Clerkship Teaching Sites
University of Washington Medical Center (UWMC)
Clerkship coordinator: Doug Paauw, M.D.
University of Washington Medical Center provides inpatient care to patients referred from affiliated primary care clinics in the Puget Sound region as well as care for patients referred from throughout the state for complicated medical problems.
On their four-week inpatient rotations at UWMC, students commonly encounter such diagnoses as advanced liver disease, pulmonary diseases including asthma/COPD, cystic fibrosis, infectious diseases including pneumonia, urinary tract infections, and HIV disease, and infectious complications of chronic renal failure and transplantation.
Students are assigned to a team consisting of two interns, a senior resident, and attending physician. Students are on overnight call with their team every fourth night, and work up at least one patient per night to include a complete history, physical examination, write-up, and organized presentation for morning rounds. (Picking one patient is required; additional patients are optional.) There are didactic conferences designed for the students as well. Students meet with the chief medical resident for two sessions per week. One session emphasizes physical diagnosis skills and the other emphasizes problem-solving skills. Students at UWMC also meet with the clerkship coordinator, Dr. Paauw, once a week for workshops covering important skill-development areas, such as appropriate antibiotic selection, how to write effective orders, evaluation of dyspnea, evaluation of abdominal pain, and sessions devoted to clinical problem solving.
The four-week outpatient rotation at UW is located at the satellite clinic, UWMC-Roosevelt. Working one-on-one with their attending physician, students provide acute care and ongoing care to clinic patients. Students see patients with problems and diagnoses such as hypertension, arthritis and other rheumatologic disease, diabetes, coronary artery disease, dermatologic conditions, abdominal pain, and depression. Students also attend half-day clinics in women’s health care, virology (a clinic devoted to the care of patients with HIV infection), and bone and joint. Students are also expected to spend two ½ days in the ER in the evenings or on weekends to see emergent medical problems. Didactic sessions are given by the outpatient coordinator, Dr. Anne Eacker. These sessions cover hypertension, diabetes, cough, headache, and preventive medicine.
Harborview Medical Center (HMC)
Clerkship coordinator: John V. L. Sheffield, M.D.
Harborview Medical Center’s mission is twofold. The overriding concern is provision of excellent medical care to King County’s underprivileged and emergently ill population, who are referred from HMC affiliated clinics, Western State Hospital, the King County Jail, Public Health Department, and Seattle’s Medic One system. Harborview’s other purpose is medical education. Our operative philosophy is that housestaff and students learn when busy and when immediately responsible for patient care.
The Medicine 665 ward clerkship provides an intense introduction to the practice of acute care internal medicine. The clerkship features exposure to patients with a variety of acute and chronic problems and offers excellent autonomy. This is an extremely busy rotation. During the four weeks, students will learn how to work effectively and efficiently on the inpatient ward and improve their ability to work up, present, and care for patients with complicated medical and social problems. For additional information and learning objectives, please see the HMC Inpatient Medicine clerkship web page.
The clinic month of the medicine clerkship is intended to provide a thorough introduction to the practice of outpatient medicine. Instruction in internal medicine occurs in clinics, classrooms, and other care areas affiliated with Harborview Medical Center. Our goals are to give students an appreciation for the challenge and excitement of primary care medicine, the opportunity to see and learn from patients with a variety of general and subspecialty problems, and didactic instruction in several topics related to ambulatory care. Whenever possible, students receive individualized bedside instruction in patient evaluation from faculty. We hope students find these four weeks particularly valuable in improving their problem-solving, physical diagnosis, and patient evaluation skills. For additional information and learning objectives, please see the HMC Outpatient Medicine Clerkship web page.
VA Puget Sound Health Care System
Clerkship coordinator: Steve McGee, M.D.
Located just 15 minutes south of the University of Washington, the VA Puget Sound Health Care System (formerly the Seattle VA Medical Center) provides primary care to western Washington veterans and serves as the tertiary referral center for Alaska, Montana, and Idaho. Over 70 faculty from the University of Washington’s Department of Medicine are permanent staff at the VA.
During their time at the VA, all Medicine 665 students become the primary providers (with appropriate supervision) for patients with a variety of acute and chronic medical conditions. Infections, malignancies, and heart, lung, neurological, and abdominal disorders are especially frequent.
Inpatient rotation (four weeks): The Medicine 665 student works with a team consisting of one senior resident, two interns, one faculty physician, and one medical team assistant (who provides administrative and secretarial help). On call with his/her team overnight in the hospital every fourth day, the student works up one or two patients per call night and cares for these patients until they are discharged. The senior resident and attending physician teach clinical diagnosis and management at the bedside and review the student’s written and oral presentations. In addition, students round weekly with the clerkship coordinator, Dr. Steve McGee, who emphasizes problem-solving, differential diagnosis, and case presentation. Opportunity to perform technical procedures—including venipuncture, arterial puncture, nasogastric tube placement, and some advanced procedures (such as thoracentesis, paracentesis, central line placements, and lumbar puncture)—is also available to the student.
Outpatient rotation (four weeks): Working closely with two faculty physicians, the Medicine 665 student evaluates and follows 15 to 20 different patients who present to the outpatient clinic with new medical problems. The student should encounter most of the common ambulatory problems, including chest pain, dyspnea, abdominal pain, musculoskeletal pain, diabetes, hypertension, dizziness, and rash. In addition, the student attends one or two subspecialty clinics per week, practices phlebotomy and placement of intravenous lines, and attends weekly rounds with Drs. Wheeler or McGee, who teach problem-solving, electrocardiogram analysis, and advanced physical diagnosis. No on-call or weekend responsibilities are scheduled.
What distinguishes the VA rotation is the student’s direct involvement in the patient-clinician relationship and in all diagnostic and therapeutic decisions—the ideal environment for fostering the development of clinical judgment, problem-solving, and bedside communication skills. Veterans enjoy working with medical students and benefit greatly, in turn, from the care they receive from students. Please contact Dr. McGee or Dr. Wheeler at any time if you have questions about our rotation
VA Puget Sound Health Care System - Hospitalist Program
Clerkship coordinator: Mehraneh Khalighi, M.D.
The Medicine 665 student on the VA hospitalist service works with a team consisting of one senior resident, co-students and subinterns, one faculty physician, and one medical team assistant (who provides administrative and secretarial help). There is no overnight call, rather the student works up one to three patients per week and cares for these patients until they are discharged. The student is expected to work two weekends out of four. The senior resident and attending physician teach clinical diagnosis and management at the bedside and review the student’s written and oral presentations. In addition, students round weekly with the clerkship coordinator, Dr. Steve McGee, who emphasizes problem-solving, differential diagnosis, and case presentation. Opportunity to perform technical procedures—including venipuncture, arterial puncture, nasogastric tube placement, and some advanced procedures (such as thoracentesis, paracentesis, central line placements, and lumbar puncture)—is also available to the student. The VA Hospitalist service rotation is four-weeks in length.
Virginia Mason Medical Center (VMMC)
Clerkship coordinator: Alvin Calderon, M.D.
Virginia Mason Medical Center has been a major teaching hospital for nearly 80 years. VMMC is also an integrated health care system, providing primary, referral, and tertiary care to inpatients and outpatients from throughout the Pacific Northwest region. VMMC sponsors residency programs in Internal Medicine (Categorical, Primary Care, and Preliminary), General Surgery, Radiology, Anesthesia, and Transitional Year.
During their eight-week inpatient Medicine 665 rotation at VMMC, students work in teams of one resident, two interns, and a faculty internist. Night float team covers the inpatient service M-Th and interns and residents cover Saturday and Sunday. The senior resident, interns, attending, chief medical resident, and site coordinator provide bedside teaching of interviewing, physical diagnosis, and medical decision-making.
Didactic opportunities at VMMC include Teaching Rounds four times a week, Noon Conference (our core IM venue), Resident’s Clinic Didactic (our Primary Care venue), and Intern Report. Students meet with the chief medical resident once a week, and with the site coordinator once a week.
Madigan Army Medical Center (MAMC)
Clerkship coordinator: Col. Joseph Morris, M.D.
Madigan Army Medical Center provides inpatient and outpatient care to over 400,000 active duty and retired military beneficiaries in the Pacific Northwest. It is located in the South Puget Sound with a view of Mount Rainer to the east and the Olympic Mountains to the west. MAMC is a referral center for smaller military health care clinics and hospitals in the Puget Sound area, as well as northern California, Alaska, Idaho, North Dakota, and South Dakota, for complicated medical problems that cannot be managed effectively at the local facility.
On their four-week inpatient rotation at MAMC, students will be assigned to a team consisting of one to two interns, a second- or third-year resident, and an attending physician. Students will be on call every fourth night with their team and will be expected to evaluate at least one patient per night. The evaluation will include a thorough history and physical examination, differential diagnosis, and preliminary management plan for each of the recognized problems. Students will be expected to attend a daily Morning Report, followed by a didactic lecture. They may be asked to present their patient at the Morning Report session. Students will also meet with their attending physician at least three times a week for formal teaching and with the clerkship coordinator, Dr. Joseph Morris, every Friday to see and discuss interesting physical findings in patients.
