M3 clerkship – department of internal medicine – vcu estenosis lumbar tratamiento school of medicine

The guiding principle is that, under appropriate supervision, you will be as responsible for the care of assigned estenosis lumbar tratamiento patients as you are able to be, for your level of training and your schedule of teaching estenosis lumbar tratamiento activities. Responsibilities and assignments

• as a member of the clinical team, you will make teaching rounds with the attending physician and estenosis lumbar tratamiento work rounds with housestaff. You should be present at discussions or procedures involving your estenosis lumbar tratamiento patients. You will be expected to present your patients on daily estenosis lumbar tratamiento rounds with the attending physician. Note that the attending physician may ask you to present estenosis lumbar tratamiento new patients either the day they are admitted to your estenosis lumbar tratamiento team or the morning following the day of admission. For new patient admissions, you are expected to be ready to present a complete estenosis lumbar tratamiento history and physical to the attending physician, but note that there are instances where the attending physician estenosis lumbar tratamiento may ask for a truncated presentation depending on time constraints estenosis lumbar tratamiento on a given day.

• you will record a complete history and physical on your estenosis lumbar tratamiento patients when they are first admitted. You will also record daily progress notes for the patients estenosis lumbar tratamiento assigned to your care. The most essential features of work-ups are accuracy, completeness, and precision. Your notes should be forwarded to either the resident or estenosis lumbar tratamiento attending physician for review.

• you are NOT expected to write orders on your patients. You may do so if given the opportunity, but all student orders MUST be cosigned by housestaff, and most housestaff typically prefer to enter their own orders. Under no circumstances will your written orders be carried out estenosis lumbar tratamiento until they have been countersigned. UNAUTHORIZED COMPUTER ACCESS OR USING THE PASSWORDS OF OTHERS IS estenosis lumbar tratamiento EQUIVALENT TO THE FORGERY OF MEDICAL ORDERS.

• you may assist with other procedures as deemed appropriate by estenosis lumbar tratamiento your team. No procedures other than peripheral venipuncture and placement of peripheral estenosis lumbar tratamiento IV line shall be performed by a student without direct estenosis lumbar tratamiento supervision of an intern, resident, or attending. If informed consent is required for a given procedure and estenosis lumbar tratamiento if a student will be actively participating in the procedure estenosis lumbar tratamiento (NOT simply observing), the informed consent form MUST indicate student involvement in the estenosis lumbar tratamiento procedure.

• you are required to complete your medicine passport online throughout estenosis lumbar tratamiento the course of your rotation (practical learning experiences). Students must log observation of diagnoses or procedures before 4:30 PM on the last day of the clerkship. Failure to do so will result in an incomplete for estenosis lumbar tratamiento the IM clerkship.

• excused absences from mandatory activities will be granted for illness estenosis lumbar tratamiento or personal emergencies, provided appropriate notification is made to the clerkship office. Students must email the clerkship administrator as soon as is estenosis lumbar tratamiento possible to initiate documentation of the absence, and are expected to notify their attending physician/housestaff members by pager/email. Although absences less than four hours in duration do not estenosis lumbar tratamiento require an exception request form, the clerkship will require students to notify the clerkship administrator estenosis lumbar tratamiento by email to document the absence. All unexcused absences from required clerkship activities will be documented estenosis lumbar tratamiento in a professionalism concern note. Please see the internal medicine clerkship absence & exception request policy included later in this manual.

• you will be required to complete a mid-rotation feedback form which will be sent to you at estenosis lumbar tratamiento the beginning of your third week. These forms are to be turned in on or before estenosis lumbar tratamiento 4PM on friday of your fourth week to the clerkship estenosis lumbar tratamiento administrators. *for the students at the VAMC, please email a picture of the completed form to the estenosis lumbar tratamiento clerkship administrators at or before 4PM on the fourth friday estenosis lumbar tratamiento of the clerkship, then bring the forms with you to your first didactic estenosis lumbar tratamiento the following week. These forms will be scanned, sent and reviewed by the clerkship director or associate clerkship estenosis lumbar tratamiento director/s. The mid-clerkship feedback forms, coupled with any and all summary evaluations that have accumulated, are intended to provide feedback for your development after the estenosis lumbar tratamiento first month of your time in the internal medicine clerkship; they are NOT used to determine your overall grade. You will receive direct comments from the clerkship director or estenosis lumbar tratamiento associate director/s regarding the mid-clerkship feedback form via email or a meeting.

