Clerkship Responsibilities and Expectations

Welcome to the Inpatient Internal Medicine Clerkship! We in the Department of Internal Medicine view the Clerkship as integral to your development as a physician. We believe that what you will learn over the next eight weeks will be of use to you no matter what field of Medicine you ultimately choose.

You are expected to learn from each patient. As a member of the rounding team you should know all the details about your patients’ support system, medications, lab data, radiology data, etc. We think the best way to learn Internal Medicine is to read about your patients. Therefore you should be reading about your patients’ medical conditions every night. There is something to be learned from every patient on the service. Therefore, you should participate in the rounds of all the patients (NOT just the ones that you follow personally) and point out interesting findings on your patients to your fellow classmates. We want to encourage you to take responsibility for your patients appropriate for your level of training.

The scope of Internal Medicine can be daunting. We have designed the Clerkship to promote self-directed, reflective learning habits that should serve you well throughout your career. You are expected to take the initiative in all aspects of your learning. This includes actively seeking feedback, participating in discussions, sharing your knowledge with others, and of course, spending time with your patients.

The Inpatient Internal Medicine Clerkship is divided into two 4-week blocks. Every student will have at least one month on a ‘General Medicine’ service and at least one month at Creighton University Medical Center (CUMC). The rotation sites are CUMC for University Medicine, Pulmonary and Cardiology, Bergan Mercy Medical Center for Cardiology, The Omaha Veterans Administration Hospital for general medicine, and St. Mary’s Medical Center in San Francisco, California for general medicine.

We find that this combination of sites allows you to see a broad variety of patients and provides you with exposure to core general medicine diagnoses and conditions. You also will care for some very complex patients with multiple chronic and acute medical problems. You will also have the opportunity to see some esoteric and complicated tertiary care patients.

We cannot teach you all of internal medicine in eight weeks. We will, however, do our best to teach you the core topics that we think are important for every physician to know. We emphasize clinical reasoning and utilization of educational resources to encourage your own self-study. We have formal teaching activities including Student Morning Report, lectures and Inpatient Student Grand Rounds. Furthermore there are Departmental noon conferences, Grand Rounds and CPCs. There are sign in sheets available at all conferences.  All conferences are mandatory so it is your responsibility to make sure you sign in.  Lecture schedules, times and locations for conferences are posted on the website and in the syllabus.

You should admit at least three new patients each week. You may admit new patients during the day or when you are on call. You may also ‘pick up’ new patients in the morning who were admitted overnight to your service. We do not ‘cap’ the student in terms of number of patients each can follow. HOWEVER you probably will be comfortable following up to three patients at a time. As the rotation and the year progresses, you may be able to follow more patients. Obviously the level of complexity of the patients may limit your patient numbers as well. Your residents and attending can help you determine the number of patients you can appropriately follow. You should not put yourself in a position to have more responsibilities than you can handle. You are an integral member of the team and the housestaff will count on you. Talk to your resident, attending, or the Clerkship Director if you are getting overwhelmed.

Every patient you follow needs an H&P and daily progress note. All notes should be legible and have the date, time, and your signature followed by ‘M-3’. If your signature is illegible, print your name next to it (it is actually a good habit to begin printing your name following or under your signature). All patient orders must be co-signed by a physician. Dictations for the medical record are not permitted. Students should turn in three H&P's for their file.

There is in-house night call for the junior medical student during the medicine clerkship at Creighton University Medical Center (as well as the VA Medical Center).  It is the responsibility of the student on-call at Creighton University Medical Center to be members of the night call team.  The clerks are expected to work directly with the first year resident on call.  Each clerk will be informally assigned to work with a specific intern at the beginning of the shift.  The junior student will assist both the intern and supervisory resident in the evaluation and management of all new admissions in the Emergency Department by the intern or supervisory resident.  In addition, in order to maximize the educational experience while on-call, you will be expected to "shadow" the intern until 11:00pm.  This not only includes "working-up" the new admissions, but also participating in reasonable "floor calls" of educational value (i.e., the management of any problems that may arise on the floors).

