Internal Medicine

Internal Medicine

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Acting Internship - Internal Medicine (IM4 903I-4)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. Students may not take time off during this AI. See the Attendance Policy for other details.

Location: CRMH

Available: August 2014 - June 2015

Duration: 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: The AI is an intensive 4-week inpatient learning experience at CRMH similar to that of a PGY1 Internal Medicine Resident. The student will be assigned to an inpatient Faculty Internal Medicine teaching team comprised of an attending physician, a PGY2 or 3 resident, 2 PGY1 residents, and possibly 1 or 2 other medical students. The student will be assigned patients admitted to the team and will assume an integral role in providing care for those patients during their hospitalization. The student will be assigned duties and responsibilities very similar to those of the PGY1 residents. These duties include but are not limited to taking a complete history and performing a complete physical on the patients assigned to them, initiating appropriate orders on their patients which will require co-signature, following the patient throughout their hospitalization, and assisting with discharge planning. The student may also be involved in procedures on his/her patients when indicated. The student will be expected to be on call when their team is on call, including overnight call similar to other PGY1 residents (presently 1 in 8) as well as follow all duty hour rules of the program. The student will also be expected to participate in teaching activities including contributions to teaching rounds and morning report and will be expected to attend the didactic conferences provided to the students and residents.

The student will become progressively proficient and knowledgeable in the following:

  1. Accurately and reliably obtaining and report all aspects of the patient's history, physical exam, and diagnostic studies
  2. Demonstrating skill in interpreting the historical, physical and diagnostic data in relation to the patient's illness
  3. Developing a complete problem list and differential diagnosis
  4. Describing various management options available to their patients
  5. Bringing pertinent readings related to his/her patients' illnesses to rounds and contribute to the education of the team

Ambulatory Internal Medicine 2 wks (IM4 903G-2) or 4 wks (IM4 903G-4)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: Carilion Clinic Internal Medicine

Available: August 2014 - June 2015

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: Students will be paired with an IM faculty member and see patients at Carilion Clinic Internal Medicine, Riverside. Students will be exposed to a wide array of patients with diseases and conditions typically seen in an outpatient setting, such as, diabetes, hypertension, and chronic lung disease. Students will learn to do a focused history and physical exam pertinent to the patient’s reason for being seen. Students will then report their findings to the attending physician and together formulate a management plan for the patient. The preceptor is the ambulatory faculty attending and the location is the outpatient clinic.

The student will become progressively proficient and knowledgeable in the following:

  1. Obtaining and reporting an accurate, focused history and physical appropriate to the patient
  2. Setting priorities in developing management plans to address the patient’s most critical problems first
  3. Proposing a course of management for common diseases encountered in the patients you evaluate
  4. Choosing testing and medicines consistent with cost constraints patients face
  5. Incorporating recommendations for adult health maintenance
  6. Recognizing and managing the interaction between the social setting, patients, and illness, particularly in regard to the chronic disease mode
  7. Articulating symptoms and historical details, pertinent physical findings, differential diagnoses, initial diagnostic approach, initial treatment, relevant patient education

Clinical Infectious Diseases (IM4 903A-4)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: CRMH

Available: August 2014 – June 2015

Duration: 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 3

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: The student will be introduced to a diverse population of individuals with a wide variety of infectious diseases, while further developing skills of history taking, physical examination, critical thinking and knowledge of infections and antimicrobial medications and becoming competent and confident in the diagnosis and management of these diseases.

