Internal Medicine is a 12 week core rotation. During this experience, the student performs complete histories and physical examinations, becomes proficient in case write-ups and presentations, learns about clinical charts and record keeping, and is introduced to the health-care team, the laboratory, the radiologic services, and other ancillary facilities.
The student is expected to develop a logical approach to the diagnosis and treatment of patients’ complaints. Some of the skills that must be acquired and refined are: how to elicit and assess patient information; how to perform a complete and accurate physical examination; how to formulate a differential diagnosis and problem list; how to construct a diagnostic workup and a plan of management; and how to write up and present cases.
The student thoroughly studies at least two new patients per week, presents them on teaching rounds, follows them throughout their hospital stay, and uses his or her patients’ problems as a basis for reading. A large amount of experience-based knowledge should be accumulated by the end of the rotation since the student is assigned cases in various major areas of medicine such as cardiology, gastroenterology, and endocrinology.
Self-learning techniques, as well as compulsory attendance at lectures, conferences, and teaching rounds and careful study of patients, should foster a sound pathophysiologic approach to medical disease and a concern for and awareness of the patient’s needs.
The goal of the surgery rotation is to acquaint the student with those clinical problems that require surgery as part of the therapeutic management. The emphasis of this rotation is not primarily on surgical technique, but on the understanding of the pathophysiology of disease and the management of preoperative and postoperative therapy.
Besides the many short histories and physical examinations done during this rotation, a student is required to perform detailed histories and physical examinations on at least two patients admitted to the surgical service each week, and to follow these patients through surgical and postoperative therapy.
Attendance in the operating room is required when surgery is performed on a patient for whom a student obtained an admission history and performed a physical examination. The student must assist in the operating room to gain an understanding of basic surgical techniques, surgical discipline in relation to asepsis, and care of the unconscious patient. The more common postoperative complications must be recognized. Student follow-up of patients is required (i.e., pathology, radiology, rehabilitation medicine).
Procedures that involve manual skills, such as venipuncture, placing and removing sutures, and urethral catheterization, are incorporated into the surgical rotation. Initially, students are under direct supervision. After demonstrating proficiency, they are indirectly supervised.
The goals of the clinical rotation in obstetrics/gynecology are to provide the student with knowledge and experience in managing the normal and abnormal changes that occur during pregnancy, labor, delivery, and the puerperium, as well as in diagnosing and treating gynecologic disorders.
Students become proficient in taking a history from and examining such patients, learning to perform pelvic examinations, including how to pass a speculum and obtain a cervical smear, and attending their patients in the operating and delivery rooms.
Additional student experiences include the observation of labor, delivery of cases, installation of intravenous infusions, recording of partograms, helping with problems of anesthesia, and attendance at special clinics, such as pre- and post-natal care, family planning, infertility, and high-risk cases.
As in other clinical rotations, students are expected to attend conferences, lectures, and teaching rounds; to follow their patients carefully; to read textbooks and literature referable to their patients’ problems; and to pay special attention to public health aspects of reproductive medicine, especially as they relate to maternal and perinatal morbidity and mortality, sexually transmitted disease, cancer detection, and human sexuality.
The students should spend time on the wards in general pediatrics and outpatient clinics and also in the neonatal area. The goal of the rotation in pediatrics is to allow the student to acquire the basic knowledge of the normal physical, mental, and emotional development of children; to learn how this development is influenced by medical, social, and educational factors; to understand the common disorders and diseases of childhood, especially their diagnosis, management, and prevention; and to be aware of the special needs of the newborn, the handicapped child, and the adolescent.
An integral part of the rotation is the opportunity to acquire the necessary skills of taking a pediatric history, to examine children of all ages, and to acquire experience in evaluating the essential clinical information so that a coherent plan of management can be formulated and explained to the parents and, as appropriate, to the child.
The student learns to appreciate the value of a confident, but sympathetic approach to the child and the family, while recognizing and accepting the limits of their expectations and understanding.
The student’s reading is structured during the six weeks so that he or she first becomes acquainted with the normal child, and then learns history taking and physical examination, reactions of children to illness and hospitalization, and the principles of infant feeding and fluid and drug therapy.
The student should spend time on the psychiatry wards and outpatient clinics and learn how to manage violent and suicidal patients, acute alcoholics, and psychotropic medication overdose and drug abusers.
The purpose of the rotation is to convey psychiatric concepts, attitudes, and skills that are needed by all students, regardless of their future career plans. By the conclusion of the rotation, the student should be able to elicit, organize, and present a full psychiatric history; perform a mental status examination as well as a differential diagnosis; and suggest methods of treatment. Students will have improved their ability to establish a physician-patient relationship and will have acquired knowledge of psychological factors in physical illness.
The student will also demonstrate improved interviewing skills; know the major indications, uses, and side effects of commonly used psychotropic drugs; become familiar with the major psychiatric syndromes in children and adolescents as well as the effects on the child/adolescent/family of the life-disrupting syndromes of child abuse and substance abuse; learn detection and treatment of these syndromes; learn to evaluate and manage psychiatric emergencies; feel more comfortable with psychiatric patients; and, ultimately, possess an understanding of biological, psychological, and social determinant behavior.
Each student must fully work up at least one patient a week. The history and mental status examination are presented to the preceptor, and the case is discussed. The student must follow each patient’s progress throughout the duration of the rotation. A student must attend ward rounds and outpatient sessions. Attendance will be expected at case conferences and seminars.
DMS4 (Diagnostic Manuel for Psychiatry. APA-Practice Guidelines/Psychiatry Disorders Compendium 2006).
Bate’s Guide to Physical Examination and History Taking, ISBN: 13: 978-0-7817-8519-8 or the pocket version Bates’ pocket guide to Physical Examination and History Taking, 6th edition, ISBN: 13: 978 – 0-7817-8066-7
These review books are very popular among medical students in the USA preparing for the USMLE Step I and Step II exams. Besides these review books you should also purchase a textbook in each field from the many titles suggested on the previous pages.
