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Electives - Internal Medicine - General Medicine

ACE - A. I. in Internal Medicine: Hospitalist Service

Elective Number: 1529 (lottery)

Rotation Supervisor: Dr. Christopher Arnold

Designated Signer: Karen Ward krw5v@virginia.edu

Evaluation should be given to: Attending on Service

Duration: 4 weeks

Available: All Rotations

This elective is not available to visiting students.

A pager is required for this rotation but is not supplied by the department

Time to Report: Students will be contacted in advance with information regarding when & where to report.

Place to Report: Students will be contacted in advance with information regarding when & where to report.

Attendance: A student may not take time off during this rotation.

Number of students per rotation: 1

Course Description: Students will work on the Hospitalist Service at the University of Virginia Hospital. The student will work under the direct supervision an attending physician. The extern will work up and manage the care of selected patients, serving in the position of the intern. Appropriately supervised, the student will assume primary responsibility for the care of the patient. The Externship will complement the experience of the third year clerkship. The main goal of the externship is enhancement of the student's training in all aspects of inpatient clinical medicine by allowing him or her to initiate and direct the medical management of hospitalized patients. Specific objectives (modified from Fagan, et al: Am J Med 1998;104:409-12) will obviously vary with the setting, but will in general include:

  • Additional exposure to inpatient procedures and processes such as interpretation of EKGs, roentgenograms, chemistries, and blood gasses, which are less frequently encountered in the ambulatory setting
  • Advanced levels of responsibility in patient care, particularly focusing on the extern as the primary caregiver for his or her assigned patients
  • Advanced knowledge of differential diagnosis of syndromes encountered in the inpatient setting. Whereas, for example, the third year student would be expected to learn the differential diagnosis of defined conditions such as community-acquired pneumonia, emphasis for the extern is expanded to include the approach to common syndromic problems such as chest pain or fever.
  • Expansion of therapeutic emphasis from specific treatments to total management of the patient and his or her problems, thus including arranging for followup, delivery of bad news, defining total level of appropriate intervention, and ethical decision making
  • Development of skills in the areas likely to be encountered as an intern providing cross-coverage, e.g. recognition and management of changes in fluid balance, changes in mental status, development of new fever, acute drug toxicities, etc.
  • Active contribution to the education of third year clerks
  • Experience of a higher level of direct interaction with nursing and ancillary services
  • Preparation of the medical student for internship by providing an introductory exposure to its independence, responsibilities, and achievements

Emphasis is placed on advanced physical diagnosis, clinical reasoning and presentation, development of an ordered differential diagnosis and suitable plan, daily management of the patient, and professionalism in all aspects of patient care.