Internal Medicine Syllabus

INTERNAL MEDICINE SYLLABUS

THIRD YEAR MEDICINE SELECTIVES

Marc Heincelman, M.D., Clerkship Director

Mary Ann Snell, Student Education Coordinator

Medical University of South Carolina

Charleston, South Carolina

2017 - 2018

JUNIOR SELECTIVES

OVERVIEW

This month is, in essence, three weeks of core medicine. You will experience the daily work schedule of the subspecialty division to which you are assigned. This has the potential to include inpatient wards, inpatient consultations, outpatient clinics, and conferences.

GOALS

1.  Learn and practice the personal and professional characteristics of a superb physician.

2.  Learn the core concepts and clinical skills of Internal Medicine specific to each selective course.

3.  Have fun.

OBJECTIVES

1. Patient Care

a. Demonstrate proper techniques for interviewing a patient to obtain a medical history and performing a physical examination.

b. Demonstrate analysis, synthesis, and integration of pertinent patient data.

c. Formulate a comprehensive, ordered differential diagnosis.

d. Demonstrate an ability to build a positive, healing relationship with a patient.

2. Professionalism

a. Demonstrate professional demeanor and ethical behavior.

3. Medical Knowledge

a. Apply knowledge of the pathophysiology, epidemiology, and natural history of diseases to the diagnosis and management of common patient conditions in Internal Medicine.

4. Interpersonal Skills and Communication

a. Present patient data gathered from patient interviews, physical examinations, and laboratory sources, including progress notes on patients, in standardized format.

b. Document patient data gathered from patient interviews, physical examinations, and laboratory sources, including progress notes on patients, in standardized format.

c. Demonstrate effective and professional interpersonal and communication skills in interactions with patients and families, including an awareness of psychosocial factors related to patients’ problems.

5. Practice Based Learning and Improvement

a. Use evidence based medicine to determine patient care decisions.

b. Identify errors in patient care and knowledge deficits. Change future practices based on past mistakes.

c. Use information technology successfully to access and manage patient information.

6. Systems Based Practice

a. Demonstrate appreciation and collaboration with other members of the health care team including nursing, social workers, care managers, pharmacy etc as applicable to the specific course.

b. Identify issues related to the cost-effectiveness of diagnostic evaluations and patient care.