It is imperative that your pager number be made available to the interns on-call with you that night.  A list of the residents standard pager numbers is included in the syllabus

You spend the night on in-house call and are entitled to a free meal, which provides supper and breakfast on the weekdays, and three meals on the weekends. 

It is imperative that you submit YOUR own work and not a copy of a resident’s H&P for your H&P.

The Department of Medicine has no formal "dress code".  It is expected that you will be neat and clean in your appearance at all times.  Jeans and sandals are not permitted.  In general, men should wear a shirt and tie as everyday apparel.  You are expected to wear a name tag identifying you to your patients and to hospital personnel.  If you remain overnight in the hospital on call, you may wear "scrub suits" between the hours of 8:00 PM and 8:00 AM.  Such attire is not considered appropriate for morning rounds or during the usual working hours.  Similarly, there is no behavior code; it should be obvious that conduct befitting a future physician is expected at all times.  Nurses, ancillary medical personnel, and other hospital employees should always be treated with professional respect.

Discussion of patients should not occur within hearing distance of the patients nor in public areas, such as elevators and hallways.  There should be no eating or drinking while on rounds during any other patient related activities.

You should pre-round on all your patients and be on time and prepared for work rounds. You are expected to attend all the educational conferences unless an acute patient care need arises. (Your patient care responsibilities take precedence over everything.)

You should be polite and respectful to your patients and colleagues at all times.

Never falsify information. If you do not know something, simply say "I don’t know." (We do not expect you to know everything, despite how it may seem sometimes.) Cutting and pasting anything other than medication lists and lab data is plagiarism. You are expected to do your own work, regardless of what you may observe others do.

Unprofessional behavior will result in a lowering of your grade and potentially an unsatisfactory evaluation for the entire clerkship.

All patient information is confidential and should be discussed only with those involved in the patient’s care. Do not talk about patients in public places, no matter how softly you think you speak.  

You are held to the same standards as the residents in terms of work hours—no more than 80 hours per week. Students will be allowed four weekend days off per four-week block during the Inpatient Internal Medicine Clerkship to be coordinated with their rounding team.  This includes the final weekend of the rotation and the weekend for the Dimensions Course at the 4-week mark.  For example, during the first four-week block a student may have 2 weekend days off coordinated with their rounding team and the weekend following the Dimensions Course.  The second four-week block the student will have two weekend days off plus the final weekend between the rotations (following the dedicated days).  In the event of a holiday (for example, Thanksgiving) the student could take the Thursday of Thanksgiving as one of their allowed ‘weekend’ days off with coordination of their rounding team. Realize that all days need to be coordinated with the rounding teams and allowances may be needed depending on staffing and rotation site. It is often not possible for one to obtain the exact day one wishes to have off each month.  This is part of assuming the responsibilities associated with being a physician. Any days off required for illnesses, family emergencies, or other reasons will count as part of your allowed time off.

In the event of illness, emergency or a special event (such as a family member’s wedding) you can complete the standard form the Medical School utilizes for absences. You must get approval of your attending and the Clerkship Director. If any emergencies should occur during the clerkship, contact the Clerkship Director, the Chief Residents or Linda Spencer immediately so arrangements can be made

It is your responsibility to keep track of your hours and alert the Clerkship Director if you are being expected to work more than the allotted hours and days. Given the structure of our clerkship this should not be an issue. But, we take it very seriously if the problem arises.

Clinical experiences by their nature involve students in a variety of settings, locations and communities, as well as with a variety of patients/clients. Students are expected to exercise good judgment and reasonable caution in insuring their own safety during clinical experiences (e.g. lock car doors, travel with classmates when possible, be aware of security services). Patient care areas may have the potential for exposure to hazardous substances such as radioactive materials. Students who require protection beyond those of all staff are to notify faculty prior to any clinical assignments. If any time students believe the clinical setting is unsafe, students should take appropriate steps to protect themselves and their patients including leaving the setting if necessary. Contact the course instructor or any college administrator immediately so that appropriate arrangements can be made.