Basic Core 1 Design

Site:

Working Group

Surgery: Marjie Persons MD, Gilles Pinault MD, Howard Nearman MD, Kelly Buchanan

Internal Medicine: Debra Leizman MD, Cliff Packer MD Cindy Neczypor

Louis Stokes Cleveland VA Medical Center

Overall Design Structure

Week 1 2 3 4 5 6 7 8

Internal Medicine

UH or VA Inpatient Out patient GIM

Specialty Procedure, Education Week, and Shelf Exam

Surgery

UH or VA Inpatient Electives: Anesthesia/SICU,

Vascular and Student’s Choice

Finish elective, Oral Exam, Education Week, and Shelf Exam

Surgery

Electives: Anesthesia,

Vascular and Student’s Choice

UH or VA Inpatient Finish elective, Oral Exam, Education Week, and Shelf Exam

Internal Medicine and Surgery Sample Education Week

Mon Tue Wed Thu FriMedicine Week 8

Procedural Day

Didactics

Student Abstract and Case Conference

Musculoskeletal and Heart

SIMPLE Cases

Study Day IM Shelf

Surgery Week 8

Oral Exams Didactics

Student Abstract and Case Conference

Musculoskeletal and Heart

SIMPLE Cases

Study Day Surgery Shelf

Medicine Week 16

Procedural Day

Student Abstract and Case Conference

OSCE

Lectures

Study Day IM Shelf

Surgery Week 16

Oral Exams Student Abstract and Case Conference

OSCE

Lecture

Study Day Surgery Shelf

Sample Weekly ScheduleTime Mon Tue Wed Thu Fri Sat (1 ) On

CallSun *

5:45 am Rounds Rounds Rounds Rounds Rounds Rounds

7:00 am M&M Outpatient/ Ambulatory Clinic

Grand Rounds

8:00 am Outpatient/ Ambulatory Clinic

12:00 pm Outpatient/ Ambulatory Clinic

IQ+ SOM

1:00 pm IQ+ SOM

2:00 pm Lecture IQ+ SOM

3:00 pm Lecture Lecture Lecture Lecture IQ+ SOM

4:00 pm Lecture Resident conference (1)

GI Tumor Board (1)

Colorectal/ Breast Conference (1) or Lecture

IQ+ SOM

5:00 pm Lecture or Case Presentation (2)

6:00 pm Case Presentation

Educational Activities

Grand RoundsMorbidity and Mortality ConferenceResident ConferenceDidacticsTumor Boards – GI and BreastColorectal ConferenceIM/Surgery - Education WeekDidactics

Orientation

First Day of Surgery Clerkship Agenda REVIEW EXPECTATIONS

STUDENT LECTURES OTHER LECTURES - M&M, Tumor Boards, Resident

Lectures, etc. ELECTIVES ORAL EXAMS TAKING CALL CASE PRESENTATIONS - Group and individual with Dr.

Ponsky REVIEW GRADE PROCEDURE - CAS

H&P WORKSHOP WRITING ORDERS

OR Orientation - obtain scrubs TECHNICAL SKILLS TYING and SUTURING SKILLS

Learning Relationships

Case Presentations with the Clerkship Director and fellow students

Individual presentations with the Chairman

Individually assigned to attend clinic with a Preceptor

Students interact daily with Attendings and Residents on the service

Feedback

Students can expect formal and informal feedback

Formal CAS

Attending / Resident Feedback to Student Requests

Summative Evaluations Discussion at Mid-Point Shelf Exam Oral Exam

Feedback

Informal Conversations and Teaching opportunities

with Attendings and Residents Preceptor Feedback Individual Meeting with Chairman Feedback Progress in achieving the core clinical

conditions – Case yellow cards “Mid-Point Feedback and Review of Core Clinical Conditions”

Direct Observation

The Clerkship Director Reviews H&Ps and gives individual feedback to students

Case Presentations Rounding with Attendings and Residents See patients with Preceptor in

ambulatory/outpatient clinic

Exposure to Career Options

Elective week in surgical subspecialties Vascular week Anesthesia and Critical Care week

