there are prolonged absences or deferments of departmental or board exams.
Student H&P Write-Ups: The Core Clerkship Committee has reduced the requirement for long H&Ps from two per week to six per month. The full H&P and problem list must be turned in to your attending the day after you see your patient; a discussion may be handed in a day later - or when you are required by your attending. You are expected to work up additional patients per month, but you may use the intern's format for your initial H&P and problem list, and you need not turn in a discussion to your attending. The attending or the resident will review the shorter work-ups. However, you are expected to follow the patient, keep flow sheets, and write progress notes on all patients. You are expected to carry 4-6 patients at any one time. On some call days you will admit two patients - one with a long work-up, one with a briefer note. The goal of this change is to reduce the make-work aspect of the traditional H&P and to increase the number of patients for which you are responsible. We expect you to spend more time with the team in the hospital and less time at home preparing the long H&P. If your attending is dissatisfied with your initial long H&P, you may be required to complete additional long H&Ps.
A requirement of the course is to keep a log of the patients you follow. For each month we need the patient names, hospital numbers, and diagnoses for six patients you work up fully and for an additional six patients who you followed. The name of the attending or resident who can vouch for your contact with an individual patient must also be listed. The log will be collected by your Chief Residents at the feedback session conducted at the end of each hospital rotation. Failure to submit a satisfactorily completed patient log by the end of the course will result in a reduced grade in Medicine.
The H&P should be done in a form that can be included on the standard forms used by your hospital for the admission H&P. The history, physical examination, laboratory results, and initial problem list should be available for review by your attending or resident the day after being assigned to the patient or within 24 hours. We encourage you to write your H&P long hand and to type or word process your discussion. This means that you will have to learn how to write an H&P quickly, without the ability to annotate or correct extensively. This practice will prepare you to write or dictate complete and concise notes on the spot. Discussions may be typed and handed in separately. Students can abbreviate their H&P by shortening the review of systems to pertinent positives and negatives after demonstrating to their attendings that they can write a full review of systems. Discussion need not exceed two pages and often can be done in less. The discussion should be focused on the differential diagnosis of the chief problem, or if the disease is known, on an important aspect of the natural history or treatment of the patient. Frequently, your attending will base his or her evaluation on the quality of your H&Ps, the discussion, and your ability to present this information orally on rounds. The student H&P should be placed on the chart after it has been read and corrected by the attending or the resident if the attending so designates.
Examinations: The Departmental Exam counts for 30% of your grade and is given at the end of the rotation. This is an essay, short answer exam that takes 4 hours. There are three long cases to discuss, practical questions about interpretation of x-rays, peripheral blood films, and some short answer questions that require interpretation of laboratory data or simple calculations (creatinine clearance, A-a gradient). A grade of 70 or greater is considered a passing grade. If a student makes a grade of less than 70, he or she will be asked to retake the exam or will fail Medicine if the student's subjective evaluations are considered to be weak by the Core Clerkship Committee. Cases for test questions are based on topics in the core hospital lecture series and also will come from the therapeutics lecture series. You will also be required to take and pass the NBME shelf exam in Medicine given at the end of the rotation. A passing score is 55 or better. If you score below 55, then you will be asked to repeat the NBME. Although the NBME is no longer calculated as a part of the grade in Medicine, it is to your advantage to do well on the NBME exam. This is particularly true for students planning to match in a Medicine residency.
Reading: You will have to purchase a Washington Manual, and you should also use one of the short textbooks of Medicine. Cecil's Essentials of Medicine is the preferred short textbook. There is a new short book by Stobo that is also worth looking at. Your reading about individual patients should begin with appropriate sections of a major textbook of Medicine--Harrison's, Cecil's, or Kelly's. All students should make an effort to use the library's search engine (PubMed) to find recent articles concerning their patient's disease or treatment.
Work: There is work on Medicine, particularly in the public hospitals. Most students have the opportunity to do a certain number of procedures and participate in the care and management of a sizable group of patients. A social contract exists such that you can learn from a patient if you are functioning as a member of the team; working--not just observing. We do not want you to be doing random tasks on patients who are not assigned to you unless you feel that it is a reasonable part of the quid pro quo of the team. If the residents are teaching you, it will do you no harm to help them out. However, if you feel that you are being abused, taken advantage of, or being blackmailed by the resident for their grade, then you must talk to your Chief Medical Resident immediately. The Chief of Service is also there to help you. If you are still unhappy or there are academic or scheduling issues, call me at 798-6105. I usually keep hours available on Tuesday afternoons.
Blood borne Disease: Patients on Medicine may have HIV, or hepatitis B or C. You should not do procedures of any kind on these patients during this, your first clinical rotation on a Medicine Service. We expect you to examine and follow such patients, but ask that you not learn procedures when there is risk of acquiring a blood borne pathogen. Also be aware of TB and exercise caution when there is a chance of exposure.
Baylor Autopsy Requirement: The medical school requires that each student attend an autopsy. If you have not met this requirement, please contact the Pathology attending or resident physician on autopsy call at the hospital of your choice so that you can do so while on Medicine.
Holidays: Baylor holidays are usually considered core medicine student holidays. One holiday is scheduled for the Second Quarter 2000-2001. This is Thanksgiving and your days off are Thursday November 23rd, Friday November 24th, Saturday November 25th, and Sunday November 26th.
Religious Observances: Days for religious observances are honored. Please notify Arlene Back, Core Clerkship Coordinator at 798-6105 if you plan to observe a religious holiday. Also inform your team resident and attending of your plans.
Announcements: Refer to our website http://www.bcm.tmc.edu/medicine/coreclerk for announcements, schedules and other clerkship information.
©1995-00 Baylor College of Medicine
Contact: Mark M. Udden, M.D. (udden@bcm.tmc.edu)
URL: http://www.bcm.tmc.edu/medicine/coreclerk/content_02.html
(Modified: Sept-26
-00)
