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Inpatient Medicine Clerkship Objectives for Third Year Medical Students

(updated 08/19/2008)

The goal for students on the required Clerkship in Medicine is the attainment of an understanding of adult patient illnesses and the non-surgical management of those illnesses.  The clerkship emphasizes the integration of basic science with clinical skills.  The student should also develop awareness that the patient is an individual in an unfamiliar and stressful setting.
Specific skill objectives include attaining proficiency in history taking and physical examination, written and oral case presentation, appropriate use of clinical judgment, and establishing priorities.  Specific knowledge objectives include attaining an understanding of common medical illnesses and of medical ethics.
Skills for Students to Acquire:

1. Achieve proficiency in the following:
1. Obtaining a patient history.
2. Performing a full or directed physical examination.
3. Writing up data in a problem-oriented format.
4. Presenting cases orally.
5. Performing basic diagnostic and therapeutic procedures.
2. Gain experience in writing orders and problem-oriented progress notes.
3. Learn how to establish priorities in ordering diagnostic tests and how to interpret laboratory data.  Consider the cost-effectiveness of different strategies.
4. Begin to develop clinical judgment and decision-making skills.
5. Ascertain the patient’s goals of the therapeutic encounter.
6. Ascertain patient’s understanding of and compliance with medications.
7. Begin to understand the basic concepts and dilemmas in medical ethics.

Knowledge for Students to Acquire:

1. Develop familiarity with common medical illnesses.  Develop the ability to construct an adequate differential diagnosis.
2. Build on previous knowledge of pathophysiology and begin to integrate basic sciences with clinical medicine by reading pertinent texts about the problems of each patient.

Attitudes for Students to Develop:

1. Become an integral part and enthusiastic member of the medical team by participating in ward activities and by contributing to discussions related to patient care.
2. Gain perspective regarding roles of various health care personnel in patient care.
3. Learn how to establish rapport with patients and paramedical personnel.
4. Begin to function as a physician by working with patients and accepting some responsibility for their care.
5. Begin to understand the humanistic side of medicine.  Treat and discuss patients in a concerned and compassionate manner.  Begin furthering concepts in and around death and dying.

Clinical Problems for Students to Assess and Manage:

1. Cough
2. Dysuria
3. Back pain
4. Joint pain
5. Chest pain
6. Abdominal pain
7. Headache
8. Electrolyte abnormalities
9. Hypertension
10. COPD
11. HIV infection
12. Ischemic heart disease
13. Congestive heart failure
14. Diabetes mellitus
15. Elevated cholesterol
16. Depression
17. Fever
18. Smoking
19. Stroke or TIA
20. Substance Abuse

Recommending a Student for a Letter of Distinction

1. History Taking:  Precise, logical, thorough, reliable, purposeful, and focused.  Include all pertinent positives and negatives.
2. Physical Examination:  Very complete, accurately done, directed toward to patient’s problems, and elicits subtle findings.
3. Case Presentations:  Extremely clear, organized, accurate, and polished presentations appropriate in length for the situation.  Use precise, accurate terminology.
4. Write-Ups:  Outstanding, conscientious and accurate in recording patients’ histories and physical examinations.  Differential diagnoses are extensive.  Outstanding analysis of patient’s problems.  Therapeutic plans are thorough.
5. Fund of Knowledge:  Extensive, well-applied knowledge of disease, pathophysiology, diagnoses, and therapies.  Consistently up to date.  Familiar with relevant journal articles.  Judicious in selection of WWW materials.
6. Clinical Judgment:  Regularly integrates medical facts and clinical data, weighs alternatives, costs, risks, and benefits.  Understands limitations of knowledge.   Wise use of diagnostic and therapeutic procedures.  Applies evidence-based medicine.
7. Physician-Patient Interactions:  Does not use jargon with the patient or families.  Communication reflects clarity and empathy.  Effective communication with teams, staff, etc.
8. Professional Attitudes and Behavior:  Enthusiastic, responsive, reliable.  Committed, cooperative, and respectful.  Establishes trust.  Displays initiative.  Provides leadership.