CHICAGO MEDICAL SCHOOL

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1 CHICAGO MEDICAL SCHOOL Internal Medicine Clerkship MMED Credit Hours SYLLABUS ACADEMIC YEAR Medical Education Director Stuart Kiken, MD Clinical Education Specialist Tonya Dixon, RN, MSN, MBA, MPH, EdD(c) Undergraduate Medical Education Specialist Marissa McCarthy Office Phone: Room RWCLC 1.090

2 CLERKSHIP DESCRIPTION The 3rd Year Internal Medicine Clerkship is an 8 week (primarily inpatient) rotation that is available at the following sites: Advocate Christ Hospital, Advocate Illinois Masonic Medical Center, Advocate Lutheran General Hospital, Captain James A. Lovell Federal Healthcare Center, Centegra Health Systems, John H. Stroger Hospital, Little Company of Mary Hospital, Weiss Memorial Hospital, and the Billings Clinic. The curriculum covers core topics in internal medicine. Learning activities include case discussions, lectures, and clinical exercises. Feedback is given by the site directors, teaching attendings, and housestaff. A Shelf Exam is given at the end of the rotation. Evaluation tools include: direct observation by faculty performance of a Mini-CEX (Clinical Evaluation Exercise) performance of an Oral Presentation Exercise completion of Chest X-Ray Reading and Interprofessionalism Exercises completion of all required minimum encounters (on the Patient Log) INTERNAL MEDICINE CLERKSHIP OBJECTIVES LINKED TO CMS COMPETENCIES AND OBJECTIVES Upon completion of the clerkship, students will be able to: Distinguish the causes and underlying mechanisms of disease and examine the principles of diagnostic and therapeutic decision-making. (1.2, 1.4, 1.5) Determine factors that place individuals at risk for disease, perform reliable history and physical examinations, choose diagnostic and therapeutic strategies, and advise patients and their families. (2.1, 2.2, 2.3, 2.5, 2.6) Demonstrate respect, dignity, compassion and integrity when engaging patients, their families, peers, the university community and other healthcare providers, critically reflect on one s own biases, and seek and respond to feedback. (3.2, 3.3, 3.4) Evaluate evidence-based medicine in the context of patient care, and critically reflect on one s own performance. (4.1, 4.3) Identify one s own role on the healthcare team and how it is complementary to other health professionals in the delivery of patient care, and communicate with other health professionals when assistance is needed. (5.1, 5.2) Demonstrate interpersonal communication skills with patients, families and colleagues through effective listening, verbal, and non-verbal, and written practices that support a team approach to the promotion and maintenance of health. (6.1, 6.2) Demonstrate effective communication by providing an organized, comprehensive and legible medical record as well as demonstrating effective written and verbal presentation skills (6.3, 6.4) Reference D2L for the INTERNAL MEDICINE CLERKSHIP COMPETENCY MAP

