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INPATIENT INTERNAL MEDICINE CORE

CLERKSHIP STUDENT HANDOUT


Welcome to your Internal Medicine rotation at Larkin Community Hospital! We hope you have
an enjoyable and educational month. Please be sure to read this handout in its entirety, as it
will answer most questions you may have.

Contact Information

Jean Pierre – Student Coordinator JJeanPierre@larkinhospital.com


Mary Ann Santiago – LCH IM Program Coordinator msantiago@larkinhospital.com

Dr. Nityanand Peri – IM Co-chief aperi87@gmail.com


Dr. Zaid Rana – IM Co-chief zrana@larkinhospital.com
Dr. Kanza Soomro – Co-student liaison kanza.soomro@gmail.com
Dr. Mattew Soberano – Co-student liaison msoberan@larkinhospital.com

Purpose of Internal Medicine Clerkship

This clinical clerkship is a 12-week rotation in which you will experience inpatient medicine,
along with subspecialties within IM. This rotation serves to provide a supervised high quality
clinical opportunity for third and fourth year medical students to transfer knowledge learned in
the classroom setting into the clinical setting.

Clerkship Learning Objectives:

At the end of your 4 week inpatient IM rotation, students should be able to:

1. Describe characteristic history, physical, and general treatment for the following
common disorders
 Acute coronary syndrome
 Acute Renal Failure
 Alcoholism
 Anemia
 Asthma/Asthma exacerbation
 Delirium/Dementia
 DVT/PE
 Cholelithiasis/-cystitis
 Cirrhosis
 CHF
 COPD
 Diabetes/DKA/HHS
 GI Bleed
 Hyperlipidemia
 Hpertensive Urgency/Emergency
 Meningitis
 Pneumonia
 Sepsis/Septic shock
 Stroke
 Syncope
 Thyroid Disease
 UTI
2. Formulate a prioritized list of differential diagnoses
3. Perform a comprehensive history and physical
4. Formulate an adequate diagnostic and treatment plan
5. Present in a concise and logical manner a presentation that includes H&P, pertinent
labs, imaging, and treatment
6. Perform detailed and accurate documentation in patient’s medical chart
7. Demonstrate compassion, professionalism, and respect
8. Demonstrate a desire to learn by exhibiting active participation and asking relevant
questions to residents, staff, and attending physicians.

Educational Resources

 Pocket Medicine (The Massachusetts General Hospital Handbook of Internal Medicine)


 Maxwell Quick Medicine Reference – provides templates for writing notes, etc
 Up-to-date
 Epocrates
 MKSAP
 Step Up to Medicine

Hierarchy/Chain of Command

1. Director of Medical Education


2. Program Director
3. Attending Physician
4. Chief resident
5. Senior resident on service
6. Student liaisons
7. Interns on the service
8. Medical students

If, at any time, you have an issue you feel needs to be addressed, please go through this chain
of command. Your first point of contact should always be a resident on service, not the
attending, program director, or DME. If the issue cannot be resolved this way, please contact
one or both of the student liaisons and so on.

General Information

1. Address: 7031 SW 62nd Ave Miami, FL 33143


2. Parking: There is parking available two blocks from the hospital at the metro station
parking lot
3. Resident lounge: Enter through the main entrance and make a right at the front desk.
The resident lounge is located directly to the right of this desk.
4. 4th floor conference room in GME: This is where morning report and didactics will be
held.

Work Hours

 Day shift: 6:30 AM – 7PM


 Weekend day shift: 7AM – 7PM
 Night shifts: 7PM – 6:30 AM

Schedule

 Students are required to have a short call and long call schedule, just like the residents.
Short call students are required to be present from 6:30 AM-3PM. Long call students are
required to present the entire shift, from 6:30 AM-7PM.
 It is possible that you will not stay until 3PM if you are short call or 7PM if you are long
call. This will be up to the residents on service to relieve you early if they see fit. It is
common courtesy not to ask to go home. Residents are well aware that you are present
and will relieve you when they see fit.
 All students will be required to work one weekend day while on inpatient days.
 Sign out will be every morning at 6:30 AM on the 2nd floor behind the nursing station.
 Morning report will begin at 7AM in the GME 4th floor conference room.
 Rounding times vary, but usually start between 9AM-10:30AM.
 Didactics are every Wednesday from 12PM-5PM. Students are required to fill up the
front three rows.

