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Internal Medicine Clerkship MMED 700 12 Credit Hours
SYLLABUS
2019-2020 ACADEMIC YEAR
Education Director: Stuart Kiken, MD [email protected]
Clinical Education Specialist: Tonya Dixon, EdD, MSN, MBA, MPH, RN [email protected]
Undergraduate Medical Education Specialist: Marissa McCarthy [email protected] 847-578-3338 RWCLC 1.090
7/24/19 1 CLERKSHIP DESCRIPTION
The 3rd year Internal Medicine Clerkship in an 8-week (primarily inpatient) rotation that is available at the following sites: Advocate Christ Hospital, Advocate Illinois Masonic Medical Center, Advocate Lutheran General Hospital, Captain James A. Lovell Federal Healthcare Center, Centegra Health Systems, John H. Stroger Cook County Hospital, Little Company of Mary Hospital, MacNeal Hospital , Weiss Memorial Hospital, and the Billings Clinic. The curriculum covers core topics in internal medicine. Learning activities include case discussions, lectures and clinical exercises. Feedback is given by the site directors, teaching attendings and housestaff. A Shelf Exam is given at the end of the rotation. Evaluation tools include:
• Direct observation by faculty • Performance of a Mini-CEX (Clinical Evaluation Exercise) • Performance of an Oral Presentation Exercise • Completion of Chest X-ray reading, Interprofessionalism Exercise and Evidence Based Medicine discussion • Completion of all required minimum encounters (on the Patient Log)
CLERKSHIP OBJECTIVES
1. Perform medical, diagnostic and surgical procedures essential for the internal medical area of practice within the clerkship. (1.1)
2. Perform reliable history and physical examinations by gathering essential and accurate patient information in addition to the physical examination, interpreting laboratory data and other tests results. (1.2, 1.4)
3. Develop, organize and carry out patient management plans that are safe and effective. (1.3, 1.6)
4. Demonstrate informed decision making using current technology to search for, evaluate and apply biomedical information and evidence in the care of patients. (1.5, 2.1, 3.6, 3.7)
5. Demonstrate interpersonal communication skills with patients, families, peers and other healthcare professionals through effective listening and written practices that support a team approach for the promotion and maintenance of health and the education of patients and their families. (1.7, 3.8, 4.1, 4.2, 4.3, 4.5, 4.6, 4.7, 7.3)
7/24/19 2 6. Describe the normal and abnormal bio-physical and clinical scientific principles underlying mechanisms and methods of diagnostic and therapeutic decision-making and clinical problem-solving of care in emergent and non-urgent internal medicine cases. (2.2, 2.3)
7. Describe epidemiological and social-behavioral scientific principles underlying the identification of health problems, risk factors, preventative and health promotion strategies and cultural influences impacting patients and populations in emergent and non- urgent internal medicine cases. (2.4, 2.5)
8. Identify one’s own strengths, limitations, biases, learning needs, and vulnerabilities to improve oneself and positively impact patient care through self-reflection and seeking feedback from others. (3.1, 3.2, 3.3, 3.5, 8.1)
9. Demonstrate respect, compassion, integrity and ethical decision-making in patient care. (4.6, 4.7, 5.1, 7.1)
10. Identify one’s own role on the team and how it relates to other members of the healthcare team to advance the health of patients and populations served. (7.2)
Reference D2L for COMPETENCY MAP
CLERKSHIP-SPECIFIC PERFORMANCES, PROJECTS, REQUIREMENTS
1. Complete and electronically sign, via Qualtrics, the Clerkship Acknowledgment and Secure Storage Attestation by end of week 1 (Sunday at midnight). This will be emailed to you the first day.
2. Attend a mandatory all-day Palliative Care workshop and Simulation Lab at the RFU Center for Advanced Simulation at Huntley, typically on the 3rd Tuesday of the rotation. Email reminders will be sent. Schedules posted on D2L.
3. Report to the mandatory Interprofessional Clinic at the Indian American Medical Association Charitable Fund Clinic, for one half-day only (Wednesday afternoon) during the 8-week rotation. You must report to your assigned site for morning clinicals. Email reminders will be sent. Schedule posted on D2L.