3 CLERKSHIP-SPECIFIC REQUIREMENTS 1. Complete and electronically sign via Qualtrics the Clerkship Acknowledgement and secured storage documentation within 2 days of starting the rotation. This will be ed to you the first day. 2. Complete the Student Midterm Self-Evaluation Form found on D2L under Clerkship Requirements and give a hard copy to your Site Director at your face-to-face (F2F) midterm evaluation. Complete this by the end of the 5 th week. 3. Complete the following activities found on D2L under Clerkship Requirements and upload to the D2L Dropbox by the end of the 4 th week: a. Mini-CEX (Clinical Evaluation Exercise) - can be graded by resident, intern or teaching attending. b. CXR Exercise (2 forms must be submitted) - can be graded by resident, intern, teaching attending or radiologist. 4. Complete the following activities found on D2L under Clerkship Requirements and upload to the D2L Dropbox by the end of the 5 th week: a. Oral Presentation for new patient can be graded by resident, intern or teaching attending. b. Mid-term evaluation (see #2 above). c. 16 patient logs on One45 (1/2 of what is required). 5. Complete the following activities found on D2L under Clerkship Requirements and upload to the D2L Dropbox by the end of the 6 th week: a. EBM (Evidence Based Medicine) Activity b. IP (Interprofessionalism) Activity 6. Complete the Patient Log on One45 (32 entries) by the end of the 7 th week. If you have not seen the correct number and distribution of patients by then, you will be required to complete additional computer cases or see assigned patients by the end of the 8th week. (By the end of the 5 th week you should have at least 16 entries). Please give a hard copy of your logs to your Site Director at your face-to-face (F2F) midterm evaluation meeting. The list of required categories that need to be logged are as follows: Cardiology (5) Infectious Disease (5) Endocrinology (3) Renal (3) Gastroenterology (3) General Internal Medicine (2) Hematology/Oncology (3) Neurology (2) Pulmonary (5) Rheumatology (1) 7. Complete the following SIMPLE computer cases by the end of the 7 th week: Case 1 49-year old man with chest pain Case year old man with fever, lethargy and anorexia Case year old man with cough and fatigue Case year old woman hospitalized with confusion Case year old woman with confusion

4 8. Please complete the following exercises by the end of the 7 th week and complete the related quiz on D2L: a. Abdominal exam/anemia/chf: b. EKG: 1. Basics 2. Practice Drills (complete at least 20) 3. Quiz (complete all 20) c. Lymph Node/Reflex/Thyroid exam: 9. Complete the End of Clerkship Survey on D2L. This is assigned on the day of the Shelf Exam and is due by the following Monday. MINIMUM REQUIRED PATIENT ENCOUNTERS Type of Patient/ Clinical Condition Cardiology (5) Arrhythmias Chest Pain Coronary Artery Disease Dyslipidemia Heart Failure low output Heart Failure w Preserved Ejection Hypertension Peripheral Artery Disease Clinical Level of Student Setting Responsibility Benchmark/Explanation I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential Alternative with a cardiology problem or education director will assign an appropriate SIMPLE computer case (1, 2, 3, 4, or 6). Education director will then verify that student has seen the patient or completed the case.

5 Type of Patient/ Clinical Condition Infectious Disease (5) Bacteremia Cellulitis /Soft-Tissue Infection Fever HIV Infectious Diarrhea Influenza Nosocomial Infection Pneumonia UTI Endocrinology (3) Diabetes Hyperthyroidism Hypothyroidism Pituitary Disease Renal (3) Acute Renal Failure Chronic Kidney Disease Fluid, Electrolyte & Acid-Base Disorder Nephrolithiasis Clinical Level of Student Setting Responsibility Benchmark/Explanation I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential Alternative with an infectious disease problem or education director will assign an appropriate SIMPLE computer case (14, 15, 20, 21, or 24). Education director will then verify that student has seen the patient or completed the case. with an endocrinology problem or education director will assign an appropriate SIMPLE computer case (7, 8, or 13). Education director will then verify that student has seen the patient or completed the case. with a renal problem or education director will assign an appropriate SIMPLE computer case (23, 25, or 33). Education director will then verify that student has seen the patient or completed the case.

6 Type of Patient/ Clinical Condition Gastroenterology (3) Abdominal Pain Cirrhosis Diarrhea Gastrointestinal Bleeding Hepatitis IBD Pancreatitis Peptic Ulcer Disease Vomiting General Internal Medicine (2) Alcohol Abuse Depression Obesity Preoperative Evaluation Rash Substance Abuse Weight Loss Hematology/Oncology (3) Anemia Bleeding Complication of Cancer DVT Hematologic Malignancy Palliative Care Solid Tumor Thrombocytopenia Clinical Level of Student Setting Responsibility Benchmark/Explanation I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential Alternative with a gastroenterology problem or education director will assign an appropriate SIMPLE computer case (9, 10, 11, 12, or 36). Education director will then verify that student has seen the patient or completed the case. with a general internal medicine problem or education director will assign an appropriate SIMPLE computer case (15, or 16). Education director will then verify that student has seen the patient or completed the case. with a hematology/oncology problem or education director will assign an appropriate SIMPLE computer case (17, 19, or 27).Education director will then verify that student has seen the patient or completed the

