Third Year Internal
Medicine (BCC 7112) Clerkship Syllabus
2009-2010
Faculty
Gene G. Ryerson, M. D., Chair Department of
Clinical Sciences
Jonathan S. Appelbaum, M. D., Director,
Internal Medicine Education
Cynthia Powell, M. D., Clerkship Director,
Orlando
Robert Anderson, M. D., Clerkship Director,
Pensacola
Kathleen Kennedy, M. D., Clerkship
Director, Sarasota
Eugene Trowers, M.D., Clerkship Director,
Tallahassee
Vinny Purandare, M.D., Clerkship Director,
Daytona Beach
William Hood, M.D.,
Clerkship Director, Ft. Pierce
Clerkship Faculty from each regional campus
COURSE
DESCRIPTION
The third year Internal Medicine Clerkship
is an eight-week clinical rotation. The objective of the
clerkship is to acquaint the student with the varied aspects of
medical care for adults. Emphasis will be placed on enhancing
the skills of taking a history, performing a physical
examination and developing a differential diagnosis for common
clinical presentations and problems. Students will participate
in the evaluation and care of outpatients and inpatients under
the supervision of the COM internal medicine clerkship faculty
physicians. Exposure to common procedures encountered in the
practice of internal medicine will also be expected. Formal and
informal daily teaching sessions and rounds with the clerkship
faculty physician (and residents at some sites) are a major part
of the eight-week experience. Clerkship directors at the
regional campuses will meet with students once per week for
teaching, evaluation and feedback. Each student will record and
present appropriate clinical data daily to their clerkship
faculty member and will be observed performing a complete
history and physical examination on at least two occasions
during the clerkship by the clerkship director or clerkship
faculty member during the rotation. Every student will work with
a general internist four days per week for five weeks and then a
hospital based clerkship faculty physician four days per week
for three weeks or alternative similar exposure to inpatients
and outpatients. The Doctoring 3 course, which runs
concurrently with clerkships throughout the entire third year
will place the student with a community-based longitudinal
faculty member for one half-day every week and in the didactic
sessions at the regional campus for one half-day every week.
TEXTBOOKS
Required Texts
Andreoli and Carpenter’s Cecil Essentials
of Medicine (Andreoli, Carpenter, Griggs, Benjamin)
Saunders Elseviers, Inc, 7th
edition, 2007
Case Files: Internal Medicine (Toy, Patlan,
Faustinella, Cruse)
McGraw-Hill, Inc, 2nd edition,
2007 (2009 edition available September 2009, but we will use
the 2007 edition for this year)
The Washington Manual of Medical
Therapeutics (Cooper, Krainik, Lubner, Reno, Micek) Lipincott
Williams Wilkins, Inc, 32th edition, 2007 (On-line
version available)
Assigned case from Case Files and
Reading Assignments for Internal Medicine (appendix A)
Cecil
Medicine: Expert Consult/Cecil Textbook of Medicine (Goldman and
Austello)
Saunders Elseviers, Inc, 23nd
edition, 2007
Harrison’s
Principles of Internal Medicine (Fauci, Braunwald, Kasper,
Hauser, Longo, Jamesoon, Loscalzo) McGraw-Hill, Inc, 17th
edition, New York, New York, St Louis, Missouri and San
Francisco, California, 2008.
PDA
Resources
Epocrates
Essentials
DynaMed
Harrison’s Practice
PEPID
ePSS Tool (USPSTF)
M3
INTERNAL MEDICINE CLERKSHIP STUDENT SELF-STUDY PROGRAM
This self-study program has been designed
to assist the student in managing the vast amount of medical
information available. This program will result in exposure to
the core concepts and breadth of knowledge deemed necessary for
students to have acquired during this clerkship. The keys to
success during this rotation include a daily text reading
program covering not only the clinical encounters of the day,
but also enough to cover the assigned readings by the end of the
clerkship.
Internal Medicine cases, known as Case
Files, are an integral part of the clerkship learning
experience. Students are to complete at least the assigned
cases. and the readings in Andreoli and Carpenter’s Cecil
Essentials of Medicine 7 Edition.
Listed below are the assigned basic
Internal Medicine topics from Cecil Essentials of Medicine
(7th Edition), along with Lange’s Case Files
Internal Medicine (2nd Edition) that will allow
the student to maximize the learning experience:
Approach to the Patient with
Pages 799 - 803 - 803
Rheumatic
disease
Rheumatoid
Arthritis
Pages 804 – 808
Systemic Lupus Erythematosus
Pages 813 – 818
Crystal Arthropathies
Pages 840 – 844
Osteoarthritis
Pages 845 – 847
Case Files
Pages 206 – 213
Pages 234 – 239
10. Pulmonary
Disease:
COPD
Pages 214 – 223
Interstitial Lung
Diseases Pages
224 – 237
Case files
Pages 324 – 331
Pages 316 – 321 – 321
Pages 291 –298
Course
Objectives
These clerkship objectives reflect the
knowledge, skills and attitudes of the overall COM competencies
as noted below. By the completion of the clerkship, students
will be able to:
Knowledge:
Demonstrate the ability to diagnose
and present a treatment plan for commonly occurring
illnesses in IM settings.
Demonstrate the ability to use
appropriate decision support resources (e.g., treatment guidelines) in managing IM
patient problems.
Apply principles of Evidence Based
Medicine (EBM)
in making diagnostic and management decisions in IM
Discuss the major classes of drugs
used in IM and demonstrate the ability to apply appropriate
clinical pharmacological principles to the management of
common IM medical problems
List 10 indications for referral to
the emergency department or direct admission to the hospital
Write admission orders for 4 common
medical problems
List components of a discharge summary
and write a discharge summary
Discuss the importance of specific
geriatric conditions, such as dementia, delirium, and the
propensity to fall in older age populations.
Skills:
Demonstrate the ability to conduct a
focused medical history and targeted physical examination
appropriate to the patient’s chief complaint(s) and the
history of the present illness(es) in IM
Demonstrate the ability to perform a
history and physical examination
Demonstrate the ability to perform a
health maintenance examination appropriate for an adult and
to apply appropriate prevention guidelines.
Demonstrate facility in the
application of medical informatics technology, and critical
appraisal of the medical literature in making diagnostic and
management decisions in IM.
Attitudes:
Demonstrate the ability to apply the
biopsychosocial model and patient-centered clinical method
to the understanding of patient presentations.
Demonstrate a basic understanding of
ethical principles and their applications to patient care.
Demonstrate effective communication
skills with a diverse array of patients, physicians and
other health team members
Demonstrate a basic understanding of
how age, gender, race, culture and socioeconomic class
effects management of IM patients
Broad Topic Areas:
The student should have an understanding of
the following topics, commensurate with their level of
training. Students will be
required to evaluate the following categories of
problems/diagnoses in the following numbers of new or
established patients:
Hematology/Oncology and Associated Diseases (anemia) – 2
Musculoskeletal Disease (back pain) – 3
Pulmonary Disease (COPD, asthma) – 2
If unable to gain access to a patient with
a diagnosis in any one of the categories listed, the student
will be required to complete a reading assignment or a case with
a diagnosis/problem in that category. The need for completing
the reading assignment will be determined by the clerkship
director based on weekly reviews of the CDCS data, which will be
discussed with the student on a weekly basis.
Knowledge Based Resources Supporting Course
Befitting a 21st century medical
school, all of the physical resources necessary for this course
are in place. Student learning areas, complete with computers,
textbooks, internet access and videoconferencing equipment, are
available at each regional campus site.
Students have access to personal computers
and personal digital assistants as well. Hard copies of the
required and suggested readings will be available at each FSU
Regional Campus. A daily electronic log of patient encounters
will be kept by the students and transmitted weekly to the
Clerkship Director, who will insure that appropriate numbers of
patients are being seen, and that the patient mix reflects
common internal medical problems without undue duplication.
TEACHING AND LEARNING METHODS
This is primarily an apprenticeship style
experience with a single IM clerkship faculty member. There will
be experiential learning that each student will have with
his/her clerkship faculty. Students will also have the
opportunity to learn about many of the ancillary services that
occur inside and outside of the hospital setting.
Clerkship directors will meet with students
at least once per week. A general medicine topic will be
discussed at this weekly meeting. The discussion may include
review of the assigned IM Case Files, discussion of an
interesting case seen during the week or a review of materials
read prior to the meeting. It will also include a brief review
of an ethics topic developed in concert with our faculty
ethicist. CDCS entries will be reviewed and suggestions for
learning any uncovered topics/diagnoses will be made by
augmenting clinical experiences, completing IM Case Files or
paper cases and/or completing reading assignments. Students are
expected to demonstrate involvement at the moderate to full
level of participation in at least 2/3 of their patient
encounters.
Didactic sessions will be available through
grand rounds, morning lectures, noon lectures, and and/or
sessions with the clerkship faculty member or clerkship
director, depending on location and the clerkship faculty’s
schedule. Each student will be given an updated monthly
schedule indicating available learning opportunities.
The clerkship directors will observe and
certify that each student has met competency standards in the
performance of these areas:
History and
Physical Examination
Oral Case
Presentation
Chart
Documentation
Clinical
Diagnostic Decision Making (Critical Thinking)
In addition, the clerkship faculty and
clerkship directors will monitor the students’ activities to
ensure that they are exposed to the procedures listed below,
especially if the student has not had this experience on a prior
clerkship. If this criteria is not met and the clerkship
faculty member or clerkship director is unable to assist the
student with gaining exposure to the procedure (s) in an
alternate manner, the clerkship director will notify the
Education Director for IM as well as the campus dean that the
student still needs to complete the procedure (s). The student
will then be expected to gain exposure to the procedure (s) on a
subsequent clerkship. Procedures the student is expected to
gain exposure to on the IM clerkship include, but are not
limited to:
Venipuncture
Administering IM, SC and intradermal injections
Demonstrating universal precautions
Obtaining blood and wound cultures
Performing an EKG
Interpreting chest x-ray
Call and weekends
Students will be on-call at the discretion
of the clerkship faculty during the six weeks outpatient
component of the clerkship. The call frequency will not exceed
every 4th night. The student will be on call every 4th
night during the two weeks inpatient component of the clerkship
and will be expected to remain in house until 11pm or as
directed by the clerkship faculty or resident working with the
clerkship faculty member. Each student will work at least two
weekend days per eight-week clerkship unless otherwise directed
by clerkship faculty.
