Medi D605
M-III Internal Medicine clerkship
University of South Carolina School of Medicine 2010-2011
Megan Gleaton
2 Medical Park • Suite 402
Phone 803.545.5316 • Fax 803.545.5349
Megan.Gleaton@uscmed.sc.edu
Table of Contents
Introduction
Contacts
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Goals and Expectations of the Internal Medicine Clerkship
How to Learn on the Internal Medicine Clerkship
Suggestions for Success
Ways to Excel on the Internal Medicine Clerkship
Professionalism
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Your Internal Medicine Clerkship
Goals and Objectives
Core Competencies and Patient Encounters
Attendance Policy
Call Schedules and Work-hour Rules
Typical Daily Schedule
MICU Rotation
Medical Student Morning Report
Chairman Presentation
Simulation Workshop
Formal Didactics
Nutrition Activity
Senior Mentor Project
Grading and Evaluation
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Introduction
Welcome to your Internal Medicine clerkship. We are genuinely delighted to have you join
us for this short period. On the clerkship, you will likely only get a small glimpse into the
world of internal medicine. Nevertheless, through this experience, we expect that you will
acquire fundamental skills, reinforce and expand your knowledge, and develop personally
and professionally. We hope that this experience drives you to want to learn more and
experience more of what internal medicine has to offer. We wish you the most exciting,
stimulating, rewarding, and transforming experience possible over the upcoming weeks.
Clerkship Contacts:
M3 Clerkship Director:
Caroline Powell, MD, MSCR
M4 Clerkship Director
Davinder Lally, MD
Clerkship Coordinator:
Megan Gleaton
caroline.powell@uscmed.sc.edu
803 540 1000 or 545 5317 – office
803 954 6652 – pager
803 201 9910 – cell
803 754 7019 – home
davinder.lally@uscmed.sc.edu
803 540 1000 – office
803 954 2316 – pager
megan.gleaton@uscmed.sc.edu
803 545 5316 - office
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Advice from the Clerkship Directors in Internal Medicine national organization
Goals for the Clerkship
The primary focus of the medicine clerkship is to increase your capacity to function as a caring,
increasingly independent, but supervised clinician on an interdisciplinary internal medicine team.
In seeking to achieve the goals of the clerkship, we believe it is important for you to understand what
internal medicine is and what qualities characterize the ideal internist. In the broadest sense, internal
medicine is medicine for adults. Internal medicine is by far the largest medical specialty; as such,
internal medicine constitutes a major part of the overall landscape of medicine. Internists care for a
broad spectrum of patients, ranging in age from adolescence to the ever growing elderly population.
Practitioners include primary care general internists who care for adult patients who may present with
any problem. Internal medicine also includes sub specialists, such as cardiologists, nephrologists,
oncologists, critical care physicians, and many others, who focus on the care of patients with specific
diseases and disorders. Many subspecialties of internal medicine are heavily procedure-based.
An internist’s practice may be mostly office-based or hospital-based. The internist coordinates the
care of the whole patient by working in concert with colleagues, values a strong patient-doctor
relationship, and applies the best scientific evidence. The internist is a clinical problem-solver who is
able to integrate pathophysiologic, psychosocial, epidemiologic, and “bedside” information to address
urgent problems, manage chronic illness, and promote health. Internists frequently participate in
research; many teach students and residents.
“An internist is a physician who can embrace complexity yet act with simplicity.” Louis Pangaro, MD,
Vice Chair for Educational Programs, Department of Medicine, Uniformed Services University of the
Health Sciences.
Basic Professional Expectations of Third-year Clerkship Students
 Attend all clerkship activities on time. If you must be absent, get permission in advance.
 Dress professionally. The way you dress makes a statement about your school, hospital, and
the medical profession; it may influence the way you are perceived by your patients. If you
have any question about what constitutes professional dress, consult your clerkship director.
 Treat every member of the health care team, the clerkship team, and every patient with
respect.
 Answer your pager and email in a reasonable time frame.
 Make sure your handwriting is legible and ensure every note includes your name, role, and
pager.
 Preserve confidentiality--do not discuss patients in public places and destroy all papers with
patient specific information that are not part of the medical record. Do not look in the chart
(paper or electronic) of any patient for whom you and your team are not caring.
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How to Learn Most Effectively on the Internal Medicine Clerkship
Most learning will take place outside of the classroom, through experiences with patients and
interactions with your team. While you may be offered a series of lectures, the bulk of your learning
needs to be self-directed. It is essential that you read regularly to answer the questions you
encounter each day. Take responsibility for your own education. Make sure that through your reading,
experiences, and didactics, you meet the goals of the clerkship.
 Understand and clarify, if necessary, the expectations your residents, attendings, and course
directors have of you.
 Keep a list of questions that arise during your day and seek the answers.
 Be an active participant in your patients’ care. Be the “go-to” person for all your patients. Each
problem or question that arises is an opportunity to learn.
 Be a team player. Be available to help all other team members, including other students.
 Be around-do not expect your team to find you when something important is happening.
Although you may not always recognize it, you are an integral member of the team. Do not
underestimate your importance. Knowing where you fit in and fulfilling the part is very
important. As a junior member of the team, it is generally best to be malleable and “go with the
flow” of your team. However, if you have an important question or concern, it is equally
important that you ask the question or express the concern. Your statements will often result in
a valuable contribution to the education and work of the team and to patient care.
 Try to be observed and solicit feedback on a regular basis, both positive and constructive.
Constructive feedback is essential to your growth in your third year.
 Learning moments may come when you least expect it. Pay attention at all times, even when
the focus is not on you or your patient.
 Strive to practice evidence-based medicine. It is our responsibility to bring the best scientific
evidence to every clinical decision that is made. Use evidence-based clinical practice
guidelines whenever possible and learn from them.
 Demonstrate that you are a self-directed learner by reading during the medicine clerkship.
Your education will depend on it.
 Learn from your patients whenever possible. Read about all of your patients in depth. The goal
is to integrate your basic science knowledge and its application to your patient.
 Supplement reading about your patients with periodic use of a review book with test questions
to ensure you cover core topics and are prepared for examinations of your knowledge.
It is important for you to gain broad knowledge about the spectrum of medical illnesses as it may be
impossible for you to see patients with all conditions about which you need to learn during your
clerkship. Follow a structured reading program. It is helpful to have an overview textbook of medicine,
one which you can read in depth, ideally from cover to cover; over the course of the clerkship.
