Inpatient Internal Medicine Clerkship

Guidelines for Second Medicine Rotation

It is the policy of the Department of Internal Medicine that the SECOND Medicine rotation should allow for more flexibility in an effort to meet individual needs of students. It is also the policy of the Department that a general goal of the SECOND rotation should be to allow the clinical clerk to develop a real sense of being a member of the patient-care team on our medical wards.

Clinical clerks are expected to:

1. Perform an admission history and physical examination on at least three patients per week. For each patient the student will:
   1. Limit initial formal contact with patient to one hour.
   2. Submit, by the morning after admission, a detailed write-up of the history, physical findings, admission lab results, a formulation and a plan of management. If approved by the resident, this write-up will be included in the medical record.
   3. Read suggested information relevant to a major aspect of the patient's illness.
   4. Follow closely the patient's daily progress and, when asked, report on this progress during work rounds.
   5. Assist interns with routine chores (data-gathering, etc.) necessary for the care of the patient.
2. Attend and participate in all of the rounds and teaching exercises that are attended by the house staff (daily work rounds, attending rounds, and other teaching programs of the ward service).
3. A Participate in at least two "student only" sessions per week with the attending physician. The nature and format of these sessions will be established after consultation with the clinical clerks to determine their specific needs.
4. Perform various ward procedures under direct supervision. Although students should have proficiency in routine procedures such as venapuncture, etc., other procedures less commonly performed as part of the daily routine such as paracentesis, lumbar punctures, etc., will be performed by the student only under direct supervision of a house officer or attending physician.
5. Present cases during attending rounds.
6. Write progress notes in the medical record. These progress notes will be promptly countersigned.
7. Actively participate in the “core curriculum” in internal medicine to be covered during the second rotation.

During the SECOND rotation clinical clerks will not:

1. Include their admission write-up in the medical record unless specifically approved for inclusion by the ward resident

The attending physician is expected to:

1. Meet separately with the clinical clerks at least twice each week. The nature and format of these sessions may vary, but bedside teaching must be emphasized. 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 in the medical record.
3. Suggest reading material relevant to the student's cases.
4. Observe closely and improve interactions between house staff and clinical clerks.
5. Discuss with each student personally that student's progress and level of performance after two weeks and again at the end of the rotation.

The ward resident is expected to:

1. Assign new cases to the clinical clerks. In making these assignments that 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
   3. as often as possible--consistent with good medical care--arrange for student to see the patient first
   4. protect" the student from diagnostic information already available about the patient until the student's work-up is complete
2. Assign specific reading directly relevant to each patient worked up by the student.
3. Review student write-ups with the attending physician. Approve write-ups for inclusion in the medical record.
4. Closely supervise and improve interactions between clinical clerks and interns. When appropriate, supervise clerks in performing ward procedures.
5. Determine when each clinical clerk is qualified to perform ward procedures under direct supervision.
6. Discuss with each student (personally) that student's level of performance at two weeks and again at four weeks.
7. Observe the student do a comprehensive history and physical on an unknown patient the last week of the rotation

he intern is expected to:

1. Discuss personally with the student, after the student has completed a formulation and plan of management, all aspects of the case assigned to the student.
2. Review orders and the reasons for those orders written by the student or intern (with the student).
3. Directly supervise all ward procedures performed by the student.
4. Keep the clinical clerk fully informed of all developments in the clerk's cases.
5. Review (with the clerk) progress notes and orders written by the clerk and promptly countersign those notes and orders.

Evaluations

All students 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 attending. 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.