CLERKSHIP EXAMINATION AND GRADING POLICY
For students completing 3rd or 4th year clerkships in
academic year 2009-2010
Student grades for required clerkships are
calculated using information from all of the following sources:
NBME subject examinations, or FSU COM
internal clerkship-specific examinations, taken by
students at the end of each clerkship,
Standardized FSU COM student
assessment forms completed by the clerkship faculty at the
end of each clerkship,
Standardized FSU COM forms completed
by the clerkship director at the end of each clerkship,
Compliance with CDCS data entry
requirements (see individual clerkship syllabi)
Required clerkship projects and
activities, (see individual clerkship syllabi),
Patient and staff evaluations.
Students are expected to achieve the competencies/objectives
of each clerkship as articulated in the clerkship syllabus.
Third-year students who do not meet
clerkship competencies/objectives must remediate identified
deficiencies before advancing to the fourth year curriculum.
Fourth year students who do not meet
clerkship competencies/objectives must remediate identified
deficiencies before being permitted to graduate.
All students are provided frequent
opportunities throughout the year and during each clerkship
to assess their performance in non-graded activities and to
identify areas of strength and weakness.
The NBME subject exam scores and
percentiles used to calculate grades will be based upon the most
recent NBME Academic Year Norms for Examinee Performance that
are available at the beginning of an academic year.
In determining the percentile rank for each
third year clerkship student’s NBME subject exam score, the
Education Director will use the percentile ranks for the NBME
Quarter that corresponds to the quarter in which 50% or more of
the rotation was completed.
All scores of NBME subject exams taken by
fourth year students shall be referenced to national scores by
students in the fourth quarter of their third year.
Clerkship Grading:
The Education Director in the appropriate discipline is
responsible for reviewing all student assessments and assigning
the student’s grade in the clerkship.
Elective Grading:
The
Regional Campus Dean is responsible for assigning a student’s
grade for each approved elective.
Grading Standards for Required Clerkships:
FSU COM has adopted the following Honors/Pass/ Fail grading
system and a uniform policy governing the assignment of grades
to students completing required clerkships. Grades are based on
student performance on the NBME shelf examination (or, in the
geriatrics and emergency medicine clerkships, an internal COM
content exam), clerkship faculty assessments of the student
performance, the clerkship director’s summary, compliance with
data entry requirements into the CDCS system, clerkship-specific
papers or projects (when required) and in some clerkships,
patient and staff evaluations (see specific syllabi for
details).
A student may be assigned an “Honors” grade if he meets the
“Honors Criteria” below:
Honors Criteria:
A student will be assigned an “Honors”
grade if the “Honors Criteria” listed below are met:
Receives a “yes” rating in all 6 subcategories of the
clerkship assessment form pertaining to “Professionalism” and
“Ethical Standards”; AND
Receives at least 10 “excellent” ratings in the remaining 17
subcategories on the clerkship faculty assessment form; AND
Has no more than 2 ratings of “satisfactory” and no ratings
of either “marginal’ or “poor”; AND
Receives a narrative summary by the clerkship director
documenting excellent performance; AND
Scores at or above the 75th percentile for NBME shelf exam
reference scores by students completing clerkships of
comparable length at a similar time in the academic year (note:
all NBME shelf exam scores taken by fourth year students shall
be referenced to scores by students in the fourth quarter of
third year); OR scores at a pre-determined honors-level score on
the internal clerkship-specific exam; AND
Receives a satisfactory rating on all required clerkship
projects and activities; AND
Satisfactorily complies with data entry requirements
into the CDCS system; AND
Receives satisfactory patient and staff evaluations
Note: Education Directors may assign an
“Honors” grade to high-performing clerkship students meeting
either (but not both) of the following situations:
Situation # 1: If
the student satisfies all of the “Honors” criteria listed
above, but receives only 9 “excellent” ratings in the remaining
17 subcategories on the clerkship faculty assessment form, OR
Situation # 2: If
the student satisfies all of the “Honors” criteria listed above,
but receives an NBME shelf exam score at or above the 72nd
percentile when referenced to students completing clerkships of
comparable length at a similar time in the academic year, or
scores at a predetermined level on the internal
clerkship-specific exams
A student may receive a “Pass” grade if they meet the “Pass
Criteria” below:
Pass Criteria:
A
student will receive a “Pass” grade if all of the “Pass
Criteria” listed below are met:
Receives a “yes” rating in all 6
subcategories on the clerkship faculty assessment form
pertaining to “Professionalism” and “Ethical Standards”; AND
Has no subcategories rated as “poor,” and no more than two
subcategories rated as “marginal;” AND
Receives a clerkship director’s
narrative summary denoting a satisfactory performance, AND
Scores at or above the 10th percentile for NBME shelf exam
reference scores by students completing clerkships of comparable
length at a similar time in the academic year (note: all NBME
shelf exam scores taken by fourth year students shall be
referenced to scores by students in the fourth quarter of third
year); OR scores at a pre-determined minimum passing score on
the internal clerkship-specific exam; AND
Receives a satisfactory rating on all required clerkship
projects and activities, where applicable, AND
Satisfactorily complies with data entry requirements into
the CDCS system, AND
Receives satisfactory patient
and staff evaluations
A student is at risk for a grade of “Fail” if they achieve any
of the “Fail Criteria” below:
Fail Criteria:
A student is at risk for a grade of “Fail”
if any of the Criteria” listed below are met:
Receives a “no” rating in any of the 6 subcategories of
the clerkship faculty assessment form pertaining to
“Professionalism” and “Ethical Standards”; OR
Receives three (3) or more of the remaining 17
subcategories rated as “marginal;” OR,
Receives a rating of “poor” in any remaining subcategory;
OR
Receives a clerkship director’s summary denoting
unsatisfactory performance; OR
Scores below the 10th percentile of students completing
clerkship of comparable length at a similar time in the academic
year on the retake* of his/her NBME specialty subject exam.
