MSIII/MSIV Clerkships—Binghamton Campus

Family Medicine

This unique longitudinal rotation offers a year-long mentorship with a family physician. Also included are didactic activities that explore the nature of the physician-patient relationship and introduce concepts in the assessment and management of the common vexations bring people to see their doctor.

Goals include learning how to

1. interview and examine any patient, irrespective of age, sex or presenting complaint
2. recognize and manage a selection of common primary care diagnosis
3. coordinate a family's medical care over time
4. use family systems theory and a knowledge of family dynamics to optimize medical care
5. employ community health and social service resources
6. communicate effectively, in writing and orally, with other medical personnel.

Activities

The major component of the rotation is the office preceptorship. For one afternoon each week, the student will attend office hours with a family physician preceptor in the Broome County area. The student will work with the same preceptor every week throughout the year. This enables the student to develop a long-term relationship with patients in the practice, seeing them through various stages of health and illness. Didactic sessions will be held approximately one week out of six. The student will also make a visit to a patient's home, and one visit to a local health/social service agency. Required reading will be assigned.

Evaluation

The following components enter into the student's grade: evaluation by office preceptor

• 40%, written examinations
• 20%, observed structured clinical examination (OSCE) - 20%
• other written work - 20%.

Practice of Medicine III

This concurrent longitudinal course consists of bioethics and advanced communication skills. Students meet with small groups concurrently with major clerkships.

Geriatric Medicine

The Geriatric Medicine/Gerontology Program provides a four-week clerkship addressing the causes, management, and prevention of the diseases of later life. The Clinical Campus program emphasizes training in the care of older adults in community, home, and institutional settings. Students learn about the physical, social, psychological, and economic stresses experienced by older adults and the major characteristics of the health care systems which provide services to meet their needs. The promotion of positive attitudes toward the care of older people, the examination of available support systems, as well as clinical work at community and institutional sites, combine to give an integrated approach to the health care of older individuals.

Goals To help students

1. Increase understanding and knowldege of Geriatric Medicine, emphasizing basic elements that should be used in all non-pediatric specialties and that are unique or most common in elderly patients.
2. Develop a positive attitude toward geriatric patients and accept the need for appropriate evaluation and treatment of their medical problems.
3. Understand and accept the team approach to frail elderly and learn the basic functions of the different members of the team.
4. Learn the importance of psychological, social, environmental, and system factors in maintaining a satisfactory life for the elderly.
5. Understand health care delivery to the elderly in multiple settings, including long-term care. Reading: "Notes in Clinical Geriatrics", by Neil K. Hall, M.D. Criteria for Evaluation of Performance: Written examination (minimum passing score 80%); evaluation by clinical preceptors and satisfactory completion of required assignments.

Neuroscience Clerkship

The Neuroscience Program will be offered for a four-week period, six times throughout the academic year.

1. Clinical exposure in common neurological diseases, including diagnosis and therapy
2. Development and acquisition of skills in both interviewing and doing physical examinations on a neurological impaired patient
3. The formulation of diagnostic and therapeutic approaches
4. The application of basic science knowledge to the clinical setting.

Activities

The core activity consists of evaluating and examining patients and following these patients througout their hospital course. The students will be expected to review their cases with their faculty preceptors and to write appropriate history and physical exams.

The clerkship experiences will include

1. Morning rounds
2. Attending rounds
3. Ambulatory office rounds
4. Formal history and physical exam write-ups
5. Seminar/case study presentations and supervision
6. Reading assignments
7. Formal lectures
8. Final examination.

Evaluation

1. Skills: This will be measured by faculty observing student work-ups and reviewing the students written history and physical exams
2. Knowldege: This will be evaluated by a multiple choice exam at the end of the clerkship; 3) Habits and attitudes: Faculty and nursing staff will assess habits and attitudes appropriate to a physician.

Ambulatory Surgery

The program will consist of

1. One-week block rotations in each specialty (ENT, Ophthalmology), over a two-week period using a modified preceptorial model in the physicians office
2. Morning seminars, Monday through Friday, 7:30-9:00 a.m.
3. Students will accompany their preceptor to surgery at the discretion of the preceptor.

Goals

1. To provide the student exposure in office problems and management for each of the above named surgical subspecialties;
2. To develop diagnostic and therapeutic skills in each of the above disciplines;
3. To recognize and manage acute medical and surgical emergencies.

Student Evaluation

1. Evaluation of history taking, physical examination, differential diagnosis, and treatment plans will be reviewed by faculty in each setting
2. Evaluation of skills will be done by direct observation
3. Habits and values will be subjectively rated by each discipline
4. Two written case studies will be presented by each student at the Summary Conference in Ophthalmology
5. Knowledge will be assessed by multiple choice questions (10% of grade)

OB-GYN Clerkship

The OB/GYN Clerkship will be offered in a six-week period in both inpatient and ambulatory settings. The general goal of the program is to provide clinical opportunities for the students to develop skills and knowledge related to antepartum care, management of normal labor and delivery, care of the newborn and postpartum care.

