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Internal Medicine Clerkship

Clerkship Co-Director: Mai Mahmoud, MBBS
Clerkship Co-Director: Dora Stadler, MD
Clinical Curriculum Coordinator: Deema Al-Sheikhly, MRes
Senior Curriculum Assistant: Sohaila Cheema, MBBS

1. Welcome to the Medicine Clerkship

The clerkship is designed to be an Active Learning Experience. The way to learn is to take care of your patients in the most thoughtful, caring, and conscientious manner. The clinical problems that you encounter in your patients will serve as springboards for reading and learning, investigating and diagnosing. If your patient has hemochromatosis, you will become expert in hemochromatosis--both to help the patient get better, and to inform yourself.

• Be Curious
• Be proactive
• Keep an Open Mind
• Be a Self Learner

2. Goals and objectives

The overall goal of the clerkship is to develop the knowledge, skills, and professional attributes that are involved in the practice of internal medicine. Specifically, you should become competent in:
A. Knowledge

1. Disease: pathophysiology, etiology, clinical features, diagnosis, prognosis, and therapy.
2. Health: preventive medicine, health screening, healthy living

B. Skills

1. Complete medical history
2. Complete physical examination
3. Focused history and physical
4. Making a problem list
5. Differential diagnosis of internal medicine conditions
6. Planning a diagnostic and management strategy
7. Interpretation of basic tests
8. Performing basic medical procedures phlebotomy, intravenous catheter, arterial blood gas, thoracentesis, paracentesis, lumbar puncture, nasogastric lavage
9. Writing admission and daily progress notes.
10. Write orders, co-signed by physician.,

C. Professional attributes

1. Honesty
2. Respect
3. Accountability
4. Conscientiousness
5. Ethical patient care and confidentiality
6. Performing as a member of the health-care team

3. Description of Rotations

• Two 4-week Blocks at the Hamad General Hospital on the Medicine service (all in general medicine), AND
• 4 weeks at Hamad Medical Center in Cardiology and Intensive Care Units, divided into two 2-week periods

4. General student responsibilities

Your major responsibilities are:

1. To provide care to patients, and to provide care of the highest quality. Care is provided under appropriate supervision.
2. To be there! Your patients and your team counts on you to be there. The clinical medical education assumes obligations to other people. If you are not there, your patient will miss you and your major contributions to their care
3. To learn art and science of clinical medicine, in the context of real patients

5. Patient responsibilities

• a. Patient load. You will be responsible for the care of the following numbers of patients.
• Regular medical services: 3-5 patients.
• Cardiology: 2 patients
• MICU: 1-2 patients
• b. Admitting patients. You will admit at least one patient every time you are on call. Once you finish the first admission, and, if your patient load permits, you may admit additional patients. You may also admit patients on non-call days, provided your patient load is in the acceptable range.
• Perform an admission history and physical examination.
• Write the admission note (admission H&P).
• Write patient orders, including admission orders, daily orders, and any others that may be indicated.
• Interview and examine each patient daily.
• Write a daily progress note.
• Perform clinical procedures, when necessary. Procedures performed by you are always under supervision. (See procedure guide)
• Order appropriate diagnostic tests
• Obtain, interpret, and record test results.
• Discuss the diagnostic and therapeutic plan with the patient and family. Make sure your discussions are in line with the opinion of doctor in-charge of the patient
• Always coordinate care with other members of the health care team.
• c. The model for learning by caring for patients is:
• Collect clinical data
• Analyze the data
• Make a plan
• Entertain Possibilities (differential diagnosis)
• Review this process with a supervising physician. Modify your interpretation based on this step.
• Act

Follow-up on your actions frequently. Repeat steps 1-6 as needed
Be Curious! Read regularly! Have the best option for your patient

6. Schedule

• Daily schedule In general, the day begins at about 6:30 AM and finishes at about 5:15 PM. If you are on call, you should plan on staying on the hospital floor until about 11 PM, leave by 11:00 PM.
• Transportation to and from provided for the morning and afternoon, but not for the night or weekends.
• Attendance is required: It is imperative that you are present during ward rounds and scheduled teaching activities. (At HMC, there are some conferences designed for medical residents and your participation is optional, EXCEPT Morning Report, your attendance and participation is required)
• Weekends work schedule: The clerkship continues during weekends See weekly schedule,
• If Post-call on Friday: Round with your team, finish, your work and leave. Take Saturday off if you were post call on Friday.
• If On-call on Friday: Start your day as usual, stay with your team in the hospital until 11PM. Start your day at usual time on Saturday, make rounds with the team, finish your work and leave.
• If neither on-call nor post-call on Friday: Friday is your day off. Start your day at usual time on Saturday, make rounds with the team, and finish your work and leave.
• If you are on-call Saturday: Start your day at usual time, stay with your team till 11PM. Take Friday off.
• Holidays. You are excused from work on official Cornell holidays as notified.
• Religious observances. The Weill Cornell policy regarding religious observances may be found in the Student Handbook In brief, you are excused from responsibilities for the purpose of religious observances. We will make every reasonable effort to accommodate your requests and to provide you with an opportunity to make up any missed work or information.