OBJECTIVES OF SPECIFIC SELECTIVES

Allergy & Immunology Selective / LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:
1. Explain how to diagnose and treat allergic and non-allergic rhinitis, asthma, atopic dermatitis, urticarial, and chronic sinusitis. (MK3, MK4, MK5, MK6, PC1, PC2, PC3)
2. Define indications for skin testing and immunotherapy. (MK5, PC3, PL2)
3. Demonstrate appropriate history and physical exam techniques for this patient population. (PC1, CS1)
INSTRUCTIONAL METHODOLOGIES & ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:
1. Reading an allergy/immunology review provided during the rotation.
2. Direct observation by faculty during direct patient care and review of other clinical and didactic activities (history and physical, progress notes, prescriptions, etc.
3. Ungraded quiz at the end of the rotation that Dr. Ramey will review with the student to help them evaluate knowledge.
PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:
1. Allergic and non-allergic rhinitis
2. Asthma and COPD
3. Atopic dermatitis, contact dermatitis, and urticaria
4. Recurrent infections
5. Food allergy
Hepatology / LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:
1. Demonstrate proficiency in assessing patients with liver disease and understanding the components of the history and physical exam that are essential for managing these patients. (MK2, MK3, MK4, PC1, PC2, PC3)
2. Describe the pathophysiology, differential diagnoses, and management of complications that result from cirrhosis and portal hypertension. (MK3, MK4, PC2, PC3)
3. Demonstrate understanding of the timing of referral for liver transplant evaluation by assessing severity of liver disease and short term prognosis in patients with cirrhosis. (MK4, MK5, PC3, PC4)
4. Demonstrate knowledge of the comprehensive evaluation required of patients undergoing consideration for liver transplantation. (MK5, PC3, SL1, IP1)
5. Identify and describe the indications for and complications of immunosuppressive agents post-transplant. (MK4, PC2, PC3)
INSTRUCTIONAL METHODOLOGIES & ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:
1. Participate in the General Hepatology Clinics. In each clinic, students will be specifically responsible for assessing and formulating a management plan for the patients seen as an Initial Clinic Visit (ICV) in the respective clinics.
2. Round with the Liver Attending on the inpatient service & evaluate patients on the consult service.
3. Observe outpatient endoscopy, to learn the management of patients with esophageal varices.
4. Attend the following Hepatology (and Gastroenterology) didactic conferences: GI Fellows Conference, Liver Biopsy Conference, Liver Imaging and Tumor Board, and Liver Transplant Selection Committee.
PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:
1. Complications of cirrhosis/portal hypertension: ascites, encephalopathy, variceal bleeding, and spontaneous bacterial peritonitis
2. Complications that occur after liver transplantation: biliary stricture, rejection, opportunistic infections, and complications of immune suppressing meds
3. Complications of alcoholic liver disease, including alcoholic hepatitis
4. Chronic hepatitis C
5. Chronic hepatitis of unclear etiology – namely the evaluation of these patients, including the role of liver biopsy
VA Pulmonary Selective / LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:
1. Demonstrate proper patient interview and physical examination techniques in the context of consultative medicine. (PC1, CS4, CS5)
2. Analyze, synthesize, and integrate pertinent patient data to formulate a comprehensive and logically ordered differential diagnosis when assessing patients on the Pulmonary Consult service. (MK4, MK6, PC1, PC2)
3. Present and document data gathered from patient interviews, physical examinations, and laboratory sources, in standardized format in both initial consult notes and daily progress notes. (PC2, PC3, CS4, CS5)
4. Perform diagnostic and laboratory test interpretation for common studies in pulmonary medicine (e.g. chest x-rays and pulmonary function tests), and actively consider cost-effectiveness when ordering or recommending diagnostic studies. (MK4, MK5, PC2, PL4, SL2)
4. Apply knowledge of the pathophysiology, epidemiology, and natural history of diseases to the diagnosis and management of common patient conditions in pulmonary medicine. (MK3, MK4, MK6, MK8, PC2, PC3)
5. Demonstrate effective and professional interpersonal and communication skills in interactions with patients and their families, including an awareness of psychosocial factors related to patients’ problems. (CS1, PR1, PR2)
INSTRUCTIONAL METHODOLOGIES AND ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:
1. Students will participate in the Pulmonary Consult service, and possibly the VA ICU, and evaluate patients with supervision.
2. Students will present and discuss of patients with the consult attending, fellow, and team.
3. Selected reading material on topics pertinent to critical care and pulmonary medicine.
4. Attendance at Pulmonary Clinical Conferences at noon on Mondays and Fridays and the pulmonary medical student lecture series.
PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:
1. Chronic respiratory failure, including very severe COPD with hypoxemia and/or hypercarbia
2. Obstructive lung diseases, including COPD (due to either emphysema and/or chronic bronchitis), asthma, and bronchiectasis
3. Restrictive lung diseases, including interstitial lung disease, pleural effusion, pneumoconiosis, and collagen-vascular diseases
4. Pulmonary malignancies, including non-small cell lung cancer, small cell lung cancer, metastases, and malignant effusions
General Internal Med Ambulatory Experience / LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:
1. Demonstrate proper techniques for interviewing a patient to obtain a medical history and performing a physical examination in the ambulatory clinical setting. (PC1, CS1)
2. Formulate a comprehensive, ordered differential diagnosis. (MK3, MK4, PC2)
3. Present and document patient data gathered from interviews, physical examinations, and laboratory studies in a standardized format. (PC1, PC2, PC3, CS1, CS5)