4. Complete the Student Midterm Self Evaluation form found on D2L under Clerkship Requirements and give a hard copy to your Site Director at your face-to-face midterm evaluation. Complete this by end of week 4 (Sunday at midnight).
7/24/19 3 5. Complete the following activities found on D2L under Clerkship Requirements and upload to the appropriate D2L Dropbox by end of week 4 (Sunday at midnight): • Oral Presentation Exercise – can be graded/observed by teaching attending, senior resident or intern • Midterm Self Evaluation (see #4 above). • 16 patient logs on one45 (½ of what is required).
6. Complete the following activities found on D2L under Clerkship Requirements and upload to the appropriate D2L Dropbox by end of week 5 (Sunday at midnight): • Mini-CEX (Clinical Evaluation Exercise) – can be graded/observed by teaching attending, senior resident or intern. • CXR Exercise (2 forms must be submitted) – can be graded/observed by teaching attending, senior resident, intern or radiologist.
7. Complete the following activities found on D2L under Clerkship Requirements and upload to the appropriate D2L Dropbox by end of week 6 (Sunday at midnight): • EBM (Evidence Based Medicine) Exercise • IP (Interprofessionalism) Exercise – assignment MUST be TYPED – no handwritten submissions will be accepted.
8. Complete the patient logs on one45 (32 entries) by end of week 7 (Sunday at midnight). If you have not seen the correct number and distribution of patients by then, you will be required to complete additional computer cases or see assigned patients by the end of the 8th week. (By the end of the 4th week, you should have at least 16 entries). The list of required categories that need to be satisfied are as follows: • Cardiology (5) • Endocrinology (3) • Gastroenterology (3) • General Internal Medicine (2) • Hematology/Oncology (3) • Infectious Disease (5) • Neurology (2) • Pulmonary (5) • Renal (3) • Rheumatology (1)
7/24/19 4 9. Complete the following Aquifer Internal Medicine/High Value Care computer cases by end of week 7 (Sunday at midnight): • IM Case #1 49 y/o man with chest pain • IM Case #21 78 y/o man with fever, lethargy and anorexia • IM Case #22 71 y/o man with cough and fatigue • IM Case #25 75 y/o woman hospitalized with confusion • IM Case #33 49 y/o woman with confusion • High Value Care Case #5 78 y/o woman – high value care in the inpatient setting • High Value Care Case #9 66 y/o woman – redefining value at end of life
10. Complete the following online exercises (no submission to D2L; requirement isn’t tracked – this is merely for your edification) by end of week 7 (Sunday at midnight): • EKG: https://www.practicalclinicalskills.com/ i. Basics ii. Practice Drills (complete at least 20) iii. Quiz (complete all 20) • Must complete Competency Quiz in reading EKGs and basic knowledge of medical issues encountered and common exams performed (on D2L under the “quizzes” tab) by end of week 7 (Sunday at midnight). Must receive 80% to pass. Retake quiz until passed. There is an unlimited number of times to take the quiz. Review with Education Director if assistance is required until successfully able to obtain passing score on quiz.
11. Complete the “End of Clerkship Survey” on D2L. This is assigned on the day of the final exam and is due by the following Monday.
12. Administrative Professionalism is a clerkship requirement, independent of any specific timeline. It is found on the Content tab of D2L Clerkship Requirements & Forms Administrative Professionalism (see policy/requirements). Any reflections for administrative professionalism, that are required, are to be submitted to the D2L Dropbox entitled Administrative Professionalism Reflections.
Remediation of Clerkship-Specific Performances: • Students who do not complete all clerkship requirements by 11:59 pm on Sunday following the clerkship end date will receive an Unsatisfactory for “Clerkship-Specific Performances, Requirements or Activities,” resulting in a temporary notation of Needs Remediation for the clerkship. • Students will have one additional week (ending at 11:59 pm the following Sunday) to remediate any missing/insufficient requirements. • Per the CMS Clerkship Grading Policy, if the student passes the remediation, they will receive a grade of “Pass” for the rotation. If the student fails to remediate within this one-week remediation period, they will receive a grade of “Fail” for the rotation.
