medical diagnostic procedures, adherence to evidence based established guideline and follow up care that includes both medical and psychological support.
2. For the student to effectively participate as a Team Member, in a professional manner including communication with fellow students, residents, attending physicians and patients' family members.
Students are expected to:
A. Admit at least 2 patients per week to the ward service. Perform complete history and physical exam on these patients. Assist the PGY-1 with entering admission orders into the hospital order entry system. Leave history, physical exam and assessment on patients chart to be countersigned by PGY-2 or PGY-3 resident. A copy of the H&P should be made and submitted to the attending for critique.
B. Write daily progress notes on patient to be countersigned by PGY-1 orPGY-2.
C. Present patient at morning report, attending rounds, tumor board or any other appropriate setting where patient to be discussed.
Attendings will be assigned to groups of 3-4 students at each site.
The attending will review students' histories and physical exams, assessments and plans. Students and attending should evaluate patients at the bedside. The attending should review the written record and assess that the student is able to present each case succinctly. Attendings will submit an evaluation via New Innovations of each student after the ward rotation.
The attending will observe each student perform a history and physical exam on a patient some time during their ward rotation. During the ward rotation a strong emphasis on the development of bedside clinical skills is a necessity. Students should see as many patients as possible with abnormal physical findings. Physical diagnosis textbooks such as DeGowin and DeGowin and Sapira will be available at each site. Students should perform the following:
A. Review peripheral blood smear.
B. Perform and read an EKG.
C. Describe urinary sediment.
D. Gram stain all appropriate body fluids if an infectious process is considered
MEDICINE CLERKSHIP OBJECTIVES:
-Communicate effectively with patients, family members and the health care team in a respectful and professional manner while receiving and giving feedback during H&Ps, ward rounds, and case presentations, and in the counseling and in the waiting room.
-Derive a differential diagnosis and patient treatment plan that includes appropriate Internal Medicine subspecialty consultation and therapy.
-Gather, interpret, and record an accurate history and physical examination for presentation at morning rounds.
-Assess, choose, and demonstrate learned patient care activity that confirms to the health care team, knowledge of procedures used during clinical situations.
-Associate and communicate the physiologic responses to metabolic challenges of varying degrees as identified or needed, to the health care team during patient encounters, morning rounds, case presentations, simulation lab scenarios and in the emergency room.
-Recognize and understand the indications for diagnostic procedures involved in the evaluation of medical conditions that might provide additional diagnostic or therapeutic benefit to the medical patient.