4. Apply knowledge of the pathophysiology, epidemiology, and natural history of diseases to the diagnosis and management of common patient conditions in Internal Medicine. (MK1, MK2, MK5, MK8, PC2, PC6)
5. Identify basic concepts of preventive health care, including patient education, immunization, and appropriate age-specific screening recommendations. (MK7, PC3, PC5, CS1, CS2, PL6)
INSTRUCTIONAL METHODOLOGIES & ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:
1. Participation in ambulatory clinic activities in a variety of local locations.
2. Participation in patient care as supervised by the attending and residents in clinics, including evaluation, presentation, and documentation of a minimum of 1 new patient per half-day day clinic session.
PATIENT ENCOUNTERS: Students will be expected to work with patients with conditions from all organ systems. For example (but not limited to), patients with acute or chronic medical conditions in the following areas will be encountered:
1. Cardiology: hypertension, atrial fibrillation, hyperlipidemia, coronary artery disease, congestive heart failure
2. Endocrinology: diabetes, hypo- or hyperthyroidism, metabolic syndrome, hyperlipidemia, obesity
3. Infectious Disease: upper respiratory infections, pneumonia, cellulitis
4. Nephrology: chronic kidney disease, nephrolithiasis
5. Pulmonary: COPD (emphysema and chronic bronchitis), asthma (controlled and uncontrolled)
Subspecialty Consults/Clinics / LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:
1. Describe the role of a consultant in medical practice, in both an inpatient and outpatient setting. (CS4, SL1, CS4)
2. Effectively interview patients to obtain medical histories, and perform physical examinations in the inpatient setting. (PC1, CS1, CS4)
3. Analyze, synthesize, and integrate pertinent patient data to formulate comprehensive and prioritized differential diagnoses. (MK3, MK5, MK6, PC2, PC3, CS4)
4. Present and document patient data gathered from patient interviews, physical examinations, and laboratory studies, including progress notes on patients, in standardized format. (PC2, CS1, CS4, CS5)
5. Apply knowledge of the pathophysiology, epidemiology, and natural history of diseases to the diagnosis and management of common patient conditions in Internal Medicine subspecialties to effectively address a consultative question. (MK1, MK2, MK5, MK8, PC2, PC6, CS4)
INSTRUCTIONAL METHODOLOGIES & ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:
1. Attending and working with the consult team on in-hospital consult rounds, clinics, and other clinical activities.
2. Participating in patient care, supervised by the attending and residents on the service, including assessment and evaluation of a minimum of 3 new patients and following a minimum of 3 patients on the service each week.
3. Attendance at noon conferences and/or any conference supplied by the specific subspecialty. Note that these conferences are generally intended for the residents and fellows on the consult team, such that some material may be relatively advanced. These conferences are intended to provide students exposure to aspects of a specific specialty and not necessarily review ‘basics’.
PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:
Varies depending on the subspecialty service to which the student is assigned
Cardiology Outpatient Clinic / LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:
1. Obtain good cardiac history and understand cardiac risk factors. (MK3, MK4, PC1, CS1)
2. Perform and accurately document a complete cardiovascular examination. (PC1, CS5)
3. Define and analyze EKGs, ECHO, and stress testing with supervision to evaluate cardiac disorders. (MK5, PC2)
4. Readdress use of basic cardiac oral medications with patients in a clinic environment. (MK5, PC5, CS1, CS2)
5. Evaluate cardiac risk factors and modify them appropriately as per clinical practice guidelines. (MK4, MK7, PC5, PL3)
INSTRUCTIONAL METHODOLOGIES & ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:
1. Students will evaluate clinic patients under attending supervision. They will take a detailed history of new patients. Cardiovascular examination skills will be imparted to the students at the bedside. Return visit patients will be followed along with the attending. Any interesting findings or EKGs will be brought to their attention.
2. Students will assist the nurses in obtaining vitals, thereby learning how to assess pulse, BP, respiration and temperature.
3. Students will also assist with performing and interpreting EKGs for their own patients, accompany and observe Echocardiography and Exercise stress testing on their patients, and learn how to hook up Holter and Event Monitors.
4. Students will attend all morning reports. They will also be expected to attend all Cardiology AM conferences during the rotation. After the morning conferences they will report to their clinic.
5. Students will be exposed to the cardiac cath lab on Wednesday mornings.
PATIENT ENCOUNTERS: Students will be expected to work-up patients with these specified conditions:
1. Coronary artery disease
2. Congestive heart failure
3. Arrhythmia
4. Valvular heart disease
5. Risk Factor Modification (DM, HTN, hyperlipidemia, smoking)
Inpatient Cardiology / LEARNING GOALS & OBJECTIVES: At the completion of this clinical rotation students should be able to do the following:
1. Take a good cardiac history, define and modify cardiac risk factors, complete cardiovascular system examination, and demonstrate understanding of cardiac medications. (MK1, MK3, MK4, MK5, PC1, CS1)
2. Discuss the use of lab tests, EKGs, ECHO, stress testing and cardiac invasive procedures in working up cardiac disorders. (MK5, CS5)
3. Discuss basic cardiac, coronary and electrophysiological anatomy along with basic cardiac hemodynamics and improve EKG interpretation skills. (MK1, MK5, PL2)
4. Present new cases confidently, follow-up cases allotted and learn to work efficiently as a team member. (CS1, CS2, PC2, IP1)
5. Demonstrate developing skills in patient and family interaction. (CS1, CS2, CS3, PC5)
INSTRUCTIONAL METHODOLOGIES & ROTATION ACTIVITIES: Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities: