91PORN

To meet the objectives in increasing knowledge and skills and developing professional attitudes and behavior while caring for adult patients on General Internal Medicine floor service.

By participation in this rotation, the student will be able to…

• Formulate a plan for the cost-effective diagnosis of diseases commonly seen by general internists in the hospital setting (A2,3; B2,3,5)
• Formulate a plan for the cost-effective management of diseases commonly seen by general internists in the hospital setting (B3;C1)
• Communicate prognosis and plan of care with patients and families using lay terms (B1;C4)
• Initiate discussion of end-of –life issues and advanced directives in a culturally sensitive manner (C2)
• Formulate and clearly communicate clinical histories and the plan of care to members of the health care team both verbally and in the form of written orders and progress notes (B1)
• Develop a systematic approach to organizing and acting upon clinical information in a time efficient manner (B5)
• Evaluate their own fund of knowledge and utilize available resources to provide evidence based answers to clinical questions (D3)

1. KNOWLEDGE

The student should

• Demonstrate ability to evaluate and manage patients in a hospital setting with the following conditions and complaints:
• Abdominal Pain
• Acute Renal Failure
• Chest pain
• Congestive Heart Failure
• Fever
• Drug and alcohol withdrawal
• Dyspnea  (Asthma/COPD Exacerbations, Pneumonia etc.)
• GI bleeding
• HTN
• Seizures
• Learn and understand the diagnosis and treatment of conditions being managed while reading necessary texts and articles simultaneously making evidence based care decisions.
• Become competent in performing and accurately recording complete H/P with assessment, differential diagnosis and plan independently.
• Learn to order labs appropriately.
1. SKILLS

The student should

• Participate in procedures such as thoracentesis, abdominal paracentesis, lumbar puncture, central venous catheter placement etc., as and when appropriate.
• Interpret lab tests.
• Learn effective communication skills with patients and families using appropriate language and avoiding jargon and medical terminology.
• Learn to consult other specialties and/or nonmedical personnel in a timely and appropriate manner and communicate with them about patient care.
• Determine the clinical stability of the patient for proper disposition.
1. BEHAVIOUR

The student should

• Provide compassionate and empathic patient care in hospital care setting.
• Be sensitive to the diverse factors affecting patients and their health care beliefs and needs including culture, income and ethnicity.
• Coordinate care with nursing staff and other ancillary services.
1. ATTITUDE

The student should

• Practice patient privacy and confidentiality while maintaining highest standards of professionalism.
• Discuss ethical issues including end of life care.

The student should

• Care for approximately 3 adult patients per day with above described disease mix.
• Stay overnight during at least three- four nights on call and see at least two new patients per call night with their complete assessment and plan.
• Present cases during rounds with complete assessment, differential diagnosis and plan.
• Maintain patient log to assess meeting the above mentioned objectives.
• Attend morning reports and noon conferences.
• Write discharge/transfer summaries.
• Read texts relevant to their patient’s disease process.  Examples of resources may include Cecil’s Essentials, Washington Manual, or other resources suggested or supplied by the course director.

End of rotation evaluation forms to be filled by the attending on the floor.

Review of student's case presentations, documentation, professionalism and counseling skills during management rounds and conferences.

The student should

• Try to manage patients independently while remaining under the supervision of the senior resident.
• Demonstrate high standards of professionalism during patient care. 

The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation form.