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MEDICINE CLERKSHIPS

Click on the programs below for more information about each clerkship.  If you are interested a particular one, contact the Office of Academic Affairs at (215) 829-8764.


Ambulatory Care Internal Medicine

Provides clinical exposure to a wide variety of medical experiences relevant to the practice of general internal medicine in the ambulatory setting, including opportunities to participate in various subspecialty clinics. Faculty supervision provides ample opportunity for one-to-one teaching, and students are encouraged to assume responsibility for clinical decision making at levels appropriate to their experience.

Although a four-week clerkship does not allow for continuing patient care, conferences and clinical experiences enable students to better understand the principles or primary care: clinical epidemiology, periodic health examinations, screening for disease, psychosocial aspects of health and illness, nutrition and medicine, and in-depth discussion of common ambulatory problems. Students work with interns and residents assigned to these clinics and contribute to daily teaching conferences in the primary care curriculum. They also participate in daily conferences on common diseases in primary care, as well as daily medical subspecialty conferences.


Clinical Cardiology

This elective aims to teach the student about the diagnosis and management of common cardiac disorders. The importance of history taking and physical examination in clinical evaluation of the patient is emphasized. Students are exposed to non-invasive testing (exercise tests, echocardiography with Doppler flow studies, electrocardiography, nuclear imaging) and invasive testing (cardiac catheterization, coronary angioplasty). These goals are achieved through the students’ participation in inpatient rounds with the designated staff cardiologist and Coronary Care Unit Rounds.

Students will also be encouraged to participate actively in the cardiologist offices and can perform cardiac consultations under attending supervision. A core curriculum of lectures is offered. Intensive instructions on the physical examination of the cardiac patient are a key element of the course.


Critical Care Medicine

The student will spend four weeks as a working member of the critical care team. He or she will work-up patients who are admitted to the combined Medical Intensive Care/Coronary Care Unit under the supervision of the critical care residents and attendings. The student will have the opportunity to perform many bedside procedures that are routinely done in the critical care units. Formal rounding will take place each day the Pulmonary and Cardiology staff.

The student is expected to take night call every fourth night. Emphasis is placed on ventilator management, invasive hemodynamic monitoring and problem-oriented assessment and management of critically ill patients. The critical care team is responsible for responding to all cardiac arrests in the hospital. The goal of the course is to provide the student with clinical experience in the broad field of critical care medicine, which encompasses both cardiac and multi-system disease.


Emergency Medicine

Under direct faculty supervision, students develop the ability to rapidly evaluate patients and plan the management of a spectrum of medical, surgical, obstetrical and orthopaedic problems. They are given excellent opportunity to sharpen their history taking and clinical skills as they have initial contact and are primary caretakers of their patients. They will be instructed on and encouraged to perform routine procedures such as wound prep and suturing, splinting, IV, foley, and NGT insertion, ABG and venipuncture. Students are on duty in Emergency Services approximately 40 hours per week on rotating shifts and participate in all regularly scheduled Emergency Medicine conferences offered by the Pennsylvania Hospital Emergency Attending Staff.


Clinical Endocrinology

The clinical endocrinology program allows the student to develop the skills needed to diagnose and treat patients with various endocrine problems using their own basic and clinical knowledge. The student will learn to identify the typical and atypical features of endocrine disorders, their presentation, clinical course and expected outcome. The student will also improve his or her ability to perform a comprehensive physical diagnosis of the endocrine system; order, perform and interpret endocrine tests and make important decisions that affect therapeutic outcomes. This is achieved by utilizing all of the services available to the Section on Endocrinology and Metabolism.

The student is supervised by Endocrinology faculty and has the opportunity to evaluate patients and make clinical decisions during hospital rounds and outpatient visits in private offices and the Endocrine Clinic. The student also works with the consulting resident while performing inpatient endocrine consultation. Ample time to follow patients through surgery, review ultrasound, CT and MRI studies and examine results from fine needle aspiration biopsies is provided.

In addition to daily patient rounds, teaching is provided by Endocrinology Faculty during daily office and clinic hours, and conferences which cover the core of endocrinology. Ample time is allowed for reading and literature searches. Night and weekend coverage is not required.


Gastroenterology

The gastroenterology rotation enables students to witness gastroenterologic consultations on a first-hand basis and then present the cases to the fellow and attending physicians in the section. Students will also observe several types of gastroenterologic endoscopic procedures on a daily basis, including upper gastrointestinal endoscopy and cessation of hemorrhage from ulcer disease, colonoscopy and colonoscopic polypectomy, endoscopic retrograde cholangiopancreatography and sphincterotomy with stone extraction and biliary stent placement.