On-Call Schedule

On-Call – Short One day per week short call; stay until

11:00pm

On-Call – Long Two 24-hour long call; on weekend with

night float Resident

Inpatient/Outpatient Balance

Outpatient ½ day per week in Clinic

Vascular Elective/Subspecialty General

Inpatient Throughout the 8 weeks

Integration of Advance CoreLearning Objectives

Peri-Op and Acute Pain Conferences/Didactics

Critical Care/Peri-op Care Acute Pain Management Pre-operative risk assessment

1 week Anesthesia/SICU Clinical Experience See Peri-op Care daily throughout 8 weeks

Internal Medicine Sample Weekly Schedule

Time Mon Tue Wed Thu Fri Sat Sun

7:30 am

8:00 am

9:00 am Didactics

10:00 am Didactics Intern Morning Report

10:30 am Teaching Attending (4/8)

11:00 am Didactics Teaching Attending

12:00 pm Noon Conference Grand Rounds Noon Conference

Noon Conference

M&M / IQ+ SOM

1:00 pm Clerkship Director (6/8)

Chairman (4/8) Teaching Attending

IQ+ SOM

2:00 pm Clerkship Director

Chairman Teaching Attending

IQ+ SOM

3:00 pm IQ+ SOM

4:00 pm Didactics IQ+ SOM

5:00 pm Didactics

6:00 pm Didactics

Internal Medicine Educational Activities

Clerkship Director Bedside Rounds/Publication Rounds Teaching Attending Rounds Chairman Rounds Grand Rounds Morbidity and Mortality Noon Conference Intern/Student Noon Conference Didactics

Internal Medicine and Combined Medicine-Surgery Large and small groups

Specialty Procedure Day General Internal Medicine Week IM/Surgery - Education Week

Internal Medicine Orientation Combined UH and VA Inpatient and

Ambulatory Orientation sessions Detailed review of Clerkship Manual Assignments (Inpatient Services / Outpatient

General Internal Medicine physicians) Schedules / Meetings / Conferences Computer Systems Expectations

Professionalism Patient Responsibility and Workload Call and Duty Hours CAS Assessment System Feedback/Evaluations

Internal Medicine Learning Relationships

Ongoing relationships with the Clerkship Director, Bedside Rounds UH Case Report Publication Conference VA Clinical case Report UH and VA

Chairman, Teaching Attending, Ward Attendings, Residents, and Ambulatory General Internists

Internal Medicine Feedback

Students can expect formal and informal feedback

Formal CAS

Attending / Resident Feedback to Student Requests

Summative Evaluations Shelf Exam Clinical Abstract / Professionalism Mid-Point Evaluation, Feedback cards Clinical Exposure (Case Green Cards)

Internal Medicine Feedback

Informal (Feedback) Clerkship Director Attendings / Residents Teaching Attending Chairman Rounds Interactive Didactics

Internal Medicine Direct Observation

UH Director Led Bedside Rounds New Undifferentiated Patient History, Physical Diagnosis, etc. divided

between the group members All student write-up case Director and Students give Feedback

VA Director Led Publication Conferences Case Report requirement Weekly conference to prepare case for ACP

or Journal submission

Internal Medicine Direct Observation

Teaching Attending Rounds Students Present Case for feedback and

specialized education Ward Attendings and Residents

Morning Work Rounds Presentation and patient specific education

Ambulatory General Internists

Internal Medicine Exposure to Career Options

Specialty Procedure Day Cardiology Gastroenterology Nephrology Pulmonology Rheumatology

GIM Ambulatory Week Community VAMC

Internal Medicine On-Call Schedule

Call – Long and Short With Resident Every fourth night Pick up one patient every call Carry four patients at a time

Internal Medicine Inpatient – Outpatient Balance

Inpatient - 6 weeks Outpatient GIM - ~1 week Specialty / Procedural -1 day Concentrated Education/Testing 1 week

What are the unique features of this rotation?

UH/VA site preference (up to space limitations)

Immersion Inpatient Internal Medicine and Surgery

Specialty / Elective options Small and large group educational activities Student specific General Surgery / Medicine

conferences