Examples include:
Internal Medicine Essentials for Clerkship Students
Cecil Essentials of Medicine
Paauw’s Internal Medicine Clerkship Guide
First Exposure Internal Medicine: Hospital Medicine
Case Files: Internal Medicine
Step Up to Medicine
A reference textbook of medicine is recommended for most patient-related reading (Harrison’s
Principles of Internal Medicine, Cecil Textbook of Medicine, ACP Medicine). Students also need
additional resources to read in greater depth; review articles from the literature (New England Journal
of Medicine, Annals of Internal Medicine, Mayo Clinic Proceedings) or electronic resources are good
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resources to access. You will also want to have access to small texts for rapid reference (on bedside
rounds or in the emergency department, for example). The Washington Manual of Medical
Therapeutics is invaluable for formulating treatment plans and writing orders. Ferri’s Care of the
Medical Patient and The 5 Minute Clinical Consult also serve this function. Many books and manuals
can be purchased as iPhone / iPod apps as well. However, they will not be adequate for helping you
understand differential diagnosis, pathophysiology, etc. When it comes time to prepare for the
clerkship final examination, many students use MKSAP for Students, an excellent resource produced
by the American College of Physicians (ACP) and the Clerkship Directors in Internal Medicine that
contains questions with detailed explanations that are organized around the core CDIM training
problems. Other sources for practice questions include Pretest: Medicine, USMLE World (requires
subscription fee) and Kaplan (requires subscription fee).
ACP’s Physician Information and Education Resource (PIER) is an electronic resource that provides
evidence-based guidance for managing clinical problems. Access to PIER is free for ACP members
and membership is free for students. UpToDate is another excellent electronic resource for
investigating specific clinical questions. However, these resources will be less valuable for overview
reading of larger clinical topics (an overview of congestive heart failure, for instance). Additionally, the
Internet provides access to an enormous library of medical information as a rapid reference.
Students should be self-directed learners and share what they have learned with their colleagues.
This practice of continuous, ongoing learning will be necessary throughout your career. When you
read, consider preparing a single-page summary; be prepared to present this synopsis to your team.
You should do at least one topical presentation per four-week rotation. If your attending or resident
does not assign you a topic, pick a clinical subject that interests you and is relevant to at least one of
the patients on your current team. If you are having trouble choosing a topic, ask for help from your
attending or resident. If you have been given a specific topic to research, do not be afraid to ask for
guidance. A concise, summative handout is a nice touch.
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Suggestions for Success in the Inpatient Setting
Your job in the inpatient setting is to care meticulously for the limited number of patients you are
assigned, while at the same time learning as much as you possibly can. At times, service and
learning may be at odds but generally speaking they coexist quite well. It is useful to recognize that
the faculty and house officers you work with are attempting to balance competing demands as well.
 Actively and enthusiastically participate in rounds.
 Demonstrate effective organizational skills.
 Develop skills in efficiency.
You will learn more, have more fun, contribute more to patient care, and be less stressed if you keep
yourself, your schedule, and your patient information organized. It will come as no surprise to you that
being a doctor is a very hectic business. There is a lot to remember. Start training yourself to be
organized now!
 Carry a calendar and mark all conferences and call days right away.
 Develop a system for keeping patient data and tasks at your fingertips (note cards, fill-in-the
blank templates, electronic applications).
 Have information about your patients immediately available (e.g., vital signs, laboratory data,
diagnostic studies, medications).
Communicate effectively with patients and their families.
 You have the ability to make an important impact on the care and experience of your patient.
You will likely spend more time with your patients than other members of the team. Your
patients may see you as their primary provider, in effect, as “their doctor.”
 Spend additional time learning about who your patient is—understand their social, economic,
personal background, and values.
 After diagnostic and therapeutic plans have been formulated with the assistance of your
resident and attending, return to the bedside and discuss them with your patients.
 Feel free to have personal and emotional discussions with your patients. You will have the
ability to comfort your patients during times of anxiety and fear. You will likely benefit from
these discussions as much as your patients. Some sensitive discussions, like disclosing very
bad news, should be conducted by more senior members of the team, but you can still be
available to provide additional information and support to the patient and family once this
information has been presented. Discuss with your team and attending.
Show competency with patient care responsibilities.
 Be fully prepared and on-time for conferences and attending rounds everyday and have all
pertinent data available. Have a daily plan for each of your patients.
 Take the lead in talking with your patients during rounds.
 Try to be the first one to get the important pieces of information about your patients.
 Have all notes and orders promptly co-signed.
 With the guidance of your resident, contact and communicate with all consultants.
 Participate (including just watching) in as many procedures as possible, even if you are not
following the patient.
 Try to accompany your patient to any diagnostic evaluations that occur during the hospital
stay.
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 Write admission orders on all patients that you admit. (Even if the intern has already completed
this task, it is very instructive to write your own.)
 Assist your interns with cross-coverage.
 Learn about the other patients on your team. You should have at least a basic understanding
of what is going on with all the patients on the team.
 Pitch in and be of assistance to your resident and intern when your other responsibilities are
taken care of. However, you should not do this to a degree that interferes with your selfdirected learning.
Integrate fully into the team.
 Clarify your role on the team. Ask what is expected of you and deliver it. Show your interest.
 Offer to help other members of your team with their patient care if you fulfill your other
responsibilities. This cooperation will allow you to make a greater contribution to patient care
and give the team more time for teaching. Offer to research topics and contribute educational
presentations in teaching conferences.
 Ask for guidance in your reading. Bring what you have learned back to the team. Ask
questions when you cannot find the answers yourself.
 Ask for feedback. Respond to the feedback you receive.
Top 10 Ways to Excel on the Internal Medicine Clerkship
1. Find out what your residents and preceptors expect of you. Meet and try to exceed their
expectations. Follow through on every assigned task.
2. Be actively involved in the care of your patients to the greatest extent possible. Go the
extra mile for your patients. You will benefit as much as they will.
3. Go the extra mile for your team. Additional learning will follow. The more you put in, the
more you will gain.
4. Read consistently and deeply about the problems your patients face. Raise what you
learn in your discussions with your team and in your notes. Educate your team
members about what you learn whenever possible.
5. Learn to do excellent presentations as early as possible. This will make you more
effective in patient care and gain the confidence of your supervisors to allow you more
involvement in patient care.
6. Ask good questions.
7. Speak up—share your thoughts in teaching sessions, share your opinions about your
patients’ care, constructively discuss how to improve the education you are receiving
and the systems around you.
8. Actively seek feedback and reflect on your experiences.
9. Keep your goals focused on the right priorities, in the following order: patient care,
learning, and personal satisfaction. You should always strive to meet all three goals.
