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The third year Internal Medicine Inpatient Clerkship is a 6-week rotation with the over-arching goal of acquainting students to the evaluation and treatment of adults hospitalized with acute medical illness. Emphasis is placed on developing the skills to diagnose common clinical conditions and to recognize clinical presentations of common diseases. This is facilitated by enhancing the skills used in taking a patient history, performing a comprehensive physical exam and formulating problem lists with appropriate differential diagnosis.
Teaching and learning in the context of patient care is vastly different from learning in the classroom. On the inpatient service the questions to be answered are posed by the patients and the healthcare team. Answering such questions is an excellent way to learn about the patient while also solidifying the students’ knowledge base by learning the scientific and clinical material. Students will participate in the evaluation of a diversity of patients as part of a team of residents and students under the supervision of an internal medicine faculty member.
The clerkship will also provide students with opportunities to enhance their knowledge of core training problems and to develop basic clinical skills (such as EKG and CXR interpretation, physical diagnosis skills) through scheduled structured teaching sessions. These sessions are facilitated by a Teaching Resident, a third-year Internal Medicine resident specifically selected to teach M3 and M4 students on Internal Medicine. Students are encouraged to use these structured teaching sessions to guide their learning and to use the variety of patients encountered to enrich their knowledge base through hands-on experience and targeted reading.
The learning experiences on inpatient internal medicine follow the continuum of self-directed learning established in the first 2 years of medical school. This type of learning is crucial in a field which like internal medicine is not static. Developing patient based learning patterns will allow students to adapt to the changing body of knowledge and will help students become effective, efficient clinicians.
As Sir William Osler said, “The important thing is to make the lesson of each case tell on your education.” It is important to learn something from every patient by identifying one question that is not understood. By going to textbooks, journals and peers to find the answer, students learn and are able to apply this knowledge in the clinical setting. The retained images of patients will not only serve as the ‘outline, lecture notes and laboratory’ wrapped into one, but their many wonderful stories will also serve as a rich resource for student reflection.