Activities

The program will consist of the following experiences.

1. History and Physical Examinations.
2. Following of patients in labor and delivery.
3. Care of newborn.
4. Rounds including antepartum and postpartum rounds.
5. Ambulatory obstetrics experience in obstetrician's office or obstetrics clinic.
6. Sexuality/behavioral science seminars.
7. Obstetrics and Pediatrics seminars.

Schedule

Individual schedules will be worked out for each student at the beginning of their rotation.

Evaluation

Student evaluation in writing will be required at the end of each clerkship. Approximately halfway through each rotation, the principle obstetrical tutor will be contacted for a verbal evaluation. This is in order to take whatever remedial changes that might be necessary in order to help a student improve his/her grades. Written evaluation, on special Clinical Campus forms, will be required for each student. These rating forms will be made available for each preceptor. Each student will keep a log of activities in both Obstetrics and Gynecology. This must be countersigned by the attending. At the end of the clerkship, the student will be required to hand this log into the Coordinator's Office.

Medicine Clerkship

This 12 week clerkship is comprised of 8 weeks of hospital ward service and 4 weeks of ambulatory service. During the ambulatory part of the rotation, students will be excused from their clinical duties one afternoon per week in order to participate in sessions at the Clinical Campus on disease prevention and health promotions.

Goals

1. To develop strong skills in the art of medical history taking and the performance of an accurate physical examination;
2. To develop the skill of presenting clinical cases;
3. To develop a basic fund of knowledge in the major areas of internal medicine;
4. To develop clinical problem-solving skills. This will require the synthesis of clinical information that is gathered from various sources including the history and physical examination, laboratory studies, radiologic and other special studies, consultants opinions, etc. and then relating all this information to the student's fund of knowledge in internal medicine;
5. To develop those psycho-social skills essential for the practices of good medicine - proper bedside manner, empathy, active listening, compassion, how to work as a team member with peers, house officers, attendings, consultants, nursing staff, and many other health care professions;
6. To learn basic concepts in disease prevention and health promotion as it relates to the field of internal medicine. Emphasis will be placed on the concepts of screening tests for disease prevention;
7. to begin to learn about the concepts of Evidence-Based Medicine.

In order to achieve the above goals, the Internal Medicine Clerkship has been designed to include an inpatient experience, outpatient experience, didactive lectures, formal attending rounds and other interactive learning experiences. During the clerkship, the student will participate in the Continuity of Care program and be excused from Internal Medicine duties at those assigned times (one afternoon per week) in the Continuity of Care Program. The clerkship is designed so that all students spend four weeks at Wilson Hospital/UHS where general medicine is emphasized. Four weeks are spent at the Guthrie Medical Center where the students are assigned to vaious medicine specialty services, and/or the general medicine service.

1. Work rounds;
2. In-depth attending rounds;
3. Psychosocial seminars in internal medicine;
4. Radiology conferences
5. Weekly Internal Medicine Grand Rounds;
6. Occasional "Teaching Days" on various topics,
7. Night Call - as established by the Coordinator and site directors;
8. Submission of complete written histories/physicals obtained from ward patients to senior residents/faculty for evaluation.

There will be a four week ambulatory internal medicine experience. Each student will be assigned to an office-based internist with whom she/he will participate in activities including office visits, consultations, hospital rounds, staff conferences, ER visits, et. During the ambulatory part of the rotation, students will be excused from their clinical duties on Thursday afternoons in order to participate in sessions at the Clinical Campus on disease prevention and health promotions and Evidence-Based Medicine.

• inpatient attending evaluations (20%),
• inpatient house office evaluations (20%),
• ambulatory attending evaluations (20%)
• ambulatory participation in disease prevention and health promotion sessions (10%)
• standardized final examination (30%).

Achieving a passing grade on the final examination is a prerequisite albeit not the sole criterion for obtaining a passing grade for the clerkship.

Surgery Clerkship

The clinical clerkship in surgery, including cardiovascular, trauma and general surgery will extend for eight weeks and be centered around the care of inpatients. Additional opportunities to participate in care of patients undergoing plastic surgery and urologic surgery will be included at the discretion of the attending staff. The overall aim shall be to ensure that the student learns skills important to functioning as a complete physician, with the emphasis on the management of the surgical patient.

Activities and Schedule

In order to acheive these aims, the teaching program will encompass seven areas.