10. Always be enthusiastic. Be caring and conscientious and strive to deliver outstanding
quality to your patients as you learn as much as you can from every experience.
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Professionalism
The development of professionalism is an explicit and important goal of your clerkship. In 2002, the
American Board of Internal Medicine Foundation, American College of Physicians Foundation, and
the European Federation for Internal Medicine wrote a charter on professionalism that has gained
widespread support (see the charter at www.abimfoundation.org). It starts by stating that
“professionalism is the basis of medicine’s contract with society.”
The fundamental principles of professionalism are as follows:
Principle of primacy of patient welfare.
Principle of patient autonomy.
Principle of social justice.
The charter’s set of professional responsibilities are as follows:
Commitment to professional competence.
Commitment to honesty with patients.
Commitment to patient confidentiality.
Commitment to maintaining appropriate relations with patients.
Commitment to improving quality of care.
Commitment to improving access to care.
Commitment to a just distribution of finite resources.
Commitment to scientific knowledge.
Commitment to maintaining trust by managing conflicts of interest.
Commitment to professional responsibilities.
It is important to note that some of these principles are occasionally at odds with one another, and in
these situations it is important to be able to recognize and effectively negotiate these conflicts when
they arise. There are a number of ways to grow your level of professionalism over the course of the
clerkship.
 Do your best to get to know your patients well. Understand who they are and why they have
the problems that they have. Treat every patient as you would hope your family member would
be treated. As you invest in your patient, they will invest in you, and this will allow you to
experience something that you may not have had before – a true therapeutic relationship.
 Follow your patients over time; call them after they have left the hospital to find out what
happened to them.
 Be an advocate for your patient whenever necessary. Discover for yourself what Francis W.
Peabody, MD, articulated: “The secret to caring for the patient is caring for the patient.”
 Reflect actively on your actions and experiences, on a regular basis. After each interaction,
especially those in which you find you are having strong emotions, spend some time
considering and analyzing what you have experienced. Write it down. Discuss your thoughts
with your peers and advisors.
 Be honest to yourself and others. It is honorable to say, “I don’t know.”
 Be aware of the “hidden curriculum.” This refers to that which is taught outside the classroom
and which may not be the best examples. Think critically about everything that you are taught,
no matter the source.
 Work to improve the quality of the system in which you work. Every medical system has
weaknesses, gaps, inefficiencies, and processes that allow errors to occur. Be a part of the
solution. Consider ways that the system might be improved and pass them along.
 Learn from your mistakes. You will make mistakes. We are human, and we can expect no less
of ourselves. And, as a learner, you do not yet have all the knowledge and skills to practice
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independently. Strive to never make the same mistake twice. Share your experiences with
your peers, so they can avoid repeating mistakes. Learn as much as you can about ways to
prevent making important errors (and there is a growing literature on how to do this), and be
willing to adapt your practice to provide the highest quality and safest patient care.
 If any problems occur during your clerkship, let your clerkship director know as early as
possible
Conclusion
The Internal Medicine clerkship is one of the most important experiences of medical school.
Regardless of what specialty training you ultimately pursue, you will unquestionably advance your
knowledge and skills on this clerkship.
Ultimately, we will view this as a successful clerkship experience if it makes you a better caregiver,
improves your skills, improves your confidence in yourself, helps you to become more professional,
and helps you to become more aware of your career preferences. You will be one step further to
where you ultimately will be—a skilled, caring, knowledgeable physician in the area of your choice.
You will only have one Internal Medicine clerkship. As much as we may try to make experiences
consistent, no two Medicine clerkships are ever the same—from school to school or from student to
student. You, your patients, your team, your preceptors and attendings, and your hospital and clinics
will ultimately determine the outcome of this experience. This clerkship will shape you, even if in small
ways. You will carry your experiences from these weeks with you for the rest of your professional
career. We encourage you to do everything that you can to make the very most of this experience.
We hope that this handbook has served as a guide of how to do exactly that. We wish you the very
best clerkship experience possible. Your clerkship director feels genuinely privileged to accompany
and guide you.
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Your Internal Medicine Clerkship
Overview of Goals / Learning Objectives:
Our goal is to help each student:
 To develop clinical skills in medical interviewing, physical examination, and medical decisionmaking through observation and active participation in medical care.
 To develop skills in developing differential diagnoses
 To develop skills in interpreting laboratory data
 To understand the pathophysiology of medical illnesses and use this information to direct the
evaluation and treatment of patients.
 To learn basic differences between inpatient and outpatient medical practice.
 To understand the importance of using an evidence-based approach to medical care.
 To work as part of a health care team (systems-based practice) in the management of
medically complex and socially diverse patients.
Specific Clerkship Objectives:
By the end of the rotation, the student will be able to:
1. Elicit a through and pertinent patient history, adapting it to the urgency of the time allowed for the
interaction. Include the following history:
A. Chief complaint
B. History of present illness: Describe the significant attributes of a symptom, including location
and radiation, intensity, quality, temporal sequence (onset, duration, frequency), alleviating
factors, aggravating factors, setting associated symptoms, functional impairment, and patient's
interpretation of symptom.
C. Past medical history
D. Health maintenance history
E. Family and social histories, etc.
F. Review of Systems
2. Conduct a thorough physical examination. Include the following:
A. Describe the four methods of physical examination (inspection, palpation, percussion,
and auscultation), including where and when to use them, their purposes, and the
findings that they elicit.
B. Position the patient properly for each part of the physical examination.
C. Perform the physical examination for a patient in a logical, organized, respectful, and
through manner, giving attention to the patient’s general appearance, vital signs, and
pertinent body regions.
3. Use information gathered from the patient’s history and physical to complete the following:
A. Describe physiologic mechanisms that explain key findings in the history and physical.
B.
Include a discussion of the diagnostic value of the history and physical examination
information.
C. Formulate a differential diagnosis (problem list) based on the findings from the history and
physical examination.
D. Formulate a plan of patient evaluation and management, including diagnostic studies and
consultations, therapeutic efforts, education of patient, and follow-up plans using an evidence- based
approach.
4. Participate in the selection of diagnostic studies with the greatest likelihood of providing useful results at a
reasonable cost.
5. Interpret laboratory data including basic metabolic panels, liver functions tests, blood counts, arterial blood
gases.
6. Assess each problem further by synthesizing and analyzing the data obtained from the diagnostic studies.
7. Demonstrate familiarity with basic clinical procedures of internal medicine.
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8. Prepare written, comprehensive, and focused new patient workups. Include the following features when
clinically appropriate:
A. Provide a history of the present illness accurately, objectively, chronologically, without
repetition, omission, or extraneous information.
