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Objectives of the Clerkship
Welcome to the Advanced Clerkship in Medicine Elective (Medicine Sub-Internship) on the Osler and Polk services
Sub-interns are active members of the ward team and assume responsibilities for patient care as close as possible to that of an Intern. The Course Director of the sub-internship has determined the following objectives for the experience:
- To enhance communication skills with patients and colleagues
- To hone history taking and physical examination skills
- To utilize diagnostic reasoning skills and hypothesis testing to develop differential diagnoses and cogent plans of action
- To enhance oral and written presentation skills
- To build on knowledge base of adult internal medicine problems through readings related to patients
It is expected that, throughout the clerkship, you will demonstrate the following professional attributes:
- Accept personal responsibility for learning; seek out additional resources, expert help.
- Accept limitations of competence, that is, ask for help when needed.
- Assume responsibility for patients under your care.
- Approach the practice of medicine with the highest ethical and professional standards, respectful of patients, families and colleagues.
- This is particularly important in the writing/entering of orders. You are allowed to transcribe verbal orders received from an Intern or Resident. This conversation should be specific, that is: drug name, dose, route and frequency. If not, it is your responsibility to clarify with the prescribing physician by stating specifically what you intend to write, and receive their specific approval, which constitutes their verbal order.
By the end of the rotation, you should be able to:
- Succinctly communicate the patient history and objective findings to colleagues: the oral case presentation.
- Competently perform the basic physical examination of the patient; seek out and develop expertise in expanded clinical examination maneuvers.
- Completely document the appropriate findings in the medical record.
While the sub-internship is an active clinical experience, it is expected that you will be reading nightly on the case material encountered during the day. We recommend a good textbook in Internal Medicine or online resource similar to what was expected during the Medicine Core Clerkship. Additionally, we expect further inquiry into the evidence-basis of disease diagnosis and treatment as it pertains to your patients. PubMed searches for primary data and thorough evidence-base reviews are encouraged.
Things to Remember
- All orders must be countersigned within 24 hours. This is a legal requirement of the hospital and a part of the By-Laws. An unsigned order may receive delayed attention, which can jeopardize your patient, and be frustrating to everyone involved.
- You are on your honor to discuss all medication orders with a supervising provider prior to entering them as a verbal order. The acceptance of verbal orders is a privilege for a sub-intern that assumes this conversation has occurred. Failure to follow this procedure will result in loss of that privilege.
- You are not permitted to write orders (including verbal borders) in the intermediate or intensive care areas in the Department of Medicine: CCU, CCP, MICU, MPC. If your patient is transferred to those areas, the orders for that patient need to be entered by an intern or resident. Subinterns are encouraged to follow the medical issues for such patients for educational purposes.
- Identify yourself to nursing staff as an “Acting Intern.” This is done best by wearing your white coat with a name tag. This is particularly important for dealing with patients/nursing staff on other floors. Remember that you are only passing through a nursing unit but the permanent staff members have many continuing obligations to your patients and many others. It will help everyone (especially your patients) if the lines of communication remain open.
- Verbal orders must be transcribed verbatim, e.g. “Digoxin 0.125 mg by mouth twice daily per Dr. XYZ.”
- White coats are available in the Hospital Laundry room, Carnegie basement.
- Communicate with the attending physicians.