7/24/19 5
REQUIRED PATIENT ENCOUNTERS
Type of Patient/ Clinical Level of Student Benchmark/Explanation Alternative Clinical Condition Setting Responsibility Cardiology (5 required) I, O FP FP: Student will fully participate by completing a Education director will ask the site history and physical, evaluating laboratory data and director to assign student to a patient • Chest Pain: 1 test results, generating a differential diagnosis, with a cardiology problem or education • Coronary Artery Disease: 1 devising a treatment plan and following the patient director will assign an appropriate • Dyslipidemia: 1 during their hospitalization. Aquifer Internal Medicine computer case • Heart Failure: 1 (1, 2, 3, 4, or 6). Education director will • Hypertension: 1 PP PP: Student will be involved in a discussion about a then verify that student has seen the patient that includes reviewing the differential patient or completed the case. diagnosis and treatment plan, which can occur on rounds or at a conference. Endocrinology (3 required) I, O FP FP: Student will fully participate by completing a Education director will ask the site history and physical, evaluating laboratory data and director to assign student to a patient • Diabetes:1 -2 test results, generating a differential diagnosis, with an endocrinology problem or • Other (e.g. Pituitary devising a treatment plan and following the patient education director will assign an Disease, Thyroid Disease): during their hospitalization. appropriate Aquifer Internal Medicine 1-2 computer case (7, 8, or 13). Education PP PP: Student will be involved in a discussion about a director will then verify that student has patient that includes reviewing the differential seen the patient or completed the case. diagnosis and treatment plan, which can occur on rounds or at a conference. Gastroenterology (3 required) I, O FP FP: Student will fully participate by completing a Education director will ask the site history and physical, evaluating laboratory data and director to assign student to a patient • Abdominal Pain: 1-2 test results, generating a differential diagnosis, with a gastroenterology problem or • Gastrointestinal Bleeding: devising a treatment plan and following the patient education director will assign an 1 - 2 during their hospitalization. appropriate Aquifer Internal Medicine • Other (e.g. Cirrhosis, computer case (9, 10, 11, 12, or 36). Diarrhea, Hepatitis, IBD, PP PP: Student will be involved in a discussion about a Education director will then verify that Pancreatitis, Peptic Ulcer patient that includes reviewing the differential student has seen the patient or Disease, Vomiting): 0-1 diagnosis and treatment plan, which can occur on completed the case. rounds or at a conference.
7/24/19 6 Type of Patient/ Clinical Level of Student Benchmark/Explanation Alternative Clinical Condition Setting Responsibility General Internal Medicine I, O FP FP: Student will fully participate by completing a Education director will ask the site (2 required) history and physical, evaluating laboratory data and director to assign student to a patient test results, generating a differential diagnosis, with a general internal medicine problem • Pain Management: 1 devising a treatment plan and following the patient or education director will assign an • Substance Abuse (e.g. during their hospitalization. appropriate Aquifer Internal Medicine Alcohol, Opioids, Tobacco): computer case (15, or 16). Education 1 PP PP: Student will be involved in a discussion about a director will then verify that student has patient that includes reviewing the differential seen the patient or completed the case. diagnosis and treatment plan, which can occur on rounds or at a conference. Hematology/Oncology I, O FP FP: Student will fully participate by completing a Education director will ask the site (3 required) history and physical, evaluating laboratory data and director to assign student to a patient test results, generating a differential diagnosis, with a hematology/oncology problem or • Anemia: 1 devising a treatment plan and following the patient education director will assign an • DVT: 1-2 during their hospitalization. appropriate Aquifer Internal Medicine • Other (e.g. Bleeding, computer case (17, 19, or 27). Education Complications of Cancer, PP PP: Student will be involved in a discussion about a director will then verify that student has Hematologic Malignancy, patient that includes reviewing the differential seen the patient or completed the case. Palliative Care, Solid Tumor, diagnosis and treatment plan, which can occur on Thrombocytopenia): 0-1 rounds or at a conference. Infectious Disease (5 required) I, O FP FP: Student will fully participate by completing a Education director will ask the site history and physical, evaluating laboratory data and director to assign student to a patient • Fever: 1-2 test results, generating a differential diagnosis, with an infectious disease problem or • Pneumonia: 1-2 devising a treatment plan and following the patient education director will assign an • Urinary Tract Infections: 1-2 during their hospitalization. appropriate Aquifer Internal Medicine • Other (e.g. Bacteremia, computer case (14, 15, 20, 21, or 24). Cellulitis, HIV, Infectious PP PP: Student will be involved in a discussion about a Education director will then verify that Diarrhea, Nosocomial patient that includes reviewing the differential student has seen the patient or Infection): 0-2 diagnosis and treatment plan, which can occur on completed the case. rounds or at a conference.