B. Provide comprehensive physical exam information with detail pertinent to the patient’s
problem.
C. Provide a succinct and unified list of all problems identified in the history and physical
examination.
D. Provide a differential diagnosis for each problem.
E. Provide a diagnosis/treatment plan for each problem.
9. Present orally, clearly, and concisely the plan of problem evaluation and patient management.
10. Participate in discussion with the patient care team (faculty, staff, etc.) during teaching sessions.
11. Communicate positive interpersonal skills with patients and staff. Include the following:
A. Demonstrate respect and appropriate listening skills, including both verbal and nonverbal
techniques.
B. Demonstrate effective verbal skills, including appropriate use of open- and closed-ended
questions, repetition, facilitation, explanation, and interpretation.
C. Describe how patients’ and physicians’ perceptions, preferences, and actions are affected by
cultural and psychosocial factors, including how these factors affect the doctor-patient relationship.
12. Relate successfully to patients, families, and professionals. Include the following:
A. Demonstrate appropriate listening skills, including both verbal and nonverbal techniques.
B. Demonstrate interest and responsibility in patient care and patients’ needs.
13. Display professional attitudes to learning. Include the following:
A. Demonstrate good, consistent work habits.
B. Demonstrate inquisitiveness.
C. Demonstrate evidence of a desire to learn and improve by reading, studying, and
discussing.
D. Demonstrate an ability to respond positively to constructive criticism.
14. Recognize, evaluate, and treat common adult medical problems in both inpatient and outpatient settings.
Include the following:
A. Cardiovascular Diseases
1. Valvular heart disease
2. Congestive heart failure
3. Ischemic heart disease
4. Pericardial disease
5. Peripheral vascular disease
6. Arrhythmias
B. Respiratory Diseases
1. COPD/asthma
2. Pulmonary vascular disease
3. ARDS and pulmonary critical care
4. Lung cancer
C. Renal Disease
1. Fluid and electrolyte disorders
2. Hypertension/vascular disorders of kidney
3. Acute renal failure
4. Chronic renal failure
D. Gastrointestinal Disease
1. Neoplasms of the GI tract
2. Pancreatitis
3. Peptic Ulcer Disease
4. Gastrointestinal bleeding
5. Diseases of the Liver and Biliary System
a. Jaundice
b. Cirrhosis, complications
c. Gallstones
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E. Hematology
1. Anemia
2. Leukocyte disorders
3. Hemostasis
4. Coagulation disorders
5. Leukemia / lymphoma
6. Myelodysplastic syndromes
F. Oncology
1. Oncologic emergencies
2. Solid tumors
G. Metabolic Diseases
1. Principles of nutritional support
2. Hyperuricemia and gout
3. Lipids
H. Endocrine Diseases
1. Thyroid disorders
2. Diabetes
I. Diseases of Bone and Bone Mineral Metabolism
1. Hypercalcemia
2. Osteoporosis
J. Musculoskeletal and Connective Tissue Disease
1. Rheumatoid arthritis
2. SLE
3. Osteoarthritis
4. Crystal-induced arthropathies
5. Infections of joint spaces
K. Infectious Diseases
1. Host defenses
2. Fever and febrile syndromes
3. Bacteremia and septicemia
4. Meningitis
5. Pneumonia (includes tuberculosis)
6. Urinary tract infections
7. Immunocompromised host
8. Management of/approach to the HIV+ patient
9. Cellulitis and osteomyelitis
L. Neurologic Diseases
1. Disorders of consciousness and higher brain function, including syncope
2. Drug and alcohol abuse, including alcohol withdrawal
3. Autonomic dysfunction
4. Sensory dysfunction
5. Cerebrovascular disease
6. Seizure disorders
M. The Aging Patient
1. Biology of Aging
2. Identify preventive standards for the various adult age groups, to include counseling
and guidance
3. Evaluate the effects of illness on the adult and his/her family
N. Cutaneous Disease
1. Infectious Disease (Impetigo, HPV, Herpes, Tinea)
2. Psoriasis
3. Eczema
4. Skin Cancer
5. Skin breakdown and wound care
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Core Competencies:
The core competencies and recommended patient encounters for the M3 Internal Medicine
Clerkship in Columbia and Greenville are summarized below.
These clerkship goals are based on the national recommendations of the Clerkship Directors in
Internal Medicine, as summarized in the “Clerkship Directors’ in Internal Medicine Core Clerkship
Curriculum Guide”. This reference may be found at
http://www.im.org/CDIM/CurriculumGuide/OnlineCDIMCurriculum.pdf
The Clerkship Directors will ensure that students meet these goals by
1. Communicating these goals to students, supervising residents and faculty physicians
2. Monitoring the students’ patient encounter logs routinely, including a formal assessment at
the midpoint of the rotation
If any deficiencies are identified, the Clerkship Director will develop a corrective plan with the student
and his supervising resident/faculty physicians.
Given the variability in patient admissions, it is likely that students will not personally care for a patient
with every recommended training problem. Students may obtain additional training through
participation in care of other patients on the teaching services, and by discussion of patients during
attending rounds and educational conferences, and through didactic lectures. Students are expected
to supplement their training through self-directed learning.
Core Competencies
Students are expected to develop basic competence in the following areas:
 History Taking and Physical Examination
 Interpretation of Clinical Information
 Diagnostic Decision Making
 Therapeutic Decision Making
 Case Presentation
 Basic Procedures
o Required
 Venous blood draw
 Interpretation of basic chest radiograph findings
 Interpretation of basic electrocardiogram findings
 Observation of endoscopic procedure
 Participate in cardiac resuscitation using Basic Cardiac Life Support skills
o Recommended
 Lumbar puncture
 Microscopic examination of peripheral blood smear
 Microscopic examination of sputum Gram stain
 Observation of cardiac catheterization
 Basic Nutrition in Clinical Medicine
 Geriatric Care
 Coordination of Care and Team Work
 Communication and Relationships with Patients and Colleagues
o Including cultural competence
 Self-Directed Learning
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

Bioethics of Care (Ethical Principles in Clinical Medicine)
Prevention
Patient Encounters
Students are encouraged to participate in care of patients with the following problems. Required
patient encounters are noted in bold font.
