University of Virginia School of Medicine
Pathology Conference Room, 4:00 p.m.
Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Lisa Herrmann, Evan Lapinsky, Debra Reed (secretary) Guests: Brad Bradenham, Evan Heald, Amy Tucker
- Internal Medicine/AIM Clerkship Review. Drs. Amy Tucker and Evan Heald, Clerkship Directors for Internal Medicine and AIM met with the Curriculum Committee to discuss the recent Clerkship review.
The Internal Medicine Clerkship is composed of a four week rotation in AIM and a four week rotation on an inpatient Internal Medicine service.
Dr. Heald outlined the structure and content of the AIM portion of the Internal Medicine Clerkship. Students in AIM are assigned to a general Internal Medicine practice, either at UVA or in the greater Virginia area. Students generally see an average of at least 7 patients per day. Preceptors in these practices provide feedback to students midway through the rotation. Students begin their rotation with an orientation and clinical skills workshop day at UVA and return to UVA twice more during each rotation for workshops. Students in the various practices see a variety of patient populations.
The on line "Simple" cases (comparable to the CLIP cases in Pediatrics) provide exposure to patient diagnoses that may or may not have been seen on every student's rotation. There are 18 cases in this on-line course and each takes approximately 30 minutes to complete. The passport is a competent method of assessing whether students have received instruction in the required clinical skills. The AIM mentors put a great deal of effort into developing the student as a clinician. AIM has a mid-month review form that preceptors must complete, discuss with their students. This form is reviewed by the clerkship director for deficiencies.
Dr. Tucker outlined the structure of the four-week inpatient Internal Medicine portion of the clerkship. Students are assigned to inpatient services at UVA as well as at Roanoke Carrilion and the Salem VA Hospital. While each experience represents a slightly different patient population, the passport and "Simple" cases help to ensure a consistent experience for all students. While on the inpatient service, students participate in morning report, are given the opportunity to complete history and physical exams and participate in the patient care team. Twice during a student's rotation at UVA, they receive an ethics lecture/discussion. Students at outside sites receive at least one didactic ethics lecture during their rotation.
Last year students on the inpatient Internal Medicine clerkship spent two hours twice a week with a faculty preceptor specifically going over clinical skills. While valuable, this was time consuming and took students away from team activities in the afternoons. This year, based on recommendations by the SOM and on feedback from students, the ward attendings will be focusing on clinical skills during some of their usual afternoon teaching sessions with the students, particularly on physical examination, but also on developing a differential diagnosis, integrating clinical data, and history taking. Two to four hours per week should be spent by the attending helping the students polish their clinical skills.
Shelf exam scores are one third of each student's Medicine clerkship grade. The scores are adjusted to take into account which period the student participates in the Medicine clerkship. Mean grades on shelf exams taken earlier (after periods 1, 2, 3) in the student's clerkship experience are often 4-5 points lower than those taken later in the year.
One third of a student's grade is a compilation of attending and resident evaluations. Better standardization of this evaluation process is sought. A suggestion was made that residents and attendings meet prior to completing their evaluations to discuss each student. This presents logistical problems.
Each student is required to keep a patient log on Oasis. Adding a line to the passports that at the midpoint of the rotation, the patient log has been reviewed with an attending and is approximately half complete would be another way of assuring an equitable experience for all students.
Student reported problems with scheduled lectures not actually occurring at the Salem VA will be addressed by Dr. Tucker.
Communication with outside sites as well as attending and resident instructors is mostly done by e-mail.
The Committee expressed thanks to Drs. Heald and Tucker for their comprehensive self-study report and a well run clerkship.