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Medicine Clerkship Home

Welcome to the Clerkship in Medicine.  We are very pleased that you are with us.  We recognize that you contribute greatly to the quality of care that we provide to our patients.  Additionally, you will find that the housestaff and faculty in the Department of Internal Medicine are dedicated to providing you with an excellent educational experience.

You are about to embark on an exciting two months; one month in an outpatient setting (Ambulatory Internal Medicine, AIM) and one month on a general medical service (at University Hospital, the Salem Veterans Affairs Hospital, or Carilion Roanoke Memorial Hospital).  Next year, you will do one month of Internal Medicine selectives on subspecialty rotations at University Hospital.

You will receive additional information from the Salem Veterans Affairs Hospital or Carilion Roanoke Memorial Hospital and from the AIM administrative offices depending on your rotation schedule.  Please direct questions about the clerkship to Dr. Brian Wispelwey, Clerkship Director, or Ms. Karen Ward,  Clerkship Coordinator (243-9397); Dr. Evan Heald, AIM Director (924-1685); or Ms. Leslie Stewart, AIM Coordinator (982-2516).

Medicine Clerkship Goals and Objectives

The University of Virginia School of Medicine has defined a set of competencies required of the contemporary physician.  These are as follows:

1. The development and practice of a set of personal and professional attributes that enable the independent performance of the responsibilities of a physician and the ability to adapt to the evolving practice of medicine. These include an attitude of:
       a. Humanism, compassion and empathy,
       b. Collegiality and interdisciplinary collaboration,
       c. Continuing and lifelong self-education,
       d. Awareness of a Personal response to one's personal and profession limits,
       e. Community and social service,
       f.  Ethical personal and professional conduct,
       g. Legal standards and conduct,
       h. Economic awareness in clinical practice;

2. Competence in the human sciences:
       a. In the understanding of current clinically relevant medical science
       b. In scientific principles as they apply to the analysis and further expansion  
           of medical knowledge.

3. The ability to engage and involve any patient in a relationship for the purpose of clinical problem solving and care throughout the duration of the relationship,

4. Eliciting a clinical history,

5. Performing a physical examination,

6. Generating and refining a prioritized differential diagnosis for a clinical finding or set of findings,

7. Developing and refining a plan of care for both the prevention and treatment of illness and the relief of symptoms and suffering,

8. Developing a prognosis for an individual, family or population based upon health risk or diagnosis, with and without intervention, and planning appropriate follow-up,

9. Selecting and interpreting clinical tests for the purpose of health screening and prevention, diagnosis, prognosis or intervention,

10. Organizing, recording, presenting, researching, critiquing and managing clinical information,

11. Selecting and performing procedural skills related to physical examination, clinical testing and therapeutic intervention, and

12. Knowledge of the social, economic, ethical, legal and historical context within which medicine is practiced.

The Department of Medicine supports these competencies and has developed a set of clerkship-specific learning objectives.  The objectives and their relationship to the competencies is outlined in the following table.

 Medicine Clerkship Specific Learning Objectives  UVa Competency
1. Obtain an accurate and complete clinical history of new admissions in the inpatient setting.
 2,3,4
2. Obtain an accurate, focused clinical history in the outpatient setting. 
 2,3,4
3. Obtain an accurate and complete physical examination of new admissions in the inpatient setting.
 2,3,5
4. Obtain an accurate focused physical examination in the outpatient setting.
 2,3,5
5.  Select appropriate laboratory investigations, including chemical, serological, radiological, and functional.
 2,8,9
6. Interpret basic laboratory tests.  
 2,9
7. Interpret the totality of the collected clinical data correctly and derive from that interpretation an appropriately ordered differential diagnosis.
 2,4,6,8,9,10
8. Set priorities in developing management plans, so the patients' most critical problems are addressed first.    
 2,6,7,8
9. Implement plans with compassion, efficacy, and efficiency.
 1,2,3,7,12
10. Apply principles of medical ethics to the clinical process.
 1,3,12
11. Present information to colleagues correctly, completely, and efficiently.
 2,4,5,6,7
12. Acquire a basic fund of knowledge about common clinical problems in internal medicine.
 2,10
13. Formulate appropriate questions about clinical problems and find the answers efficiently, making use of textbooks, computers, and the primary medical literature.
 2,10
14. Gain experience with the practice of evidence-based medicine.
 2,10
15. Gain experience in the coordination of ancillary services, such as PT, OT, Social Work. 
 3,7,12
16. Gain experience in the use of consultants.
 2
17. Practice humanism.
 1,7,12
18. Practice professionalism.
 1,7,12
19. Practice cost-effective medicine in a variety of settings.
 3,7,9,12


AIM Goals= Medicine Clerkship goals plus:

