Internal Medicine Clerkship: A Student Guide
This guide prepares medical students for the internal medicine clerkship by outlining expectations for patient care, teamwork, and communication. It covers aspects of history taking, physical exams, documentation, oral presentations, consults, and the unique culture of internal medicine.
The introduction highlights the core values of internal medicine, emphasizing strong patient relationships, clinical reasoning, problem-solving, and procedural skills. Trainees and clinicians interact with these aspects through inpatient rounds and outpatient clinical encounters. This workshop aims to prepare students for these experiences.
The learning goal of the workshop is to familiarize students with the facets of patient care, teamwork, and communication skills specific to the medicine clerkship. This involves a combination of didactic and active learning activities. Students are expected to prepare a formal H&P note based on a recorded intake history and physical examination.
The learning objectives focus on equipping students with the ability to explain the unique considerations and expectations of the medicine clerkship, including obtaining medical histories, performing physical exams, documenting written notes, and delivering oral presentations. Students will also learn about the unique cultural environment of the medicine clerkship, which includes teamwork and communication strategies.
The agenda for the workshop includes dedicated time for H&P oral presentations, H&P written notes, calling consults, and a discussion of medicine culture, specifically focusing on teamwork and evidence-based practice. The schedule allocates time for each activity to ensure comprehensive coverage of the key areas.
The section on make-up plans provides alternatives for students with appropriate absences. These students will submit their 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 version of the written H&P note, highlighting information to be included, excluded, or revised for oral delivery.
The document provides templates and examples for documenting key components of the History and Physical (H&P) exam. These include Chief Complaint (CC), History of Present Illness (HPI), Review of Systems (ROS), Past Medical History, Medications, Allergies, Family History, Past Surgical History, Social and Sexual History, and Vaccine History. Each section is designed to capture comprehensive patient information.
The Physical Exam section includes vital signs (temperature, pulse, respiration, blood pressure, SpO2) and sections for documenting findings from different body systems: Constitutional, HEENT, Cardiovascular, Pulmonary, Abdominal, Musculoskeletal, Skin, and Neurological. These sections ensure a thorough assessment of the patient's physical condition.
The Laboratory Results section presents a detailed hematological and chemistry panel with reference ranges and units. It shows a comparison of the patient's lab values from two time points (2 months ago and at admission) and highlights abnormal values (high and low) for parameters like WBC, Hgb, Hct, Plt, RBC, MCV, MCH, MCHC, RDW, NRBC, Reticulocyte count, Sodium, Potassium, Bilirubin, and Creatinine. This data is crucial for understanding the patient's condition and formulating a plan.
The Assessment and Plan section requires students to provide a summary statement followed by a numbered list of key issues or problems identified during the evaluation. For each problem, the student should outline a plan of action, including further investigations, treatments, or monitoring strategies. This section is critical for demonstrating clinical reasoning and decision-making skills.
Key points
- Internal medicine emphasizes patient relationships, clinical reasoning, and procedures.
- The clerkship involves inpatient rounds and outpatient encounters.
- Students are expected to master medical histories, physical exams, written notes, and oral presentations.
- Understanding the unique cultural environment of the medicine clerkship is crucial.
- Teamwork and evidence-based practice are emphasized in internal medicine.
- Accurate and efficient documentation is a key skill.
- Effective communication, including calling consults, is essential.
- The H&P (History and Physical) note is a fundamental component of patient care documentation.