Requirements and Guidelines
for Core Medicine Students

The educational objectives for students taking the core medicine clerkship are necessarily broad in scope. These objectives include:

1. Continued development of clinical skills, to develop competence in performing the history and physical exam, and in presenting patients.
2. Learning to analyze and organize data from a variety of sources (clinical, laboratory, reading, etc.) into an assessment of the status of the patient, followed by development of an orderly, scientific plan of further diagnostic studies and patient care. This should be incorporated into an organized, readable write-up.
3. Steady intellectual growth, with continued emphasis on relating the scientific aspects of medicine to the care of patients.
4. Developing positive relationships with individual patients while assuming responsibility for their personal care.

1. Perform and submit written history and physical exam on 18 patients during the rotation. This should include review of old hospital records, supplementation of history by information from family members and/or the referring physician, and the performance of a systematic and complete physical examination. The write-up should include at the beginning of the rotation a complete review of systems. The review of systems should be abbreviated once the student has demonstrated the ability to complete a full review. The basic laboratory results should also be included. Each history and physical should include a brief summary, a complete but concise and organized problem list, and a brief discussion. The discussion should focus on the differential diagnosis of the chief problem or the natural history and pathophysiology of the underlying disease already identified.
2. A complete written record of the history and physical examination and problem list should be finished and made available in a suitable format for placement in the chart within 24 hours of assignment of the student to the patient. It is the responsibility of the attending and/or resident to review and co-sign the write-up before it is placed in the chart. The discussion may be typed and handed in later.
3. At the public hospitals, the student is expected to personally perform a microscopic examination of the urine and an assessment of the Wright-stained blood film, as well as evaluation of Gram's stains of material when appropriate. These should be completed on the day that the student is assigned to the patient. The EKG and chest x-ray obtained on admission should be reviewed and evaluated.
4. An initial progress note should be written which formulates a plan for each problem, including recommendations for further diagnostic studies, therapy, and patient education.
5. A complete set of legible orders should be written.
6. The student should be prepared to present orally (in 10 minutes or less) the important features of the history, the physical examination, the laboratory data, and the assessment. If requested, the student should be able to present a concise summary of this material within 3 minutes. Opportunities will be provided in sessions with residents, attending physicians, and in conferences for these skills to be developed.
7. Patients should be followed closely during hospitalization, and careful progress notes should be written every two days, or more often if warranted.
8. Students should read about specific medical problems identified in the patients they have worked up. This should include a minimum of thorough reading of the appropriate areas in a standard medical text, but may also include supplementary reading in medical journals. The progress notes should reflect this reading.

The above list contains the most important requirements for students taking the core medicine clerkship. Certain other skills should be learned, including:

1. Cardiopulmonary resuscitation
2. Venipuncture techniques
3. Starting intravenous infusions
4. Urinary catheterization
5. Nasotracheal suction
6. Lumbar puncture
7. Thoracentesis
8. Obtaining and processing specimens for laboratory studies
9. Abdominal paracentesis

1. Students should attend the core medicine clerkship lectures.
2. The major teaching conferences at the hospital to which the student is assigned should be attended.
3. Students should attend Medical Grand Rounds on Thursday throughout the clerkship.
4. Students will participate in special student conferences organized by their resident or by the medical service of their hospital.

Following completion of the 12-week clerkship, the Core Clerkship Committee will assign a grade to each student, based on the following:

1. Written evaluation of performance by attending physicians and residents with whom the student worked, and from the chief resident of service at the public and private hospital. The assessment of clinical performance will comprise 70% of the grade.
2. A written, practical departmental examination will be given near the end of the 12-week clerkship. This examination will cover material from morning lectures, hospital-based lectures, Medical Grand Rounds, and knowledge from general medicine textbooks. This examination will count 30% of the grade.
3. The Core Clerkship Committee will give a grade based on the total performance of the student with input from all sources, including a consensus evaluation from the chief resident and chief of service. Those students having a marginal or failing performance during the 12 week rotation may be asked to take an oral examination by the members of the committee. The committee reserves the right to render a final grade of failure based on consideration of the written evaluations, departmental exam, or board score.
4. To pass the clerkship, the student must pass the National Board Examination (score 55 or greater) and the departmental exam (score 70 or greater). A final grade (H, HP, P, MP, F) will be determined by the Core Clerkship Committee and forwarded to the Student Promotions Committee.

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©1995-00 Baylor College of Medicine

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Contact: Mark M. Udden, M.D. (udden@bcm.tmc.edu)
URL: http://www.bcm.tmc.edu/medicine/coreclerk/content_03.html (Modified: July-10-2000)