Internal Medicine Clerkship

Internal Medicine is an eight-week clerkship that includes six weeks of inpatient experience in which students care for hospitalized adult patients with a variety of medical problems and two weeks of ambulatory experience in which they develop skills to enable provision of primary care services. These experiences provide ample opportunity to gather histories, develop differential diagnoses, formulate assessments, and develop treatment plans for patients with a variety of diagnoses.

Internal Medicine (Inpatient) Clerkship Objectives

At the end of this rotation, the student should be able to do the following:

Inpatient Objectives:

Medical Knowledge for Practice (MK)

  1. Apply knowledge of the pathophysiology, epidemiology, and natural history of diseases to common patient conditions listed in the Core Required and Recommended Medical Conditions. (MK3)
  2. Describe how altered structure and function (pathology and pathophysiology) of the body and organ systems are affected by diseases encountered in the practice of Internal Medicine (MK4)
  3. Use patients’ histories and physical exams to compare and contrast normal and abnormal physiologic, anatomic, and histologic structure and function. (MK6)
  4. Describe the scientific principles underlying diagnostic methods, including laboratory and radiologic testing, and treatment approaches (pharmacologic and non-pharmacologic) that may be applied to major diseases and conditions. (MK5)
  5. Explain how preventive measures, health behaviors and social determinants affect disease, injury and health in individual patients and across populations. (MK7)
  6. Demonstrate knowledge of the scientific method in establishing causation of health and disease, the utility of diagnostic modalities, and the efficacy of therapies (traditional and non-traditional), through critical evaluation of current basic and clinical scientific knowledge. (MK8)
  7. Demonstrate knowledge of Advanced Cardiac Life Support (ACLS) algorithms to treat cardiac arrest, respiratory arrest, symptomatic bradycardia, and symptomatic tachycardia (MK5)
  8. Demonstrate understanding of the fundamental principles and terminology of point-of-care ultrasound and the ability to obtain basic sonographic images to augment the physical exam and answer specific clinic questions. (MK4)

Patient Care (PC)

  1. Demonstrate proper techniques for interviewing a patient to obtain a thorough medical history and performing a comprehensive physical examination in the inpatient setting. (PC1)
  2. Use analytic reasoning to synthesize and integrate pertinent patient data to develop rational, justified and prioritized differential diagnoses. (PC2)
  3. Using a rational, justified and prioritized differential diagnosis, develop safe, effective, and efficient evaluation and management plans for common inpatient medical conditions. (PC3)
  4. Counsel, educate, and partner with patients and families to address acute and chronic clinical conditions. (PC5)
  5. Demonstrate an ability to build a positive, healing relationship with a patient inclusive of culture, ethnicity, spirituality, gender, age, health beliefs, practices, and decisions. (PC5)
  6. Organize and prioritize patient care responsibilities to provide patient-centered care that is safe, effective, and high value.
  7. Perform routine procedures safely and correctly, in a patient-centered manner, with supervision. (PC7)
  8. Demonstrate proper treatment of cardiac arrest, respiratory arrest, symptomatic bradycardia, and symptomatic tachycardia via participation of ACLS megacodes (PC3)

Interpersonal and Communication Skills (CS)

  1. Present patient data gathered from patient interviews, physical examinations, and laboratory and other diagnostic tests, including progress notes, in standardized format. (CS1)
  2. Consistently engage is respectful and honest communication with patients, families and team members. (CS2)
  3. Document patent data gathered from patient interviews, physical examinations, and laboratory sources, including progress notes, in standardized format. (CS5)
  4. Engage in effective and professional interpersonal and communication with patients and families, including an awareness of psychosocial factors related to patients’ problems. (CS2)

Professionalism (PR)

  1. Demonstrate honesty, integrity, respect, and compassion in all interactions with patients, peers, faculty, staff, and other health care professionals in all settings. (PR1)
  2. Demonstrate ethical, patient-centered decision making and respect for the confidentiality of patient information in all settings (i.e., clinical, academic, electronic, or web-based). (PR2)
  3. Demonstrate sensitivity and responsiveness to the personhood of the patient inclusive of culture, race, ethnicity, spirituality, gender, sexual orientation, age, physical characteristics, medical condition, disabilities, socioeconomic status, family-context and other aspects of personal and health beliefs, practices and decisions. (PR3)
  4. Demonstrate accountability for academic, patient care and professional responsibilities including concern for societal needs. (PR4)
  5. Be responsive to patients needs in a manner that supersedes self-interests. (PR5)