 Clerkship Specific Learning Objective  Level of Competence  Evaluation Methods  UVa #
1. Obtain an accurate and complete clinical history of new admissions in the inpatient setting. Knows G, CL, Log, RecR
 2,3,4
2. Obtain an accurate, focused clinical history in the outpatient setting. 
 Knows 
 G, CL, Log, RecR, OSCE 2,3,4
3. Obtain an accurate and complete physical examination of new admissions in the inpatient setting.
 Knows
 G, CL, Log, RecR 2,3,5
4. Obtain an accurate focused physical examination in the outpatient setting.
 Knows G, CL, Log, RecR, OSCE 2,3,5
5. Select appropriate laboratory investigations, including chemical, serological, radiological, and functional.
 Knows how G, RecR 2,8,9
6. Interpret basic laboratory tests. Knows how G, CL, RecR, MCQ 2,9
7. Interpret the totality of the collected clinical data correctly and derive from that interpretation an appropriately ordered differential diagnosis.
 Knows how G, CL, RecR, MCQ 2,4,6, 8,9,10
8. Set priorities in developing management plans, so the patients' most critical problems are addressed first. 
 Knows how
 G, CL, RecR, MCQ 2,6,7,8
9. Implement plans with compassion, efficacy, and efficiency.
 Shows how G, RecR 1,2,3, 7,12
10. Apply principles of medical ethics to the clinical process.
 Shows how G 1,3,12
11. Present information to colleagues correctly, completely, and efficiently.
 Shows how G 2,4,5, 6,7
12. Acquire a basic fund of knowledge about common clinical problems in internal medicine.
 Knows G, RecR, MCQ 2,10
13. Formulate appropriate questions about clinical problems and find the answers efficiently, making use of textbooks, computers, and the primary medical literature.
 Knows MCQ, G, OSCE 2,10
14. Gain experience with the practice of evidence-based medicine.
 Does G 2,10
15. Gain experience in the coordination of ancillary services, such as PT, OT, Social Work.
 Does G 3,7,12
16. Gain experience in the use of consultants. 
 Does G 2
17. Practice humanism. Does G 1,7,13
18. Practice professionalism. Does
 G
 1,7,12
19. Practice cost-effective medicine in a variety of settings. Does G
 3,7,9, 12

Additionally:  

Learn to communicate findings and plans effectively to team members both orally and in writing.

Learn recommendations for adult health maintenance and how to incorporate them into practice.

Learn to recognize and manage the interaction between the social setting, patients, and illness particularly in regard to the chronic disease model.

Gain experience with common clinical skills and disease states, especially those identified in the Passport.

Gain sufficient technical skill with the ophthalmoscope to be able to identify:

  1. Landmarks in the anterior chamber.
  2. Venous pulsations.
  3. Arteriovenous crossings.
  4. Cup to disk ratio.


Learn a strategy for interpreting electrocardiograms and be able to identify common abnormalities of rate, rhythm, axis, intervals and waveforms.
Learn to identify and address personal clinical knowledge deficits. Learn to access and critically appraise medical information resources.

Learn:

  1. Evaluation of urinalyses (including microscopy) and correlation with clinical diagnoses.
  2. Assessment of kidney function.
  3. Differentiation of acute versus chronic kidney disease.
  4. Common presentations of kidney disease.


Learn a Chest X-ray interpretation strategy and recognize common findings.
Learn a logical approach to interpreting PFTs including:

  1. How to differentiate obstructive from restrictive respiratory diseases.
  2. How to interpret a flow-volume curve.
  3. The differential diagnosis of obstructive and restrictive diseases.


Learn: Common cardiac auscultatory findings and a strategy for identifying them correctly.

Learn the physiologic differences seen in the geriatric population and incorporate this knowledge into prescribing practices.

Learn to:

  1. Recognize the top 7 etiologies for shoulder pain in the primary care setting.
  2. Assess and understand importance of shoulder range of motion assessments
  3. Palpate AC joint, supraspinatus tendon, biceps tendon
  4. Assess rotator cuff integrity and strength
  5. Assess for shoulder impingement signs
  6. Assess for bicipital weakness and pain
  7. Assess for shoulder instability
  8. Assess for referred sources of shoulder pain, primarily cervical spine


The student will be able to identify the major categories of 3rd party payors for medical services. The student will be able to demonstrate how billing affects patient costs, societal costs and physician reimbursement.

Students will become familiar with strategies to: distinguish infectious from noninfectious etiologies of various syndromes and learn principles of appropriate antibiotic use.

Students will:

  1. have a chance to rehearse a bad new conversation
  2. learn an organized approach to bad news conversations
  3. learn the purpose and function of hospice
  4. learn to solicit advance directives while guiding patients in the process