INTERNAL MEDICINE 1

For Students Internal Medicine 1 Clerkship Requirements (3rd Year)
•	Internal Medicine 1 Syllabus
•	Required Booklist
•	Evaluation Forms; Clinical encounter log, procedure logs
Internal Medicine 1 Rotation Sites & Faculty
•	Meet the Internal Medicine 1 Faculty
•	Internal Medicine 1 Site-Specific Instructions
Internal Medicine 1 Fellowship and Career Information
•	Internal Medicine 1 Fellowships and Careers
•	Internal Medicine 1 Web Links and Resources
Internal Medicine 2
For Faculty
•	Faculty Development and CME Program
•	Useful Faculty Development Links (go to Quick Links)
•	Clinical Faculty Application
•	Preceptor Evaluation of Students
•	Clinical Faculty Guide

 

 

 

 

 

 

Internal Medicine 1 Syllabus

Chairs:

Virginia Campus: Peter J. Recupero, D.O. (precupero@vcom.vt.edu)

Carolinas Campus: Teresa Kilgore, D.O., FACOI (tkilgore@carolinas.vcom.edu)

Rotation Credit Hours: 4

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Goals

• To acquire the knowledge, skills and competencies that are required to evaluate and treat patients with acute and chronic medical conditions commonly found in the adult at a level consistent with a graduating generalist medical student. 
• To develop the physical examination and clinical skills required of a graduate medical student in general internal medicine practice, including the ability interpret information relative to normal and abnormal structure, function and physiology. 
• To apply historical and clinical information for problems solving to advance the health of the patient. 
• To develop the psycho-social and communication skills and competencies that are required to communicate with, and treat a wide diversity of patients in acute, outpatient and institutional settings. 
• To develop the ability to research medical literature and scientific resources for information that affects the patient’s condition, treatment and outcomes and the ability to evaluate and apply scientifically valid information to maximize the outcome of the patient. 
• To develop knowledge, skill application and understanding of the indications, contra indications and application of medical procedures and therapies common to the specialty, including but not limited to ordering and interpretation of diagnostic studies, utilization of pharmacological agents, psychological and nutritional therapies, incorporation of osteopathic principles and practices into the patient’s care, and clinical procedures such as central line placement, lumbar punctures, intubation, management of ventilators, etc.

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Rotation Description

During the third year internal medicine rotations, students expand their knowledge of adult health and wellness, preventative, primary, secondary and tertiary care.  They learn about the treatment of acute and chronic medical conditions, palliative and end of life care and gain the ability to apply this knowledge in the clinical setting. The curriculum is taught through VCOM TV on-line lectures, on-line case modules and presentation, assigned readings, bedside and clinic teaching, journal clubs, tumor boards, grand rounds, and through one-on-one student-preceptor experience in caring for patients in the clinical setting.  The Core Internal Medicine rotations include inpatient and outpatient exposure, as well as general internal medicine and medical sub-specialty exposure.

Clinical Setting in Which Rotation Occurs
The practice of internal medicine occurs in the private, public and governmental clinic settings, in long-term care facilities, in inpatient institutional settings and in the emergency departments of hospitals and institutions.  Due to the variety of practice opportunities and formats in internal medicine rotations, students should review their specific site instructions for a more detailed description of their specific practice setting.

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Requirements for Completion

Required Textbooks:

• Internal Medicine Essentials for Students: A Companion to MKSAP for Students 5 (Available in electronic format on the VCOM Library in the Stat!Ref Section)
• Somatic Dysfunction in Osteopathic Family Medicine, Nelson and Glonek

The specific reading assignments in this textbook have been designed to correspond to the core clinical topics for the rotation and can be found on the web site along with the “Clinical Modules – Required Curriculum.”

Requirements for Successful Completion of the Internal Medicine 1 Rotation:

1. Attendance according to VCOM and preceptor requirements as defined in the College Catalog and Student Handbook
2. Completion of all Clinical Modules in the Required Curriculum
3. Clinical Encounter and Procedure Logs
4. Preceptor Evaluation at end-of-rotation 
5. Successful completion of the end-of-rotation written exam
   The end-of-rotation exam questions will be derived directly from the specific objectives presented in each of the below modules.