Personal and Professional Development (PD)

  1. Acknowledge personal limitations and mistakes openly and honestly, seek and respond to feedback in a constructive manner, and demonstrate flexibility and maturity in adjusting your behavior. (PD1)
  2. Set personal learning and improvement goals to effectively develop and employ strategies for analyzing, identifying, and improving personal deficiencies in knowledge, skills, and attitudes. (PD2)
  3. Evaluate your own personal health and well-being and appraise and address attitudes or behaviors that may adversely affect your health and effectiveness as a physician. (PD3)
  4. Discuss the role of ambiguity and uncertainty in clinical reasoning and clinical decision making, and actively develop strategies to deal with uncertainty in clinical medicine. (PD6)

Practice-based Learning and Improvement (PL)

  1. Use evidence-based medicine and medical knowledge resources to determine patient care decisions. (PL3)
  2. Identify opportunities for system-based quality improvement in the context of caring for patients. (PL4)
  3. Apply the foundational principles of physiology, anatomy, histology, biochemistry and genetics to patient care. (PL5)
  4. Describe and apply principles of public health and population health improvement for specific populations with attention to access, cost, and patient-centered clinical outcomes. (PL6)
  5. Use technologic resources (including the electronic medical records and medical knowledge resources) to optimize personal learning and to engage in effective patient care. (PL2)

Systems-based Learning (SL)

  1. Discuss effective strategies to provide cost-effective, high value diagnostic evaluations and therapeutic interventions in the context of in-patient medical care. (SL2)
  2. Describe health disparities and health care disparities, define how these disparities affect both patients and society, and identify strategies to address disparities. (SL4)

Interprofessional Collaboration (IP)

  1. Define the roles and responsibilities of all health care professionals involved in patient care in the in-patient setting. (IP1)
  2. Actively work to develop a climate of mutual respect, dignity, diversity, ethical integrity and trust. (IP2)
  3. Communicate effectively and respectfully with other health professionals in a responsive and responsible manner. (IP3)
  4. Collaborate with other health professionals and health care teams to deliver quality patient care and improve system performance. (IP4)

Ambulatory Objectives:

At the end of this two-week block, the student should be able to do the following:

  1. Demonstrate proper techniques for interviewing a patient to obtain a medical history and performing a physical examination in the ambulatory clinical setting. (PC1)
  2. Formulate a comprehensive, ordered differential diagnosis. (PC2)
  3. Present and document patient data gathered from interviews, physical examinations, and laboratory studies in a standardized format. (CS5)
  4. Apply knowledge of the pathophysiology, epidemiology, and natural history of diseases to the diagnosis and management of common patient conditions in Internal Medicine. (MK8)
  5. Identify basic concepts of preventive health care and population health/panel management, including patient education, immunization, and appropriate age-specific screening recommendations. (PC5)
  6. Identify members of a primary care inter-professional care team and understand their roles and responsibilities.  (IP1)
  7. Understand key USPSTF guidelines for clinical preventative services. (PL6)

Internal Medicine Clerkship PxDx Log

Diagnosis: Participate in the care of patients with the following diagnosis: Output or Input
Acid Base Disorder I
Acute Kidney Injury I
Anemia I,O
Chest Pain I
Chronic Kidney Disease O
Congestive Heart Failure I,O
Diabetes II I,O
DVT or PE I
Dyspnea I
End of Life Care I
Fever I
GERD O
Hyperlipidemia O
Hypertension I,O
Perform an Immunization Needs Assessment O
Pneumonia (CAP/HAP) I
Substance Use Disorder (alcohol, tobacco, or drugs) I,O
Upper Respiratory Infection I
UTI I,O
Participate in the care of uncontrolled Diabetes I
Procedure Output or Input
Perform an interpretation of a Basic Metabolic Panel (BMP) I,O
Perform an interpretation of a Blood Culture I
Perform an interpretation of a Complete Blood Count (CBC) I,O
Perform an interpretation of a CXR I
Perform an interpretation of an EKG I,O
Perform an interpretation of LFTs I
Perform an interpretation of an Urinalysis I,O
Perform an interpretation of an ABG I
Perform an Opioid Conversion (Pain Management) I
Participate in an Interprofessional Experience I
Exam Output or Input
Perform a cardiac exam on a patient
 I,O
Perform a pulmonary exam on a patient I,O
Perform an abdominal exam on a patient I,O
Perform a cardiopulmonary POCUS exam on the VA Simulator I