You are not required to perform procedures during your clerkship. You are encouraged to observe and participate in procedures when estenosis lumbar tratamiento possible, particularly if the procedures involve your patients. The following procedures, if you perform them, MUST be supervised by an intern, resident, or attending:

There is no arbitrary “required” patient number during inpatient rotations. However, a reasonable goal is 3 patients at any given time. However, the number of cases that you both admit and carry estenosis lumbar tratamiento is up to your supervising medical team. You are expected to perform a complete history and physical estenosis lumbar tratamiento examination and formal write-ups on each patient that you admit to your service. Your resident is in charge of assigning patients. Work day schedule & call

You are responsible for pre-rounding on each of your assigned inpatients. You are expected to arrive on the wards at an estenosis lumbar tratamiento early enough time to have seen your patients and be estenosis lumbar tratamiento ready to present your patients on rounds. At both MCV and the VAMC, rounds will begin at 8:00 or 8:30 AM. Rounds are expected to be finished by 10:30-10:45 AM so that residents may attend morning report at estenosis lumbar tratamiento 11:00 AM. You are encouraged to accompany your team to morning report. You are expected to remain available until 5:00 PM or later (as patient responsibility dictates). You will admit patients with the team as directed by estenosis lumbar tratamiento your supervising resident and attending. None of the inpatient ward teams take overnight call. Days off

The department of internal medicine is committed to providing discretionary estenosis lumbar tratamiento time off to residents, interns, and students. During your inpatient rotations, you will be given one weekend day off each weekend. On the weekend between your two rotations (after the 4th week of the clerkship), you will have the entire weekend off. You may not take weekdays off. Any additional time off must be requested through the clerkship estenosis lumbar tratamiento administration—please complete an exception request form and turn it in estenosis lumbar tratamiento to the clerkship administrator for approval. For additional information about the clerkship’s policy regarding excused absences, please see the internal medicine clerkship absence & exception request policy (found on page 17 of this manual). PLEASE NOTE: exception requests are approved at the discretion of the clerkship estenosis lumbar tratamiento director and will be honored according to the guidelines set estenosis lumbar tratamiento forth by the school of medicine. The definition of “scut”

You are expected to help with patient care duties on estenosis lumbar tratamiento your assigned patients. This can include obtaining outside medical records, transporting patients in urgent situations, sending hospital records to referring physicians, etc., and these duties are not considered “scut.” note that attendance at formal didactic sessions is required and estenosis lumbar tratamiento you are not to perform these patient care duties if estenosis lumbar tratamiento they preclude you from attending mandatory clerkship activities. Dress

Students should adhere to the school of medicine policy on estenosis lumbar tratamiento student attire in the inpatient setting. This policy recommends– but does not require–a "bare below the elbows" approach for inpatient care. It is the preference of the IM clerkship that students estenosis lumbar tratamiento prioritize professional dress which complies with a "bare below the elbows" approach when possible. Students wishing to wear scrubs may do so, provided that the scrubs are freshly laundered. Further questions regarding appropriate dress on your rotations should be estenosis lumbar tratamiento directed to your supervising attending. Your VCU ID badge must be visible at all times estenosis lumbar tratamiento in all clinical areas. Blood and/or body fluid exposure

An occupational exposure to blood and/or body fluid should be treated with medical urgency and estenosis lumbar tratamiento evaluated by a specially trained health care practitioner. Medications prescribed for HIV exposure should ideally be started within estenosis lumbar tratamiento one to two hours of exposure. Please report all exposures to MCV student health so that estenosis lumbar tratamiento appropriate care and follow-up can be provided.

• your team should help with the following: obtain a medical history on the source patient and have estenosis lumbar tratamiento blood specimens drawn: HIV, hepatitis B surface antigen, hepatitis C antibody, & a hepatic panel. Previously drawn labs are acceptable if dated in the past estenosis lumbar tratamiento 30 days. The source patient’s verbal assurance of being disease-free is not acceptable in any situation.

• attendings are expected to allow the students to present their estenosis lumbar tratamiento patients during the rotation. The attending physician may determine how and when the students estenosis lumbar tratamiento present their patients in order to manage the work of estenosis lumbar tratamiento the team most appropriately. The attending should discuss the differential diagnosis and treatment plans estenosis lumbar tratamiento with the student.

