Internal Medicine Clerkship
Medicine Externship I
MED 7500 (Medicine Externship I, or "Med I") is the core clinical clerkship that provides the critical foundations for not only adult inpatient medicine but also for the care of the acutely ill patient. Students will be part of inpatient care teams that will include interns, residents, and faculty.
Students will learn through case discussions and presentations, didactics, independent study, and in the daily care of their patients. Students are expected to care for their patients as their primary point of contact, to begin to assume the responsibility for caring for, and coordinating care for, their patients.
In addition, students on MED 7500 are expected to develop the basic skills of patient care in an academic environment. These skills include working across disciplines and professions on a health care team, effectively documenting and relaying patient care information between other care providers, and learning how to gather information to create a well-formulated assessment and plan. The skills learned on MED 7500 provide the foundation for patient care that students will use across disciplines for the remainder of medical school, into residency, and beyond.
Further information for currently enrolled students can be found on the Black Bag site.
For a detailed description of Internal Medicine Electives offered, please visit the Course Directory.
The MED 7900 Subinternship in Critical Care is an innovative, unique educational experience that focuses on develop of knowledge and skills in caring for acutely ill patients that builds upon the skills gained in MED 7500. The goal in MED 7900: Sub-Internship in Critical Care is to prepare medical students for internship and residency, through a clinically-focused experience focusing on higher acuity patients (ICU, IMC), clinical care, and emphasizing tasks necessary for internship. Students on this rotation care for patients on General Medicine services and in the Medical, Surgical, Neonatal and Pediatric Intensive Care Units. Subinterns on this rotation will have primary responsibility for the care of acutely, and often critically, ill patients in the hospital setting. Students will also work to develop skills in practicing safe handoffs, cross-covering patients, and participating in family meetings.
For More Information
The Department of Medicine has a major responsibility for guidance of student development throughout the four years of medical school, and the Medicine Externships (Medicine 7500 and 7501) are integral to the overall educational process designed to foster clinical competence. There are significant differences in emphasis between the two clerkships. It is essential that all tutors, attending physicians and residents understand the Course Objectives and schedule as they relate to their particular student(s). This will enable both student and teacher to share the same goals and to establish reasonable expectations and will allow the process of evaluation to be fair and objective.
THE RED PROGRAM
Setting expectations should be an initial activity. We encourage you to sit down with all learners and teachers (students and residents and attending) to set expectations on Day 1 of the rotation. This should include:
- Go over the student and resident schedule to understand what will take them off the ward (include scheduled core conferences, resident clinic schedule, understanding of days off)
- Understand learners goals
- Clarify your expectations of students regarding patient care
- Set a schedule of times you will round
- Tell students what you value in student performance
The clerkship committee expectations of students are detailed in the evaluation forms found on E*Value. Upon completion of the first medical externship (Medicine 7500), the student should be able to conduct a complete general physical examination and appropriate special examinations. In addition to identification of relevant symptoms and physical findings, the student should know the pathophysiologic basis and clinical correlates of these findings for problem identification and problem solving, and based upon a reasoned differential diagnosis be able to plan an adequate diagnostic evaluation using principles of evidence-based medicine. Students in the second medical externship (Medicine 7501) will continue to practice and develop these skills and begin to participate responsibly in the management and treatment of patients.
Ongoing thoughtful and supportive feedback from faculty and residents is critical. Feedback should be timely and focus on specific strengths or areas needing improvement providing the student with an opportunity to identify and correct any problems noted during the course. Any potentially serious deficiencies or problems perceived in student performance should be brought to the attention of the hospital coordinator as early in the rotation as possible. Formal mid-rotation feedback will be student-initiated at mid-rotation (see Feedback below).
The hospital coordinator at each teaching site bears the primary responsibility for the development and maintenance of a program to fulfill the learning objectives of the Externships in Medicine. The coordinator is responsible for organizing the tutorials and seminars and encouraging faculty members to take the expected approach toward student involvement in seminars and tutorials. Since there are differences in student responsibilities for Medicine 7-500 and 7-501, coordinators will also reinforce at the beginning of each period, with the attending physician and resident, the objectives to be met by the students assigned to their ward team.
Each student is part of a medical team usually consisting of one or two first-year residents, a senior resident, and an attending physician. Some teams may pair students (subinterns) with an attending physician without residents. Students in both Medicine 7500 and 7501 attend morning work rounds each day and participate in attending rounds as scheduled.
The attending physician has the primary responsibility for educating students assigned to the ward team. The immediate day-to-day supervisor for students is the senior resident. All of the physician-teachers with whom the student has contact are expected to serve as positive role models.
