Tips for the Medicine Clerkship
The Internal Medicine Clerkship is the educational experience during which students are expected to gain the basic knowledge, skills, and attitudes needed to care for adult patients with medical disorders. Traditionally, the clerkship has been hospital-based and geared to the diagnosis and management of acutely ill inpatients. With changes in the delivery of health care in the United States, clerkships at many medical schools have also included some training time in the ambulatory environment. The clerkship can be an anxiety-provoking time for some students as they move from the objective evaluation system (i.e., tests and quizzes) of the preclinical years to the subjective evaluation system of the clinical years, which is based on day-to-day knowledge and care of patients. That is not to say that students will never encounter a written examination, as many schools administer the National Board of Medical Examiners (NBME) Shelf Examination in Medicine at the end of the clerkship, which may account for a significant portion of the student’s final grade. This chapter provides a few pointers to hopefully ensure success in this very exciting, but sometimes intimidating, clinical journey.
There are levels of proficiency throughout medical school and during the clerkship that are usually linked to the goals and objectives. Schools either distribute the goals and objectives or have a website devoted to the clerkship where they can be found. In addition, many schools have adopted the national Clerkship Directors in Internal Medicine—Society of General Internal Medicine Core Medicine Clerkship Curriculum; the national goals, objectives, and syllabus can be accessed at the Alliance for Academic Internal Medicine’s website (www.im.org). These elucidate what the learner will need to master, as the goals and objectives are usually tied in some way into the final evaluation for the Internal Medicine Clerkship.
Many students struggle with what is expected of them as junior clerks. It is optimal for students to discuss the expectations of their resident and attending physician early during the first week of the rotation. The following are examples of basic duties and responsibilities that are commonly suggested across a wide variety of medical schools and other clerkships.
Always be on time; in fact, try to be a bit early. This includes lectures, teaching rounds, and other required activities. Timeliness is a part of being a professional and working within a profession. If you need to be late or absent, you should immediately notify the attending physician, resident, and the person responsible for the clerkship at that site (director or administrator). It is also important to realize that if illness is the reason you are absent, you may need a doctor’s note to return. This is not because your supervisors don’t believe you but instead because if your absence is related to an infection, you may need to be deemed noninfectious before returning, as many of your patients may have depressed or absent immune systems such that close contact can expose them to serious illness.