(note: all NBME shelf exam scores taken by fourth year students
shall be referenced to scores by students in the fourth quarter
of third year); OR scores below a predetermined minimum passing
score on the retake of the internal clerkship-specific exam; OR
Does not receive a satisfactory rating on all required
clerkship projects and activities, where applicable; OR
Does not comply with data entry requirements into the
CDCS system; OR
Does not receive satisfactory patient and staff
evaluations
A student who
fails the initial post-clerkship NBME subject exam or fails to
achieve a minimum passing score on the initial internal
clerkship-specific exam, but performs at a satisfactory level in
other aspects of the clerkship, will receive an initial
clerkship grade of “IR” and will be reported to the Student
Evaluation & Promotion Committee (SEPC). The student will be
given one opportunity to re-take the examination to achieve a
passing score. This re-take must occur within 90 days from the
day the student is notified that he/she has failed the initial
subject examination, unless a different time-frame is approved
by the SEPC. The student and his/her regional campus dean will
determine the date of the re-take examination, and provide at
least four (4) weeks notice to the regional campus student
support coordinator who will coordinate the ordering and re-take
of the previously-failed examination.
Students who have an initial third-year clerkship grade of “IR”
and re-take the shelf exam must achieve a score at or above the
10th percentile for the NBME shelf exam reference scores by
students taking the exam at a similar time in the academic year.
The date of the re-take exam---and not the date of the original
failed exam--will establish which quartile is used to determine
whether a passing grade has been achieved. Students who complete
the re-take exam during or following the fourth quarter of their
third year curriculum, will have their scores referenced to
those fourth quarter scores.
If a passing score is achieved on the re-take examination, the
initial “IR” grade will be changed to a grade of “Pass.” (A
student who fails the initial exam cannot achieve an “honors”
grade regardless of the score on the re-take exam.) If a
student does not pass the re-take examination or fails to
re-take the examination within the 90 day window, the original
“IR” grade will be changed to a grade of “Fail.”
Students who
receive a failing clinical evaluation from the Clerkship Faculty
will receive a grade of “Fail” for the clerkship (regardless of
the subject exam score or the score on the internal
clerkship-specific exam) and will be referred to the Student
Evaluation and Promotion Committee (SEPC).
Students who fail to meet CDCS requirements for required
clerkships:
Data from the CDCS system is used to assess
and direct individual educational objectives for each student as
well as meet accreditation standards for the COM. This makes
accurate and timely data entry into the CDCS system imperative
for clerkship students. Identification by the clerkship director
of failure to comply with clerkship-specific CDCS data-entry
standards may result in a lowering of the student’s clerkship
grade by the Education Director, and in cases of blatant
noncompliance, may result in a student’s failing the clerkship
due to concerns of professionalism.
Students who receive poor evaluations by patients or staff:
Patient and staff evaluations provide
important information about student performance, and are
required to be collected during all third-year required
clerkships. Consistently low evaluations by either patients or
staff may result in a lowering of the student’s clerkship grade
by the Education Director, and in extreme cases, may result in a
student’s failing the clerkship due to concerns about
professionalism.
Students who receive a grade of “Fail”
for any reason not covered above (ie, concerns re: student
professionalism, for example) will be referred to the SEPC for
disciplinary action.
A student must receive a “Pass” or “Honors” grade for all
required third-year clerkships in order to be eligible for
promotion to the fourth year of the curriculum. In addition, a
student must receive a “Pass” or “Honors” grade for all
fourth-year required clerkships and electives in order to be
eligible to graduate from FSU COM.