7 Type of Patient/ Clinical Condition Neurology (2) Altered Mental Status Cerebrovascular Disease Delirium Dementia Dizziness Headache Parkinson Disease Seizure Disorder Pulmonary (5) Asthma COPD Dyspnea Lung Cancer Pneumonia Pulmonary Embolism Rheumatology (1) Gout Joint Pain Osteoarthritis Osteoporosis Rheumatoid Arthritis SLE Clinical Level of Student Setting Responsibility Benchmark/Explanation I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential I, O FP FP: Student will fully participate by completing a history and physical, evaluating laboratory data and test results, generating a differential Alternative with a neurology problem or education director will assign an appropriate SIMPLE computer case (18 or 26). Education director will then verify that student has seen the patient or completed the case. with a pulmonary problem or education director will assign an appropriate SIMPLE computer case (22, 28, 29, or 30).Education director will then verify that student has seen the patient or completed the case. with a rheumatology problem or education director will assign an appropriate SIMPLE computer case (31, 32, or 34).Education director will then verify that student has seen the patient or completed the case. EVALUATION, EXAMINATION, AND REMEDIATION POLICIES and OTHER GUIDELINES Refer to D2L for: CMS Excused Absence Policy document for examination and other clinical experience remediation guidelines. CMS Clerkship Grading Policy

8 Clinical Evaluation Standards Required Minimum Patient Encounters are included in the syllabus and indicate specific patient type/clinical condition remediation guidelines. Refer to D2L for: CMS Clerkship Remediation/Rescheduled Exam Policy document for specific make-up/retake examination guidelines. CMS Exam Conduct Policy RFUMS Exam Loaner Laptop Policy RFUMS Exam Loaner Laptop Policy NBME Online Shelf Exam The NBME Online Shelf Exam is typically held at the RFUMS Campus on the last Friday of the rotation from 9:00 a.m. to 12:00 p.m. However, please refer to D2L for the most recent updates. The NBME is responsible for grading exams. No challenges are accepted for NBME exams. Scores will be available approximately 1-2 weeks after the exam has been completed, but will not be published until clinical evaluations have been received. In general, Education Directors will determine how the student will make up patient encounters, clinical activities or other clerkship requirements. Education Directors will determine if and when the student will be required to repeat the clerkship. Education Directors will use case-by- case evaluation and coordinate with the Office of Student Affairs & Education. Please reference the following additional Polices and Guidelines posted to D2L: SEPAC Handbook SEPAC Policy Clinical Grade Appeal Policy Clerkship/Sub-Internship Grade Appeal Form Student Policies Handbook Testing Accommodations Guidelines CMS Learner Mistreatment Policy and Procedures Medical Student Work Hours Policy Off-Site Secure Storage Policy Teacher-Learner Expectations

9 CMS Professionalism Policy and Procedures CMS Dress Code Policy Ebola Virus Policy Exposure Incidents Policy Alcohol and Drug Use Policy Holiday Schedule: You must follow the holiday schedule for your site, not Chicago Medical School's schedule. Weather Emergencies: If the University is closed due to extreme weather, check with your clinical site regarding its status. Unless otherwise directed by your Site Director, you should go to your clinical site. ACADEMIC ACCOMMODATION STATEMENT Rosalind Franklin University of Medicine and Science is committed to providing equal access to learning opportunities for students with documented disabilities. To ensure access to this class and your program, please contact the ADA Coordinator, Elizabeth Friedman at or to engage in a confidential conversation about the process for requesting accommodations in the classroom and clinical settings. Accommodations are not provided retroactively. Students are encouraged to register with the ADA Coordinator as soon as they begin their program. Rosalind Franklin University of Medicine and Science encourages students to access all resources available. More information can be found on the Academic Support InSite page or by contacting the ADA Coordinator. RECOMMENDED READING AND PRACTICE QUESTIONS: Reading: o Harrison s Principles of Internal Medicine, 19th Edition o Step-Up to Medicine, 4th Edition Practice Questions: o IM Essentials (formerly MKSAP for Students). American College of Physicians. o USMLE World, o It is recommended that you complete at least 1,000 USMLE World questions.