7/24/19 7 Type of Patient/ Clinical Level of Student Benchmark/Explanation Alternative Clinical Condition Setting Responsibility Neurology (3 required) I, O FP FP: Student will fully participate by completing a Education director will ask the site history and physical, evaluating laboratory data and director to assign student to a patient • Altered Mental Status: 1 test results, generating a differential diagnosis, with a neurology problem or education • Dementia: 1 devising a treatment plan and following the patient director will assign an appropriate • Syncope: 1 during their hospitalization. Aquifer Internal Medicine computer case (18 or 26). Education director will then PP PP: Student will be involved in a discussion about a verify that student has seen the patient patient that includes reviewing the differential or completed the case. diagnosis and treatment plan, which can occur on rounds or at a conference. Pulmonary (5 required) I, O FP FP: Student will fully participate by completing a Education director will ask the site history and physical, evaluating laboratory data and director to assign student to a patient • Asthma: 1-2 test results, generating a differential diagnosis, with a pulmonary problem or education • COPD: 1-2 devising a treatment plan and following the patient director will assign an appropriate • Dyspnea: 1-2 during their hospitalization. Aquifer Internal Medicine computer case • Other (e.g. Lung Cancer, (22, 28, 29, or 30). Education director will PE): 0-1 PP PP: Student will be involved in a discussion about a then verify that student has seen the patient that includes reviewing the differential patient or completed the case. diagnosis and treatment plan, which can occur on rounds or at a conference. Renal (3 required) I, O FP FP: Student will fully participate by completing a Education director will ask the site history and physical, evaluating laboratory data and director to assign student to a patient • Electrolyte and Acid-Base test results, generating a differential diagnosis, with a renal problem or education Disorders: 1-2 devising a treatment plan and following the patient director will assign an appropriate • Renal Failure: 1-2 during their hospitalization. Aquifer Internal Medicine computer case (23, 25, or 33). Education director will PP PP: Student will be involved in a discussion about a then verify that student has seen the patient that includes reviewing the differential patient or completed the case. diagnosis and treatment plan, which can occur on rounds or at a conference.
7/24/19 8 Type of Patient/ Clinical Level of Student Benchmark/Explanation Alternative Clinical Condition Setting Responsibility Rheumatology (1 required) I, O FP FP: Student will fully participate by completing a Education director will ask the site history and physical, evaluating laboratory data and director to assign student to a patient • Joint Pain: 1 test results, generating a differential diagnosis, with a renal problem or education devising a treatment plan and following the patient director will assign an appropriate during their hospitalization. Aquifer Internal Medicine computer case (31, 32, or 34). Education director will PP PP: Student will be involved in a discussion about a then verify that student has seen the patient that includes reviewing the differential patient or completed the case. diagnosis and treatment plan, which can occur on rounds or at a conference.
REQUIRED AND RECOMMENDED CLERKSHIP MATERIALS
Reading: • Harrison’s Principles of Internal Medicine, 19th Edition • Step-Up to Medicine, 4th Edition
Practice Questions: • IM Essentials (formerly MKSAP for students). American College of Physicians. • UWorld: http://www.uworld.com/ o It is recommended that you complete at least 1,000 UWorld questions.
EVALUATION, EXAMINATION, AND REMEDIATION POLICIES
Refer to D2L for:
• CMS Clerkship Absence Policy document for examination and other clinical experience remediation guidelines. • Clerkship Absence Request Form • CMS Clerkship Grading Policy • Clinical Evaluation Standards • Required Minimum Patient Encounters are included in the syllabus and indicate specific patient type/clinical condition remediation guidelines.
