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Internal Medicine Clerkship Orientation

Sean A. Whelton MD

Internal Medicine Clerkship Director

Division of Rheumatology

Georgetown University

 

 

Catherine Okuliar MD

Ambulatory Medicine Clerkship Director

Division of General Internal Medicine

Georgetown University

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Welcome to Medicine

    • The Big Clerkship
    • Foundation of all the other clerkships
    • Huge and diverse body of knowledge and skills

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Internal Medicine

Even if the treatment might be simple, we embrace complexity

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Internal Medicine

    • Goals
      • We want to give you the tools so that you can finally become a doctor.
      • Formal Objectives and Syllabus of the course are listed on the website 
      • http://www.georgetown.edu/faculty/wheltosa

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Outline

    • Goals/objectives
    • Overview of the rotation
    • Wards at Georgetown
      • conferences
    • Ambulatory
      • Conferences on Mondays
    • Affiliates
      • Virginia Hospital Center
      • INOVA Fairfax
      • Washington Hospital Center
    • Grading
    • Exam
    • Final Items (Time Off Requests)

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Internal Medicine

    • Foundations are in knowledge
      • Big books – Cecil’s essentials, Harrison’s
      • Journal articles – NEJM review series
      • Little books / mobile resources
      • First Aid, Crush the Boards type books
      • Question books - MKSAP for students
      • Question banks - USMLE world

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Internal Medicine rotation overview

    • Third Year Clerkship
      • 4 weeks at Georgetown
      • 4 weeks at either VHC, WHC, or Fairfax
      • 4 weeks at an ambulatory site

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      • Or 6 weeks at Georgetown and 6 weeks at WRAMC

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Georgetown Wards

    • Team
      • Resident
      • Intern
      • Acting Intern
      • GT3
    • Multiple attendings will care for patients.
    • One attending facilitates teaching. 
    • This may or may not be the "attending of record" for your patients.

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Georgetown Wards

    • Typical Day
      • Pre-round before 8am
      • 8:00am lecture, Grand Rounds, or morning report
      • Rounding begins at 9:00
      • Teaching rounds begin at 10:30
      • Noon conference daily
        • Including morbidity and mortality conference and the clinical-pathologic conference.
      • Teaching sessions are listed on the website and are usually at 1pm or 2pm
      • Argy Teaching Resident lectures

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Georgetown Wards

    • GT 3 Lectures are either from 8am-9am or in the afternoons. Lectures are posted on the website.
    • Morning Report
      • 8am in the Harvey Conference Room and 4 bles residents conference room
    • Argy Lectures
    • All are mandatory
    • All are listed on the website.
    • Please evaluate the lecturers (tool is on the website)

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Morning Report

    • On Mondays and Fridays
    • A GT4 (acting intern) will present a case that we all work through in 45 – 50 minutes.
    • Our Argy resident will assign which GT4 will present at the conference.
    • Note: GT3s & GT4s working on the Admit team (1 in 7):
    • Your team hours will be from 10:00am to 10:00pm
    • Your hours will be 8am to 8pm to allow you to make it to lectures on Monday, Wednesday, and Friday.

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History and Physicals

    • Over the month while at Georgetown, you need to turn in weekly complete H&Ps. Turn these in to your teaching attendings each week (you’ll need to do 3).
    • WRAMC students are to do 4.
    • Holiday and test weeks are exempt.
    • Guidelines for the H&P are on the website

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Observed Physical Exam �(AKA mini-CEX)

    • At least once during the month your attending, resident, or the Argy teaching resident will observe you doing a history and physical exam.
    • Formative (ie. Non-graded exercise) for your benefit

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Mid-term Clinical Evaluations

    • Formative Feedback - from your instructors to you and from you to you.
    • It is required but the content does not count toward your grade
      • Serves only to indicate if there is a major problem
      • “am I on-track”
      • addresses knowledge, skills, attitudes
      • You’ll need to submit one each month.

