Objectives

1. REPORTER
   1. Achieves competence in the following areas:
      • History-taking skills
      • Physical exam skills
      • Written H&Ps and Progress/Transfer/Discharge Notes
      • Oral presentations
      • Identification of patient problems (generating a problem list)
   2. Requires:
      • Effective communication skills to accurately, reliably, and efficiently collect data from patients, families, colleagues, and various other sources
      • Organization and clear presentation (communication) of the data
      • Basic knowledge base to know what to look for and to identify patient problems


2. INTERPRETER
   1. Achieves competence as a "Reporter" and in the following areas:
      • Prioritizing patient problems according to clinical importance/urgency
      • Analyzing and integrating data to formulate an appropriate differential diagnosis for each problem
      • Defending differential diagnosis
   2. Requires:
      • A higher knowledge base with ability to apply knowledge to patient care
      • Clinical judgment to be able to prioritize patient problems
      • Analytical skills and clinical reasoning skills to formulate and defend differential diagnosis based on the collected data


3. MANAGER
   1. Achieves competence as a "Reporter," "Interpreter," and also in the following areas:
      • Developing reasonable diagnostic and therapeutic plans (with several options), tailored to the individual patient's circumstances and continually adjusted in response to new data
      • Reasonable understanding of the pros and cons of each option
      • Coordination and facilitation of care of the patient through the health care system by appropriate and efficient use of, and cooperation with, subspecialty consultants and non-physician members of the health care team
   2. Requires:
      • An even higher knowledge base to know different diagnostic and therapeutic options and their pros and cons
      • Clinical reasoning skills and clinical judgment to thoughtfully adjust management plans according to the individual patient and to new data (i.e., clinical decision-making skills)
      • Knowledge base, problem-solving skills, clinical judgment, organizational and prioritizing skills to effectively and efficiently coordinate patient care


4. EDUCATOR
   1. Achieves competence as a "Reporter," "Interpreter," "Manager," and also in the following areas:
      • Posing insightful questions above and beyond basic knowledge base and independently seeking answers
      • Sharing new knowledge with team members and others
      • Taking initiative/responsibility for education of team and others
   2. Requires all of the above, plus:
      • Extensive, in-depth reading with self-directed learning traits and appropriate, basic EBM skills
      • Leadership


5. PROFESSIONALISM
   1. Demonstrate the following humanistic and professional qualities:
      • Altruism: always putting patients' interests before your own
      • Duty: reliability, responsibility, accountability, conscientiousness, and dedication to patient care
      • Caring, Compassion, and Communication
      • Excellence and Scholarship: through self-awareness
      • Respect for others: professional working relationships with patients, staff, faculty, and students
      • Honor and integrity

Expectations

1. ATTENDANCE
   • Students will be on service Monday through Friday and work out one weekend day off with the team, depending on the team's call schedule; i.e., weekdays are not to be taken off due to all of the scheduled clinical and didactic teaching sessions.
   • Students must call both the clerkship coordinator (Patty Neureiter) and team resident ASAP when unforeseen emergencies arise causing absence or tardiness; otherwise, the absence or tardiness will be considered unexcused.
   • Days off for interviewing are not permissible (School of Medicine policy).


2. OVERNIGHT CALL
   • Required at all hospital sites—every 4th to 5th night, depending on hospital site (exception is St. Vincent's ICU which is shift work with a week of nights). In order for the number of call nights to be equitable across all hospital sites, those students on Q5 night call systems are expected to take all calls for the month (5-6 calls per month), while those students on Q4 night call systems are expected to take a minimum of 5-6 calls per month - extra calls are optional.


3. PATIENT CARE DUTIES AND WORKLOAD
   • With close supervision and guidance from the team's resident and attending, students are expected to take primary responsibility for the care of their patients—i.e., act as interns—but know your limitations and ask for help! This is the time to further hone your Reporting and Interpreting skills while learning and developing your Management skills (R-I-M-E).
     • - Be present and actively participate from pre-rounds through sign-out rounds
     • - Keep a constant and open channel of communication with your resident to insure work gets done appropriately and efficiently.
     • - Have your orders co-signed ASAP, always!
   • Caps on patient load: no more than 3 new patient workups per call night. Each student's patient load should not exceed 6 patients at any one time (this number may be smaller in the ICU setting).


4. H&Ps AND OTHER NOTES
   • Students' admit notes on new patients should be placed in the patient's chart shortly after admission.
   • Students are expected write daily progress notes on his/her patients and get these notes edited and co-signed by the team resident before leaving the hospital.
   • Students are expected to write transfer and discharge summaries and off-service notes on their patients.


5. CONFERENCES / LECTURES
   • Attendance at all of these sessions is required for all students. The number and type depend on each hospital site.


6. EXPANDING KNOWLEDGE BASE
   • Students are expected to aggressively engage in expanding their knowledge base about their patients' problems. New knowledge acquisition should come from reading reference textbooks of internal medicine and subspecialty medicine (or equivalent resource such as UpToDate™), searching the medical literature for best evidence, and discussions with subspecialty consultants.
   • Students are expected to practice evidence-based medicine (EBM) by formulating pertinent, focused clinical questions and appropriately searching and appraising the literature. This EBM approach will be apparent during discussions on rounds and should be reflected in the A/P portion of your notes.
   • Students are expected to complete the following web-based (ANGEL) modules before finishing the rotation:
     • - Procedural Quizzes: emphasis on the importance of knowing the indications, contraindications, and complications of common medical procedures.
     • - Substance Abuse (including the post-test): modules on drug withdrawals and toxicities.


7. MID-MONTH FEEDBACK FORM
   • Each student is expected to give this form to his/her team attending and resident at mid-rotation for discussion of the student's performance thus far and for constructive feedback with some specific plans for improvement. The form must be returned to Patty Neureiter afterwards. Students are strongly encouraged to self-reflect to assess your own performance before these mid-rotation feedback sessions in order to optimize their usefulness for you.


8. PATIENT MIX TRACKING - this is a School requirement mandated by the LCME
   • Students are expected to log their exposures to patient mix on a consistent basis and review their log reports regularly to identify experiential gaps throughout the sub-internship. Students are required to print out a report of their logs at mid-rotation for Dr. Vu to review; turn this report into the Chief Resident’s Assistant or faxed to Patty at 630-2667.