7/24/19 9 • CMS Exam Conduct Policy • RFUMS Exam Loaner Laptop Policy • CMS Clerkship Retake/Rescheduled Exam Policy • RFU Remediation Policy
NBME Online Shelf Exam:
The NBME Online Shelf Exam is typically held at the RFUMS Campus on the last Friday of the rotation from 9:00 a.m. to 12:00 p.m. However, please refer to D2L for the most recent updates.
The NBME is responsible for grading exams. No challenges are accepted for NBME exams. Scores will be available approximately 1-2 weeks after the exam has been completed, but will not be published until clinical evaluations have been received.
In general, Clerkship Directors will determine how the student will make up patient encounters, clinical activities or other clerkship requirements. Clerkship Directors will determine if and when the student will be required to repeat the clerkship. Clerkship Directors will use case-by- case evaluation and coordinate with the Office of Student Affairs & Education.
CMS Remediation Procedures:
Eligibility Criteria for Remediation: At the end of the rotation, students who have an unsatisfactory/failing grade in any of the applicable course components (final exam, clinical evaluation, and/or performances) will be offered remediation for the component(s) they have failed.
Process for Remediation: Students are required to take exams, if applicable, as scheduled and in the proscribed manner outlined in the CMS Clerkship Retake/Rescheduled Exam Policy. Clinical evaluations and/or rotation-specific performances requiring remediation will be addressed by the Education Director based upon the deficits.
Remediation Grading Outcomes: If the student passes the remediation, they receive a grade of “Pass” for the rotation. If the student fails the remediation, they receive a grade of “Fail” for the rotation. A failure will result in the student repeating all or part of the rotation at the discretion of the Education Director, in consultation with the Assistant Dean of Clinical Education.
Maximum number of attempts to remediate: Students will have one opportunity to pass a remediation.
7/24/19 10 Please reference the following additional Polices and Guidelines posted to D2L:
• SEPAC Handbook • SEPAC Policy • Clinical Grade Appeal Policy • Clerkship/Sub-Internship Grade Appeal Form • Student Policies Handbook • Testing Accommodations Guidelines • CMS Learner Mistreatment Policy and Procedures • Medical Student Work Hours Policy • Off-Site Secure Storage Policy • Teacher-Learner Expectations • CMS Professionalism Policy and Procedures • CMS Dress Code Policy • Ebola Virus Policy • Exposure Incidents Policy • Alcohol and Drug Use Policy
Administrative Professionalism in Internal Medicine:
This type of professionalism refers to the non-clinical aspects of professionalism. Physicians and medical students demonstrate their administrative professionalism in many ways. Some aspects of administrative professionalism address timely completion of medical records, timely communication with patients and peers, presentation for didactic sessions and committee work on time, and being dressed in a professional manner.
Examples of infractions in administrative professionalism include: • Unexcused tardiness for required CMS-sponsored didactics (excludes the affiliate site didactics that are provided to students only assigned to that site) • Unexcused tardiness for simulation activities • Unexcused assignments turned in after clerkship-specific stated deadlines • Unexcused remediation of assignments submitted after established deadlines
7/24/19 11 The deadlines for clerkship requirements are posted in D2L under “Clerkship Requirements & Forms.” *Note: The list of administrative infractions for this requirement includes the examples mentioned above. This list is not all-inclusive.
Administrative professionalism is a clerkship requirement for the Internal Medicine clerkship. It must be passed in order to pass the clerkship. For the administrative component of professionalism, students will be assessed using the 3-strike (infraction) rule.
• First strike (infraction): The Education Director or his/her designee will contact the student informing him/her of the specific infraction and any required remediation. • Second strike (infraction): The Education Director or his/her designee will contact the student and inform them of the second infraction with notification that third infraction will affect their professionalism grade. • Third strike (infraction): The student will fail the administrative professionalism requirement, which will result in a decrease in one of the Clinical Professionalism grade the student received (i.e. High Pass to Pass).
The Clerkship Policy states that any unexcused absence may result in a decrease in one level of the professionalism grade for any required clerkship activity such as a lecture or simulation workshop (refer to the CMS Clerkship Grading Policy).
For any infractions beyond three, the Education Director will meet with the student and determine whether an overall failure of the professionalism component is warranted. Failure of the overall professionalism component will result in a grade of Needs Remediation. Upon successful remediation, the highest attainable grade in the clerkship is a PASS. If remediation is not successful, the student will fail the clerkship.
