"The important thing is to make the lesson of each case
tell on your education."
Sir William Osler
General Philosophy
The Medicine Clerkship is designed to be patient centered, which
reflects internists’ devotion to patient care. You are expected to
learn from each patient. You should be involved in every aspect of
your patients’ care from taking a history to writing orders to
observing studies that they undergo (when possible). You are the
member of the team who should know all the details about their
support system, medicines, lab data, etc. You should also be reading
about their medical issues every night. There is something to be
learned from every patient on the service. Therefore, you should
participate in the rounds of all the patients and point out
interesting findings on your patients to your fellow classmates.
The scope of Internal Medicine can be daunting, thus the
clerkship also is designed to promote self-directed, reflective
learning habits that should serve you well throughout your career.
Therefore, you are expected to take the initiative in all aspects of
your learning. This includes actively seeking feedback,
participating in discussions, sharing your knowledge with others,
and of course, spending time with your patients. (Make sure you
document all your hard work in your
Education Portfolio.)
Course Logistics/Formal Teaching Sessions
The Medicine Clerkship is divided into two 4-week inpatient
experiences. Everyone will spend one moth at STH and the second
month at either the VAMC or
Shands
Jacksonville.
We find that this combination allows you to see some of the
esoteric and complicated tertiary care patients along with plenty of
the bread-and-butter medicine cases. Because you spend two weeks in
a General Medicine clinic during your FMG rotation, we chose to give
you exposure to the outpatient medical subspecialties. Refer to the
section on clinics below for more details.
It is impossible to teach you all of internal medicine in eight
weeks but we will do our best to teach you the core topics that we
think every physician should know. We will also emphasize the
clinical reasoning process and utilization of educational resources
to encourage your own self-study. There is a noon teleconference
every Tuesday, Wednesday, and Friday in C2-33 and this series of
interactive, case-based discussions will cover the core topics
identified in the learning objectives. Preparatory materials are
online and you are encouraged to come prepared. Attendance is not
mandatory but strongly encouraged and there is a sign-in sheet.
Other formal teaching activities including morning report, Grand
Rounds, Morbidity and Mortality conference, and the ever popular
‘Doc-in-the-Box’ sessions. Times and locations for all the
conferences are posted on our website in the
student activity schedule.
Patient Census
You should admit at least one new patient per long call day. More
than one patient is only encouraged if you and your resident agree
that you are able to handle 2 patients. This may occur if you get
one straightforward patient early in the day and do not have a high
census. It is expected that you will work up a minimum of 16
new patients over an eight-week rotation. You should limit your
patient census to 4-5 (5 near the end of the year when you are more
efficient). Sometimes you may have a very sick patient on your
service that takes up much of your time. In this situation you may
need to carry a smaller census. You should not put yourself in a
position to have more responsibilities than you can handle. You are
an integral member of the team and the housestaff will count on you.
Talk to your resident, attending, or the Clerkship Director if you
are getting overwhelmed.
Students assigned to the subspecialty teams of GI and Oncology
will note that these teams are “on call” everyday. You are not
expected to pick up a new patient everyday, rather an average of two
per week. On days you are not expecting to take a new admission, you
should plan to wrap up your work and check out with your resident
around 5PM. (You are not expected to stay until 7PM with your team
everyday.)
Write-ups and Charting
Every patient you admit needs an H&P and daily progress note.
H&P’s should be on the chart by the day after the admission and
progress notes should be on the chart everyday (ideally by noon).
All notes should be legible and have the date, time, and your
signature followed by MS3. If your signature is illegible, print
your name next to it. All patient orders must be co-signed by a
physician. Dictations for the online medical record are not
permitted. Detailed instructions for patient write-ups can
be found on the website in the portfolio section under
patient care. Though your portfolio
advisor carries the primary responsibility for giving you formal
feedback on your H&Ps, you are strongly encouraged to review them
with your attending as well.
Scut
Scut work is defined as activities that are not educational on
patients that are not assigned to you. This means you are
responsible for even the ‘menial’ tasks on your own patients. But,
you are not obligated to perform tasks like looking up data on other
people’s patients or running errands for the housestaff.
Overnight Call
You are strongly encouraged to take advantage of cross cover
activities at the VA and Shands. At the VA and Shands there are
night teams, who will be rested and able to spend time with you as
you help with cross cover. The night team comes on at 7PM and you
should plan to page the intern at that time to let them know you
will be working with him/her that night. I would suggest you try to
experience cross cover 1-2 times during the rotation but it is not
mandatory. (Many students find even a few hours of cross coverage
experience, e.g. 7PM-11PM, to be of great value.)