Please note: For the Internal
Medicine Clerkship, patient and staff evaluations are generally
used for formative feedback, and not numerically calculated into
the final grade. However, consistently low evaluations by
either patients or staff may result in a lowering of the grade
on this clerkship, and in extreme cases, may result in a failing
grade due to concerns about professionalism. Furthermore,
consistently high evaluations by patients or staff may result in
elevating the student’s grade from a “pass” to an “honors” for
certain students who fall just below the “honors” cutoffs.
Students will be provided with frequent
feedback about their performance. Mid-clerkship formative
feedback will be given to the students by their clerkship
faculty member and clerkship director. Remediation opportunities
will be provided. Students who have serious problems meeting
clerkship requirements will be referred to the Student
Evaluation and Promotions Committee.
The NBME subject exam will generally be
given on the morning of the last day of the clerkship.
Course
Evaluation
Thoughtful student feedback is vital to
assuring a high quality clerkship. All students will be given an
opportunity to provide constructive feedback to the clerkship
faculty and clerkship directors using the on-line evaluation
system. Numerical ratings and comments by all students will be
solicited at the end of each clerkship.
FSU COM ATTENDANCE POLICY
We believe that:
Professionalism is a major component of our
medical curriculum. We believe students should conduct
themselves appropriately in the various educational activities
of the curriculum. This conduct includes coming to educational
activities on-time, using the laptop computers only for course
work during the educational activity, and not disrupting the
class if late. The faculty should also demonstrate
professionalism, by starting and ending all scheduled
educational activities on time and providing a course schedule
with clearly explained course policies in the course syllabus.
Any changes in the schedule should be given to the students in a
timely manner.
Students will be accountable and personally
responsible for attending all educational activities (small
groups, labs, clinical experiences, examinations, lectures,
computer sessions, etc.).
Unexcused absences reflect negatively on
the goals and objectives of the medical curriculum and
demonstrate unprofessional behavior by the respective student.
We owe it to our state legislature and the
citizens of the State of Florida to provide a quality
educational program that meets the needs of our students in
preparing them for the M.D. degree.
Attendance Policy
Students are expected to attend all
scheduled activities. Students are expected to be on time.
Being on time is defined as being ready to start at the assigned
time. If a student has an emergency that prevents her/him from
attending a scheduled activity, s/he is to call and notify the
Office of Student Affairs (Year 1/2) or the Regional Campus Dean
/ Student Support Coordinator (Year 3/4) and request that they
inform the supervisors/professors/clerkship faculty/education
director for that activity. If at all possible, the student
should also call and at a minimum, leave a message with one of
the course/clerkship directors. It is important that students
realize that their absence or tardiness negatively impacts a
number of other people. Attendance, including tardiness, is
part of the student’s evaluation for professionalism. Negative
evaluations may result in decreased grades and in severe cases,
referral to the Student Evaluation and Promotion Committee.
Year 3/4 Required Clerkships
If the student requests an absence in
advance, the “Advance Request for Absence from Educational
Activity(ies)” form (Appendix B) should be completed, signed by
the student and given to the Regional Campus Dean. Requests for
excused absences from a required clerkship should be rare and
made only in situations that cannot be rescheduled to occur
during a scheduled time off or during an elective. An excused
absence from a required clerkship may be allowed when it is
determined by the Regional Campus Dean that the student has no
alternative (see Fourth Year Scheduling Policies).
The Regional Campus Dean, after
consultation with the Education Director and the Clerkship
Director, will make the final decision regarding the student’s
request and give the student the implications for the absence
(e.g., remediation, course grade adjustment, make-up exam,
etc.). Final decisions regarding implications for the
student’s grade shall rest with the Education Director. The
Clerkship Director will notify the clerkship faculty member of
the decision. The form will be filed in the Office of Student
Affairs at the regional campus.
If the absence occurs due to an unforeseen
emergency, the student should contact the Clerkship Director and
the Regional Campus Dean immediately to report the absence
including the reason for the absence. The Regional Campus
Dean, after consultation with the Education Director and the
Clerkship Director will make the final decision regarding
implications of the student’s absence. The implications for
the absence (e.g., remediation, course grade adjustment, make-up
exam, etc.) will be given to the student by the Regional Campus
Dean. Final decisions regarding implications for the student’s
grade shall rest with the Education Director. The Clerkship
Director will notify the clerkship faculty member of the
decision. The form will be filed in the Office of Student
Affairs at the regional campus.
Year 4 Electives
If the student requests an absence in
advance, the “Advance Request for Absence from Educational
Activity(ies)” form should be completed, signed by the student
and given to the Regional Campus Dean. The Regional Campus
Dean, after consultation with the Elective Director, will make
the final decision regarding the student’s request and give the
student the implications for the absence (e.g., remediation,
course grade adjustment, make-up exam, etc.). Final decisions
regarding implications for the student’s grade shall rest with
the Regional Campus Dean, who will notify the Elective Director
of the decision. The form will be filed in the Office of
Student Affairs.