Students will also observe new technological advances in endoscopic ultrasonography and laser therapy for ablation of esophageal and rectal malignancies. Didactic clinical case conferences are held twice each week with pathologists and general surgeons.


Hematology and Medical Oncology

A rotation through hematology and medical oncology at Pennsylvania Hospital will provide students with a broad exposure to both subspecialty areas. Daily inpatient rounds and consultations will be coupled with extensive emphasis on outpatient treatment, evaluations and follow-up. A multidisciplinary approach to the management of malignancies is emphasized by regular cancer conferences with other specialty areas. The goal is to provide an overall conceptual approach to oncology, dealing with general medical, oncologic and psychosocial issues.


Infectious Disease

The Infectious Disease Section provides consultative service for adult medical, surgical and OB/YN patients, providing opportunities for broad exposure to all types of disease-related illnesses. As consultants, students have initial contact with patients and work with attending staff and fellows to formulate diagnostic and therapeutic plans. These plans are presented daily to the teaching attending for discussion and review. Students are expected to follow their patients for the duration of the patients’ active infectious illness.

There will also be exposure to the Microbiology Laboratory where students will obtain a basic knowledge of antibiotic susceptibility testing and develop proficiency at interpreting gram stains.

By the end of the rotation, students should be capable of explaining the indications for and mechanisms of action on the commonly used antibiotics and understanding the pathogenesis and pathophysiology of common infectious diseases. Students are required to have completed all basic clinical clerkships prior to enrolling in this course. Prior completion of a sub-internship in internal medicine is preferred but not required.


Medicine Sub-Internship

A general medical subinternship with significant student responsibility for the care of hospitalized acutely ill patients. Provides experience with diagnostic and therapeutic procedures. Students learn to work efficiently and rapidly, and to trust their clinical skills, leading to better preparation for the work load and responsibilities of internship. Faculty supervision provides ample opportunity for one-to-one teaching.

Students will be members of the inpatient team, which includes a teaching attending, supervising resident, and two interns. Students will be expected to admit new patients during call days, write up and present cases to the attending physician, and have direct responsibility for all diagnostic procedures and management decisions related to these cases. Students gain experience in writing orders and progress notes, and taking night coverage team admissions.

In addition to direct patient care responsibilities, students actively participate in three hours of didactic teaching sessions daily. These conferences include teaching attending Rounds, daily Morning Report and Noon conferences. The daily Noon conferences are divided into subspecialty conferences, weekly Medical Grand Rounds and multi-disciplinary conferences including CPC’s.


Pulmonary Diseases and Critical Care Medicine

In addition to exposure to acute care medicine in an intensive care setting, the elective in pulmonary diseases and critical care medicine will offer students a broad exposure to a wide variety of pulmonary diseases and disorders.

Students are expected to make daily rounds, Monday through Friday, with both house and attending staffs. Rounds commence daily at 7:30 a.m. in the Intensive Care Unit Conference Room. This exercise will expose students to a wide variety of disorders characterized by acute respiratory failure. It will also provide an opportunity to familiarize the student with ventilator management. Students will be asked to write up consults on any new admissions with respiratory failure.

In addition, students will be asked to see consultations that are placed with the Pulmonary Disease Service. This will provide exposure to a wide variety of acute, sub-acute, and chronic lung disorders of hospital patients. Students will be asked to evaluate the patients and later in the day present the patients to one of the attending physicians on the Pulmonary Disease Service. In addition to performing an initial evaluation and presentation, students will be expected to complete independent library research on questions of interest.

Students will be provided an opportunity to interact with all members of the attending staff in the Section on Pulmonary Diseases and Critical Care Medicine. They will be exposed to pulmonary function study interpretation, radiograph interpretation and general management issues in the day-to-day care of patients with pulmonary disorders.


Renal Diseases and Hypertension

Offers students the opportunity to participate in an active nephrology program involving acute and chronic renal diseases, fluid and electrolyte disturbances, acid-based abnormalities, peritoneal dialysis and hemodialysis. Basic physiologic mechanisms are stressed, particularly as they relate to clinical nephrology. Students are taught to perform and interpret urinalysis and clearance measurements.

Students observe nephrology consultations and work up new patients admitted to the clinical services. Students also present new cases to the attending physician, participate in daily teaching rounds and observe peritoneal dialysis, hemodialysis, and renal biopsies. Renal conferences permit active student participation. Extensive reprint files are available as educational aids.


Rheumatology

The clinical and pathophysiological study of rheumatic diseases with emphasis on differential diagnosis of arthritis and connective tissue disease, synovial fluid analysis, serologic and radiographic interpretation, and management. Rheumatology as it pertains to general internal medicine is stressed. Patient workups, rounds, clinic, and inpatient consultations. Provides an opportunity for close faculty supervision.

 



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