Post on 01-Feb-2023
DEPARTMENT OF MEDICINE
KECK SCHOOL OF MEDICINE
2020 Zonal Avenue, IRD Room 626
Los Angeles, CA 90033
Phone 323-409-6620 • Fax 323-226-2116
Internal Medicine Sub-Internship Clerkship Manual
Academic Year 2021-2022
Clerkship Faculty and Staff
Jeff Canceko, M.D.
Clerkship Director
323-409-6620
canceko@usc.edu
Matthew Johnson, M.D.
Associate Clerkship Director
323-409-6620
msjohnso@med.usc.edu
Sonya Earley, PA-C, M.A., CDCES
Medical Student Educator
Clinical Associate Professor
323-409-6620
earley@usc.edu
Angel Vallejo
Clerkship Coordinator
323-409-6620
medclerk@usc.edu
Department of Medicine Office Hours
8:30 am to 4:30 pm
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Table of Contents Introduction ................................................................................................................................................... 2
Internal Medicine Sub Internship Learning Objectives ................................................................................ 2
Internal Medicine Sub Internship Goals ....................................................................................................... 3
Clerkship Structure ....................................................................................................................................... 3
Clerkship Site Descriptions ........................................................................................................................... 3
Clinical Learning Activities .......................................................................................................................... 4
Curriculum .................................................................................................................................................... 4
Student Practice Profile (SPP)/Must-See Encounters ................................................................................... 6
Student Assessment ...................................................................................................................................... 7
HIPAA Privacy Regulations ......................................................................................................................... 8
Medical Student Time Requirements ............................................................................................................ 8
Wellness Day Policy ..................................................................................................................................... 8
Attendance Policy ......................................................................................................................................... 9
Professional Responsibilities and Behavior .................................................................................................. 9
Clerkship Evaluation ..................................................................................................................................... 9
Mistreatment ................................................................................................................................................. 9
Additional Information ................................................................................................................................. 9
Disability Services and Programs (DSP) .................................................................................................... 10
How to Deal with Urgent/Emergent Personal Issues .................................................................................. 10
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Introduction Welcome to the Internal Medicine Sub-Internship! We hope that you will find the following four weeks of
Internal Medicine experience both fun and educational.
Senior Medical Students will work directly with attending physicians and residents in the provision of
patient care in an inpatient, sub-internship experience. Your experience on the Internal Medicine Sub-
Internship will be directly proportional to the energy and interest that you invest. You must attend all
student lectures and conferences, be an integral member of your Medicine team, and perform in-depth
investigations and research about your patients’ medical problems. Students are expected to perform and
carry a patient load at a level nearly equivalent to that of an Internal Medicine Intern. The Internal Medicine
Sub-Internship is designed to prepare students for the challenge and rigors of internship.
We hope that you will enjoy this learning opportunity and will find gratifying the profound contributions
that you can make to your patients' care.
Please note that you are responsible for knowing and following the Keck School of Medicine Student
Policies.
Internal Medicine Sub Internship Learning Objectives In real or simulated clinical settings, students will:
1. Apply advanced basic-science and clinical knowledge to the clinical data and develop
comprehensive differential diagnoses.
2. Accurately gather information to develop prioritized differential diagnoses, and suggest evidence-
based diagnostic and review in real time treatment strategies for a resident and/or faculty
supervisor.
3. Write complete, concise, and evidence-based daily progress notes using the SOAP format.
4. Demonstrate proficiency in the care of patient’s common inpatient cross cover and emergency
scenarios.
5. Accurately describe the indications and contraindications for common procedures in internal
medicine
6. Accurately interpret common laboratory and diagnostic tests: EKG, CXR, UA, blood chemistries,
CBC, peripheral blood smear, ABG, cell counts and chemistries of spinal, pleural, joint or ascitic
fluids.
7. Design appropriate, evidence-based, cost-effective diagnostic and treatment strategies.
8. Perform concise, complete, and well-organized verbal case presentations.
9. Communicate effectively with patients and develop close and therapeutic medical student-patient
relationships with progressively increasing independence
10. Work effectively and harmoniously with colleagues, nursing staff, allied health personnel, and
physicians.