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Clinical Modules - Required for Completion

The Internal Medicine curriculum is delivered through 22 on-line cases that accompany the 17 curriculum modules found below.  Each module will cover the core topics, assigned readings and cases and will assist students in developing knowledge and competency in the clinical conditions most commonly encountered in the care of the adult patient.  Each of the following topics has specific learning objectives and is accompanied by an assigned reading in the text as well as an online case.  Some topics may also have an accompanying VCOM TV lecture.  The end-of-rotation exam questions will be derived from the objectives presented in the modules and accompanying the reading assignments from Internal Medicine Essentials (except OMM specific readings which are found in Nelson’s).  Thus success on the exam will require that students complete all module assignments, reading assignments, viewing of online videos and review of any accompanying cases or presentations.

1. Abdominal Pain I [+]

2. Abdominal Pain II  [+]

3. Altered Mental Status [+]

4. Anemia [+]

5. Chest Pain [+]

6. Arrhythmias and Disorders of Cardiac Output [+]

7. Cough and Shortness of Breath [+]

8. Flank Pain, Dysuria and Fever [+]

9. Joint Pain [+]

10. Congestive Heart Diseases [+]

11. Chronic Lung Disease [+]

12. Diabetes Mellitus [+]

13. HIV with Complicating Illness [+]

14. Secondary Hypertension [+]

15. Renal Disease and Electrolyte Disorders [+]

16. OMM for Internal Medicine I  [+]

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Clinical Performance Objectives

While the end-of-rotation exam is derived from the didactic curriculum, reading assignments and objectives described in the Curriculum section, the end-of-rotation evaluation completed by your internal medicine preceptor is based on clinical competencies, demonstrated professionalism and demonstrated knowledge of the discipline and the ability to apply that knowledge to the care of the patient. These core competencies reflect student performance in 6 key areas: communication, problem solving, clinical skills, medical knowledge, osteopathic medicine and professional and ethical considerations. Your end-of-rotation evaluation from your preceptor will be based directly on your performance in these 6 core competencies as described below.

1. Communication - the student should demonstrate the following clinical communication skills:
   
   1. Effective listening to patient, family, faculty, peers, and other members of the healthcare team
      
   2. Demonstrates respect, compassion and respect in patient communications and interactions
      
   3. Demonstrate the ability to conduct both a focused and comprehensive patient interview, obtain historical and current information that is pertinent to the care of the patient and demonstrate accuracy and effectiveness in their investigation of medical complaints, medical, social and psychosocial history specific to the rotation.
      
   4. Considers whole patient: social, spiritual & cultural concerns
      
   5. Efficiently gathers, interoperates and prioritizes essential from non-essential information
      
   6. Skill in educating and motivating patient compliance and understanding of condition, treatment instructions, consents & medications
      
   7. Demonstrated ability to present patient cases and medical information in an accurate, concise, well organized manner in both “written” documents and oral formats.
      
2. Problem Solving – the student should demonstrate the following problem solving skills:
   
   1. Identify important questions, identify and sort data in organized fashion organizing and prioritizing positives & negatives
      
   2. Discern major from minor patient problems
      
   3. Formulate an appropriate differential diagnosis while identifying the most common and probable diagnoses
      
   4. Identify indications for, interoperate and apply findings from the most appropriate diagnostic or clinical tests for the patient and the condition
      
   5. Identify correct treatment and management plans considering contraindications & interactions based on scientifically valid, outcome proven information from research of literature
      
   6. Incorporate patient’s and family perspectives and values into the diagnostic and therapeutic decision making.
      
   7. Be knowledgeable of socioeconomic considerations in design of diagnostic and treatment plans for the patient.
3. Clinical Skills - the student should demonstrate the following skills:
   
   1. Demonstrate the ability to utilize inductive and deductive reasoning to problem solve patient complaints and conditions.
      
