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Responsibilities and Expectations

Clerkship Responsibilities and Expectations

“The important thing is to make the lesson of each case tell on your education.”
~
Sir William Osler

General Philosophy: Be caring and curious

The Medicine Clerkship is designed to be patient centered, which reflects internists’ devotion to patient care. You are expected to learn from each patient. You should be involved in every aspect of your patients’ care from taking a history to writing orders to observing studies that they undergo (when possible). You are the member of the team who should know all the details about your patients’ support systems, medicines, lab data, etc. You should also be reading about their medical issues 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 and point out interesting findings on your patients to your fellow classmates.

The scope of Internal Medicine can be daunting, thus the clerkship also is designed to promote self-directed, reflective learning habits that should serve you well throughout your career. Therefore, 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. (Make sure you document all your hard work in your Portfolio.)

Course Logistics/Formal Teaching Sessions

The Medicine Clerkship is divided into two, 4-week inpatient experiences. Everyone will spend at least one month at either the VAMC or UF Health Shands Jacksonville to gain exposure to “bread and butter” medical conditions. Most students will have the opportunity to spend a month at  UF Health Shands Gainesville caring for the more subspecialized, complex conditions treated in academic medical centers. It is impossible to teach you all of internal medicine in eight weeks but we will do our best to teach you the core topics that we think every physician should know. We will also emphasize the clinical reasoning process and utilization of educational resources to encourage your own self-study. We will be using the on-line, interactive SIMPLE (simulated internal medicine patient learning experiences) cases. These are 36 cases that cover the core topics of internal medicine recommended by our national curriculum and emphasize the clinical reasoning process. For a list of the recommended cases and instructions about how to log on, please refer to the SIMPLE link under Resources on the website. Eight SIMPLE cases of your choosing are required during this clerkship and 6 brief High Value Care cases (modules A and E are required, you may choose the others). SIMPLE is detailed enough to use in lieu of a textbook. Other formal teaching activities include Grand Rounds, Morbidity and Mortality conference, physical findings rounds and the ever popular Doc-in-the-Box’ sessions. Times and locations for all the conferences are posted on our website in the student activity schedule.

Patient Census

You should admit at least two new patients per week. You may admit more than one patient per call day if you and your resident agree that you are able to handle 2 new patients. This may occur if you get one straightforward patient early in the day and do not have a high census. You are allowed to pick up a patient who was admitted overnight as a “holding note”. However, you are expected to perform your own H&P prior to reviewing the holding note. It is expected that you will work up a minimum of 16 new patients over an eight-week rotation. You should limit your patient census to 4 (4 near the end of the year when you are more efficient), two is the average number of patients most 3rd years carry at one time. 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 directors if you are getting overwhelmed.

Students assigned to the subspecialty teams of GI and Oncology will note that these teams are “on call” everyday. You are not expected to pick up a new patient everyday, rather a minimum of two per week. On days you are not expecting to take a new admission, you should plan to wrap up your work and check out with your resident around 5PM. (You are not expected to stay until 7PM with your team everyday.) If you are havng trouble meeting the 2 new patients per week minimun, you must let one of the clerkship directors know ASAP as faiure to meet this requirement will result in an incomplete (I) grade for the clerkship until the requirement is met.

Write-ups and Charting

Every patient you admit needs an H&P and daily progress note. H&P’s should be on the chart by the day after the admission and progress notes should be on the chart everyday (ideally by noon). Students are NOT permitted to use templates or smart phrases in the EMR. Copying and pasting portions of other providers’ notes constitutes fraud and is not permitted. You are encouraged to pend up orders for your patients. All patient orders must be co-signed by a physician.  Detailed instructions for patient write-ups can be found on the website in the portfolio section under patient care. Though your portfolio advisor carries the primary responsibility for giving you formative feedback on your H&Ps, you are strongly encouraged to review them with your attending as well.

Scut

Scut work is defined as activities that are not educational on patients that are not assigned to you. This means you are responsible for even the ‘menial’ tasks on your own patients. But, you are not obligated to perform tasks like looking up data on other people’s patients or running errands for the housestaff. However, if you have the time, this can be a wonderful way to offer to help someone who may be busier at that time.

Overnight Call

There are no overnight requirements. You are strongly encouraged to take advantage of cross cover activities at the VA and UF Health Shands. At both sites there are night teams, who will be rested and able to spend time with you as you help with cross cover. The night team comes on at 7PM and you should plan to page the intern at that time to let them know you will be working with him/her that night. I would suggest you try to experience cross cover 1-2 times during the rotation but it is not mandatory. (Many students find even a few hours of cross coverage experience, e.g. 7PM-11PM, to be of great value.)