11. Appropriately incorporate ancillary services, community resources, and appropriate discharge
planning techniques to optimize patient care.
12. Demonstrate a commitment to caring for all patients, regardless of gender, race, socioeconomic
status, intellect, sexual orientation, ability to pay or cultural background.
13. Identify patients whose illnesses may put the community at risk.
14. Conduct a focused literature search, critically appraise the medical literature and apply best
evidence to the internal medicine problems encountered.
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Internal Medicine Sub Internship Goals A variety of presentations and experiential learning opportunities are designed to introduce the students to
the following topics/ skills under the supervision and guidance of residents and faculty:
1. Caring for diverse adult inpatients at a variety of clinical settings.
2. Admitting and cross covering patients.
3. Writing orders, prescriptions, and discharge summaries.
4. Effectively communicating with patients by:
a. Using lay terms appropriate to patient’s level of understanding.
b. Recognizing and managing denial and grief.
c. Communicating abnormal results and “bad news” to patients in a sensitive manner.
d. Discuss end of life issues with attention to patient’s wishes and needs.
e. Providing concise daily updates for patients and families regarding hospital course and
rationale for ongoing or new treatment plans.
5. Identifying alternatives in difficult ethical choices, analyze conflicting considerations and execute
a course of action that takes into account the ethical complexities.
6. Recognize the potential conflicts between patient expectations and medically appropriate care.
7. Applying the concepts surrounding advance directives in patient care activities.
8. Apply the concepts surrounding informed consent in patient care activities.
9. Preparing concise, evidence based, write-ups on clinical diagnoses
10. Conducting continual self-evaluation and life-long learning.
14. Recognizing the importance of systems – especially interprofessional collaboration in delivering
high quality patient care.
15. Adequately asses the limits of his/her medical knowledge in relation to the patient problems
encountered.
16. Actively incorporate formative feedback and evaluation into his/her daily practice.
Clerkship Structure During the Internal Medicine Sub-Internship, you will become a member of a team consisting of a faculty
attending, a resident, two interns, one to two 4th year students, and one to two 3rd year students. One of
the primary responsibilities of the resident is to teach and supervise medical students. Your resident will
select patients who are appropriate for you to manage and aid you in fulfilling the goals covered in the
Learning Objectives (see link above). It is important to remember that an attending or resident must
countersign all histories and physicals, orders, progress notes, and discharge summaries.
Wellness Day- On the second Friday of the Clerkship, students will have the afternoon off (1/2 day off) for
Wellness. It’s recommended to use this half-day for doctor appointments, studying, and to simply BE
WELL. At KSOM, student health and well-being are the highest priority.
Clerkship Site Descriptions Clerkship site descriptions can be viewed at the following website:
https://ksom.usc.edu/curriculum/year3/
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Clinical Learning Activities A. Schedule Overview
Time Schedule: Conference/Activity
6:30 – 7:00 am Pre-Rounds on Patients
7:00 – 8:00 am Work Rounds with Team
8:00 – 9:00 am Morning Report
9:00 – 11:00 am Teaching Rounds
12:00 – 1:00 pm Lunch
1:00 – 4:00 pm Discharge Planning & Management Rounds
1:00 – 4:00 pm Student Curriculum (TBD)
6:30 am – 6 pm Clerkship Work Schedule
Students are expected to admit patients on a daily basis. Students are expected to remain with their
residents daily from 6:30 am to 6 pm. You will return the next morning prepared to pre-round on
your patients. Remember that your supervising resident must countersign all of your work via
computer. You are relieved of all clinical responsibilities on the last Tuesday of the rotation at 6
pm.
B. Work Rounds - The team's established patients will be seen by the entire team. You should be
prepared to present your patients and discuss your findings with your resident. Work rounds
provides an opportunity to determine and implement the plans you wish to carry out for the day:
which lab studies need to be drawn, which diagnostic studies need to be scheduled, which lab
results need to be checked, which films or scans need to be reviewed, which consults need to be
called and which therapies to continue or change.