• M3 students are excused for university holidays and designated school estenosis lumbar tratamiento of medicine holidays. M3 students will follow the university guidelines and announcements regarding estenosis lumbar tratamiento inclement weather. These do not count toward the one in seven days estenosis lumbar tratamiento off requirement and should be regarded simply as an extra estenosis lumbar tratamiento day(s) off.

• attending physicians are required to complete the students’ midpoint evaluation forms, which will be provided to the attending by the students. It is a school of medicine requirement that these forms estenosis lumbar tratamiento be completed by an attending physician.

• students rotating on an inpatient MCV rotation are required to estenosis lumbar tratamiento attend all MCV core lectures. Students on inpatient rotations at the VAMC are only required estenosis lumbar tratamiento to attend those core lectures which are given jointly at estenosis lumbar tratamiento the VAMC/MCV or which are broadcast to the VAMC by teleconference.

• illnesses or other personal emergencies/issues should be documented with an exception request form and estenosis lumbar tratamiento cleared with the student’s team on the day of the absence. All unexcused absences from required clerkship activities will be documented estenosis lumbar tratamiento in a professionalism concern note.

All grades in internal medicine are determined by committee. A careful review is given to every student prior to estenosis lumbar tratamiento finalization of his/her individual grade. Students may review the content of student file in the estenosis lumbar tratamiento presence of the clerkship coordinator. These reviews must be scheduled one day in advance of estenosis lumbar tratamiento the desired meeting time. The clerkship director or associate clerkship director is available to estenosis lumbar tratamiento meet with students should they have any additional questions regarding estenosis lumbar tratamiento a grade calculation after they have reviewed the orientation materials.

If a student disagrees with his/her final grade in internal medicine, he/she is encouraged to file a formal appeal with the estenosis lumbar tratamiento department of internal medicine according to the policies outlined by estenosis lumbar tratamiento the school of medicine. Please note, the department of internal medicine highly values the evaluations of estenosis lumbar tratamiento its faculty and residents and is not in the habit estenosis lumbar tratamiento of expunging evaluations and comments.

A student who would like to file a formal appeal estenosis lumbar tratamiento of his/her final grade has 30 days from receipt of his/her final grade to do so. To submit an appeal, the student must draft a letter of appeal to the estenosis lumbar tratamiento internal medicine clerkship appeals committee. This letter should be submitted directly to the clerkship coordinator, by email or campus mail, along with any other additional documentation the student would like estenosis lumbar tratamiento included supporting the appeal. Once the coordinator has received the letter of appeal, s/he will compile an appeal summary which includes: the student’s letter of appeal, a summary of the student’s final grade scores, and a copy of each evaluation the student has received. The student will be informed of the internal medicine appeals estenosis lumbar tratamiento committee’s decision by email within 30 days of the initial estenosis lumbar tratamiento appeal submission. Should the student disagree with the appeals committee, a second formal appeal may be submitted to the department estenosis lumbar tratamiento chair. The student has 30 days from receipt of the appeals estenosis lumbar tratamiento committee’s decision to file the second appeal, which is also sent to the clerkship coordinator, who will prepare a file for the department chair. The decision of the department chair is final. O-rime pathway

• reporter = accurately gathers history and performs basic physical examination; clearly organizes and communicates data, orally and written; able to recognize normal from abnormal and identify a new estenosis lumbar tratamiento problem; reliable: day-to-day, punctual, follows-up.

• interpreter = can do everything described under "reporter" plus the following: demonstrates independent and critical thinking; prioritizes problems and develops a differential diagnosis; interprets follow-up test results; shows a higher level of knowledge, increased skill in selecting data which support diagnosis; and can applying test results to specific patients.

• manager = can do everything described under "reporter" and "interpreter" plus the following: actively and directly involved in patient care; decides when action needs to be taken; proposes and selects among different diagnostic and therapeutic options; tailors the plan to the particular patient

• educator = has mastered the skills in reporter, interpreter, and manager; seeks out literature and does in-depth research into a central clinical question; appraises the quality of relevant scientific literature; takes a role in educating other members of the team. (*note: the educator designation is not available for M3 students)

• multiple formative, brief evaluations based on focused skills with a single summative estenosis lumbar tratamiento evaluation at the end of faculty/resident block with student; evaluator will provide comments and select appropriate RIME level for estenosis lumbar tratamiento student’s overall performance