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Final Clinical Evaluations

    • Your attending, resident, and intern will give you a final evaluation that is used to generate your grade.
    • I suggest seeking feedback on a weekly basis.

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Clinical Evaluations

    • “RIME”
      • Reporter
      • Interpreter
      • Manager
      • Educator

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“Professionalism”

    • Courteous
    • Polite
    • Well groomed
      • No scrubs except on overnight call
      • Men wear ties with top buttons fastened
      • Women wear professional clothing
    • Honest
    • Completing your evals (CoursEval)

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“Professionalism”

It is what you do when no one is looking.

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“Professionalism”

Goes beyond being a good person.

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It includes your duty as a physician to make yourself into the best person that you can be.

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“Reporter”

    • Accurately gathers information
    • Uses appropriate terminology
    • Reliable
    • Adequate knowledge base
    • Committed
      • Pass

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“Interpreter”

    • Ability to identify and prioritize problems independently
    • Generates and can defend a differential diagnosis
    • Good knowledge base
      • High Pass

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“Manager”

    • Proactive in suggesting diagnostic and reasonable therapeutic plans
    • Complete differential diagnosis
    • Excellent level of knowledge
      • Honors

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“Educator”

    • Identifies questions that are not answered in textbooks
    • Cites evidence that new or alternative therapies/tests are worthwhile
    • Educates the team
      • Honors

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Final Clinical Evaluations

    • Don’t be a loud mouth or a show off.
    • Don’t sit there completely silently.
    • Participate in rounds.
    • Show off your reading.

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Grades

    • Grading
      • Honors / High Pass / Pass / Fail
    • 70% clinical evaluations
      • Includes H&P and completing CoursEval
    • 25% exam
    • 5% completing course eval
    • Heart sound exam - nudge

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Grades – Exam Policy

    • If the NBME exam result is a failure, you will be issued an incomplete and will have the chance to retake the test. If the grade is passing, you will be issued a grade. 

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    • If it is a second test failure, you will have to repeat the entire clerkship.

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Final Clinical Evaluations

    • Know all the details of your patients.
    • Learn how to prioritize data. (is. Focus on the major issues)
    • Learn to present patient information without using notes
    • Know how to obtain the information from the various systems at the hospital

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Final Clinical Evaluations

    • Try to put the clinical data together to draw appropriate conclusions.
    • Help to manage your patient’s care.
    • Learn about your patients and offer to teach the team about topics that they may not already know.

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Acting Interns

 

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Acting Interns

Goals

We want to give you the tools to function as an intern

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Formal Objectives of the course are listed on the website http://www.georgetown.edu/faculty/wheltosa

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Acting Interns

Good Communication is essential !

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  • Admission – discussion with your resident and attending
  • Change in status – notify your resident immediately
  • Sign-out / Cross-coverage
  • Discharge planning

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Acting Interns

  • Grading
    • Honors / High Pass / Pass / Fail

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  • 100% clinical evaluations

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Acting Interns

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Acting Interns

    • Please go with our Argy Teaching resident for a separate brief orientation.

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Things to avoid

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Things to avoid

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Clerkships at WHC, VHC, WRAMC and Fairfax

    • Separate orientations will occur at each affiliate site by Dr. Ouellette (VHC), Dr. Trimble (Fairfax), and Dr. Topol (WHC).
    • Similar in overall pattern to the Georgetown Wards

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Ambulatory Clerkships

    • By definition these will all be different experiences.
    • Learn to perform a focused history and physical
    • Basics of outpatient management of illness
    • Exposure to community practice
    • Minimum of 2-3 patients / half-day session 
    • Read, read, read!!!

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Ambulatory Clerkships

    • Attending will complete your clinical evaluation for this month
    • Attitude, enthusiasm, bedside manner are the keys to success
    • Efficiency
    • Would they want to hire you to join their practice?

