Purpose
Fourth-year electives provide students with an intensive clinical experience in a selected specialty or subspecialty. Through progressive participation in patient care, students expand their clinical knowledge, refine specialty-specific clinical skills, gain exposure to both common and complex conditions within the discipline, and develop an understanding of the scope of practice and appropriate use of specialty consultation.
Learning Experience
Under the supervision of the attending physician and clinical staff, students function as members of the specialty healthcare team and participate in the daily clinical management of patients. As appropriate to the specialty and clinical setting, students obtain initial histories and perform physical examinations, present patients to the healthcare team, observe and assist with procedures and surgeries, and gain experience in selecting and interpreting relevant imaging studies. Through supervised patient care and self-directed learning using standard texts and appropriate electronic resources, students further develop consultative skills and an understanding of specialty-specific patient management.
Clinical Expectations and Structure
- Students are assigned to a clinical team for a 4-week period.
- Students participate in all team activities, including daily rounds, conferences, and other educational activities.
- Students maintain a daily patient census of approximately 2 to 4 patients, as appropriate to the specialty and clinical service.
- The clerkship director or preceptor supervises the overall educational experience, monitors student progress, provides formative feedback, and completes the final evaluation.
Learning Objectives
By the end of the rotation, students will have achieved the following objectives under the supervision appropriate to their level of training:
Medical Knowledge
- Demonstrate the etiology, pathogenesis, structural and molecular alterations as they relate to the signs, symptoms, laboratory results, imaging investigations, and causes of common and important diseases within the specialty.
- Demonstrate the impact of factors, including aging, psychological, cultural, environmental, genetic, nutritional, social, economic, religious and developmental, on health and disease of patients as well as their impact on families and caregivers.
- Describe important pharmacological and non-pharmacological therapies available for the prevention and treatment of disease based on cellular and molecular mechanisms of action and clinical effects.
Clinical Skills
Communication Skills
- Demonstrate effective communication with patients and family members.
- Demonstrate effective verbal and non-verbal clues of a patient’s mental and physical health.
- Demonstrate cultural sensitivities and patient wishes when providing information.
- Demonstrate effective communication with physician and non-physician members of the healthcare team and consultants.
- Demonstrate the ability to clearly and concisely present oral and written summaries of patients to members of the health care team.
Coordination of Care Skills
- Demonstrate the effective prioritization of tasks for daily patient care in order to effectively utilize time.
- Demonstrate effective utilization of non-physician members of the healthcare team, including nurses, pharmacists, social workers, clinical care coordinators, physical therapists, and other hospital personnel.
- Demonstrate appropriate indications for a consultant referral and how to appropriately utilize consultants.
- Demonstrate effective transfer of care throughout a patient’s hospitalization, including end-of-day and end-of-service coverage.
- Demonstrate appropriate care and follow-up for the patient after discharge from the hospital or clinic, including coordinating the care plan and utilizing community resources when necessary.
Information Management Skills
- Demonstrate the ability to document the patient’s admission information, daily progress, on-call emergencies, transfer notes, and discharge summaries accurately and in a timely manner.
- Demonstrate the ethical and legal guidelines governing patient confidentiality.
- Demonstrate effective retrieving of clinical information at the hospital, including clinical, laboratory, and radiologic data.
- Demonstrate how panic/critical values are communicated from the hospital laboratory to the responsible team member.
- Demonstrate the importance of precision and clarity when prescribing medications.
- Demonstrate electronic or paper reference to access evidence-based medicine to solve clinical problems.
- Demonstrate continuous reevaluation and management revisions based on the progress of the patient’s condition and appraisal of current scientific evidence and medical information
Procedures Skills
- List risks and benefits of common invasive procedures, and how to obtain informed consent.
- Demonstrate the rationale, risks, and benefits for the procedure in language that is understandable by the patient and/or his/her family.
- Demonstrate skill in common procedures that are performed by interns and residents.
- List potential procedure-related risks for the operator and the need for universal precautions.
- Demonstrate the skill of documenting a procedure note.
- Demonstrate that samples obtained are properly prepared for laboratory processing.
Professionalism
- Demonstrate the ability to accept criticism and react appropriately to difficult situations.
- Demonstrate the ability to work independently and within a healthcare team effectively.
- Demonstrate a sensitivity and respect for patients and healthcare team members
D. Assignments
Assignments include the following:
- Participate in daily rounds and case-based discussions
- Complete daily self-directed reading related to active patient cases
E. Assessment
Students receive formative feedback during the rotation on:
- Communication skills
- Case-based presentations
- Daily patient management and treatment (including procedures)
- Documentation and transition of care
- Utilization of non-physician and consultants in patient care
At the end of the rotation, the clerkship director or preceptor completes a summative assessment using feedback from as many members of the healthcare team as appropriate. The preceptor grades the student on medical knowledge, clinical skills, and professional behavior. A narrative description of the student’s strengths and areas for improvement is required.