10 MEDICINE CLERKSHIP SITE DIRECTORS Advocate Christ Hospital: Dr. Lee Tai, Advocate Illinois Masonic Medical Center: Dr. Jim Dunphy, Advocate Lutheran General Hospital: Dr. Brenda Affinati, Billings Clinic: Dr. Steve Gerstner, Captain James A. Lovell Federal Healthcare Center: Dr. Anil Ramesh, Centegra Health Systems: Dr. Ted Lorenc, Little Company of Mary Hospital: Dr. Kent Armbruster, John H. Stroger Hospital: Dr. Michael Alebich, Weiss Memorial Hospital: Dr. Sabah Khan, MacNeal Hospital: Dr. Jennifer Sardone-Ponnappan,

11 Internal Medicine Clerkship Competency Map with IPEC Competencies I. Medical and Scientific Knowledge: Demonstrate knowledge about established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences and apply this knowledge in caring for ill and healthy patients of all ages. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 1.1 Describe the normal structure and function of the body. N/A N/A N/A 1.2 Distinguish the causes and underlying mechanisms of disease. Distinguish the causes and underlying mechanisms of disease and examine the principles of diagnostic and therapeutic decision-making. Participation in patient cases as defined by the Medicine Required Patient Encounters Document. Required lecture topics/ presentations attended during clerkship. Making presentations on resident and attending rounds, with particular emphasis on causes of disease. Performance on NBME Medicine Shelf Examination. 1.3 Identify the epidemiology of common illnesses. N/A N/A N/A 1.4 Describe the principles and methods of diagnostic decision-making (to include clinical, laboratory, pathologic and imaging Distinguish the causes and underlying mechanisms of disease and examine the principles of diagnostic and therapeutic decision-making. Participation in patient cases as defined by the Medicine Required Patient Encounters Document. Required lecture topics/ Performance on NBME Medicine Shelf Examination. Updated: Internal Medicine Clerkship Competency Map Page 1

12 studies). presentations attended during clerkship. Making presentations on resident and attending rounds, with particular emphasis on diagnostic decision-making. 1.5 Describe the principles of therapeutic decisionmaking. Distinguish the causes and underlying mechanisms of disease and examine the principles of diagnostic and therapeutic decision-making. Participation in patient cases as defined by the Medicine Required Patient Encounters Document. Required lecture topics/ presentations attended during clerkship. Making presentations on resident and attending rounds, with particular emphasis on therapeutic decision-making. Performance on NBME Medicine Shelf Examination II. Patient Care and Prevention: Demonstrate patient centered care that is compassionate, appropriate and effective for the promotion of health, quality of life, prevention of illness, treatment of disease, and the end of life. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 2.1 Identify factors that place individuals at risk for disease or injury and use strategies to prevent or slow the disease process. Determine factors that place individuals at risk for disease, perform reliable history and physical examinations, choose diagnostic and therapeutic strategies, and provide effective education to patients and their families. Participation in patient cases as defined by the Medicine Required Patient Encounters Document. Performance of Clinical Evaluation Exercise (CEX). Performance on NBME Medicine Shelf Examination. Updated: Internal Medicine Clerkship Competency Map Page 2