 Patients Presenting with a Symptom, Sign, or Abnormal Test Result
o Abdominal Pain
o Altered Mental Status
o Anemia
o Back or Knee Pain
o Chest Pain
o Cough
o Dyspnea
o Dysuria
o Fever
o Fluid, Electrolyte, and Acid Base Disorders
o Gastrointestinal Bleeding
o Upper Respiratory Complaints
 Patients Presenting with a Known Condition
o Acute Myocardial Infarction
o Acute Renal Failure and Chronic Kidney Disease
o Common Cancers
o COPD/Obstructive Airways Disease
o Diabetes Mellitus
o Dyslipidemia
o Coronary Artery Disease/Heart Failure
o HIV Infection
o Hypertension
o Liver Disease
o Major Depression
o Nosocomial Infections
o Obesity
o Pneumonia
o Smoking Cessation
o Substance Abuse
o Venous Thromboembolism
Specific Clerkship Requirements
M3 students must see the following conditions/patient types over the course of the 8-week rotation
1. 2 new acute conditions with the emphasis on diagnosis
2. 2 new acute conditions with the emphasis on treatment
3. 2 chronic conditions
4. 2 acute exacerbations of a chronic disease
5. 1 patient from a culture not their own
6. 1 patient over the age of 65 years
7. 1 patient with limited access to medical care
8. At a minimum, 1 patient from each of the following categories. Note that students are
encouraged to obtain experience in all recommended patient training problems.
a. Cardiac: Congestive heart failure or coronary artery disease (includes HTN)
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b.
c.
d.
e.
f.
g.
h.
i.
j.
Diabetes mellitus (includes diabetic foot ulcer or other complications)
Shortness of breath
Fever or infection (includes pneumonia, UTI, sepsis, HIV, cellulitis)
Musculoskeletal pain (includes monoarthritic pain, tendonitis, bursitis, DJD, RA)
Anemia
Abdominal pain or gastrointestinal bleed
Renal failure (chronic, acute, ESRD, nephrotic syndrome)
Electrolyte abnormality
Alcohol, drug or tobacco abuse
Organization
Your M3 clerkship consists of essentially 8 weeks of inpatient wards. Four weeks will be spent at the
VA Medical Center and 4 weeks will be spent at Palmetto Richland Hospital. Some students will
have the opportunity to spend 2 weeks in the Medical Intensive Care Unit at Richland. There will be 2
full days of didactic learning, included as part of Orientation Day and on the day of your mid-term
exam. Your mid-term exam is a 1 hour test, based on board exam and shelf test style questions. It is
for your learning and is not graded. You must complete the exam however as a requirement of the
rotation. There will also be one afternoon of clinical topic lectures, and one afternoon will be spent in
the simulation center. You are encouraged (but not required) to join your intern, resident, or attending
for one or more half day in the resident clinic over the course of the rotation.
Attendance Policy
Attendance is required at all conferences, including morning report, Grand Rounds and noon
conference. Pre-rounding on patients in preparation for morning report or working rounds is expected
on all days. If you have previously scheduled commitments, please notify the Clerkship Director and
arrangements can be made to adjust your schedule if possible. If an emergency situation arises
(illness, family emergency), please call or page the clerkship director, Caroline Powell at 954-6652
(pager), 201-9910 (cell). If the clerkship director is not informed of the absence, it will be considered
unexcused. The need for making up time missed will be determined on a case by case basis. You
must notify the School of Medicine administration of any absence as well.
14
Call Schedules and Work-hour Rules
We follow the USC SOM student work hour rules. At Palmetto Richland, the call schedule is 1 in 4
until 9 pm weekdays, and overnight on Fridays and Saturdays. There must be a 10-hour break
between the time you leave the hospital and return the next morning.
If you are rotating in the MICU, you are required to stay overnight on 2 nights as determined by the
MICU attending or fellow.
At the VA Medical Center, the call schedule is 1 in 4 until 9 pm on most nights. There is no night float
resident at the VA, so your team will be staying overnight. You are required to stay overnight with
your team for all Tuesday and Saturday night calls. (If you do not have a Tuesday or Saturday night
admitting day during your scheduled time then you will stay overnight on Monday and Friday). When
on call overnight, your total number of hours in the hospital may not exceed 30 hours (i.e. you should
leave the hospital by noon or after noon conference on your post-call day).
You will get one day off in 7 averaged over a period of 4 weeks. All students have their “switch
weekend” off. The last call will be on Tuesday of week 8. You are done with clinical duties after
lecture / noon conference on Wednesday before OSCE.
Student work hours regulations allow for student attendance at afternoon lectures even on post-call
days.
Typical Inpatient Daily Schedule (PHR and VA)
7-8 am
8-9 am
8-9 am
815-9 am
830-930 am
9-12 pm
12-1pm
12-1pm
1210-1pm
1-4 pm
Pre-round on your patients
Morning Report / Grand Rounds
Grand Rounds – Thursdays (PHR Auditorium, Farley Conference Room VA)
Morning Report PHR (Basement Conference Room)
Morning Report VA (4th Floor Medicine Conference Room)
Work / teaching rounds with the attending
Noon conference
VA (3rd Floor Farley Conference Room)
PHR (Basement Conference Room)
Patient care
Special lectures and presentations
Chairman’s presentations – Thursdays, PHR Basement Conference Room
Dr. Humphries
PHR, Tuesdays, 3 pm (Starbucks)
VA, Thursdays, 1 pm (4 West)
Resident lectures
Ambulatory experience (optional)
15
Medical Intensive Care Rotation (MICU)
Some students will have the opportunity to rotate through the MICU for 2 weeks of their rotation.
During your time in the MICU, you will be assigned interesting patients to follow and write daily
progress notes just as on the wards.
During the rotation you will take two nights of overnight call. As per the work hours regulations, you
will be done with clinical duties after noon conference on your post-call day. You will be required to
prepare and present at least one brief topic presentation to the MICU team as part of the rotation.
Ideally this will be based on a patient case you have seen during your time in the MICU.
Typical schedule Palmetto Richland MICU:
7 am – Check in with Pulmonary fellow in MICU (5th floor PHR) (day 1)
Discuss with the fellow/residents about what time you should arrive during the
remainder of your rotation
8-9:30 am – Morning Report / Grand Rounds / Lectures
8:45-9:30 – Monday, Wednesday, Friday – Morning lecture
9:30-12 pm – Attending Rounds
12-1 pm – Noon conference
1-5 pm – Patient care, special lectures, procedures
Goals / Learning Objectives:
 To observe the MICU course of patients presenting with acute respiratory failure,
shock, acute GI bleeds, DKA, acute coronary syndromes, and other medical
illnesses requiring critical care.
