The competencies, threads, basic science and other areas will be achieved through a combination of clinical experiences (as already described), core conferences, didactics and project work. Clinical care is the cornerstone of learning in the Hospitalized Adult Care Clerkship. Students function as an integral part of the Internal Medicine team. As such, they are expected to be directly involved in patient care, including but not limited to performing complete histories and physical examinations on patients assigned to them, pre-rounding and data collection (including gathering information directly from the patient and family through daily interim history and physical examination, review of test results, and interaction with interdisciplinary colleagues and consultants), assessment and interpretation of this data with the assistance of team members, and communication of information in the form of oral presentations and written notes. Students are also expected to gain knowledge of patient illnesses through directed reading on the clinical entities of their patients, including evaluation of the evidence-base regarding diagnostic and therapeutic options for their patients. In addition to direct patient care and self-directed learning, students learn through a variety of educational formats including conferences, didactics and project work described below:

Core Conferences/ Didactics:

• Attending Rounds: During daily rounds staffed by the attending and resident, students are taught core knowledge regarding medical illnesses and core competencies in data collection, oral presentation and clinical assessment. Students are taught a standardized patient presentation.
• Morning Report: A case-based, interactive conference led by the chief medical residents (CMRs) for medical students and housestaff designed to increase clinical knowledge and diagnostic reasoning skills.
• Student Case Conference: A case-based conference specifically for students, where students present their own patients for discussion. The goal of this conference is to enhance presentation skills and develop clinical reasoning. Conferences will be lead by the clerkship directors and site directors, all of whom have extensive experience in these learning issues.
• Bedside Rounds: Our exceptional clinical faculty will perform bedside rounds with students at each site. This will train students in the art of history taking, physical examination, and interpersonal communication skills. In addition, it will provide students with an opportunity to discuss and reflect on their clinical experiences in a safe and student-centered environment.
• CMR conferences: Clinical conferences covering the core clinical entities of inpatient medicine including pathophysiology, clinical presentation, evaluation and management. Topics covered include:
  • H&Ps /soap notes on the Medicine Inpatient Service
  • CXR interpretation
  • EKG interpretation
  • Pneumonia
  • Pulmonary Embolism /Deep Venous Thrombosis
  • Acute Myocardial Infarction
  • Congestive Heart Failure
  • Atrial Fibrillation
  • Gastrointestinal Bleeding
  • COPD/Asthma
  • Acute Renal Failure
  • Diabetic Ketoacidosis
  • Liver Function Tests/liver failure
  • Hyponatremia/ hypernatremia
  • Acid/Base Disorders

• Noon Conferences: these departmental conferences include Morbidity and Mortality (M&M), CPC and Grand Rounds and offer exposure to evidence-based approaches to core medical topics. Sessions are offered to medical students, housestaff and faculty and delivered by regional, national and international experts in their field.
• Economic M & M (INTRA-SESSION ACTIVITY): faculty with training and experience in health economics will perform an interactive session whereby they dissect the medical expenses incurred during an inpatient hospital stay, discuss ways in which costs may be cut, and appropriateness of care delivered. This provides an exposure to both practice-based improvement and health economics. It will be followed by time allowed for the student to assess the costs of inpatient stay on one of their own patients. Finally, a wrap-up panel will allow students to understand some of the drivers of excess cost-utilization in the inpatient setting and ways that this cost may be contained.
• Other didactics: students will receive supporting didactics as need to obtain the knowledge and skills necessary to perform the project work outlined below.

Project Work

• Evidence-Based Medicine Project: All students must demonstrate the knowledge and skills necessary to practice an evidence-based approach to medical care. Students will be asked to:
  • Ask a clinical question relevant to a patient under their care
  • Perform a focused literature search
  • Accurately assess the relevant literature
  • Report their findings to their inpatient medical team
  • Perform a brief write-up of their findings to be handed in to the clerkship directors
• Transitions in Care Project (CLINCAL CARE AND INTRA-SESSION ACTIVITY): All students will identify one or more patients for whom they will perform a home/ nursing home/ hospice or clinic visit within a week of discharge from the hospital. These patients will be preferentially geriatric and or low literacy patients at highest risk for complications at the time of discharge. In addition, they will provide phone f/u as needed. At the follow-up visit, students will assess medication discrepancies, environmental safety, clinical status and issues of appropriate follow-up, and will determine the adequacy of discharge instructions (including appropriateness of literacy, numeracy, and communications models). Students will de-brief the follow-up visit with their attending physician within 48 hours of visit. Students will contact the primary care providers PCP) of the patients they see in follow-up to pass on relevant information regarding discrepancies and issues of follow up care. In addition, they will document the issues they encountered in a letter to the PCP, which will serve as their write-up of this visit. Students will have an interactive didactic session during intra-sessions discussing some of the common pitfalls of discharge planning and transitions in care.
• Core Quality Measures Assessment (CLINICAL CARE AND INTRA-SESSION ACTIVITY): Students will be asked to evaluate the quality of care provided to one or more of their patients using core quality measures. They will report this information to their team. An interactive didactic session on the impetus for and evidence behind quality measures will be held during intra-session.
• Durable Power of Attorney and Do Not Resuscitate Orders in the Inpatient Setting; Practical tips for these Challenging Situations (INTRA-SESSION ACTIVITY): Session in development with Drs Jackie Glover and Dan Johnson.
• Palliative Care in the Inpatient Setting (INTRA-SESSION ACTIVITY): Session in development with Drs Jackie Glover and Dan Johnson. Will request input from Dr. Sauaia for cultural competency integration.
• Reflective Writing Exercise (INTRA-SESSION ACTIVITY): Students will reflect on an experience- clinical, interpersonal, learning, etc that deeply affected them during their rotation. Students will be asked to especially reflect on issues of delivering bad news, death and dying, or cultural competence (including the culture of medicine). In written format, they will discuss the impact of this experience and how it has affected/ altered them. They will then share these written documents and personal experiences with a small group of their peers and facilitated by a faculty member in the challenges and issues faced in the process of medical education.