13 Review of CEX with resident or attending. 2.2 Perform reliable (comprehensive and problem focused) history and physical examinations. Determine factors that place individuals at risk for disease, perform reliable history and physical examinations, choose diagnostic and therapeutic strategies, and provide effective education to patients and their families. Review of history and physical examinations by residents and attendings. Performance of Clinical Evaluation Exercise (CEX). Review of CEX with resident or attending. 2.3 Order and appropriately interpret the results of commonly used diagnostic procedures. Determine factors that place individuals at risk for disease, perform reliable history and physical examinations, choose diagnostic and therapeutic strategies, and provide effective education to patients and their families. Participation in patient cases as defined by the Medicine Required Patient Encounters Document. Performance of chest x-ray reading exercise. Performance on NBME Medicine Shelf Examination. Review of chest x-ray reading exercise with resident or attending. 2.4 Perform routine technical procedures. N/A N/A N/A 2.5 Construct appropriate diagnostic and therapeutic strategies for patients with common acute and chronic conditions. Determine factors that place individuals at risk for disease, perform reliable history and physical examinations, choose diagnostic and therapeutic strategies, and provide effective education to patients and their families. Making presentations on resident and attending rounds, with particular emphasis on diagnostic and therapeutic decision-making. Performance on NBME Medicine Shelf Examination. Updated: Internal Medicine Clerkship Competency Map Page 3

14 2.6 Provide effective education to patients and their families. Determine factors that place individuals at risk for disease, perform reliable history and physical examinations, choose diagnostic and therapeutic strategies, and provide effective education to patients and their families. Interacting with patients and families to educate them on treatment plans. III. Professionalism and self-awareness: Demonstrate a commitment to professional services, adherence to ethical principles, and awareness of one s own interests and vulnerabilities. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 3.1 Apply the theories and principles that govern ethical decision-making in medicine. N/A N/A N/A 3.2 Demonstrate respect, shared values, dignity, compassion and integrity when engaging patients, their families, peers, the university community and other healthcare providers. IPEC Competency 1 (Values/Ethics) Demonstrate respect, dignity, compassion and integrity when engaging patients, their families, peers, the university community and other healthcare providers, critically reflect on one s own biases, and seek and respond to feedback. Participation in patient cases as defined by the Medicine Required Patient Encounters Document. Discussion of cases with faculty with particular emphasis on best practices for professional behavior. Performance of Clinical Evaluation Exercise (CEX). Review of CEX with resident or attending. 3.3 Recognize how one s own limitations, personal biases and vulnerabilities may impact patient care and interactions with other Demonstrate respect, dignity, compassion and integrity when engaging patients, their families, peers, the university community and other healthcare providers, critically reflect on one s own biases, and seek and respond to feedback. Discussion of cases with faculty with particular emphasis on the appropriate role of medical students, residents, and attending physicians, as well as other Updated: Internal Medicine Clerkship Competency Map Page 4

15 healthcare providers. members of the healthcare team. Completion of Self-Evaluation Form Review of Self-Evaluation Form with Site Director. 3.4 Seek and respond appropriately to performance feedback. Demonstrate respect, dignity, compassion and integrity when engaging patients, their families, peers, the university community and other healthcare providers, critically reflect on one s own biases, and seek and respond to feedback. Attend mid-clerkship evaluation session. Feedback from Site Director at mid-clerkship evaluation session. IV. Practice-Based, Life-Long Learning: Demonstrate the ability to appraise and assimilate scientific evidence to evaluate and improve patient care practices. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 4.1 Search for, evaluate, and apply evidence-based medicine for solving clinical problems. Evaluate evidence-based medicine in the context of patient care, and critically reflect on one s own performance. Discussion of cases with faculty with particular emphasis on current best practices for managing common medical conditions. 4.2 Apply current technology to access, manage, and use biomedical information in the context of patient care. N/A N/A N/A 4.3 Develop the ability to self-assess and demonstrate a willingness to engage in reflective practice. Evaluate evidence-based medicine in the context of patient care, and critically reflect on one s own performance. Completion of Self-Evaluation Form. Review of Self-Evaluation Form with Site Director. Updated: Internal Medicine Clerkship Competency Map Page 5