An effective way to encourage independent learning is to use rounds as a stimulus. Faculty and residents are encouraged to provide students with positive direction through both questions and assignments. Identify “knowledge gaps” which are directly important to care of current specific patients and assign students to do a (5 minute) minitalk on the topic during attending rounds in two days. Students really value the opportunity to develop some focused expertise, contribute to teaching and to patient care. Every encounter, clinical or conference should provoke discussion, questions, and the mutual search for answers. Preparation by students prior to ward rounds, seminars and tutorials is necessary because they will actively participate with student colleagues and faculty in solving problems. Faculty can frequently help by suggesting additional source materials or direct literature searching to aid in the student’s search for information.
Feedback is one of our most important responsibilities as educators. Feedback should be provided at midpoint of your rotation and at the end of your time with learners. Try first asking the learner about their assessment of their performance. Follow this with your observations about skills, attitudes and behaviors (be specific). Include any suggestions you may have for improvement. For the students include your assessment of where they are performing in the O-R-I-M-E scale and what they need to do to move to the next level. At the end ask the learner if he/she understands or has any question about the feedback. Any potentially serious deficiencies or problems perceived in student performance should be brought to the attention of the hospital coordinator as early in the rotation as possible.
Ende, J. (1983). Feedback in Clinical Medical Education. JAMA 250(6):777-81. | Irby,D. (1986) Clinical Teaching and the Clinical Teacher. J Med Educ. 61:35-45.
- A student who is “shadowing”/passive
- This does not meet criteria for passing a 3rdyear student
- The “What” questions
- Accurately gathers and clearly communicates clinical facts
- Performs a good history and physical examination, reliably distinguishing normal from abnormal.
- Demonstrates day-to-day reliability (on time for rounds, follows-up on a patient’s test results).
- Demonstrates responsibility and consistency in “bedside” skills and dealing with patients.
- The “Why” questions
- Able to prioritize patient problems
- Appropriate differential dx (3 reasonable possibilities)
- Interprets data as test results come back.
- Demonstrates skill in selecting the clinical findings which support possible diagnoses
- Should be an active participant in patient care.
- The “How” questions
- Proposes and selects appropriately among multiple diagnostic and therapeutic options
- Tailors treatment plan to fit patient circumstances, taking into account concurrent diagnosis and treatments, psychosocial factors, and patient preferences.
- Reads deeply and shares new learning with others.
- Defines important questions to be answered and has the drive to look for and evaluate evidence needed to guide therapy.
- Is an effective and accurate source of information for patients and families.
Careers in Medicine
All careers in internal medicine begin with a three year residency program. Following successful completion of residency training, the graduate may begin practice in general internal medicine or may choose to train further in one of the subspecialties of internal medicine.
What does “Internal Medicine” mean?
The term "Internal Medicine" comes from the German term Innere Medizin, a discipline popularized in Germany in the late 1800s to describe physicians who combined the science of the laboratory with the care of patients. Many early 20th century American doctors studied medicine in Germany and brought this medical field to the United States. Thus, the name "internal medicine" was adopted. Like many words adopted from other languages, it unfortunately doesn't exactly fit an American meaning.
General Internal Medicine
Doctors of internal medicine focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. Much of their training is dedicated to learning how to prevent, diagnose, and treat diseases that affect adults.
Internists are equipped to deal with whatever problem a patient brings –-- no matter how common or rare, or how simple or complex. They are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses may strike at the same time. They also bring to patients an understanding of wellness (disease prevention and the promotion of health), women’s health, substance abuse, mental health, as well as an effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
In today’s complex medical environment, internists take pride in caring for their patients for life—in the office or clinic, during hospitalization and intensive care, and in nursing homes. When other medical specialists, such as surgeons or obstetricians, are involved, they coordinate their patient’s care and manage difficult medical problems associated with that care.
Internist can choose to focus their practice on general internal medicine, or may take attritional training to “subspecialize.” Subspecialty training (often called a “fellowship”) usually requires an additional one to three years beyond the standard three year general internal medicine residency.
Specialty training is called fellowship training, and usually adds two to three years of training beyond the residency training. Generally, applications for fellowship training are submitted during the second year of internal medicine residency training.
The following is a list of subspecialties that require preliminary training in internal medicine:
- Allergy and immunology
- Endocrinology, Diabetes, and Metabolism
- Medical Oncology
- Cardiovascular Disease
- Infectious Disease
- Pulmonary Disease
- Adolescent Medicine
- Sports Medicine
Internal Medicine Clerkship Director
Nersi Nikakhtar, MD
Medical Student Education Program Coordinator
If you are interested in being a visiting student at the University of Minnesota, please view the Visiting Medical Scholar Program web page. Note: We do not offer any observerships.
Nersi Nikakhtar, MD
Ron Reilkoff, MD