Inpatient Internal Medicine Clerkship

Guidelines for First Medicine Rotation

The following constitutes general guidelines of what is expected of you, and what you should expect from us during your inpatient clerkship rotation. Although minor variations may exist on different teams and different hospitals, the basic format will apply to all.

Clinical clerks are expected to

1. Perform an admission history and physical examination on two patients per week. For each patient the student will:
   1. Limit initial formal contact with patient to one hour.
   2. Submit for review within 24 hours a detailed write-up of the history physical findings, admission lab results, a formulation, and a plan of management.
   3. Read suggested information relevant to a major aspect of the patient's illness.
   4. Follow closely the patient's daily progress, and report on this progress during ward rounds.
   5. Assist interns with routine chores (data-gathering, etc.) necessary for the care of the patient.
2. Demonstrate to the attending physician (during twice-weekly “students only” sessions) their level of skill in eliciting historical information and physical findings.
3. Observe and assist with special procedures such as bladder catheterization, NG tube insertions, bone marrow aspirations, lumbar punctures, etc.
4. Present cases during attending rounds.
5. Actively participate in the “core curriculum” in internal medicine to be covered during the first medicine rotation.

During the first rotation clinical clerks will not:

1. Include their write-ups in the medical record
2. Write progress notes in the medical record until considered by the resident as qualified to do so.

The attending physician is expected to:

1. Meet separately with the clinical clerks at least twice each week. During these sessions the attending physician will directly supervise and observe the ability of clerks to take histories and to elicit and demonstrate physical findings.
2. Participate actively with the resident in the process of reviewing and criticizing student write-ups and being certain that write-ups are returned to the student within 24-48 hours.
3. Suggest reading material relevant to the student's cases.
4. Observe closely and improve the interactions between house staff and clinical clerks.
5. Discuss the student's progress and level of performance (personally) after two weeks and again at the end of the rotation.
6. Observe the student do a comprehensive history and physical on an unknown patient the last week of the rotation

The ward resident is expected to:

1. Assign new cases to the clinical clerks. In making these assignments the resident will:
   1. select those cases most suitable for advancing the medical education of the student
   2. be certain that an appropriate one hour interval is set aside for the admission contact between patient and student.
2. Assign specific reading directly relevant to each patient worked up by the student
3. Review student write-ups with the attending physician. Discuss these with the student within 24-48 hours of submission.
4. Closely supervise and improve interactions between clinical clerks and interns.
5. Determine when each clinical clerk is qualified to:
   1. present progress data during ward rounds
   2. present cases during attending rounds
   3. write progress notes in the medical record
6. Discuss with each student (personally) that student's level of performance at two weeks and again at four weeks.

The intern is expected to:

1. Discuss with the student (personally), after the student has completed a formulation and plan of management, all aspects of the case assigned to the student.
2. Review with the student the orders written by the intern and the reasons for those orders.
3. Supervise directly "bedside" lab procedures (blood gas, cultures, etc.) performed by the student.
4. Keep the clinical clerk fully informed of all developments in that clerk's cases.
5. Review with the clerk progress notes written by he clerk and countersign these notes.

Evaluations

All student will have a written evaluation of their performance during the clerkship by their attendings and residents. Students assigned to Yale will be evaluated by their attendings, residents, the chief residents and Student/Faculty Rounds attendings. All these evaluations will be collected and summarized in one final form. We emphasize that evaluations are meant not only to classify student performance but to reinforce strengths and identify areas for improvement.

Please call (5-2477) if you have any questions or dilemmas.