16 4.4 Provide constructive feedback to peers/ colleagues aimed at fostering professional growth and improving patient care. N/A N/A N/A V. Systems-based, Interprofessional Practice: Demonstrate an awareness of and responsiveness to the larger context of health care and be able to call on system resources and other health care professionals to provide optimal care. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 5.1 Identify one s own role on the healthcare team and how it is complementary to other health professionals to appropriately assess and address the healthcare needs of patients and to promote and advance the health of populations. Identify one s own role on the healthcare team and how it is complementary to other health professionals in the delivery of patient care, and communicate with other health professionals when assistance is needed. Participation in patient cases as defined by the Medicine Required Patient Encounters Document. Discussion of cases with faculty with particular emphasis on professional role and identity, and the role of other providers in the management of medical cases. IPEC Competency 2 (Roles/Responsibilities) 5.2 Recognize when and how to initiate the assistance of other healthcare providers in the context of patient care. Identify one s own role on the healthcare team and how it is complementary to other health professionals in the delivery of patient care, and communicate with other health professionals when assistance is needed. Participation in patient cases as defined by the Medicine Required Patient Encounters Document. Discussion of cases with faculty with particular emphasis on interprofessional collaboration. Review of Interprofessionalism Exercise Updated: Internal Medicine Clerkship Competency Map Page 6

17 Completion of Interprofessionalism Exercise. by the Clerkship Director. 5.3 Describe various healthcare practice types, delivery systems, and identify interprofessional members of these practices and how they work together to meet the needs of the community. N/A N/A N/A IPEC Competency 4 (Teams and Teamwork) 5.4 Identify systematic interprofessional practices that improve patient safety, minimize error, and contribute to continuous quality improvement. 5.5 Apply relationshipbuilding values and the principles of team dynamics to perform effectively in different team roles to plan, deliver and evaluate patient/populationcentered care and population health programs and policies that are safe, timely, efficient, effective and equitable. N/A N/A N/A N/A N/A N/A IPEC Competency 4 (Teams and Teamwork) Updated: Internal Medicine Clerkship Competency Map Page 7

18 VI. Interpersonal and Communication Skills: Demonstrate effective understanding, information exchange, and teamwork with patients, their families, peers and other health professionals. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 6.1 Demonstrate the ability to initiate and sustain professional relationships with patients, their families, and other members of the healthcare team. Demonstrate interpersonal communication skills with patients, families and colleagues through effective listening, verbal, and nonverbal, and written practices that support a team approach to the promotion and maintenance of health. Discussion of cases with faculty with particular emphasis on interpersonal relationships between providers, patients, families, and other members of the medical team. 6.2 Use effective listening, questioning, verbal, nonverbal, and writing skills when communicating with patients and their families in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease. Demonstrate interpersonal communication skills with patients, families and colleagues through effective listening, verbal, and nonverbal, and written practices that support a team approach to the promotion and maintenance of health. Discussion of cases with faculty with particular emphasis on interpersonal relationships with providers, patients, their families, and other members of the medical team. Participation in palliative care exercises with standardized patients. Review of exercise with standardized patients. IPEC Competency 3 (Interprofessional Communication) 6.3 Prepare and organize comprehensive, timely, and legible medical records. Demonstrate effective communication by providing organized, comprehensive and legible medical records as well as demonstrating effective written and verbal presentation skills. Discussion of documentation of cases with faculty. Updated: Internal Medicine Clerkship Competency Map Page 8

19 Review of Histories and Physicals by Site Director. 6.4 Use effective verbal presentation and written skills when communicating with colleagues, superiors, communities and other members of the healthcare team in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease. Demonstrate effective communication by providing organized, comprehensive and legible medical records as well as demonstrating effective written and verbal presentation skills. Discussion of cases with faculty with particular emphasis on communication between members of the healthcare team. Completion of oral presentation exercise. Review of Oral Presentation Exercise with attending. IPEC Competency 3 (Interprofessional Communication) Updated: Internal Medicine Clerkship Competency Map Page 9

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