If the absence occurs due to an unforeseen
emergency, the student should contact the Regional Campus Dean
immediately to report the absence including the reason for the
absence. The Regional Campus Dean, after consultation with the
Elective Director, will make the final decision regarding
implications of the student’s absence. The implications for
the absence (e.g., remediation, course grade adjustment, make-up
exam, etc.) will be given to the student by the Regional Campus
Dean. Final decisions regarding implications for the student’s
grade shall rest with the Regional Campus dean, who will notify
the Elective Director of the decision. The form will be filed
in the Office of Student Affairs.
Remediation Policy for Absences from
Examinations, Quizzes, Small Group Sessions, Preceptor visits,
and Clerkship Call
The remediation policies for absences from
examinations, quizzes, small group sessions, and clerkship call
are:
POLICY ON MISSED EXAMINATIONS:
Students are required to take major in-term and final
examinations. Based on Curriculum Committee policy, a
student can only be excused from an examination by a
course/education director decision based on the personal
situation of the student. The Course/Education Director
will determine the time of the exam make-up session. Also,
according to the Curriculum Committee decision and the
existence of the FSU COM honor code, the student will be
given the same examination given to the other students.
POLICY ON MISSED QUIZZES: Students
are required to take scheduled and unscheduled quizzes in
the courses/clerkships. A student can only be excused from
a quiz by a Course/Education Director decision based on the
personal situation of the student. The student must make
arrangements with the Course/Education Director to make up a
missed quiz. Also, according to the curriculum committee
decision and the existence of the FSU COM honor code, the
student will be given the same quiz given to the other
students.
POLICY ON MISSED SMALL GROUP SESSIONS,
PRECEPTOR VISITS, AND CLERKSHIP CALL: The student should
contact the Course Director, small group leader, Clerkship
Director or Education director for instructions on
remediation of the missed session and material covered.
Academic Honor Code:
The Florida State University Academic Honor
Policy outlines the University’s expectations for the integrity
of students’ academic work, the procedures for resolving alleged
violations of those expectations, and the rights and
responsibilities of students and faculty members throughout the
process. Students are responsible for reading the Academic Honor
Policy and for living up to their pledge to “. . . be honest and
truthful and . . . [to] strive for personal and institutional
integrity at Florida State University.” (Florida State
University Academic Honor Policy, found at
http://www.fsu.edu/~dof/honorpolicy.htm.
Students With Disabilities
The Florida State University adheres to
Section 504 of the Rehabilitation Act of 1973 and the Americans
with Disabilities Act of 1990 (ADA) in prohibiting
discrimination against any qualified person with a disability.
Students with specific questions regarding the FSU policies
governing students with disabilities may contact the Student
Disability Resource Center.
Students with disabilities who wish accommodations based on a
disability must notify the College of Medicine Office of Student
Affairs and register with the FSU Student Disability Resource
Center (SDRC). In order to register with the SDRC the student
must provide the Center with the required documentation. A
definitive diagnosis of disability must be stated in the
documentation. Details regarding the required documentation for
each disability can be found at the SDRC website
www.fsu.edu/~staffair/dean/StudentDisability.
Exam Protocol for Students with
Disabilities at Florida State University College of Medicine
The Florida State University adheres to
Section 504 of the Rehabilitation Act of 1973 and the Americans
with Disabilities Act of 1990 (ADA) in prohibiting
discrimination against any qualified person with a disability.
Students with specified questions regarding the FSU policies
governing students with disabilities may contact the Student
Disability Resource Center (SDRC).
Students who warrant accommodations based
upon the functional effects of a physical or learning disability
should adhere to the following procedure:
Student meets with a representative of the Student
Disability Resource Center (SDRC), provides documentation of a
disability and requests accommodations. (A definitive diagnosis
of a disability must be identified in the documentation.
Details regarding the required documentation for each disability
can be found at the SDRC website:
www.fsu.edu/~staffair/dean/StudentDisability.)
For entering students, this is best accomplished prior to
the beginning of classes (e.g., Orientation Week). For all other
students, it must be completed at least one month prior
to the examination date when accommodations would be instituted.
SDRC staff will review the documentation to determine
sufficiency and eligibility for accommodations. If additional
documentation is needed, this may be obtained through the Office
of Student Counseling Services (OSCS) at the COM or elsewhere in
the community. If additional testing is required, temporary
accommodations may be granted while documentation is completed.
Student and SDRC staff identifies the type of accommodations
that are appropriate based upon the student’s disability.
SDRC staff completes and signs a Faculty Letter addressed
to the COM’s Associate Dean for Student Affairs indicating that
documentation supports specific accommodations.
Student signs Faculty Letter indicating agreement with
suggested accommodations and understanding of his or her
responsibility to present the letter to the Associate Dean for
Student Affairs at the College of Medicine.
SDRC prints two copies of the Faculty Letter and retains
a copy as a record of the initial meeting, eligibility and
accommodation request.
Student will schedule an appointment to meet with the
Associate Dean for Student Affairs within one week’s time to
present the second original Faculty Letter.