C. Teaching Rounds - All admissions and established patients with new problems will be reviewed
at the bedside by your attending faculty. During the last one-half hour of teaching rounds house
officers or medical students may give didactic presentations of medical topics relevant to the team’s
activities.
D. Sign Outs - It is imperative that you sign out your patients to the physician responsible for the care
of your patients when you are outside the hospital. You must communicate directly with this
physician in person. A sign out consists of the name and P.F. number of your patient, a brief
summary of the medical problems and present therapy, and an explanation of any procedures or
diagnostic studies you wish to be performed in your absence (such as serum glucose level in a
diabetic, a hematocrit in a bleeding patient, or a fever work up). Please do your sign outs in
conjunction with your residents.
E. Procedures - Your resident is expected to instruct and supervise you in any and all procedures you
may need to learn. Anyone who does not feel comfortable with a procedure (thoracentesis,
paracentesis, central line replacements, etc.) should express their discomfort.
Curriculum Attendances at all sessions are mandatory unless otherwise stated.
A. Syllabus and Text – There is no required text book, however, a great reference text is Andreoli and
Carpenter’s Cecil Essentials of Medicine 10th Edition. E-book available through Norris Medical
Library. Requires USC network connection. Link: http://web-
app.usc.edu/e_resources/hsl/gateways/30681.php (click on “Access this resource”).
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B. Student Afternoon Report – Two Weekday Afternoons, IPT Conference Room (see calendar). These
sessions are designed to invite student participation in a problem-solving approach to clinical case
presentations. Each session, medical students will be chosen to make case presentations and provide
supporting laboratory and test results. Internal Medicine faculty will guide a process intended to hone
one’s skill at synthesizing historical, physical and laboratory data, establishing differential diagnoses,
as well as, diagnostic and treatment strategies. Students are assigned to present.
C. Patient Care Workshops – Students are divided into two groups where they will be given typical
cross cover and emergency scenarios. As a group, students will work through various scenarios.
Workshops will be run by Internal Medicine Hospitalist Faculty.
• Workshop Topics Include:
o Seizures
o Dyspnea
o Fever
o SIRS/Sepsis
o Abdominal Pain
o Chest Pain
o Tachycardia
o Altered Mental Status
o IV Fluid Management
D. Pain Management –Palliative Care faculty review various approaches to pain management.
E. Morning Report – (Student Attendance is Mandatory) Monday and Thursday, 8:00-9:00 am,
Inpatient Tower-Conference Room B or Virtual. Residents present and discuss cases recently admitted
to the Internal Medicine Service. This is an excellent conference for observing clinical problem
solving. Wide arrays of medical problems are discussed and faculty representatives from the
Department of Medicine are present for expert advice.
F. Faculty Mentor Rounds – (Timing at the discretion of the faculty attending.) The team’s attending
spends 1-2 hours per week with the medical students reviewing clinically based topics. Topics include
medical documentation, physical examination, critical thinking and patient management.
G. Medical Grand Rounds – (Student Attendance Highly Recommended) Fridays, 12:00-1:00 pm,
Inpatient Tower – Conference Room B Senior residents, under the guidance of faculty mentors,
present interesting Internal Medicine cases with didactic overviews.
H. Evidence Based Write Ups- During the clerkship, each student will submit two evidence based
write-ups for review by the faculty attending. Both write-ups are due simultaneously, in duplicate,
the Third Monday of the rotation. One copy of each write-up is to be submitted to the MSE and
Coordinator or Clerkship office, IRD 626. The duplicate copy is presented at your mentor session.
Both write ups should be typed and include evidenced based summaries including references.
Students who present for the Student Afternoon Reports can submit that PowerPoint as one of the
required write-ups. Please see the attached Sample Write-Ups located in your Orientation packet for
the required format.
I. Clinical Inquiry and Simple Cases (CI)- The CI features aspects of the Case Based Curriculum used
at Keck School of Medicine (KSOM). You will have a computerized quiz based on your workshops
worth 15% of your grade.