Professional Behavior
You should dress professionally at all times. You should preround
on all your patients and be on time and prepared for work rounds.
(In general, allow 10-15 minutes to preround per patient. Refer to
“helpful hints”section for more
details.) You are expected to attend all the educational conferences
unless an acute patient care need arises. (Your patient care
responsibilities take precedence over everything.)
You should be polite and respectful to your patients and
colleagues at all times. Never falsify information. If you do not
know, simply say “I don’t know.” (We do not expect you to know
everything, despite how it may seem sometimes.) Cutting and pasting
anything other than online medication lists and lab data is
plagiarism. You are expected to do your own work, regardless of what
you may observe others do.
Unprofessional behavior will result in a lowering of your grade
and potentially an unsatisfactory evaluation for the entire
clerkship with appearance before the Academic Status Committee.
Patient Privacy and Confidentiality
All patient information is confidential and should be
discussed only with those involved in the patient’s care. Do not
talk about patients in public places, no matter how softly you think
you speak. (For more details about HIPAA refer to
http://privacy.health.ufl.edu) It is strictly forbidden by the
hospital to access any patient records outside of the hospital (HIS,
Stentor, MedIC, etc.). Doing so will result in all students losing
all computer privileges. Cell phones with cameras must have the
camera disabled if they are to be taken in patient care areas. (If
you would like to take a picture of a patient for
medical/educational reasons, there is an official digital camera and
consent form that can be obtained from the Chief Resident’s office.)
Clinics
You are required to spend one half day per week in your
outpatient subspecialty clinic except for long call days. On long
call days you have the option to miss clinic if there is an
admission, which takes precedence. You are required to notify
your clinic preceptor prior to the clinic if you will be absent
because it is a long call day and you are taking an admission.
Your days off cannot fall on a clinic day. If you have a patient
emergency come up and need to come late to clinic, you are
required to call your preceptor to explain the situation.
Consistent tardiness or failure to show up for clinic will result in
an unsatisfactory clinic evaluation. Clinic assignments are located
under
schedules on the website.
Time Off/Work Hours
You are held to the same standards as the residents in terms of
work hours—no more than 80 hours per week. You are allowed an
average of one day off per week including holidays (3 days off per 4
weeks as you get the weekend off after each 4 week block). You are
strongly encouraged to take your days off on the weekend so you do
not miss the educational activities during the week. You are
discouraged from pooling your days off as this breaks up continuity
of patient care. Occasionally, a special event like a family
member’s wedding may necessitate your taking off a weekend (pooling
your days off). Your attending and resident must approve this. If
you require more than the allotted days off, then this must be
cleared with the Clerkship Director before the start of the
clerkship in writing. If any emergencies should occur during the
clerkship, contact the Clerkship Director immediately so
arrangements can be made.
It is your responsibility to keep track of your hours and
alert the Clerkship Director if you are being expected to work more
than the allotted hours and days. Given the structure of our
clerkship and absence of night call responsibility, this should not
be an issue. But, we take it very seriously if the problem arises.
Clerkship Evaluation
Following the NBME shelf exam on the last day of the rotation,
lunch will be provided. During this time you will have an
opportunity to participate in a debriefing with your rotation group
and the Clerkship Director. This usually takes 45 minutes and you
are expected to be present, as your feedback is highly valued. There
is an anonymous, online clerkship evaluation that must be completed
in order for your grade to be released. (We are strict about this
only because we value your feedback.) This evaluation form can be
accessed on the website under
evaluation. You do not need to wait until the end of the
clerkship to evaluate individual noon conferences. These evaluations
can be accessed throughout the clerkship website under
clerkship seminar evaluations.
Safety
Clinical experiences by their nature involve students in a
variety of settings, locations and communities, as well as with a
variety of patients/clients. Students are expected to exercise good
judgment and reasonable caution in insuring their own safety during
clinical experiences (e.g. lock car doors, travel with classmates
when possible, be aware of security services). Patient care areas
may have the potential for exposure to hazardous substances such as
radioactive materials. Students who require protection beyond those
of all staff are to notify faculty prior to any clinical
assignments. If any time students believe the clinical setting is
unsafe, students should take appropriate steps to protect themselves
and their patients including leaving the setting if necessary.
Contact the course instructor or any college administrator
immediately so that appropriate arrangements can be made.
