Medical Student Clerkships
COURSE DESCRIPTIONS
MEDICINE
CCU Clerkship
Clinical Faculty: Peter Hui, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 1 student per block maximum
Description of the Rotation:
The medical student will closely follow the resident who will have primary patient responsibility in a closely supervised environment. A patient admitted to the CCU will be immediately evaluated by a senior resident and an R1 and be followed closely by the team on a daily basis and as frequently as needed. The patient's medical condition and plans of care will be discussed during rounds and with the patient's physician. You will directly aid in the work-up and management of critically ill patients with primary cardiac diagnoses including (but not limited to): STEMI/ACS, unstable arrythmias, decompensated CHF, heart transplant, cardiomyopathy, heart block. There is NO overnight call. The student will receive a minimum of 4 days off in a 4 week block.
Educational component of rotation:
Morning rounds involves the residents, a CCU fellow, and the CCU attending. All patients in the Unit are discussed focusing on thorough case presentations by the residents, active discussion of the patient's disease process and overall treatment plan, thorough review of electrocardiograms and hemodynamic monitoring, and clarification and emphasis on physical exam findings
Afternoon sign-out rounds recap pertinent events of patients with explicit instructions regarding plans of care for the evening.
Cath conference occurs weekly
Telemetry teaching occurs three times weekly (can typically join these rounds depending on the day)
The following additional educational rounds are held (not cardiology specific):
• Intern Report on Thursdays from 11 am to noon
• Noon conference
Objectives and Goals of the Rotation:
During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:
1. Medical Knowledge
o By managing complex medical illness you will improve your medical knowledge and will display an analytical approach to your patients and their clinical situations.
2. Communication and Interpersonal Skills
o You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team including case-managers, social workers and nurses.
3. Professionalism
o You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
4. Patient Care – clinical and management skills
o You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions.
5. Practice Based Learning and Improvement
o You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
6. Systems Based Practice
o You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including case managers, social workers, physical and occupational therapists.
Evaluation:
Your grade will be based on written evaluations from your Resident and Attending. Final grades of Pass, Honors or Fail will be given.
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ICU Clerkship
Clinical Faculty: Christopher Brown, M.D.
Year: Fourth year
Duration: 4 weeks
Enrollment: 3 students per block maximum
Description of the Rotation:
The rotation is four weeks in duration. Students will work closely with supervising interns, residents, fellows and attendings in the diagnosis and management of critically ill patients in an ICU setting. You will be exposed to patients with diverse socioeconomic, cultural and ethnic backgrounds and with wide-ranging diagnoses such as respiratory failure, acute renal failure, sepsis, CVA and subarachnoid hemorrhages, malignant hypertension and massive gastrointestinal bleeding. You will also learn the indication for and how to perform various procedures. There is NO overnight call. You will receive a minimum of 4 days off per month. You will be expected to manage 2-3 patients at a time.
Educational component of rotation:
o Patient related work rounds occur twice a day in the ICU.
o Didactic sessions on a variety of ICU related topics are held each Tuesday and Thursday from 1:30-2:30
o Noon Conference
Objectives and Goals of the Rotation:
During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:
1. Medical Knowledge
By managing critically ill patients you will be exposed to and gain knowledge in the following areas:
o Acute abdominal pain
o Acute chest pain
o Acute intoxication
o Acute liver failure
o Acute renal failure
o Altered mental status, coma
o Hypotension, shock
o Life-threatening arrhythmia
o Massive gastrointestinal bleeding
o Massive hemoptysis
o Respiratory distress or failure
o Severe hypertension
o Status epilepticus
2. Communication and Interpersonal Skills
o You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team including case-managers, social workers and nurses.
3. Professionalism
o You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
4. Patient Care – clinical and management skills
o You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions.
5. Practice Based Learning and Improvement
o You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
6. Systems Based Practice
o You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including case managers, social workers, physical and occupational therapists.
Evaluation:
Your grade will be based on written evaluations from your Resident and Attending. Final grades of Pass, Honors or Fail will be given.