 To observe the collection, synthesis, and presentation of complicated patient
data in an organized and efficient manner.
 To recognize potential clinical diagnoses on the basis of CXR findings.
 To become familiar with the indications, risks and benefits, overall technique, and
data interpretation for arterial blood gas analysis and pulmonary artery/central
venous catheter placement.
 To begin to develop skills in managing patients requiring mechanical ventilation.
 To begin to define, recognize, and describe the basic pathophysiology of acute
hypoxemic respiratory failure, acute ventilatory failure, septic shock, cardiogenic
shock, and hypovolemic shock.
 To become familiar with the practice of critical care medicine at Palmetto Health
Richland and the process by which a multidisciplinary approach to patient care is
utilized to optimally manage patients.
16
Medical Student Morning Report
In order to offer more directed assistance with oral presentations and clinical reasoning – at the
appropriate learning level for students – a separate morning report will be held for medical students
only at PHR and for medical students and interns at the VA. Students will be presenting patient cases
to the Residency Program Director, Dr. Greenberg at PHR, and Dr. McCallum at the VA.
The following offers an outline and guidelines for the sessions at PHR:
Monday – Optional large group Morning Report (for all students and residents) – 8:15 – 9:00 AM,
PHR basement conference room
Tuesday, Wednesday, Friday – Student Morning Report – 8:15 – 9:00 AM, Basement conference
room PHR
1-2 medical “post-call” students will present cases admitted the previous day
Be prepared to present the case in a concise but comprehensive fashion - history and
complete physical exam. This does take practice.
Be prepared to justify any tests, imaging ordered
Be prepared to explain the differential diagnosis and the most likely diagnoses
Be prepared to briefly explain one learning issue – what did you learn from this case that you
would like to share with the other students? What is your “take-home point”?
Discuss each of these points with your team. Learning issues will vary by case
presented.
Thursday – Grand Rounds – 8:00 – 9:00 AM (PHR Auditorium, Farley Conference Room 3rd Floor VA)
At the VA, these sessions are held Monday, Tuesday, Wednesday, and Friday 8:30-9:30 am.
Students should be prepared to present admissions from the previous day.
Chairman Presentations
These are formal case and topic presentations held on select Thursday afternoons during the
rotation. As the name suggests, these presentations are made to and evaluated by our Department
Chair, Dr. Chillag. They also offer you a chance to teach and learn from your peers. This is a
requirement of the rotation and all students should attend each session. Formal guidelines
developed by the Department Chair are included in this handbook.
17
Chairman Presentation Guidelines
M-3 Clerkship Presentation
Goal:
Prepare and deliver a formal case presentation with discussion of a key problem of the case (pathophysiology, differential
diagnosis, medical ethics, therapeutics, and/or social, make the audience work through the case, stump the attending,
etc.)
Objectives:
 Develop concise, appropriate, rehearsed case presentations
 Have thorough familiarity with all aspects of case
 Develop skills of case presentation to carry to all disciplines
Logistics:
 No more than 8 minutes, 37 seconds to present case
 Discussion of some aspect of the case of your choosing for 10-15 minutes: NO PowerPoint
 Radiological studies, electrocardiograms, pathology specimens, etc. as appropriate will always enhance a
presentation
 Do not read; no or minimal use of notes
 Stand up before your audience
Evaluation:
See form for evaluation of student
Case Presentation
“Persistently Polished, Precise Presentation”
It is a presentation of the case not a reporting of the history and physical.
You should demonstrate your knowledge and understanding of medicine in your case presentation.
Good presentations are a result of practice and thoughtful consideration. Good presentations are not reporting of
everything you know about the case. Information needs to be integrated and refined before spoke.
DO NOT READ – WE CAN READ! (We Hope)
YOU MUST PRACTICE
Presentation should rarely last >5 minutes. Summarize, integrate data.
HPI should cover most of history; ROS pertinent to HPI, etc., almost all information pertinent to case should be presented
in 2 or 3 paragraphs. NO specific references to ROS unless identifies a separated unrelated problem covered in an
accurate HPI. Social history, past medical history if vital to case and covered in an accurate HPI. DO NOT REPEAT. “As I
mentioned,” or “as I said” means you are repeating. SAY IT ONLY ONCE.
Medications are always reported.
Family history is of no significance in an 80 year old with a stroke; don’t include what is not necessary to understand case.
THINK BEFORE YOU SPEAK.
Pertinent positives and negatives in history and physical display of your thought process and knowledge of what is or is
not important.
Present case as if to communicate the story to a busy, valued consultant who needs to know about the case in detail, but
not too much detail. You are calling on your cell phone and it is costing $1.00 a second!
PRACTICE
THINK!
18
Simulation Center Workshop
Each student will participate in a Simulation workshop during the rotation. Prior to this workshop, you
will be required to view / read the appropriate Procedures Consult tutorials or NEJM articles and
videos provided in order to fully understand indications, contraindications, preparation, procedure
steps, post-procedure care, and complications. This will ensure your getting maximal benefit from the
limited time we have for hands-on activities in the Simulation Center.
Goals / Learning Objectives:
1. To draw venous blood using a model.
2. To place a central venous catheter in the internal jugular vein under ultrasound
guidance. To identify important structures on neck ultrasound. To practice technical
ultrasound skills such as measuring and saving images.
3. To perform a lumbar puncture on a model.
4. To observe and participate in a simulated cardiac / respiratory arrest (“code”).
To access the Procedures Consult tutorials on lumbar puncture, internal jugular central venous line
placement, and phlebotomy/intravenous cannulation: 1) Log onto Palmetto Health Remote Access;
2) Locate "Procedures Consult" in the lefthand margin of the PH Doc screen; 3) Select "Internal
Medicine;" 4) For the Phlebotomy, Intravenous Cannulation and Internal Jugular Central Venous
Line tutorials, choose "Vascular;" 5) For the Lumbar Puncture tutorial, choose "Aspirations."
Formal Didactics
Students will receive formal lectures in the following: Clinical Reasoning, EKG interpretation, Chest
Xray interpretation, Laboratory interpretation, Antibiotics, Thyroid / neck ultrasound, Congestive Heart
Failure, HIV, Acute Kidney Injury, Inpatient Management, an overview of Ambulatory Medicine.