The student will become progressively proficient and knowledgeable in the following:

  1. Taking a history for possible infectious diseases
  2. Identifying the signs and physical findings of general and specific infections
  3. Developing a differential diagnosis and prioritizing the list based on the history, physical examination, baseline laboratory results, imaging studies and knowledge of the epidemiology of infectious diseases
  4. Working comfortably with the microbiology laboratory
  5. Analyzing the interpretation of susceptibility testing
  6. Discussing the advantages and disadvantages of serological testing
  7. Describing the mechanism of action, dosing and adverse events of antimicrobial agents
  8. Accurately interpreting gram stains

Dermatology (IM4 903L-4)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: Carilion Clinic Dermatology

Available: August 2014 – June 2015

Duration: 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: The Elective consists of dermatology outpatient clinics at Carilion Riverside Complex and consults at Carilion Roanoke Memorial Hospital. The student will do the patient’s chart review, history taking, and physical examination. In consultation with the attending, the student will develop a differential diagnosis, plan the diagnostic evaluation and design a management plan for the patient’s skin disease.

The student will become progressively proficient and knowledgeable in the following:

  1. Taking a focused history for skin diseases
  2. Listing the signs and physical findings to look for in general and in certain specific skin diseases
  3. Accurately using the terms for describing the morphology of basic skin lesion
  4. Developing a differential diagnosis based on morphologic diagnosis, and prioritizing the list, based on the history, physical examination, laboratory results and knowledge of the epidemiology of skin diseases
  5. Describing Mohs Micrographic surgery and the workings of a Mohs laboratory.
  6. Discussing the interpretation of skin biopsies
  7. Performing cryotherapy, shave and punch biopsies
  8. Identifying the mechanism of action, dosing, and adverse events of topical therapeutics and phototherapy as well as systemic and biologic drugs used in dermatology
  9. Accurately interpreting KOH prep

Medical Intensive Care 2 wks (IM4 903O-2) or 4 wks (IM4 903O-4)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: CRMH

Available: August 2014 – June 2015

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: This elective is intended to expose medical students to a wide variety of acute and sub-acute medical pathologies and to enable them to provide physiologic support for patients who have suffered acute catastrophic insult. Students will gain experience in coordinating the management of critically ill patients with multiple health care providers and will apply evidence-based concepts to diagnosis, care, and outcome prediction of critically ill patients.

The student will become progressively proficient and knowledgeable in the following:

  1. Managing daily exam during rounds, explaining the impact of mechanical ventilation, sedation and paralysis; outcome prediction; and incorporating laboratory and radiographic data
  2. Explaining the physiology, differential diagnosis, and therapy of different kinds of shock; the use of fluid resuscitation and vasoactive agents
  3. Explaining the underlying pathophysiologic components of acute respiratory failure, hypoxemia, methods of monitoring oxygenation in the ICU setting
  4. Describing the indications and limitations of non-invasive ventilation techniques for patients with acute respiratory failure, endotracheal intubation and assisted ventilation, positive pressure ventilation on hemodymanics
  5. Listing the different types of breath delivered by mechanical ventilators, recognizing and interpreting alarms and complications associated with positive pressure and ventilation
  6. Discussing indications of HFOV and applications in therapy of severe refractory respiratory failure
  7. Recognizing common acid-base disturbances, the compensatory changes associated with them, and the underlying etiologies; describing the use of anion and osmolar gaps in determining etiology of acid-base disturbances and their treatment.
  8. Recognizing common fluid and electrolyte disorders and their consequences
  9. Describing the side effects of medications commonly used in the critical care setting and list their antidotes, indications, contraindications and side affects.
  10. Explaining the rational use of blood and blood products in the ICU, including the indications and contraindications of RBC, platelets, and FFP transfusion
  11. Describing basic methods used to assess nutritional status and the impact of critical illness on the patient’s nutritional requirements
  12. Performing nasotracheal and oral intubation, arterial catheters, central venous lines, arterial puncture, lumbar puncture, thoracenteses, cardioversion, temporary pacemaker insertion, transcutaneous pacing, and pulmonary artery catheters, sterile insertion of radial and femoral arterial catheters

Nephrology 2 wks (IM4 903P-2) or 4 wks (IM4 903P-4)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: CRMH and Valley Nephrology Associates

Available: August 2014 – June 2015

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 2

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: The student will work in conjunction with the nephrologists in the Dialysis Unit. The student will learn about fluid management as well as dialysis management and the illnesses that typically accompany renal disease (HTN for example.)