Evaluations

 Evaluations will be given to the senior resident in service after each inpatient rotation to
be filled out with the attending physician. If you give this evaluation to an intern or a
second year resident it will be invalid
 Interns are not permitted to sign evaluations
 Once the evaluations are filled out by other residents on service, the evaluations are still
required to be given to the student liaisons and may be subject to change when
uploaded as your final grade. This evaluation will be reviewed by the student liaison,
senior residents on service, and Dr. Michel. Based on their comments and views about
the student, the final grade will be uploaded.

Attendance

100% attendance is required to morning report and didactics. 100% attendance is expected
every day started with 6:30 AM sign out. It is encouraged to arrive earlier than sign out to learn
about your patients. You are excused from your rotation if you are able to provide
documentation of your absence and notify the team in advance. Please display professionalism
and respect by notifying your senior on service if you are running late or have an emergency
requiring your absence.

Student Expectations

 Be present and on time


 Rounds are the most important part of the day, that’s when the attending is informed
about ALL DETAILS about the patient, from history of illness to all parts of the physical
exam. Your intern will decide if you will be presenting the patient to the group, that’s
your time to shine and demonstrate how familiarized you are with that patient. Please
note that’s the only time you are allowed to talk. STUDENTS ARE NOT TO INTERRUPT
INTERNS, RESIDENTS OR ATTENDING WHILE THEY TALK. Remember the hierarchy we
rule by, respect and be polite to everyone from your intern to students in the group,
to all staff in the hospital. Everyone will notice your work ethic and will remember you
by it. Stellar students are those that get here before everyone else, they leave the
latest, they know everything about their patients, they show compassion for the
patient and extraordinary interest in their profession.
 Students will be expected to follow an intern and their patients. You are required to
know everything about your patient. This includes previous admissions, chief complaint,
labs, imaging, treatment plan, and any consulting services plan. It is important to be able
to gather an adequate history and physical. Although you may seem this as a foolish
exercise at first, this is what’s going to prepare you to be an excellent note writer and
physician once you are a resident.
 Students are encouraged to arrive earlier than 6:30 AM sign out to examine your patient
beforehand and know as much as you can and sign out to your intern about their
patient.
 Students are expected to present one patient to Dr. Michel, the IM attending, everyday.
With the limited time we have with him, this is a good opportunity to show him your
clinical skills and medical knowledge.
 Students should follow the same patient until discharge to allow for continuity of care.
When one of your patients is discharged, you will be expected to pick up an extra
patient or assist the resident on call with doing admissions.
 Each student will be required to present a short 5-10 minute presentation on a medical
topic, either assigned or of choice, after rounds to Dr. Michel and the residents.
Furthermore, students are required to present a medical topic and case presentation to
either Dr. Anthony Tran or Dr. Amy Shah at 1PM in the 2nd floor nursing building. After
the presentations, there will be a short discussion and time to ask questions.
 A majority of our patient population are prisoners. Students cannot enter their rooms
without a resident present. Also, neither students nor residents are to talk about the
disposition of the patient in front of them. They are NOT to know whether they are
being discharged.
 Students are always encouraged (and usually required) to perform their own physical
exam. But please keep in mind to always have a resident present before performing any
genital exams, rectal or pelvic.
 Students are required to attend all codes and rapid responses. If the patient is a
prisoner, students are not allowed to perform chest compressions or be a part of the
code/rapid response.

Tips

 Be nice, respectful, and courteous not onto the residents, but the staff members and
nurses as well.
 The majority of the patients are Spanish speaking only. If you need a translator, find the
patient’s nurse and he/she will most likely be willing to help if able.
 Try to be as helpful as possible for your resident and anticipate what they need to do
next. Residents always appreciate helpful students and the more you’ve gained their
trust, you will likely get to do more and receive more teaching.
 Students are encouraged to work with different residents and interns to gain different
perspectives on how to manage patients.
 The best way to learn on inpatient medicine is through self-directed reading. Go home
every night and read up on the conditions of your patients. Take the time to learn
everything you can about that topic, ask questions, and master it!
Mandatory case write-ups:

All student are required to write 8 case write-ups. What this is basically an admission note
preferably, or a progress note; however the latest does not provide enough information about
the patient most of the time. In addition, each report should include a summary of the main
illness that the patient presented with, for example: if the chief complain is headache, at the
end of the report you will do a summary of headaches. This documents are to be given to your
student liaisons for correction. The purpose of these are for you to learn and be educated on
how to write a proper note. Once you give them to the student liaisons they are supposed to go
over them and return them to you with notes and areas of improvement, after that you must
go over the notes and correct them and return to them for a final submission. You have until
the end of the 12 weeks to submit these documents, thus the earliest you start the better is
going to be for you.

Thank you and I hope you enjoy your time with us.

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