The student is also encouraged
to keep a copy of this document.
The Associate Dean for Student Affairs will review the
letter, determine appropriateness of all requests based on the
requirements for the college, and discuss concerns with student
and/or call SDRC when appropriate.
The letter will be kept in a confidential place in the
Office of Student Affairs and not made part of the academic
record of the student.
Once accommodation shave been confirmed, the student is
to schedule an appointment with the OSCS.
The OSCE’s at the COM will be the representative
responsible for facilitating accommodations for medical school
students who have been determined eligible for services. The
OSCS will explain to the student how the accommodations will be
facilitated.
The student will then be responsible for completing the
SDRC Exam Sign-Up Sheet and ensuring that his/her Year 1/Year 2
Year and Course Directors overseeing the examination have signed
it. Exam Sign-Up Sheets may be obtained from year 1/Year 2
Coordinators or the OSCS.
The student will return the completed SDRC Exam
Sign-up Sheet to the SDRC at least 5 WORKING DAYS prior
to the scheduled date/time of the exam in order to facilitate
testing/exam accommodations. Failure to meet this requirement
will release the COM and SDRC from the responsibility of
providing accommodations for that particular examination.
A special situation arises with the NBME examinations.
Since these examinations need to be ordered well in advance of
the test date, students who are requesting to take an NBME under
special accommodations should complete the Exam Sign-Up sheet at
least 4 weeks prior to the date the exam is to be
administered.
Students who qualify for exam accommodations will follow
SDRC’s Testing Center policies. If the examination is not taken
at the SDRC, the COM (in collaboration with SDRC) will
coordinate the provision of other accommodations. This might
occur for quizzes or shorter, in-class exams. The student is
responsible for notifying the instructor at least five
working days prior to the quiz/exam if on-site
accommodations are desired. Except for extenuating
circumstances, all Year1/Year2 integrated and Year1/Year2 NBME
exams requiring accommodation will be administered at the SDRC.
For those students attending the regional campuses, Steps
1- 11 should be followed in order to be approved for
accommodations. However, the Regional Campus Dean will be
responsible for overseeing the implementation of the
accommodations in collaboration with the Associate Dean for
Student Affairs.
Provision of exam proctors and appropriate distribution
of exams for students receiving accommodation will be
administered by the Office of Medical Education (for Year 1/2
and the Regional Campus Deans (Year 3/4).
APPENDIX A
M3 INTERNAL MEDICINE CLERKSHIP
STUDENT SELF-STUDY PROGRAM
This self-study program has been designed
to assist the student in managing the vast amount of medical
information available. This program will result in exposure to
the core concepts and breadth of knowledge deemed necessary for
students to have acquired during this clerkship. The key to
success during this rotation includes a daily text reading
program covering not only the clinical encounters of the day,
but also enough to cover the assigned readings by the end of the
clerkship.
Internal Medicine cases, known as Case
Files, are an integral part of the clerkship learning
experience. Students are to complete at least the assigned
cases. and the readings in Andreoli and Carpenter’s Cecil
Essentials of Medicine 7 Edition.
Listed below are the assigned basic
Internal Medicine topics from Cecil Essentials of Medicine
(7th Edition), along with Lange’s Case Files
Internal Medicine (2nd Edition) that will allow
the student to maximize the learning experience:
1. Evidence-Based Medicine, Quality of life,
and the Cost of
Medicine: Pages
19-22
2. Cardiovascular Disease:
Hypertension
Pages 167 – 176
CAD
Pages 97 – 107
Arrhythmia
Pages 118 – 143
CHF
Pages 68 – 75
Case Files
Pages 24 – 37
Pages 40 – 45
3. Renal Disease:
ARF
Pages 332 – 341
CRF
Pages 342 – 354
Case Files
Pages 170 – 178
4. Gastrointestinal Disease:
Abdominal
Pain
Pages 357 – 359
PUD
Pages 390 – 405
Gastritis
Pages 390 – 405
GERD
Pages 384 – 389
Bleed
Pages 360 – 363
Case Files
Pages 56 – 61
Pages 146 – 151
5. Cerebrovascular Disease:
CVA/TIA
Pages 1104 – 1115
Seizure
Pages 1120 – 1128
Headache
Pages 1069 – 1078
Case Files
Pages 430 – 435
Pages 274 – 281
6. Endocrinology:
DM
Pages 676 – 700
Thyroid
Pages 647 – 656
Dyslipidemia
Pages 617 – 624
Obesity
Pages 605 – 611
Case Files
Pages 386 – 392
Pages 422 – 427
7. Infectious Disease:
Hospital Acquired
Infections Pages 974
– 979
Cellulitis
Pages 947 – 952
Pneumonia
Pages 249 – 252
UTI
Pages 970 – 973
Case Files
Pages 362 – 368
Pages 484 – 490
8. Heme/Onc:
Anemia
Pages 496 – 508
Case Files
Pages 242 – 249
Pages 267 – 271
9. Musculoskeletal Disease:
Approach to the Patient with
Pages 799 - 803
Rheumatic
disease
Rheumatoid
Arthritis
Pages 804 – 808
Systemic Lupus
Erythematosus Pages 813 –
818
Crystal
Arthropathies
Pages 840 – 844
Osteoarthritis
Pages 845 – 847
Case Files
Pages 206 – 213
Pages 234 – 239
10. Pulmonary
Disease:
COPD
Pages 214 – 223
Interstitial Lung
Diseases Pages
224 – 237
Case files
Pages 324 – 331
Pages 316 – 321
Pages 291 –298
APPENDIX B (Standard FSU COM Clerkship
Assessment of Student Form)
The following
form may be used for purposes of research.