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Student Practice Profile (SPP)/Must-See Encounters SPP/“MUST SEE” encounters of the student's interaction with assigned patients. The rationale for the
timely completion of patient encounters is twofold. In addition to providing the student with a readily
accessible patient profile, it enables the faculty to review the number, complexity and breadth of clinical
experiences the student is afforded during the clerkship. The patient encounter format is concise and allows
the student to describe relevant patient findings reflected through the history, physical examination,
assessment and plan. All SPP/ Must See encounters DO NOT REQUIRE A SUMMARY!
The data that are collected and aggregated provide a representation of the patient population and clinical
sites which allows the faculty to evaluate and revise the clinical experience as it relates to the core
curriculum objectives and competencies. In addition, students and faculty are able to track learners’
experiences with the encounter of the SPP, and to assure that patient encounters are equivalent across sites.
During the four week clerkship, students should have the opportunity to care for actual patients that meet
the criteria of the SPP/“MUST SEE” encounters. However, if an actual patient encounter with a particular
diagnosis or symptom has not been available, the clerkship MSE will assist the student by identifying a
patient or an alternative experience at another site, or the student may be asked to complete a simulated or
alternative experience, e.g., a “virtual” (paper or web-based) case, a lecture or case discussion, a problem-
based learning case, etc. The student will document this alternative encounter on MedOASIS according to
the instructions given to you by the MSE.
During the clerkship, you will be required to enter an encounter for each of the Student Practice Profile
(SPP) encounters, also known as “MUST SEE” encounters.
Requirement Checklist:
1. Chest Pain
2. Pain Management
3. Fever of Unknown Origin
4. Renal Failure
5. Dyspnea
You will log all encounters in MedOASIS based on your admissions. In the encounters, you can enter up
to three (3) of the SPP/“MUST SEE” diagnoses per patient within those encounters. Just simply check off
on the drop down diagnosis menu. This will mean that you only have 2 SPP entries remaining to include in
your other admissions. Nearly all “MUST SEE” encounters are viewed in some form during the clerkship.
If, however, you are not able to see an actual patient for any of the SPP/“MUST SEE” encounters, please
talk to the MSE. You will be able to use an alternative (virtual, lecture, workshop cases, etc.) encounters.
Ideally, all encounters should be ACTUAL patients.
The MedOASIS application can be accessed via a web browser at http://mymedweb.usc.edu. Please click
on an overview of the required checklist. For technical questions, please contact Raymond Lam at 442-
2156 or email at chiyuila@med.usc.edu.
Note: Students must have all of their patient encounters completed on MedOASIS no later than 5:00
pm on the third (3rd) Friday of the rotation. The Medical Student Educator will review the patient
encounters and determine if the submissions are adequate. All clerkship evaluations (program,
attendings, and residents) must be entered on MedOASIS no later than 5:00 pm the final Thursday
of the rotation.
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Student Assessment Final examinations are administered by this Clerkship.
A. Nationally Standardized Subject Exam
B. Clinical Inquiry Quiz (CIQ)
The Subject Exam is administered on the last Friday of each rotation and is coordinated by the Assessment,
Evaluation, and Reporting Office.
Evaluation and Grading
The following components contribute to each individual's grade:
1. Written evaluations from faculty attendings and residents
Note: It is the policy of the Department, that students shall address any
concerns regarding evaluations to the Clerkship office. Students are
NOT permitted to contact their medicine team attending, senior or junior
house officers regarding any evaluations.
60% of grade
2. Nationally Standardized Subject Exam 25% of grade
3. Clinical Inquiry Quiz 15% of grade
4. Other Satisfactory Completion of:
• Mid-Clerkship Feedback Form (due on 3rd Monday) ✓
• All SPP/Must See Encounters Entered in MedOASIS (due on 3rd
Friday)
✓
• Two Evidence Based Write-Ups (due on 3rd Monday) ✓
Note: If applicable, the narrative portion of the final clerkship evaluation will indicate any of the above
requirements not met.
