Internal Medicine Clerkships

Clerkship Structure

Inpatient Medicine

At Los Angeles General Medical Center, third- and fourth-year medical students are integrated into a General Medicine team consisting of a faculty attending, one senior resident, two junior residents, three interns and, usually, two fourth-year medical students and one third-year medical students. The students participate in all aspects of their patients’ care. When on duty at Keck Hospital of USC, Huntington Memorial Hospital and Santa Barbara Cottage Hospital students are assigned clinical duties under the supervision of attending physicians and residents.

Ambulatory Medicine

Junior medical students spend 50 percent of their General Medicine Clerkship in the offices of community-based internists. Junior students are assigned to participating internists in three-week blocks and are included in all aspects of a community-based practice. Senior students’ experiences are designed as a sub-internship and are 100 percent inpatient

Curriculum

Didactic Sessions

Junior and senior medical students participate in a structured case-based curriculum developed from a template sponsored by the Clerkship Directors of Internal Medicine. Third-year medical students participate in twenty hours of case-based sessions with internal medicine faculty during the first few days of the clerkship. In addition, junior students have weekly problem-solving sessions with Dr. Ben-Ari and weekly ethics conferences with Drs. David Goldstein, Don Harper Mills and Ben-Ari. Fourth-year medical students also participate in a separate, one-hour problem-solving session per week with Dr. Felser. In addition, all students meet at least once weekly for a total of two-hours of case-based teaching with their respective faculty attendings on the General Medicine service. All medical students are expected to attend the New Patient Conference and all other core residency conferences.

Patient-Based Learning

Junior and senior medical students are assigned to work directly with attending physicians and residents in the provision of patient care in both ambulatory and inpatient venues. In the inpatient setting, patients are assigned to students upon admission (third-year students receiving one to two admissions each call night, and fourth-year students receiving two to three, typically more challenging, admissions). They perform histories, physical examinations and common procedures. The students present their patients on rounds, make daily assessments and write daily progress notes and orders. The attending physician and senior residents provide supervision. During ambulatory assignments, students are integrated into all aspects of patient care delivery and practice management.

Standardized Patient Experiences

A series of standardized patient experiences for the General Medicine I Clerkship was fully implemented in 1999. These experiences, an Observed Structured Clinical Assessment (OSCA) and an Observed Structured Clinical Evaluation (OSCE), were designed to enhance the clinical skills of junior medical students in the evaluation of patients with heart or lung disease.

Clinical Nurse Educator Sessions

Junior medical students meet with Ms. Brown for a comprehensive review of their patient – physician communication styles, and history and physical examination skills as demonstrated in their OSCA experience.

Hospice Program

General Medicine I students spend one half-day attending a multidisciplinary team meeting and observing home visits with the hospice medical director.