These will be given on orientation day, midterm day, and one afternoon during the rotation so as to
not interrupt patient care and resident teaching. A Geriatrics lecture is available on Blackboard and
should be studied in preparation for completing the Senior Mentor project due for this rotation. In
addition, students will meet with Dr. Humphries for bedside teaching in physical exam skills
(especially cardiac exam) once per week – 3:00 pm Tuesdays at PHR (Heart Hospital Starbucks) and
1:00 pm Thursdays at VAMC (4 West nurses station). Dr. Brett will also meet with students rotating at
PHR on select Fridays after noon conference to discuss heart sounds. While rotating at the VA,
students will have a series of lectures in EKG interpretation as well as a weekly MKSAP for Students
question review session led by one of the senior residents.
Clinical Worksheets
Students are provided with worksheets to guide self study in common clinical diagnoses. These are
not meant to be a comprehensive review of these topics but a guide to patient management and to
direct outside reading.
19
Nutrition Activities for M3 Clerkship (Part of CSAD)
The practical application of nutrition therapy is important to clinical practice. Medical nutrition therapy
can begin with primary intervention and follow through to care at end-stage disease. Each clerkship
provides a unique opportunity to use nutrition principles in patient care.
On the CSAD for this clerkship you will find “Participate in a nutritional assessment or other activity”.
The clerkship director may provide nutrition lectures or patient assessment opportunities during your
rotation. If these hands on opportunities are not available, you may do the online nutrition case study
design for this clerkship.
Go to: www.nutrition.med.sc.edu look under “clerkship”
1. Click on the name of your current rotation
2. Read ONE of the cases. (Remember, you only need to do one per clerkship.) Think about the
practice questions. When you are ready…
3. Take the quiz (be sure to type in your name and current clerkship) and submit. Print out the
receipt if you want to have a back-up paper showing that you took the quiz.
4. The quiz results will come to my email. They will be graded pass/fail (5/10). Your name will
then be sent to the clerkship director so you can be given credit for participation in the online
nutrition activity.
You may call or email me if you have any problems or concerns about the online case studies.
Bon Appetit!
Lynn Thomas, DrPH, RD, CNSD
Lynn.Thomas@palmettoheath.org
434-2466
Senior Mentor Project
The information regarding completion of the Senior Mentor project is provided in electronic format
accessible through Blackboard. Each student will be required to review the materials provided
including an on-line tutorial and complete the task as outlined. All completed projects can be emailed
to Megan.Gleaton@uscmed.sc.edu.
20
Grading Policy & Evaluation Procedures
The following is an overview of the various evaluation methods and procedures.

CSAD observed functions (“Blue card” / entered in New Innovations)
8 written H&P’s - approximately 1 per admitting day
Daily progress notes
Written admission orders
Written discharge instructions
Topic presentations
EKG and CXR interpretation
Observed H&P – Requires attending observation
Venous blood draw
Senior mentor fall risk assignment
Observed endoscopic procedure
Central venous line placement under ultrasound-guidance
Participation in a “code”
Nutrition assignment

Subjective assessment using specific measurement scale- 50%*

Appropriate personal and professional conduct- Unprofessional conduct can result in an
“incomplete” with need for remediation of all or some portion of the clerkship

Objective Structured Clinical Evaluation (OSCE)- 20%*

National Board of Medical Examiners Subject Exam (shelf test)-30%*
The Chairman presentation evaluation may be used to "curve" the subject exam.

Multiple choice midterm examination

Each student is given the opportunity to evaluate the lecture series, his or her attending
physicians, and the residents with whom he/she worked with. A clerkship evaluation is
completed by each student.
*These items comprise the numerical grade. Other items must be completed for successful
completion of the course.
The department policy regarding successful completion of this clerkship is that a student must receive
a passing grade on all components of evaluation in order to pass the clerkship itself. Failure of the
clinical portion of the OSCE will require remediation as Department determined by the Clerkship
Directors. Likewise, the time frame in which this remediation occurs will be determined by the course
directors and/or Education Committee. As to failure of the shelf exam, retesting will occur in
December for periods 1 and 2 and in June for periods 3, 4, and 5. Those failing in period 6 must take
the retest in August. If the second attempt at the shelf exam is successful, the final shelf exam score
will be an average of the two scores. A second failure of the shelf exam will necessitate repeating the
entire clerkship. Until such time that all three components are successfully completed, the student will
receive an “Incomplete” for the clerkship but will be permitted to continue on the other clerkships.
Likewise, failure to submit CSAD, Patient Encounter Information, and/or the online clerkship
evaluation will result in an “Incomplete.”
21
In order to complete the rotation, you must turn in the following items:
 Completed Observed H&P form
 Completed Senior mentor fall risk assessment
 Completed CSAD (“blue”) card - to be entered into New Innovations
 Completed PEC data – to be entered into New Innovations
You may receive an “Incomplete” if these items are not completed in a timely fashion.
PEC Data
You should enter data on your medical patients into New Innovations. In addition, you should keep a
record of the types of medical conditions to which you are exposed and have the opportunity from
which to learn. A table has been provided on the back of your CSAD card for collecting this data for
review by the clerkship directors; however, with transition to entering completed CSAD requirements
into New Innovations, PEC data will be reviewed at the midpoint evaluation. This information is used
to ensure that you are seeing the variety of patients and medical conditions needed for an optimal
Internal Medicine clerkship learning experience.
Formal Feedback
Over the course of the rotation, you should receive formal feedback from each intern, resident, and
attending with whom you work closely. On average, you should receive formal feedback every 2
weeks. You should also be aware that most teachers consider any constructive criticism feedback
and will offer suggestions, criticisms, and advice throughout the day as part of feedback on your
performance. But don’t be shy about asking for formal feedback. Formal feedback from clerkship
directors will be provided at the midpoint evaluation.
This handbook has been adopted from the Primer to the Internal Medicine Clerkship, 2nd Ed., A Guide Produced by the Clerkship Directors in Internal
Medicine.
22
University of South Carolina School of Medicine
M3 Internal Medicine Clerkship
Midpoint Review of Performance
1. Ability to take a thorough and efficient history
Satisfactory
Needs Improvement
2. Ability to perform an accurate physical examination
Satisfactory
Needs Improvement
3. Ability to formulate appropriate differential diagnosis
and assessment
Satisfactory
Needs Improvement
4. Ability to formulate appropriate management plan
Satisfactory
Needs Improvement
5. Ability to select appropriate diagnostic tests
and interpret results
Satisfactory
Needs Improvement
6. Fund of knowledge
Satisfactory
Needs Improvement
7. Clinical reasoning abilities;
Ability to integrate and utilize new knowledge
Satisfactory
Needs Improvement
8. Quality of patient notes
Satisfactory
Needs Improvement
9.