The final clerkship grade is determined by your composite score and the following grades are possible:
Overall Score cut off for
each grade
Minimum NBME Subject
Exam Score for each grade
Internal Medicine
Sub Internship Honors 90+
62 High Pass 73-89
Pass 67-72
Fail 66 or below
Passing the Clerkship: To receive a passing grade (Pass, High Pass, or Honor) for the clerkship,
students must demonstrate minimum competence based on their 1) overall clerkship performance; 2) the
NBME subject exam performance; and 3) the absence of unprofessional behaviors as outlined in the
student handbook.
1. Students who do not pass the NBME subject exam on their first attempt will be ineligible for
Honors.
2. Students who pass the retake exam (second attempt) will receive their original clerkship grade of
Pass (P) or High Pass (HP) on their transcript for that clerkship. If their original grade is H, their
final clerkship grade will be downgraded to an HP.
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3. Students who fail the retake exam (second attempt) will continue to have a grade of Incomplete
(I) noted on their transcript for that clerkship and will be required to sit for a second retake (third
attempt) of the NBME subject exam.
4. Students who pass the second retake exam (third attempt) will receive a grade of “Pass” for the
clerkship. They are ineligible for a grade of HP or Honors.
5. Students who fail the second retake exam (third attempt) will receive a grade of “Fail” (F) for the
clerkship and must repeat the clerkship.
Fail: A grade of fail may be given in the following situations: 1) failure to demonstrate minimum
competence based on overall clerkship performance, 2) any unprofessional behavior as outlined in the
student handbook, 3) failure to resolve a grade of incomplete.
Incomplete: Not a final grade, but a designation that is used if a student has been excused from meeting a
clerkship deadline.
• Grades of “Incomplete” will be assigned to any student who does not complete any required
component of the clerkship.
• Grades of “Incomplete” will be assigned to any student who has not yet achieve the minimum
score set for passing the clerkship on their NBME Subject Exam.
HIPAA Privacy Regulations Please note that HIPAA privacy regulations are in effect at all times in all clinical settings. Individual
practitioners (including medical students) are held personally responsible for violations of HIPAA
regulations which may result in financial and other penalties. You have previously completed a HIPAA
training on Trojan Learn and have access to the training modules if you wish to review them. You can also
find additional information by visiting https://ooc.usc.edu/data-privacy/health-information/hipaa-privacy-
regulations/
Medical Student Time Requirements In general, students on their Internal Medicine clerkship work Monday-Saturday, in an inpatient setting,
with no required call responsibilities. Students are expected to work in the hospital with their team
members- medical students, Interns, Residents, and faculty members six days per week (often, students
work 60 + hrs/week). Because students are placed at a wide variety of practice sites with varying business
hours, students should understand and accept that their work schedules will vary, although every student
will be working full-time.
Student hours include the following limits: a maximum of 28 hours in the hospital over one period and a
maximum of 80 hours per week averaged over four weeks. Students receive at least one day off per week
(pre-set off day). Please review the Medical Student Time Requirements Policy for more comprehensive
information.
http://medweb.usc.edu/policies/medical_student_time_requirements_for_clinical_and_educational_activit
ies.html
Wellness Day Policy Wellness days are mandatory and are incorporated into clerkship schedules to provide students with an
opportunity to attend to their personal wellbeing. Students are released from clinical duties one full day for
each 6-week clerkship and 1/2 day for each 4-week clerkship. The timing of wellness days are electronically
posted and communicated by the clerkships.
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Attendance Policy It is the responsibility of the student to notify the proper individuals (Medical Student Educator, Attending,
Senior Resident) of absences in case of personal emergencies and unforeseen events. Please review the
KSOM Attendance Policy for more detail.
http://medweb.usc.edu/policies/attendance_and_absence_request.html
Professional Responsibilities and Behavior Unique to the Family Medicine Clerkship is the opportunity for you to be an ambassador and exemplary
representative of KSOM and USC to other cities and institutions across CA and the U.S. Promoting a
positive image of KSOM ensures that we continue to recruit and maintain outstanding preceptors who
kindly open their practices to USC students and also benefits you directly with residency applications and
eventual practice.
