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Jefferson Medical College Alpha Omega Alpha Guide to the Clinical Years
Medicine is a very important rotation where you will learn to manage sick patients. Students spend a total of twelve weeks on IM. The time is divided into three 4-week blocks during the rotation. Two blocks are spent at an affiliate hospital and one at Jefferson. During the course of the rotation, students will be exposed to a wide variety of diseases. Most patient encounters deal with cardiac, GI, renal, hematology/oncology, pulmonary, endocrine, infectious disease and rheumatologic disorders.
The four weeks at Jefferson tend to be the most demanding part of the rotation. Each student is assigned to a specific team made up of an intern, a second or third year resident and one attending supervising the team. Sometimes, you may even have a fourth year sub-intern.
Unfortunately, students may not have much time with the attending physicians while at Jefferson. Interns and residents, for the most part, will be able to answer any questions or address any concerns. Students are expected to see each of their patients (usually three or four) first thing in the morning before rounds and to write a complete SOAP note. The SOAP note includes a thorough assessment and plan for each of the patient's concerns. Taking the time to write a thoughtful plan can score big points. As a third year, it is important to know your patient through and through. If you "own your patient" and know them as if you are the only one caring for them, it will be difficult for you not to get noticed. Some people find it easier to keep track of their patients by using a patient record form where they record vitals, medications and lab values throughout the patient’s stay. Alternatively, some students find it helpful to photocopy their SOAP notes and carry them around during the day for presentations and jotting down new developments.
Some teams will expect the students to renew any medications on the charts and to write for any new medications or electrolyte replacements needed. Someone must co-sign all orders and nurses make it a priority to contact them regarding your orders. During rounds with the team, students will present the patients they are following. Students are also expected to attend lecture series on various topics given by various attending physicians and chief residents.
At the affiliates, students tend to have more autonomy, responsibility, and greater attending contact. Students also attend daily lectures throughout their rotation at the affiliate. Some affiliates offer excellent radiology sessions to the students that go over reading chest x-rays. On the whole, the affiliate experience can be quite gratifying and instructive. The Jefferson month is typically weighed more heavily than the affiliate months with regard to your final clerkship grade.
Call is every fourth night at Jefferson and is often every fourth to fifth night at the affiliates. You will be asked to help with admissions and check on patients during the night. Students usually are given one to two admissions while on call. At Jefferson and most of the affiliates, call involves staying until 9 or 10 PM (if a night float system is present). Sites that do not have a night float system may require overnight call. You may wear scrubs the day of call.
References – bolded titles are highly recommended
Up-To-Date is an on-line reference that is continually updated. It contains the most current clinical thinking in an extremely useful format that includes data pooled from the original studies on which the management recommendations are based. It is available via JEFFLINE (but only on campus). Many students find Up-To-Date to be the best resource for reading up on patients.
The best pocket reference for internal medicine, and in fact, overall is the 5 Minute Clinical Consult, which is sold at the TJU bookstore for approximately $60 or available via JEFFLINE in Stat!Ref. If you enjoy interfacing with a PDA, 5MCC is truly a must-have. The second must-have resource is Epocrates, a pharmacopeia that may be downloaded free-of-charge at epocrates.com.
Formal History & Physical (H&P)
You must complete one formal H&P during your medicine clerkship. Dr. Diemer (clerkship director) does read each student's H&P, and a narrative grade for this manuscript will appear on your final medicine evaluation. It should be typed and as complete as possible. Following the example at the end of Bates' Physical Diagnosis is a good idea. This H & P tends to be quite long and should not be put off until the last minute.
Internal Medicine uses the NBME shelf examination. The best reference (aside from reading on patients throughout the clerkship) is MKSAP for Students 3. Go through the entire book a week before the examination. One of the best questions books written for any clerkship!
Last revised: 6/08