The Education Director is responsible for determining the administrative infractions, appropriate remediation(s), identifying remediation activities and deciding when remediation is successful. In addition, the Education Director can determine any additional administrative professionalism infractions as serious. For these, the 3-strike rule may not apply. An infraction that is deemed serious will be addressed on a case-by-case basis. One example would be signing-in for another student at didactic sessions.
The remediation for any/all of the 3 infractions may include one or more of the following remediations: • Writing a reflection on the type of infraction and how it may affect one’s professionalism when a physician • Referral to the Professionalism Committee • Referral to the SEPAC Committee • Meeting with another specified faculty member • Any additional remediation appropriate to the infractions
7/24/19 12 Holiday Schedule:
You must follow the holiday schedule for your site, not Chicago Medical School's schedule.
Weather Emergencies:
If the University is closed due to extreme weather, check with your clinical site regarding its status. Unless otherwise directed by your Site Director, you should go to your clinical site.
ACADEMIC ACCOMMODATION
Rosalind Franklin University of Medicine and Science is committed to providing equal access to learning opportunities for students with documented disabilities. To ensure access to this class and your program, please contact the ADA Coordinator at 847.578.8354 or [email protected] to engage in a confidential conversation about the process for requesting accommodations in the classroom and clinical settings.
Accommodations are not provided retroactively. Students are encouraged to register with the ADA Coordinator as soon as they begin their program. Rosalind Franklin University of Medicine and Science encourages students to access all resources available. More information can be found on the Academic Support InSite page or by contacting the ADA Coordinator.
7/24/19 13 SITE DIRECTORS, FACULTY AND STAFF
Advocate Christ Hospital Centegra Health Systems Site Director: Dr. Lee Tai Site Director: Dr. Ted Lorenc [email protected] [email protected] Site Coordinator: Ruth Mrochen Site Coordinator: Edie Best [email protected] [email protected]
Advocate Illinois Masonic Medical Center Site Director: Dr. Jim Dunphy Little Company of Mary Hospital [email protected] Site Director: Dr. Kent Armbruster Site Coordinator: DeB Anderson [email protected] [email protected] Site Coordinator: Geri Kieffer Admin: Maria Garcia [email protected] [email protected] John H. Stroger Cook County Hospital Advocate Lutheran General Hospital Site Director: Dr. Michael Alebich Site Director: Dr. Brenda Affinati [email protected] [email protected] Site Coordinator: Dixie Dominguez Site Coordinator: Marisol Hernandez-Martinez [email protected] [email protected] MacNeal Hospital Billings Clinic Site Director: Dr. Jennifer Sardone-Ponnappan Site Director: Dr. Keith Davis [email protected] [email protected] Site Coordinator: Jakki Persak Site Coordinator: Kristina McComas [email protected] [email protected] Weiss Memorial Hospital Captain James A. Lovell Federal Healthcare Center Site Director: Dr. Sabah Khan Site Director: Dr. Ashley Wang [email protected] [email protected] Site Coordinator: Karen Verga Site Coordinator: Alan Taylor [email protected] [email protected]
7/24/19 14 CLERKSHIP SCHEDULE FOR 2019-2020
1. July 8 to August 30, 2019 • IM Orientation at CMS: July 8, 2019 • SIM/EEC: July 23, 2019 2. September 2 to October 25, 2019 • IM Orientation at CMS: September 3, 2019 • SIM/EEC: September 17, 2019 3. October 28 to December 20, 2019 • IM Orientation at CMS: October 28, 2019 • SIM/EEC: November 12, 2019 4. January 6 to February 28, 2020 • IM Orientation at CMS: January 6, 2020 • SIM/EEC: January 14, 2020 5. March 2 to April 24, 2020 • IM Orientation at CMS: March 2, 2020 • SIM/EEC: March 17, 2020 6. April 27 to June 19, 2020 • IM Orientation at CMS: April 27, 2020 • SIM/EEC: May 12, 2020
CONTACT HOURS
Lectures 40 Small Group Discussion 20 Patient Contact 360 Online learning 8 Exams 4 Simulation/EEC 8 TOTAL 440
7/24/19