Following a one-week orientation to the third year, students rotate through a set of required core clerkships in Internal and Family Medicine, Neurology, Obstetrics and Gynecology, Pediatrics, Psychiatry and Surgery, as well as two elective courses.
Internal and Family Medicine
During this clerkship, students participate and demonstrate competence in humanistic and evidence-based inpatient and outpatient care of patients with common medical disorders. Students also learn appropriate health promotion and health screening for adult patients. Students learn to work as part of a medical team in all settings and will understand the roles of the interdisciplinary patient care team. Learning activities include preceptor-supervised clinical experience, clerkship-specific didactics, use of standardized patients and medical simulations and self-directed learning utilizing information technology. The clerkship has specified the types of clinical encounters, physical examination skills and testing and procedural skills that students need to master.
Between 10% and 15% of primary care visits may involve complaints referable to the nervous system. Neurologic problems may account for up to one in five hospital admissions. Stroke is the third leading cause of death in the U.S., and is the single most common cause of long-term disability, and Alzheimer’s disease is a growing public health problem. For these and other reasons, education of non-specialists in diagnosis, treatment, and prevention of neurologic disease is essential to integrated health care delivery. The goal of the Neurology clerkship is to formulate a diagnosis, begin an appropriate diagnostic evaluation, and initiate a rational treatment plan for common neurologic conditions. The clerkship accomplishes these aims by application of clinical neuroscience to the neurologic history and examination. Inpatient and outpatient experiences expose students to the full spectrum of neurologic disease.
Obstetrics and Gynecology
While on the Obstetrics and Gynecology clerkship, the student is considered an integral part of the clinical team and has the opportunity for a broad range of clinical experiences in the Labor and Delivery suite, operating room, ambulatory clinics and inpatient hospital services. Didactic sessions including lectures, clinical skills workshops and case study seminars supplement the core clinical experience. Students come away from the clerkship with an understanding of the role of the obstetrician/gynecologist as a primary health care provider for women of all ages, the importance of the gynecologic history and physical examination in the overall assessment of the health of women, and the major significance of competent obstetrical and gynecologic care in public health and preventive medicine.
This clerkship introduces third-year medical students to the basic principles of general pediatrics. Through both inpatient and outpatient encounters with children across the age range of pediatric, from neonates through young adulthood, the student receives exposure to the clinical care of children. The learner participates in the newborn nursery and outpatient health supervision visits where the fundamental concepts of the pediatric interview and physical exam, growth and development, anticipatory guidance, primary prevention, screening, and vaccination are presented. Clinical experience with acute/chronic illness visits afford the learner exposure to common pediatric complaints and symptoms as well as common pediatric diagnoses. Participation in the inpatient component of this course solidifies students’ pediatric skills of data gathering, data synthesis, the development of problem lists and working diagnoses, and formulating therapeutic plans while being a member of a health care team providing family-centered care to children.
During this clerkship, students will participate in the evidence-based and patient-centered inpatient and outpatient care of patients with psychiatric disorders. The goals and objectives for the clerkship are presented below.
Students will participate in the assessment and treatment of patients with an emphasis on: experience with patients with the most common psychiatric disorders; recognition of cases needing specialty psychiatric referral; and understanding what psychiatric treatment can offer their patients in terms of emotional health/quality of life.
Learning activities will include: preceptor-supervised clinical experience, clerkship-specific didactics, and self-directed learning including use of self-learning modules. The specific types of patients and clinical conditions that students need to encounter, and the physical/mental examination skills and testing and procedural skills students need to master, are detailed below.
There will be both formative and summative evaluations. Students’ final clerkship grade will be determined by the preceptors’ evaluations of clinical performance, the written NBME shelf exam in Psychiatry, and two Clinical Skills Evaluations to assess clinical performance in psychiatric diagnostic interviewing including mental status examination, establishment of a therapeutic alliance, diagnostic formulation, and biopsychosocial treatment planning.
The clerkship director can also provide a wealth of information, resources, and opportunities for students’ potentially interested in pursing a career in Psychiatry.
The Surgical Clerkship introduces the student to the workup, diagnosis, treatment and follow-up of a wide variety of surgical diseases. Evidence-based practices are emphasized. The student spends four weeks on a general surgery core rotation such as general or trauma and the remaining four weeks on one surgical selective in specialties such as anesthesiology, colorectal surgery, ophthalmology, orthopedic surgery, pediatric surgery, plastics and wound healing, thoracic surgery, urology or vascular surgery.
Students are responsible for the evaluation and workup of patients in the emergency room and wards as well as in the outpatient setting. Participation in daily inpatient multidisciplinary ward rounds is emphasized as well as active participation in a wide array of bedside surgical procedures and major operative interventions under general anesthesia. In-hospital call is a requirement. The student is also responsible for regular attendance at grand rounds, journal clubs, morbidity and mortality conferences, tumor boards, and simulator/animal lab experiences.
Longitudinal Clerkship Curriculum
The Longitudinal Clerkship Curriculum in the M3 year is delivered across the year within the Transition to Clerkship, Intersession 1 and Intersession 2 modules. In the Transition to Clerkship module, students are introduced to the LCT related core concepts and principles that will be revisited and reinforced in subsequent M3 LCT sessions. The LCT sessions are designed 1) to meet learning objectives across LCTs so students have opportunity to analyze medical scenarios from relevant social determinants of health, patient safety, medical informatics, patient demographic and ethical perspectives and 2) for students to be actively engaged in their own learning and to function effectively on a team when there is limited time to get organized and be productive.