Professional Behavior

Professional expectations are discussed explicitly under Goal 1 in our goals and objectives. You should dress professionally at all times. (Wearing scrubs is strongly discouraged as we do not perform procedures in an OR or lab and do not stay overnight for call.) You should preround on all your patients and be on time and prepared for work rounds. (In general, allow 10-15 minutes to preround per patient. Refer to “helpful hints” section for more details.) Though we do not take attendance, 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, 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 online medication lists and lab data is fraud. 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 with appearance before the Academic Status Committee.

Patient Privacy and Confidentiality

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. (For more details about HIPAA refer to http://privacy.health.ufl.edu). It is strictly forbidden by the hospital to access any patient records outside of the hospital. Doing so will result in all students losing all computer privileges. You may not use USB ports to transfer patient information.  If you need to work on a write-up at home, de-identify it and you may email it using ONLY your ufl.edu email account. Cell phones with cameras must have the camera disabled if they are to be taken in patient care areas. (If you would like to take a picture of a patient for medical/educational reasons, there is an official digital camera and consent form that can be obtained from the Chief Resident’s office.)

Clerkship Evaluation

There is an anonymous, online clerkship evaluation that must be completed in order for your grade to be released. (We are strict about this only because we value your feedback.) This evaluation form can be accessed through StudyCore under medicine clerkship evaluations. You do not need to wait until the end of the clerkship to evaluate individual noon conferences. These evaluations can be accessed throughout the clerkship in StudyCore under clerkship lecture evaluations.

Patient Logs

The patient logs are a College of Medicine graduation requirement. To help you stay on track with this requirement, we identified 15 of the presentations that you should be able to see during this rotation. You are encouraged to log as many of the presentations as you can. Although it is not a clerkship requirement to log all 15 of them, you are required to log during this clerkship.* failure to demonstrate a reasonable effort to log (defined as less than 10 presentations logged or logging all entries the last week of the clerkship) may result in a reduction in your grade or an incomplete for the clerkship.  If a patient you already entered develops a new problem, you may log that in as a separate entry. *We do not require you see all 15 presentations because not everyone may be able to and you have ample opportunity to see any missing presentations during your 4th year subinternship and/or required Emergency Medicine clerkship.
Tutorial: Patient Logs in New Innovations 2016

Time Off/Work Hours

You are held to the same standards as the residents in terms of work hours—no more than 80 hours per week. You are allowed an average of one day off per week including holidays (3 days off per 4 weeks as you get the weekend off after each 4 week block). You are strongly encouraged to take your days off on the weekend so you do not miss the educational activities during the week. You are discouraged strongly from pooling your days off as this breaks up continuity of patient care. You cannot “make-up” missed patient care, someone simply covers for you. You will have the weekend off that falls between the change in your rotation assignment.

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 and absence of night call responsibility, this should not be an issue. But, we take it very seriously if the problem arises.

Unexpected absences

Students must notify the supervising attending and clerkship coordinator (Kathy Pipkins 265-0230). If a student is unable to contact the clerkship coordinator, they should notify the staff in COMCEC. If the absence is of greater duration than a single day (including missed days that are not back to back), the staff in COMCEC (352-273-8573) must be notified in addition to the course director or supervising attending and clerkship coordinator. If the absence occurs while in Jacksonville on a clinical rotation, the Office of Educational Affairs (904-549-5128) in Jacksonville must be notified in addition to COMCEC.

Planned absences

In the case of planned absences for religious holidays, to attend meetings, or family events such as weddings etc., students must contact the clerkship director as far in advance as possible (these requests must be made at least 4 weeks prior to the beginning of the clerkship in writing) to discuss and obtain the permission of the clerkship director to be absent from assigned responsibilities and to arrange make-up if required. Once permission is obtained for the planned absence, the student must notify COMCEC of the approved dates for the absence.

Please note that on the Internal Medicine clerkship we consider you an integral member of the team with patient care responsibilities.  Thus, when you are away someone else covers these responsibilities.  Unlike an undergraduate course, you cannot “make-up” assignments.  For this reason, on this clerkship planned absences are strongly discouraged.

Safety

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.

For needle sticks or any exposure to potentially infectious body fluids, call the hotline IMMEDIATELY 1-866-477-6824.

College of Medicine Policies and Procedures

https://osa.sites.medinfo.ufl.edu/files/2014/04/Policies-and-Procedures-Handbook.pdf