Internal Medicine Clerkship

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:

1. 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)
2. Understand learners goals
3. Clarify your expectations of students regarding patient care
4. Set a schedule of times you will round
5. 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).

SUPERVISION

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.

OBSERVER

• A student who is “shadowing”/passive
• This does not meet criteria for passing a 3rdyear student

REPORTER

• 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.

INTERPRETER

• 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.

MANAGER

• 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.

EDUCATOR

• 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.

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.

Subspecialty Training
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:

1. Allergy and immunology
2. Endocrinology, Diabetes, and Metabolism
3. Hematology
4. Medical Oncology
5. Rheumatology
6. Cardiovascular Disease
7. Gastroenterology
8. Infectious Disease
9. Nephrology
10. Pulmonary Disease
11. Adolescent Medicine
12. Geriatrics
13. Sports Medicine

Internal Medicine Clerkship Director

Nersi Nikakhtar, MD
nikak001@umn.edu
VCRC 137

Subinternship Director

Ron Reilkoff
rreilkof@umn.edu

Medical Student Education Program Coordinator

Julie Pierce
medclerk@umn.edu

Visiting Students

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.