Internal Medicine

The purpose of this rotation is to provide an understanding of the scope of internal medicine as a specialty. The rotation offers an introduction to the knowledge and skills basic to internal medicine as practiced in a hospital-based clinical setting. Management is emphasized as an important goal.

All 4th yr students must write an abstract on a patient seen while on rotation. This should be suitable fora poster or publication. Weekly rounds /discussions with Sub-I course Director or other attending.

A knowledge of intensive care medicine is important to the practice of Internal Medicine. The recognition of the critically ill patient and then responding to that person’s needs is essential.

The ChristianaCare rotation will provide sub-interns with a thorough experience in the assessment and management of the critically ill medical patient. Students will be assigned patients to manage as part of a team under the direct supervision of attendings, residents, and interns.

Physician assistants, nursing staff and respiratory staff, may be involved in assisting with the educational objectives.

Directly supervised patient care activities—4th years will learn through direct patient care with supervision. New patients will be evaluated, and a thorough differential diagnosis and plan will be derived. Patients will then be cared for in follow-up and differential diagnoses and plan will be adjusted as per the clinical situation. Patients assigned who have been previously worked up and a differential diagnosis and plan derived will be managed as dictated by the changing clinical scenario. Patients will be presented on rounds in the manner determined by the attending and residents. The 4th year will assume direct responsibility for his/her patients.

The 4th year should understand and respect the roles played by ancillary staff—nursing, respiratory, social work, nutrition—these departments will add significantly to one’s understanding of a patient’s course.

Attendings, interns, and residents will instruct students in various areas during the course of the rotation. Lectures and other educational tools will be discussed by the team.

Demonstrate knowledge and treatment for common critical care problems including shock, sepsis, asthma exacerbation, GI bleeding, DKA/Hyperglycemic hyperosmolar state, acute kidney/liver injury, etc.

The subspecialty experience may be inpatient, outpatient, or both. The student will see patients with a broad mix of diseases and illness severity. It is an expectation that consultations/progress notes will be entered into the EHR. This will be at the discretion of the supervising attending physician.

Unique interviewing skills, hypothesis driven physical exams, and specialized procedures as well as common diagnostic differentials and treatment plans are components of most rotations.

Students encounter patients in both the inpatient and/or outpatient clinic settings. Faculty supervise histories, physical exams, and management. Patients are seen both under direct supervision and in concurrent (exception model) care with attending involvement. Evidence-based management is stressed, as well as an emphasis on cost-effective care and health-systems’ impact on the treatment plan. Communication skills are stressed as an essential component of all students.

Students are encouraged to attend the ongoing core didactic series of lectures while on most of these rotations. This includes Medical Grand Rounds and the Noon Conference Series. Further direction will be given by each subspecialty preceptor.

Students will collect a thorough history by soliciting patient information and by consulting other sources of primary data in a logical and organized fashion.

Students will conduct a hypothesis driven physical exam.

Students will progressively be able to generate a rational differential diagnosis for the most common conditions seen on each rotation, and they will correctly identify and interpret abnormal findings. They will understand their limitation of knowledge and seek the advice of more advanced clinicians.

Students will consistently apply current concepts in the basic sciences to clinical problem solving. They will use information from the literature and other sources including electronic databases.

Students will develop and refine their individual style when communicating with patients. They will create effective written communications through accurate, complete, and legible notes. They will exhibit listening skills appropriate to patient-centered interviewing and communication. Students will respond to feedback in an appropriate manner.

Students will demonstrate integrity, accountability, respect, compassion, patient advocacy, and dedication to patient care.. They will be punctual and prepared for teaching sessions. Students are expected to show sensitivity and responsiveness to patients’ culture, age, gender and disabilities.

Students will utilized evidence based materials to augment their understanding of various diseases and apply this to develop an appropriate differential diagnosis and plan.

Students will be sensitive to health care costs while striving to provide quality care. They will effectively coordinate care with other health care professionals as required for patient needs. Clinical practice guidelines will be used whenever applicable students will be expected to seek out and understand current clinical guidelines of various disorders and recognized their limitations.

All 4th yr students must write an abstract on a patient seen while on rotation. Suitable for poster or publication.