Cores 2008/2009

2008/2009 FOURTH YEAR
CORE CLERKSHIPS

FOURTH YEAR CURRICULAR REQUIREMENTS

Members of the Class of 2009 are required to successfully complete seven months of elective study as well as the following three core clerkships:

Internal Medicine Sub-Internship
Emergency Medicine
Radiology

Students should submit their preferences for the three core clerkships using the on-line form in Angel. Click on the "Fourth Year Clerkship Preferencing" option. Preferences must be submitted by Monday, February 11. Link to Angel here.

Internal Medicine Sub-Internship

This core rotation is designed to provide students an experience that closely resembles the internship year. Students are assigned to inpatient Medicine teams that care for patients in the medical intensive care unit, the ward setting, or both. Students are given primary patient care responsibilities with a closely guided experience in decision-making and in diagnostic and therapeutic management of typical medical conditions related to general internal medicine and/or related subspecialties. Close supervision is provided by the team’s resident and attending physician. Students will provide care to no more than 6 patients at a time and will take overnight calls with the team to admit new patients and cover their own patients. Overnight call frequency will depend on the rotation site, but a total of 6 overnight calls for the month will be the minimum requirement. The primary method of teaching is active participation in patient care activities with daily teaching attending rounds; daily conferences and morning reports along with Web-based case modules provide complementary educational venues. The course is a one month rotation.

Students will have the opportunity to achieve Level 3 in the Communications competency (Competency I) while on this rotation.

Objectives:

Students will demonstrate competence in the following areas:

Communication skills with patients, families, colleagues, and ancillary staff
Coordination of care for patient from initial admission through follow-up with primary care provider
Information management and prioritization
Procedural knowledge and skills

Students will apply the above competencies along with their clinical knowledge & skills to learn how to manage patients with the 17 common clinical scenarios as outlined in the course syllabus. Students will gain knowledge of these and other common medical conditions.

The following sites/services comprise the clerkship. All sites/services are available in all months:

Wishard – Ward Medicine with open ICU
8 students per month
VA – Ward Medicine
5 students per month
VA – ICU
2 students per month
St. Vincent – Ward Medicine
4 students per month
St. Vincent – ICU
4 students per month
University - ICU
3 students per month
Methodist – Ward Medicine
2 students per month

Muncie Ball Memorial - Ward Medicine
1 student per month
NOTE: Housing provided by Ball Memorial Hospital

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Emergency Medicine

Availability: All months except December and May
Clerkship Director: Butch Humbert, MD
Assistant Clerkship Director: Bart Besinger, MD

Clerkship Coordinator: Jim Graber

Course Objective: The student will learn the fundamental approach to caring for the undifferentiated patient with urgent or emergent conditions. The student will be required to identify the patient's problem with a focused history and physical taking into consideration not only the medical condition but also the psychosocial aspects of the problem. The student will implement solutions to these problems under the direct supervision of the Emergency Medicine faculty. The student will also learn to consider unexpected circumstances that arise in the emergency department. Students taking this course will have the opportunity to achieve Level III in Competency VIII: Problem Solving, or Competency V: Self-Awareness, Self-Care, and Personal Growth.

Course Description and Requirements:

Introduction to Clinical Emergency Medicine:

The first three working days of the month will follow a structured format of both lectures and workshops to provide the student with the tools necessary to perform their clinical responsibilities. Objectives for the lectures are posted on the Angel site and will be presented at the beginning of the lecture series.

Student Responsibilities:

Attendance is mandatory at the initial 3-day lecture series.
Students are scheduled to work fifteen nine-hour shifts during their rotation. Those shifts are divided between the day, evening, and night shifts. The schedule will be posted on the EM Angel site and distributed at the beginning of the month or as they become available. Any requests should be directed to the Clerkship Coordinator by the first of the month prior to the beginning of the rotation. We will attempt to honor reasonable requests.
During the clinical shifts, the student will be the patient's primary caregiver. He/She will be responsible for evaluating the patient and with the faculty or senior resident's guidance will develop and implement a focused diagnostic and treatment plan.
Students perform procedures on their patients as needed, including but not limited to suturing, arterial puncture and/or line placement, central venous access, and airway management. They will also interpret radiographs and ECGs used in the care of their patients.

Sites available for clinical activity:

	Methodist	St. Francis	St. Vincent	Wishard
Annual Visits	95,000	75,000	70,000	95,000
% Pediatric Pts.	20%	20%	10%	4%
% Pts. Admitted	20%	20%	26%	14%
% Admits to ICU	24%	8%	10%	20%

Methodist Hospital- 10 students/month
EM residency training site, Level 1 Trauma center, community based tertiary
St. Francis Hospital - 4-6 students/month
Community-based
St. Vincent Hospital - 6-8 students/month
Community-based
Wishard Hospital- 10 students/month
EM Residency Training Site, Level 1 trauma center
A site coordinator that assists with implementation of the clinical activities is available at all sites.
Students will preference a clinical site. Attempts to honor site preferences will be made.

Case Conference: Case Conference will be held the 3^rd and 4^th Tuesdays of each month (unless otherwise noted). Case Conference attendance is also mandatory. Students who wish to achieve the level 3 competency in Problem Solving are required to make a 5-7 minute presentation during the conference. All students are required to attend both case conferences. EM faculty and residents will be present to discuss the cases and any learning points.

Grading: The grade in this rotation will be comprised primarily of the shift evaluations completed after each shift by the faculty. The remainder of the grade will be determined by the end of rotation quiz, and attendance.

Level 3 Competency: Problem-Solving (Competency VIII) can be achieved by demonstrating adequate problem solving skills during clinical activities and by satisfactory completion of a case discussion that includes the oral presentation at the case conference and a written summary of the case discussion that is turned into the ECMS Web site. The written summary needs to illustrate the thought processes behind the problem solving involved in the case. Please see the EM Clerkship Angel Web site for details on the competency experience including an example of a well-written summary.

Self-Awareness, Self-Care, and Personal Growth (Competency V) can be achieved by writing and submitting a portfolio project that centers on a student’s written reflection regarding an experience they had during their Emergency Medicine Clerkship. The intent is to have the student share how the experience affected their personal growth and development to become a professional physician. Please see the EM Clerkship Angel Web site for details on the competency experience including an example of a well-written portfolio.

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Radiology

Availability: All months except December and May
Clerkship Director: Richard B. Gunderman, MD, PhD

Course Description: Radiology has revolutionized the practice of medicine, by allowing physicians and patients to peer inside the living human body without cutting it open. It is vital that every physician understand the enormous diagnostic and therapeutic potential of radiology and be equipped to make effective use of it in their practice. This month-long clerkship provides formal lectures, interactive sessions, hands-on clinical experiences, and Web-based learning opportunities. Students have the option of taking call, and every student functions not only as a learner but also a teacher.

Level 3 Competencies: Students work in groups to complete presentations and have the opportunity to demonstrate the Level III Competency in Effective Communication by preparing a 2-3 page paper.

Grading: 30% on student presentations, 70% on the final examination

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