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Gastroenterology Consultation Service
Clinical Faculty: Michael Verhille, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 1 student per block
Description of the Rotation:
By performing medical consultation on inpatient gastroenterology patients, medical students will gain exposure to common acute and chronic gastrointestinal disorders and will learn the principles of screening for disease in populations as well as diagnosis and treatment of gastrointestinal disorders. Students will have an opportunity to develop an understanding of the indications for and risk of gastrointestinal procedures and can gain experience in procedures including abdominal paracentesis, flexible sigmoidoscopy and placement of nasogastric tubes. Students may also have the opportunity to observe additional procedures such as upper intestinal endoscopy, ERCP, liver biopsy, and placement of tubes for gastro and esophageal tamponade. Learning will be primarily case oriented with attention given to the social, cultural, ethical and humanistic aspects of patient management as well as the specifics of each patient’s gastrointestinal illness. In addition, specific topics in gastroenterology will be addressed in conferences with the gastroenterology attendings and fellows.
Objectives and Goals of the Rotation:
During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:
1. Medical Knowledge
o Through your consultations you will gain medical knowledge about multiple gastrointestinal disorders. A core article collection forms a curriculum covering topics such as GI bleeding, acute and chronic diarrhea, pancreatitis, motility disorders, hepatology and others.
2. Communication and Interpersonal Skills
o You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills, and will strengthen the skills required to perform a comprehensive subspecialty consultation and communicate your recommendations to the treating team.
3. Professionalism
o You will demonstrate respect, compassion and integrity in your care of patients and in your communication with other members of the medical team. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
4. Patient Care – clinical and management skills
o You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions.
5. Practice Based Learning and Improvement
o You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid forming evidence-based recommendations for patient care. You will facilitate the learning of other team members.
6. Systems Based Practice
o You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including nurses, GI lab technicians, and case-managers.
Rounds, Conferences and Clinic
o Morning Report – M,W,Th,F – Enright Room You are required to attend morning report unless scheduled for GI clinic/conference or endoscopy experience or involved in a medical emergency.
o X-ray Rounds – Each Tuesday from 7:30am to 8:30am the GI team meets with Dr. Verhille at the California Campus to review the extensive available teaching resources at that location.
o GI Grand Rounds – these rounds are held every Wednesday morning from 8:00am to 10:00am at UCSF.
o CPMC GI Conference – This conference is held each Thursday from 12:00pm to 1:00pm in the pathology conference room on the 2nd floor of the Pacific Campus.
o GI Clinic – The resident on the GI service will attend GI clinic at the Family Health Center on Monday and Friday mornings in order to gain exposure to outpatient GI consultation and follow up management.
o Outpatient GI Lab – The endoscopy suite at the CPMC California Campus is the busiest GI lab in Northern California with up to 35 procedures performed daily. The resident is encouraged to schedule time at the GI lab to gain experience and seek proficiency in flexible sigmoidoscopy.
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Hematology/Oncology Service
Year: Fourth Year
Clinical Faculty: Kathleen Grant, M.D.
Duration: 4 weeks
Enrollment: 1 student per block maximum
Description of the Rotation:
The student will work closely with the housestaff team in admitting patients for routine chemotherapy treatments and in caring for those patients who have therapy related complications. Patient responsibilities will also include managing the terminally ill as well. There will be a teaching attending who will meet with the residents, interns and medical students each month. Education will include patient focused discussion, as well as bedside rounds and the rounds as described below. There is NO overnight call and you will receive a minimum of 4 days off per 4 week block.
Educational component of rotation:
Patient related rounds will consist of daily work rounds with your team and attending rounds three times per week.
Weekly multidisciplinary rounds occur Wednesday mornings to discuss the psychological and social aspects of individual patient care
Weekly tumor board occurs Thursday mornings
The following additional educational rounds (not Heme-Onc specific) are held
• Intern Report on Thursdays from 11 am to noon
• Noon conference
• Morning Report from 8am to 9am on M/W/Th/F
• Medicine Grand Rounds from 8am to 9am Tuesdays
Objectives and Goals of the Rotation:
During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:
1. Medical Knowledge
o By managing patients admitted to the hematology-oncology service, you will improve your medical knowledge in related diagnoses and in areas such as: tumor staging, complications of chemotherapy, chemotherapy regimens, lymphoma/leukemia, solid tumors.
2. Communication and Interpersonal Skills
o You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team including case-managers, social workers and nurses.