The student will become progressively proficient and knowledgeable in the following:

  1. Applying relevant clinical and basic science knowledge in acid-base disorders, fluid and electrolyte disorders, acute and chronic renal failure, indications for emergent dialysis, evaluation for transplant, understanding and applying medical literature related to common medical conditions
  2. Conducting routine exam as it pertains to nephrology
  3. Recognizing critical illness including sodium disorders, hypo/hyperkalemia, acute renal failure, calcium and phosphate disorders
  4. Acutely managing a patient with hyperkalemia
  5. Interpreting results of urinalysis and renal ultrasound
  6. Applying indications for Foley Catheter, Central Line placement

Palliative Medicine (IM4 903H-2)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: CRMH

Available: August 2014 – June 2015

Duration: 2 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: The medical student will see a diverse population with a wide variety of serious illnesses in order for the students to demonstrate an understanding of the management of medical problems in the specialty area of palliative medicine.

The student will become progressively proficient and knowledgeable in the following:

  1. Discussing the current state of dying in the US
  2. Identifying psychological, social, and spiritual issues of palliative care patients and their families
  3. Discussing the management of symptoms utilizing various pharmacologic and non-pharmacologic modalities, pharmacodynamics and pharmacokinetics of commonly used agents
  4. Facilitating ventilator withdrawal
  5. Managing common complications including neuro-psychiatric co-morbidities at EOL
  6. Facilitating complex discussions about goals of care and symptom management with patients and families in a structured environment
  7. Utilizing comprehensive interdisciplinary assessment of the patient and family
  8. Facilitating communication between different disciplines within the palliative care team
  9. Developing a care plan based on the identified and expressed values, goals and needs of the patient and family facilitated by professional guidance and decision making support
  10. Assessing and managing pain and symptoms based on best available evidence including equianalgesic dosing
  11. Discussing the impact of life-limiting disease on the family system resources
  12. Performing physician spiritual assessment
  13. Analyzing cultural implications of life-limiting illness
  14. Identifying the signs and symptoms of impending death that can be communicated and managed

Pathology 2 wks (IM4 903R-2)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: CRMH

Available: August 2014 – June 2015

Duration: 2 weeks, starting any Monday and ending Friday

Number of students per rotation: 2

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: Students will review gross and microscopic pathology specimens with attending pathologists, attending and participate in multidisciplinary conferences, observe the operation of the clinical and histological laboratories, participate in autopsy pathology, and correlate pathologic diagnoses with patient management using principles of evidence-based medicine. The student will review the patient’s clinical history, physical exam, laboratory data, and radiological studies and correlate the relevant information with gross and microscopic findings of patient specimens. From this information the medical student will develop a differential diagnosis, plan the diagnostic evaluation and relate the final pathologic diagnosis to patient outcome, based on sound anatomic pathology and laboratory medicine principles.

The student will become progressively proficient and knowledgeable in the following:

  1. Describing the operation of the anatomic and clinical pathology laboratory
  2. Summarizing the role of anatomical and clinical pathology in patient diagnosis and management
  3. Summarizing the role of the pathologist in interdisciplinary healthcare team
  4. Interpolating recent literature with pathologic diagnosis and patient outcome
  5. Inferring a differential pathologic diagnosis based on clinical history, radiological studies, and gross and microscopic findings of patient specimens
  6. Planning a testing strategy to test the differential diagnosis
  7. Evaluating patient specimens to achieve a final diagnosis for most common disease processes

Physical Medicine and Rehabilitation (IM4 903D-2)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: CRCH 7th Floor Rehab

Available: August 2014 – June 2015

Duration: 2 weeks, starting any Monday and ending Friday

Number of students per rotation: 2

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: The student will learn how to assist individuals who have permanent impairments (paralysis, sensory loss, cognitive dysfunction, alteration of consciousness, decreased endurance, etc.) in identifying their remaining abilities and developing them to their maximum potential. There is a strong emphasis on the team approach, with communication as the vital link between team members, most importantly the patient and the patient's family. We will focus on issues that the students will be likely to see in their primary practices. Students will participate in daily rounds, attend weekly conferences to discuss his/her patients with the team, complete admission H&P’s and consults.