   2. Demonstrate the ability to apply the clinical knowledge and skills they were instructed on during PPC and OMM education throughout the OMS-I and OMS-II years.
      
   3. Assesses vital signs & triage patient according to degree of illness
      
   4. Demonstrate good observational, auscultory, palpatory and visual skills to gather clinical information and the ability to apply the findings to the treatment of the patient.
      
   5. Perform a thorough physical exam pertinent to the patient and the systems involved with the patient’s condition or complaints.
      
   6. Demonstrate the ability to incorporate the clinical findings with osteopathic treatment of abnormalities discovered in structure or function.
4. Osteopathic Manipulative Medicine - the student should demonstrate the following skills in regards to osteopathic manipulative medicine
   
   1. Apply osteopathic principles to all patient encounters and osteopathic manipulative medicine successfully when appropriate
      
   2. Perform and document a thorough musculoskeletal exam
      
   3. Utilize palpatory skills to accurately discern physical changes that occur with various clinical disorders
      
   4. Apply osteopathic manipulative treatments successfully
5. Medical Knowledge – the student should demonstrate the following in regards to medical knowledge
   
   1. Identify & correlate the anatomical, physiological, pathological, psychological and socio-economic conditions that are related to patients condition and the disease processes
      
   2. Demonstrate characteristics of a motivated, life-long learner including demonstrating intellectual curiosity, academic and clinical interest and enthusiasm about patient care and the ability to review and research the literature
      
   3. Thoroughness and Competency in researching evidence based literature and the ability to apply scientifically valid, outcome based information for the treatment of patient populations as well as the individual patient.
      
   4. Correlate symptoms and signs with most common diseases with underlying pathophysiological conditions.
      
   5. Demonstrated ability to different normal from abnormal physiology, behavior, structure and function in the patient.
      
   6. Ability to perform a comprehensive and accurate history and physical examination and correlate the history, clinical signs, symptoms and findings with the clinical condition, its management and underlying pathology.
      
   7. Ability to utilize, evaluate and apply diagnostic processes for common adult medical conditions.
6. Professional and Ethical Behaviors - the student should demonstrate the following professional and ethical behaviors and skills:
   
   1. Is dutiful, punctual, reliable, and responsible regarding obligations of the rotation and patient care needs.
      
   2. Prepares for each day by performing assigned and required reading, self-study, documentation, review and completing individual responsibilities.
      
   3. Consistently completes all patient care, call and documentation responsibilities to ensure that they contribute to high quality patient care and outcomes.
      
   4. Accepts and appropriately responds to feedback, evaluation, praise as well as criticism without resistance or obstinacy.
      
   5. Displays professionalism in relationships with patients, staff, & peers
      
   6. Displays integrity and honesty in assessment of their medical competency and documentation
      
   7. Acknowledges errors, seeks to correct errors appropriately
      
   8. Identifies the importance to care for diverse, disadvantaged, underserved populations in a culturally competent, non-judgmental and altruistic manner.
      
   9. Demonstrated ability to work professionally, collaboratively and cooperatively in a team environment.
      
   10. Demonstrates awareness of and respect for patient’s rights, including need for informed consent, patient involvement in medical care and treatment decisions and end of life issues.
       
   11. Demonstrate respect for and complies with the rules and obligations that are established by the educational, regulatory, legislative and professional organizations that regulate, supervise and govern the profession of osteopathic medicine

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Osteopathic Manipulative Medicine Components

The student should demonstrate competencies inherent to the principle, practice and philosophy of osteopathic medicine including:

1. Demonstrate  a “whole patient” approach to the assessment and management of each patient including consideration and incorporation of cultural, social, spiritual, family, and behavioral considerations.
2. Demonstrate the ability to perform a comprehensive osteopathic examination of the patient with attention to the visual and palpatory findings of the neurological and musculoskeletal systems. 
3. Demonstrate knowledge of and the ability to utilize Chapmans points, changes in somatovisceral and viscerosomatic reflexes and dermatome nerve distribution in the evaluation and treatment of the patient.
4. Demonstrate the ability to utilize OMM techniques to treat the patient’s complaints or abnormalities.

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