3. Professionalism
o You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
4. Patient Care – clinical and management skills
o You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions. You will also help manage the increased emotional and care needs in oncologic patients.
5. Practice Based Learning and Improvement
o You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
6. Systems Based Practice
o You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including case managers, social workers, physical and occupational therapists.
Evaluation:
Your grade will be based on written evaluations from your Resident and Attending. Final grades of Pass, Honors or Fail will be given.
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Medicine Sub-Internship
Clinical Faculty: David Jacobson, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 3 students per block maximum
Description of the Rotation:
The rotation is four weeks in duration. During the Sub-internship, students will assume the role of intern. The team is on long call every 5th day (though in-house, overnight call occurs only on long call Fridays and Saturdays: i.e. two overnight calls per 4 week block). You will work closely with your supervising resident in the admission, work-up and day to day management of patients admitted to the medicine service. You will be exposed to patients with diverse socioeconomic, cultural, and ethnic backgrounds, and with wide-ranging acute and chronic medical diagnoses. You will be expected to manage 4-6 patients at a time.
Educational component of rotation:
Patient related rounds will consist of daily work rounds with your team and attending rounds 3-4 times weekly. The locations of these rounds will vary.
The following educational rounds will be held in the Enright room (lobby level of the hospital):
• Intern Report on Thursdays from 11 am to noon (required)
• Noon conference (required)
• Morning Report from 8am to 9am on M/W/Th/F (recommended)
• Medicine Grand Rounds from 8am to 9am Tuesdays (optional)
Lastly, weekly student rounds will be held from 3-4pm on Wednesdays in the conference room in the Department of Medicine office. These rounds will typically consist of case presentations and discussion. These sessions are required
Objectives and Goals of the Rotation:
During this rotation you will gain experience and improvement in each of the 6 ACGME core competencies:
1. Medical Knowledge
o By managing complex medical illness you will improve your medical knowledge and will display an analytical approach to your patients and their clinical situations.
2. Communication and Interpersonal Skills
o You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team including case-managers, social workers and nurses.
3. Professionalism
o You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
4. Patient Care – clinical and management skills
o You will perform thorough and appropriate histories and physical examinations and any necessary procedures. You will make and carry out informed patient management decisions.
5. Practice Based Learning and Improvement
o You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
6. Systems Based Practice
o You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including case managers, social workers, physical and occupational therapists.
Evaluation:
Your grade will be based on written evaluations from your Resident and Attending. Final grades of Pass, Honors or Fail will be given.
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Pulmonary Consultation Service
Clinical Faculty: Christopher Brown, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 1 students per block maximum
Description of the Rotation:
The medical student will work closely the pulmonary fellow and the attending pulmonary physician assigned to the Pulmonary Function Laboratory for the purpose of interpreting studies. The medical student will actively participate in primary and consultative patient care and evaluate and participate in the management of patients in the ICU under the close supervision of the pulmonary fellow and attending physician in the pulmonary division. Appropriate diagnostic procedures will be discussed and performed in the course of evaluating patients with pulmonary problems. The student may also attend the outpatient clinic at Highland Hospital on Tuesday afternoons. There is NO overnight call. The student will receive a minimum of 4 days off per 4 week block.
Educational Format of the Rotation
The medical student will attend and actively participate in the following conferences:
• Clinical Pulmonary Conference every Monday from 1:00 – 2:00pm in the X-Ray Conference Room with emphasis on the interpretation of radiographic studies involving the chest
• Pulmonary Journal Club on the 4th Monday of every month
• Pulmonary Physiology Conference as scheduled in the Pulmonary Function Laboratory
• Critical Care Journal Club Monthly Pulmonary Noon Conference for the medicine house staff in the Medical Education Conference Room
Objectives of the Rotation
Medical Knowledge:
• You will learn to interpret pulmonary function studies and exercise studies
• You will acquire additional experience in evaluation and managing respiratory problems such as obstructive pulmonary disease, infiltrative pulmonary disease, and pleural effusions.