Completing and submitting this form constitutes
your consent to have it included in research
projects. If you do not want your evaluation
used for the purpose of research, please contact
Dr. David Steele at 850-644-9649.
In addition, if you have any questions about
your rights as a subject/participant in this
research, or if you feel you have been placed at
risk, you can contact the Chair of the Human
Subjects Committee, Institutional Review Board,
through the Vice president for the Office of
Research at 850-644-8633.
Instructions:
Please complete this form at the end of each
rotation for each student supervised. You are
expected to share your evaluation with the
student directly in a face-to-face meeting.
Your narrative comments are particularly
important and may be used in the Dean's Letter
as part of the student's residency application.
Please evaluate the student's performance for
each component of clinical competence. Choose
the rating which best describes the student's
skills and abilities. Any rating of "Problem
performance..." OR "Excellent performance..."
requires a written comment.
*
indicates a response is required
*1.
Please indicate your specialty in this rotation.
Community Medicine
Family Medicine
Internal Medicine
Ob-Gyn
Pediatrics
Psychiatry
Surgery
Advanced Family Medicine
Advanced Internal Medicine
Emergency Medicine
Primary Care Geriatrics
Doctoring 3 Longitudinal
Fund of Knowledge: This student
*2.
Exhibits basic knowledge of pathophysiology,
disease mechanisms, diagnosis, and treatment.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*3.
Seeks and employs evidenced based knowledge in
the care of patients.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
4.
Comments on Fund of Knowledge:
Communication: This student
*5.
Communicates well with patients, their families,
allied health professionals, and physician
colleagues.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*6.
Exhibits the ability to understand the
perspective of others (empathy).
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*7.
Establishes good rapport with patients.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*8.
Communicates in a way that shows sensitivity to
cultural and ethnic differences.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
9.
Comments on Communication:
History Taking: This student
*10.
Elicits patient history at a depth that is
appropriate for the clinical situation. (e.g.,
complete history, interval history, or focused
history).
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*11.
Presents information about patient in an
accurate, logical, and organized manner.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*12.
Includes pertinent psychosocial and/or
prevention information in his/her histories as
appropriate to the patient and the patient's
condition.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
13.
Comments on History Taking:
Physical Examination (including mental status
examination in psychiatry): This student
*14.
Performs an examination that is thorough,
technically accurate, and appropriate to the
clinical setting.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*15.
Maintains sensitivity to issues of patient
privacy, comfort, and dignity during the
examination.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*16.
Recognizes and correctly interprets abnormal
clinical findings.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
17.
Comments on Physical Examination:
Clinical Problem Solving: This student
*18.
Creates a differential diagnosis relevant to the
clinical situation.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*19.
Formulates treatment plans based upon knowledge
of the risks and benefits of alternative
treatment approaches.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
20.
Comments on Clinical Problem Solving:
Documentation: This student
*21.
Accurately records information in an organized
and logical fashion and in a way that is
appropriate to the clinical situation (e.g.,
SOAP notes, progress notes, complete H and P)
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
*22.
Records information that is free of personal
bias, without implication of legal culpability
for the other members of the health care team,
and that contains no inappropriate comments.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
23.
Comments on Documentation:
Integration of technology: This student
*24.
Demonstrates ability to access current and
accurate patient care information utilizing
electronic resources.
Poor performance, area of grave concern
Marginal performance, area of concern
Satisfactory performance, meets
expectations
Good performance, exceeds expectations
Excellent performance, far beyond
expectations
25.
Comments on Integration of Technology:
Professionalism: This student
*26.
Is responsible, punctual, and well prepared.
Yes
No
*27.
Displays professional public demeanor and
comportment.
Yes
No
*28.
Displays motivation to learn.
Yes
No
29.
Comments on Professionalism:
Ethical Standards: This student
*30.
Is honest, trustworthy, and adheres to legal
standards.
Yes
No
*31.
Respects patients' right to privacy and
confidentiality.
Yes
No
*32.
Elicits and respects the point of view and
preferences of the patient (autonomy).
Yes
No
33.
Comments on Ethical Standards:
Overview:
*34.
Overall Summary of Students Performance:
Reservations:
*35.
I have reservations about the suitability of
this student for the practice of medicine. (If
yes, you must describe your concerns in the box
below. Please be specific and provide examples
to illustrate your concerns.)