Satisfactory
Needs Improvement
10. Participation in activities
Satisfactory
Needs Improvement
11. Initiative in self-directed reading
and seeking out clinical experience
Satisfactory
Needs Improvement
12. Acceptance of responsibility
Satisfactory
Needs Improvement
13. Ability to work independently
Satisfactory
Needs Improvement
14. Relationship with patients and co-workers;
Professional demeanor
Satisfactory
Needs Improvement
Ability to present a case in a concise
and well-organized manner
Areas of strengths:
Areas needing improvement:
Educational goals for remainder of rotation:
Evaluator signature:
Student signature:
23
Department of Internal Medicine
Medical Student Evaluation (Attending & Resident)
Please place a check mark under the column that best describes the students performance.
Student Information
Rotation Dates:
Name:
Ratings
Medical Knowledge
Check appropriate box:
1=Fail
Unacceptable
understanding of
etiology,
path-physiology,
prognosis and
treatment of disease.
No differential diagnosis
offered.
2= Low Pass
Adequate
understanding of
etiology,
pathophysiology,
prognosis and
treatment of disease.
Limited differential
diagnosis offered. .
3= Pass
Good understanding
of etiology,
pathophysiology,
prognosis and
treatment of disease.
Good differential
diagnosis offered.
4= High Pass
5= Honors
Advanced
understanding of
etiology,
pathophysiology,
prognosis and
treatment of disease.
Extensive differential
diagnosis offered.
Superb
understanding of
etiology,
pathophysiology,
prognosis and
treatment of
disease at a level
well above
classmates.
Extensive,
prioritized
differential
diagnosis offered.
F
C
B
B+
A
Unacceptable history and
physical
exam.
Inadequate
daily
progress notes, Frequent
use of inaccurate or
incomplete information.
Adequate history and
physical exam.
Adequate daily
progress note
monitoring active
problems. Some
minor omissions of
information. Manages
routine patients with
assistance.
Good history and
physical examination.
Good daily progress
notes with some
interpretation of data.
Suggestions for
therapy offered.
Manages routine
patients with some
help.
Complete and
focused history and
physical exam.
Complete progress
notes with
interpretation of data
and in depth
suggestions for
therapy. Manages
routine patients
effectively
Precise, complete,
chronologically
sound history and
physical
examination.
Superb progress
note with
discussion and
management of
complex patients.
Functions nearly
at the level of an
intern.
No evidence of
independent learning.
Does not learn from
errors. Unreceptive to
new ideas.
Minimal independent
learning. Learns
slowly from previous
errors. Reads about
some patients.
Some evidence of
independent learning.
Reads about all
patients, common
disease processes.
Receptive to new
ideas.
Ample evidence of
independent learning.
Seldom makes same
mistake twice.
Reads about patients
and presents finding
Substantial
evidence of
independent
learning. Learns
from others
mistakes. Skillful
in applying
medical articles to
patient care
Comments:
Patient Care Skills
Check appropriate box:
Comments:
Practiced & Based
Learning
Improvement
Check appropriate box:
Comments:
24
Interpersonal &
Communication
Skills
Unable or unwilling to
work
with
others.
Displays consistent lack
of
sensitivity,
compassion, or tack.
Disjointed presentations.
Works reasonably
well within the team.
Attempts to
communicate with
patient. Shows some
awareness of the
psychosocial factors
involved in medicine.
Presentations
ordered, but
somewhat incomplete.
Works to develop
rapport with team and
patients, Shows
awareness of
psychosocial factors
involved in medicine.
Concise
presentations.
Easily develops
rapport with patients,
patients’ family, team
members. Effectively
motivates patients.
Mature, articulate,
presentations.
Assumes
leadership role in
helping patients
and colleagues
perform at their
best. Establishes
rapport under the
most difficult of
circumstances.
Presentations
show high degree
of insight and
synthesis
Unaware
of
factors
contributing to medical
error.
Poor under
standing
of
the
organization of the health
care team and ancillary
services.
Does not
anticipate potential nonmedical problems in
patient care.
Aware of some outside
resources that may
decrease error/ improve
patient care.
Some
understanding of the
role of the physician in
the health care team.
Recognizes that other
factors besides disease
affect patients.
Shows initiative
regarding patient care
issues. Recognizes
the assistance of
ancillary staff in the
care of the medical
patient. Seeks ways
to improve quality of
care for patient
Understands dynamics
that affect patient care
including home life,
family
situation,
economic situation, etc.
Effectively
and
appropriately
utilizes
ancillary staff. Handles
day
to
day
responsibilities well.
Highly effective
member of the
ward team and
greater health care
team as a whole.
Actively engages
ancillary services
when appropriate.
Starts discharge
planning with
admission
Check appropriate box:
Comments:
Systems Based
Practice
Check appropriate box:
Comments:
Professionalism:
All students should be professional and this category does not factor in to the students grade. The vast majority of students should be “appropriate”. The
unacceptable category is indicative of severe underlying problems that need to be addressed, please explain in the comments section below. Likewise,
the exemplary category should be reserved for a select few students who serve as examples for us all- students, residents, and attendings alike.
Unacceptable: please explain below
Appropriate: respectful, punctual,
appropriate attire, respected by peers
Exemplary: please explain below
Comments:
Specific Skills (please initial)
1.
2.
3.
4.
Written History and Physical Examination (8 total)
Observed History and Physical (1/8 weeks)
Presentation of Selected Topics
Writing adequate Daily Progress Notes
________
________
________
________
How many days did student miss from the rotation? ___________
Additional Comments:
Attending/Resident Signature:
Date:
25
NBME Internal Medicine Subject Exam Content
General Principles
1%-5%
Organ Systems
Immunologic Disorders
Diseases of the Blood and Blood-forming Organs
Diseases of the Nervous System and Special Senses
Cardiovascular Disorders
Diseases of the Respiratory System
Nutritional and Digestive Disorders
Gynecologic Disorders
Renal, Urinary, and Male Reproductive System
Disorders of the Skin and Subcutaneous Tissues
Diseases of the Musculoskeletal System and Connective Tissue
Endocrine and Metabolic Disorders
95%-99%
5%-10%
5%-10%
5%-10%
15%-20%
15%-20%
10%-15%
1%-5%
10%-15%
5%-10%
5%-10%
5%-10%
Physician Tasks
Promoting Health and Health Maintenance
Understanding Mechanisms of Disease
Establishing a Diagnosis
Applying Principles of Management
10%-15%
20%-25%
40%-45%
20%-25%
26