• You will acquire additional knowledge regarding the indications, methodology, complications, and interpretation of results of the following procedures:
- pleural biopsy
- thoracentesis
- percutaneous arterial puncture and cannulation
- fine needle aspiration
- tube thoracostomy
- central venous lines
- pulmonary artery catheters
- endotracheal intubation
- fiberoptic bronchoscopy
- sleep studies
- pulmonary artery balloon flotation catheterization
- tube thoracostomy (introduction)
Communication and Interpersonal Skills
• You will demonstrate the ability to communicate clearly, respectfully and compassionately to your patients and their families. You will also exhibit effective listening and writing skills. You will also function effectively as part of the health-care team, communicating with fellow interns, your residents, attendings and other members of the team.
Professionalism
• You will demonstrate respect, compassion and integrity in your care of patients. You will demonstrate sensitivity to issues such as confidentiality, culture, age, sexual orientation, gender and disability.
Patient Care – clinical and management skills
• You will gain experience in evaluating and managing patients with pulmonary diseases who are critically ill and hospitalized in the Critical Care Unit.
Practice Based Learning and Improvement
• You will analyze your own medical practice on a case-by case basis and apply knowledge gained in the care of future patients. You will access medical literature to aid in your patient care. You will facilitate the learning of other team members.
Systems Based Practice
• You will gain understanding of types of medical practice and healthcare delivery systems and how they impact patient care. You will also gain experience in working with multiple health-care team members including nurses, respiratory therapists, pulmonary lab technicians.
Curriculum of the Rotation
• Obstructive lung diseases, including asthma, bronchitis, emphysema, bronchiectasis and cystic fibrosis
• Pulmonary malignancy – primary and metastatic
• Pulmonary infections, including tuberculosis, fungal and those in the immunocompromised host
• Diffuse interstitial lung disease
• Pulmonary vascular disease, including primary and secondary pulmonary hypertension, the vasculitis and pulmonary hemorrhage syndromes
• Occupational and environmental lung diseases
• Iatrogenic respiratory diseases including drug induced disease
• Acute lung injury, including radiation, inhalation and trauma
• Pulmonary manifestations of systemic diseases including collagen vascular disease and diseases which are primary in other organs
• Respiratory failure, including the adult respiratory distress syndrome, acute and chronic respiratory failure and obstructive lung diseases and neuromuscular respiratory drive disorders
• Disorders of the pleura and mediastinum
• Genetic and developmental disorders of the respiratory system
• Sleep disorders
• Basic sciences – molecular biology
• Basic sciences – pulmonary physiology
• Pulmonary function tests to assess respiratory mechanics, gas exchange and respiratory drive, including spirometry, flow volume studies, lung volumes, diffusing capacity, arterial blood gas analysis and exercise studies
• Calibration and operation of hemodynamic recording systems
• Ventilatory support, weaning and respiratory care techniques (introduction)
• Examination and interpretation of sputum, bronchopulmonary secretions, pleural fluids/tissue, and lung tissue for infectious agents, cytology and histopathology
• Pulmonary immunology
• Inhalation challenge studies
• Imaging procedures, including x-rays, ct scans, radionuclide scans, pulmonary angiograms
• Research project (optional)
• Sleep studies
Evaluation:
Your grade will be based on written evaluations from your Resident, Fellow and Attending. Final grades of Pass, Honors or Fail will be given.
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RADIATION ONCOLOGY
Elective Rotation
Clinical Faculty: John Lee, M.D.
Year: Fourth Year
Duration: 4 weeks
Enrollment: 1 students per block maximum
Description of Rotation:
The clerkship offers an introduction to radiation therapy.
Goals & Objectives:
Become familiar with the field of radiation oncology and interacting with medical oncology and surgical oncology.
Improve skills in performing an oncology history and physical evaluation.
Evaluate and recommend a treatment plan for patients referred to radiation oncology.
Request diagnostic tests and procedures for evaluating oncology patients.
Formulating treatment plans for patients following review of X-rays, laboratory tests, history and physical examination.
Participate in the simulation or localization of radiation fields on the CT or fluoroscopic simulator.
Follow-up patients to understand the potential benefits and side effects of their treatment.
Activity Outline:
Students are supervised directly by the consultant in radiation oncology. Students assist in evaluating cancer patients, ordering tests, and procedures. During their clerkship, students assist both the radiation therapist and radiation oncologist in simulating treatment fields in preparation for radiation therapy.
Students assist with and participate in procedures performed in the hospitals (eg. brachytherapy, gold seed marker placement)
Method of Evaluation:
Consultants who work with students provide written performance evaluations.
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