Acclimating to the Medicine Clerkship
This workshop and guide aims to prepare medical students for the unique aspects of the internal medicine clerkship, including patient care, teamwork, communication, and documentation. The content emphasizes history taking, physical exams, oral presentations, written notes, and understanding the culture of internal medicine.
The internal medicine clerkship offers a unique experience where students can engage with different facets of patient care through inpatient rounds and outpatient clinical encounters. Internists and medicine subspecialists often choose their career path because of the strong relationships they develop with their patients, the focus on clinical reasoning and problem-solving, and the opportunity to perform procedures.
This workshop will review the facets of patient care, teamwork, and communication skills that are unique to the medicine clerkship. The agenda includes H&P oral presentations, H&P written notes, calling consults, and medicine culture: teamwork and evidence-based practice. Students are expected to have completed a ReqPrep assignment involving a recorded intake history and physical and the preparation of a formal H&P note.
Students should focus on explaining the unique considerations and expectations for obtaining medical histories, performing physical exams, documenting written notes, and delivering oral presentations within the medicine clerkship. Understanding the specific cultural environment of the medicine clerkship is also crucial for a successful rotation.
The make-up plan for students with an absence involves submitting both a written H&P note and a copy of their H&P oral presentation to clerkship leadership for feedback. The oral presentation can be a separate document or an annotated copy of the written H&P note highlighting the information to be included, excluded, or revised for oral presentation purposes.
A complete medical history should include Chief Complaint (CC), History of Present Illness (HPI), Review of Systems (ROS) which covers Constitutional, HENT, Respiratory, Cardiovascular, Gastroenterology, Musculoskeletal, Skin, Heme, Neuro, and Psychiatry. Past Medical History, Medications, Allergies, Family History, Past Surgical History, Social and Sexual History, and Vaccine History are also essential components.
The physical exam involves documenting vital signs (temperature, pulse, respiratory rate, blood pressure, SpO2). It also includes a systematic examination of the patient, covering Constitutional, HEENT, Cardiovascular, Pulmonary, Abdominal, Musculoskeletal, Skin, and Neurological systems. Detailed findings should be recorded for each system.
Laboratory results are an integral part of the patient's assessment. Key components include a complete blood count (CBC) with differentials (WBC, Hgb, Hct, Plt, MPV, RBC, MCV, MCH, MCHC, RDW, NRBC, Reticulocyte count and Reticulocyte Hemoglobin) and a comprehensive metabolic panel (CMP) including Sodium, Potassium, Chloride, CO2, Anion gap, BUN, Creatinine, Glucose, Calcium, Bilirubin, Protein, Albumin, Alk phos, ALT, and AST. Compare current lab values to previous values to help assess trends.
The assessment and plan section of a patient note summarizes the patient's current condition and outlines the diagnostic and therapeutic steps to be taken. It includes a concise summary statement of the patient's presenting problems and a numbered list of specific issues being addressed.
Key points
- Internal medicine emphasizes patient relationships, clinical reasoning, and procedures.
- The workshop focuses on unique aspects of the medicine clerkship, including expectations for histories, physicals, notes, and presentations.
- Students will practice oral presentations and written documentation of a history and physical (H&P).
- Understanding the culture of teamwork and evidence-based practice is essential in internal medicine.
- The guide includes components of a medical history (CC, HPI, ROS, PMH, etc.) and physical exam.
- Laboratory results and their interpretation are a crucial part of patient assessment.
- Assessment and Plan section is vital for summarizing the patient's condition and outlining the next steps.