1. History taking and physical exam, workup plan and pre-and postoperative care on assigned patients (3-4 complete H&P/week, 1-2 abbreviated workups on uncomplicated patients with common surgical disorders, i.e. inguinal hernia, cholelithiasis);
2. A lecture series;
3. Conferences as possible within the surgical schedule;
4. Operating room experience;
5. Floor care and rounds;
6. Call schedule;
7. Outpatient office experience;
8. 1 week rotation on orthopedics;
9. 1 week rotation on anesthesiology.

Evaluation

Overall performance during the clerkhsip will be evaluated on the review of performed history and physical examinations, development of clinical skills, and the demonstration of an understanding of basic concepts related to the management of surgical patients. There is an examination at the end of the rotation as well.

Psychiatry Clerkship

Goals

The psychiatry program will be offered for a six-week period, six times throughout the academic year.

1. To acquire a positive and helpful attitude toward persons with mental or emotional illnesses and by other related medical problems;
2. To completely interview a variety of patients;
3. To recognize psychiatric signs and symptoms and to diagnose the major categories of psychiatric disorders;
4. To learn about treatment techniques (e.g.psychopharmacologic agents types and methods of psychotherapies and somatotherapies);
5. To prepare for National examinations.

Activities

The core activity consists of interviewing and examining patients, and following these patients throughout their hospital course. The students will be expected to review their cases with their faculty preceptor and to write progress notes a minimum of twice per week. The clerkship experiences will include:

1. Morning rounds;
2. Attending rounds;
3. Observed interviews;
4. Night call (3 evenings per week);
5. Formal write-ups of patient interviews;
6. Seminar-case study presentation and supervision;
7. Reading assignments;
8. A-V materials;
9. Quizzes and final exams.

Evaluation

1. Skills: This wil be measured by faculty observing patient interviews, reviewing write-ups, discussing the ongoing care of the patients being followed, and OSCES;
2. Knowledge: This will be evaluated by short quizzes and a multiple choice final exam related to Psychiatry.
3. Habits and Attitudes: Faculty, patients and nursing staff will assess habits and attitudes deemed appropriate to physicians.

Pediatrics Clerkship

The Child/Adolescent Clerkship will be offered for a six-week period in both inpatient and ambulatory settings. The specific goals of the program are to have each student accomplish during this period at least 75 percent of the Category I and Category II skills and objectives outlined in the Child/Adolescent Curriculum Guide.

1. To provide clinical opportunities to develop skills in history taking, physical examinations, technical skills, problem solving and management as they specifically relate to the pediatric patient;
2. To direct the junior student's acquisition of a core knowledge of the Pediatric discipline. Activities: All students will use Wilson Memorial Hospital as their inpatient base and will participate in patient care as a member of the Family Practice Resident team assigned to Pediatrics. Specific assignments during the clerkship will include the following: 1.) Students will be supervised by a preceptor(s) who will meet with them daily, will evaluate their work-ups and physical examinations, and will coordinate their inpatient experiences; 2.) Clerkship is divided into two three-week halves. One is Ambulatory focused in pediatricians' offices. The other is "inpatient" focused;
3. Students will be expected to attend House Staff Work Rounds and Attending Rounds whenever their schedules permit. Students will be expected to workup patients on a rotating basis and to be "on call" and at least one weekend during the clerkship. Attendance at Pediatric Conferences for residents and attending staff is required whenever individual schedules permit;
4. Each student will be assigned a Pediatric outpatient experience in either a Pediatrician's private office or Pediatric clinic. The purpose of the ambulatory rotation is to provide the student with exposure to many common pediatric problems and an approach to preventive pediatrics. The Community Medicine and Continuity of Care Programs will be conducted concurrently with the Pediatric Clerkship;
5. Weekly didactic sessions on selected Pediatric topics will be presented. Lecture lists will be provided at the beginning of the clerkship;
6. Students will be assigned to participate in a multi-disciplinary evaluation of a learning disabled and/or mentally retarded and/or physically handicapped child at Broome Developmental;
7. A recommended reading list will be provided at the beginning of the clerkship. Suggested textbooks are Barnett's or Nelson's Textbook of Pediatrics.

Evaluation

Junior students will be evaluated during their Pediatric Clerkship as to their acquisition of the basic knowledge of the discipline; the completeness and appropriateness of their histories, physical examinations, diagnostic outlines and management plans; their performance of the technical skills of the discipline; their ability to accept responsibility; demonstration of initiative; ability to communicate with peers, preceptors, patients, and parents; demonstration of leadership; punctuality and attendance; and appropriateness of general demeanor and appearance. The preceptors of the clerkship will be responsible for judging the student's performance and progress. Successful completion of an examination covering major areas of the discipline also will be required.