Guidelines for Associates during the Medicine Clerkship
INITIAL PATIENT EVALUATIONS
You will be assigned one or two new patients during each on-call
day. If the clinical situation permits, work up the patient prior to
the house staff’s examination. You will be responsible for obtaining
a complete history, performing a thorough physical examination, and
assisting the house staff with the diagnostic work-up. The data accumulated
will be incorporated into progress notes on the patient’s chart.
You should prepared to provide written and oral presentations to your
teaching attending physician, including a discussion of the differential
diagnosis, diagnostic testing, treatment plans, and a review of pertinent
literature. Review the Department of Medicine preferred formats for
clinical write-ups and for oral presentations, as enclosed in this packet.
You should personally visit and examine every assigned patient each
morning before work rounds in order to present relevant clinical facts
to the team during rounds. You should write progress notes at appropriate
intervals. Your notes should include pertinent clinical observations,
diagnostic data, and a meaningful assessment of progress, along with
pathophysiologic correlations. You might find it helpful to use the
“SOAP” format (Subjective, Objective, Assessment and Plan).
Your notes should be reviewed and countersigned by the resident prior
to being permanently placed in the medical record. However, you are
not authorized to write orders under any circumstances.
When you are on-call, you are required to remain until 10:00 p.m., although
you are invited to remain later and participate with the house staff
whenever you wish. Work rounds begin at 7:30 a.m. Mondays through Saturdays,
and at 9:00 a.m. on Sundays if your team is on call.
ATTENDING TEACHING ROUNDS
The teaching attending physician will meet with your student group three
times per week, generally Mondays, Wednesdays and Fridays at 10:30 a.m.
until 12:00 noon. You should select patients to present who are available
for bedside rounds, particularly in the early weeks of the clerkship.
At the bedside, you will have the opportunity to demonstrate portions
of the history and physical examination. You should ask the attending
to formally assess your clinical skills by direct observation during
these sessions. Remember to use the form in this package entitled, “Assessment
of Skills by Direct Observation.” When orally presenting patients,
you should use “Format for Focused Presentation of Patients”
as a guide. In addition, you are required to submit two formal clinical
write-ups to each of your teaching attending physicians (a total of
four for the clerkship). See “Format for Clinical Write-ups,”
which describes what is expected in the write-ups. It is wise to start
early, so that the feedback can lead to improvement in subsequent write-ups.
During the fifth week and the tenth week, you should meet individually
with your teaching attending to obtain a formal assessment of your performance.
RESIDENT TEACHING ROUNDS
Your ward resident is expected to provide clinical instruction as an
informal part of daily rounds. In addition, the resident and/or Chief
Medical Resident will meet with the student group once weekly for a
more formal teaching session.