The student will become progressively proficient and knowledgeable in the following:

  1. Performing a physical exam on a patient with a spinal cord injury including completing an ASIA exam
  2. Recognizing the signs and symptoms of Autonomic Dysreflexia
  3. Recognizing signs and symptoms of Dysautonmia
  4. Recognizing signs and symptoms of mild TBI
  5. Recognizing agitation in a patient with TBI
  6. Identifying spasticity and outline a treatment plan to treat spasticity in either a patient with TBI or SCI
  7. Determining a patient’s appropriateness for inpatient rehabilitation by determining if the patient has appropriate goals for acute rehabilitation services, determining barriers to a successful discharge from the hospital environment, and determining social and family factors that may impact successful rehabilitation and discharge to home
  8. Listing and defining conditions, medications, and treatments within the field

Pulmonary Medicine (IM4 903F-2)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: CRMH and Carilion Clinic Pulmonary & Sleep Medicine - Roanoke

Available: August 2014 – June 2015

Duration: 2 weeks, starting any Monday and ending Friday

Number of students per rotation: 2

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: Students will be involved in consulting on patients with pulmonary diseases in the inpatient unit and evaluating patients in the outpatient clinic. The student will do the patient’s chart review, history taking, and physical examination. From this information and the integration of physiopathological principles, the Medical Student will develop a differential diagnosis, learn how to prioritize this, and propose a treatment plan.

The student will become progressively proficient and knowledgeable in the following:

  1. Mastering the physical examination skills related to the evaluation of pulmonary diseases
  2. Identifying the presenting signs and symptoms of patients with respiratory problems
  3. Identifying variables that allow differentiating varied disorders of other systems causing similar “respiratory” symptoms
  4. Acquiring skills to develop a focused differential diagnosis, and prioritize the alternatives in order of importance
  5. Identify indications for pulmonary function testing and interpreting the results
  6. Discussing available technological diagnostic and treatment advances and determining how to use these judiciously
  7. Discussing the impact of respiratory disorders in a patient’s quality of life

Rheumatology (IM4 903C-2)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: Carilion Clinic Rheumatology

Available: August 2014 – June 2015

Duration: 2 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in IM

Overview: The medical student will be introduced to the spectrum of musculoskeletal medicine and rheumatologic complaints which may bring a patient to his primary care physician and which may require specialty consultation. The student will distinguish those patients with mechanical and degenerative processes from those who likely have inflammatory, systemic, and/ or autoimmune diseases. The student will refine their ability to take a history and document a physical exam on these patients, and expand their understanding of the natural history, the pathophysiology, the diagnostic evaluation, and the currently accepted treatments for these patients.

The student will become progressively proficient and knowledgeable in the following:

  1. Obtaining and documenting history and ROS appropriate for the presenting complaints and suspected disease process
  2. Performing and documenting a musculoskeletal and rheumatologic physical exam appropriate for the presenting complaints and suspected disease process
  3. Distinguishing history and physical finding of mechanical and degenerative disease from those of systemic inflammatory or autoimmune disease
  4. Listing laboratory tests ordered in rheumatology, understanding their utility and their limitations
  5. Identifying the presentations of the common musculoskeletal disorders and systemic rheumatologic diseases, soft tissue rheumatism, lupus like connective tissue disease, rheumatoid arthritis, spondyloarthropathies, gout and crystal induced disease, and vasculitis
  6. Interpreting bone and joint xray and musculoskeletal ultrasound