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Ambulatory Clerkships

    • Palliative care curriculum
      • Overview and lecture
      • Monday morning Community Hospice visits
      • Tuesday morning inpatient Palliative Care rounds
      • Written assignment

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Ambulatory Lecture Series

    • Every Monday you will have one to three lectures from faculty and the Argy teaching resident
    • Palliative care curriculum
    • Only for those students on the outpatient segment of the rotation.
    • Business casual - no jeans please
    • Please evaluate the lectures using our website.

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Shelf Exam

    • Developed by the National Board of Medical Examiners
    • The same people that write the USMLE 1-3.
    • 100 questions
    • 2 hours and 30 minutes

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Shelf Exam

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Shelf Exam

    • Tests:
      • Knowledge
      • Test taking skill
      • Time management

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Shelf Exam

    • How to prepare?
      • Read
        • The test is a measure of how much you read.
      • You will not see everything in Medicine over the 3 month rotation so just reading on your patients will not be enough.
      • Question books

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The bottom line

    • Study hard
    • Do well on the exam
    • Month 1 and 2, read books, review articles
    • Month 3 - do lots of practice questions.

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Practical Exam - Heart Sound Exam

    • After the Shelf exam there will be a brief practical exam.
    • Test of auscultation skills.
    • You have a CD-ROM with mp3 files of hundreds of heart sounds.

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Electronic Patient Log

    • Rather than capture all your clinical visits we have chosen those clinical exposures that we wish for all of you to experience.
    • Each item should be seen at least once
    • Please look at your laminated card for a detailed listing
    • Make sure all 16 choices have been picked over the course of the rotation.

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Electronic Patient Log

    • Abdominal Pain
    • Altered Mental Status, Coma
    • Anemia
    • Back Pain
    • Cancer,
    • UnspecifiedChest Pain
    • Congestive Heart Failure
    • COPD
    • Diabetes
    • Dysuria
    • Electrolyte, Acid/Base D/O
    • HIV/AIDs
    • Hyperlipidemia
    • Hypertension
    • Joint Pain (Unspecified)
    • Pneumonia
    • Tobacco Counseling

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Electronic Patient Log

    • Data will be used to improve your experiences in the medicine clerkship.
    • LCME requirement.
    • You can also directly enter data via the web.

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ADMISSION LOG

    • You will be required to record the number of patients that you admit.
    • Applies to all inpatient sites
    • Distinguish between a new admission from the ER vs. a Transfer (from night float team, overflow, ICU or another hospital, etc)
    • You will receive an email from Mesky once a week with a link to survey monkey

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ADMISSION LOG

1. Please enter your Net ID

2. What is your current rotation site?

3. Please choose the WEEK this data applies to:

4. During this week, how many patients did you admit directly from the ER?

5. During this week, how many patients did you admit as a Transfer from another team?

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Weekly Reflections

    • Each week while on Georgetown Wards we’ll ask that you reflect on something that has gone on or that you have learned and write it down in an email.
    • wheltosa@georgetown.edu
    • meskerem.lloyd@gunet.georgetown.edu

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CourseEval

    • We use the data from course eval and from our day to day operations to make changes and improvements to the clerkship.
    • We expect you to receive feedback during the rotation.
    • We expect your to give feedback about the rotation.
    • You can fill it out over time. I suggest completing sections after each month while the information is fresh in your mind.

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Website

    • Be sure to check the website frequently:
    • Goals and Objectives are listed out on the site

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http://www.georgetown.edu/faculty/wheltosa

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Summary

    • Daily Schedule
    • RIME
    • H&P’s
    • PACE
    • Reflection

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Any Questions?

    • Sean Whelton MD
      • wheltosa@georgetown.edu

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    • Catherine Okuliar
      • cx03@gunet.georgetown.edu

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    • Mesky Lloyd
      • Meskerem.lloyd@gunet.georgetown.edu

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Question Everything

    • Sean Whelton MD
      • wheltosa@georgetown.edu

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    • Catherine Okuliar
      • cx03@gunet.georgetown.edu

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    • Mesky Lloyd
      • Meskerem.lloyd@gunet.georgetown.edu

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