Please refer to http://medweb.usc.edu/policies/guidebooks/medical_student_teaching.html#one for more
detail.
Clerkship Evaluation We rely on your thoughtful and constructive feedback to continually improve our clerkship.
Please complete the following to meet clerkship expectations:
1. Submit Orientation week Evaluations on MedOasis by the end of the week. If you did not attend
more than ½ of a particular session, please check the “N/A” box.
2. Preceptor/Site Evaluation
3. Director/MSE Evaluation
4. Clerkship Evaluation
Completing the evaluations is expected and part of your professional responsibilities. Pease refer to the
http://medweb.usc.edu/policies/.
Mistreatment KSOM is committed to creating a positive learning environment. Students are encouraged to report
instances of disrespect that “unreasonably interferes with the learning process”. Please review
http://medweb.usc.edu/policies/mistreatment_and_professional_behavior.html for more information on
mistreatment policies and the mechanisms by which you can report mistreatment.
Consistency of Evaluations and Grading within Internal Medicine Sub-Internship
Criteria for Resident and/or Faculty Supervisors Eligibility: All residents and attendings that are the
supervisors of record for at least 1 [calendar] week (typically 6 days, 1 day off).
Minimum number of Supervisor Evaluations Required to Generate the Final Grade: One attending.
Additional Information A. MedOASIS Documentation of SPP/Must See Encounters:
Medical Student Documentation of Patient Encounters using mymedweb.usc.edu:
"MedOASIS" is a highly specialized information system used throughout the four year medical
school curriculum. In addition to course materials, class schedules, web-based educational programs
and interactive links, patient encounters and clerkship evaluations are accessed through the system.
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If you would like to review a sample on how to input a patient encounter, please review a web-casted
segment at:
http://keckmedia.usc.edu/mediasite/Viewer/?peid=a79d58bf64b046d88afaa2a8628f14a3
For complete instructions on entering SPP/MUST SEE encounters on MedOASIS, please refer to the
document entitled “Clinical Experience Portfolio User Instructions” on MedOASIS, listed under
Clerkship Learning Resources. You may also wish to view the Introduction to Clinical Experience
Portfolio Instructional Video located at the same site. Please use the patient’s diagnosis as the “alias”
for the encounter entry. This will allow easier tracking of your MUST SEE encounters throughout
the clerkship.
There is an example of a comprehensive patient encounter (Attachment B) online at:
http://medweb.usc.edu/site/clerkships/clerkship_general_resources.htm under the sub group listed
as: “Clinical Experience Portfolio User Instructions for Medicine I.” Please contact Raymond Lam
at (323) 442-2156 or e-mail him at chiyuila@med.usc.edu with any technical questions.
Note: In order for clerkship faculty to have adequate time to review SPP encounters, students
must have all of their patient encounters completed on MedOASIS no later than 5:00 pm on
Friday of week 3 of the rotation. Points will be deducted from your clerkship grade if this
deadline is not met. All clerkship evaluations must be entered on MedOASIS no later than
5:00 pm the final Thursday of the rotation.
B. Internal Medicine Sub-I lectures can be found in the Blackboard course and in the webcast
link: http://keckmedia.usc.edu/Mediasite/Catalog/Full/e14052deb3d0480ca6b0bf19262901c421
C. Information about Clinical Affiliates
Disability Services and Programs (DSP) Disability Services and Programs provides support services and accommodations necessary to enable
students with disabilities to develop their maximum potential by making their education accessible, while
having the dignity to work independently.
DSP Services Include:
• Assistance in providing readers, scribes, note-takers and/or interpreters.
• Special accommodations for test taking needs.
• Assistance with architectural barriers.
• Assistance in obtaining books and supplies from the University Bookstore.
• Information regarding accessible seating at USC sporting events.
• Auxiliary aid equipment loans.
• Assistive Technology.
• Support for individual needs that are unique to a student’s disability.
If you have any questions regarding these services, please feel free to contact us at (213) 740-0776.
Link: https://dsp.usc.edu/
How to Deal with Urgent/Emergent Personal Issues Link: http://medweb.usc.edu/students/