The four-week outpatient rotation at MAMC is under the direction of Dr. Cecily Peterson. The students will work one-on-one with Dr. Peterson or another designated attending physician, seeing new or established patients to evaluate acute problems and chronic problems such as diabetes, hypertension, and depression. Students will also rotate through some medicine subspecialty clinics to learn about such diseases as hepatitis, HIV, rheumatoid arthritis, dermatologic problems, and asthma. Didactic sessions are also provided by the outpatient coordinator or other designated attending physician.
Throughout the rotation, students are expected to attend Department of Medicine Grand Rounds and Thursday Morning Lecture Series in Seattle.
Housing is provided at Madigan Army Medical Center. Click here for more information.
WWAMI Clerkship Sites
Anchorage, Alaska
Clerkship coordinator: Norman Wilder, M.D.
Anchorage is the tertiary referral center for Alaska. It has four hospitals: two full-service private hospitals (Alaska Regional Hospital and Providence Alaska Medical Center), the Alaska Native Medical Center, and the 3rd Medical Center on Elmendorf AFB. Additionally, there is a major Veterans Administration Clinic that used Elmendorf for most of its admissions. Anchorage has a population of about 275,000 and all the amenities (opera, theatre, sports, etc) of a city twice its size. Of course, outdoor activities are nearly endless year around. As is often said, "The best thing about Anchorage is that it is only 10 minutes fro Alaska!"
As the Anchorage Clerkship Site Coordinator, I am trying to arrange clerkship opportunities with preceptors that love to teach and who represent the various career opportunities available today in Internal Medicine. The required clerkship lectures will usually be given by specialists in their respective fields utilizing course notes from the medical school. I am triple-boarded (Internal Medicine, Pulmonary Diseases, and Sleep Medicine) and have a MBA degree. Additionally, I'm a certified physician executive (CPE). I am a hospital administrator and practice sleep medicine. I am responsible for your clerkship experience and will be meeting with each student for a couple of hours each week (average) to provide additional mentoring and to monitor the clerkship experience in Anchorage.
The Anchorage site is growing and students are being assigned to one of several different preceptors for 4 weeks. Every assigned preceptor works closely with another internist which will give you additional experience. All preceptors have been asked to provide as much student independence as possible, taking into account each student's capabilities. Each week you will spend 3 1/2 days with your preceptor, a half-day with a sub-specialist, and a day with special interest assignments and/or me. Your preceptor will incorporate you into their practice and have you see an average 1 - 2 new patients and 3 - 5 return patients daily. For the remaining 2 weeks of the 6 weeks, you will be with a hospitalist with a similar schedule, but the patients will all be inpatients. You will need to be proficient with your history and physical exam skills and well practiced in your patient presentations by the time you arrive in Anchorage.
Students in the 3rd year Internal Medicine Clerkship who need housing will stay in the University of Alaska Anchorage Student Housing on Sharon Gagnon Lane. This is off of Bragaw Street between Providence Drive and Tudor Road, for those of you familiar with Anchorage. It is within easy walking distance of the WWAMI office, Providence Hospital, the Alaska Native Medical Center, and bus stops with connections to most of Anchorage and facilities used for the Clerkship. Please see the house description link for more information
A car will be provided to students who do not have a vehicle available to them. We are currently renting the cars from Rent-A-Wreck. The cars are 5-6 years old and though on average have 100,000 miles, they are mechanically sound and during the winter have four studded snow tires. In some cases, the car will be shared with another student. A parking sticker for UAA parking will be provided for parking on campus, including the student housing. All students will have an unlimited bus pass for the Anchorage transportation system.
The WWAMI program at the University of Anchorage Alaska is providing logistical support. All Clerkship students are encouraged to "get involved" with WWAMI activities and they will have the opportunity to enroll in university activities at UAA student rates.
Please feel free to contact me directly if you'd like more information about the Internal Medicine 3rd Year Clerkship opportunities in Anchorage.
Norman Wilder, MD, MBA, MACP
Vice President Medical Affairs
Alaska Regional Hospital
2801 DeBarr Road
Anchorage, AK 99508
Direct: 907-264-1166
Fax: 907-264-1143
Email: wilder@ak.net or norman.wilder@hcahealthcare.com. Click here for more information on housing.
Billings, Montana
Clerkship coordinator: Steve Gerstner, M.D.
The Billings Community Clinical Unit has been in existence for over 25 years. It offers two slots each quarter for third-year internal medicine clerkships. In addition, specialty rotations can be arranged in the fourth year. Billings is a community of approximately 100,000 and has two hospitals. Four groups of practicing internists participate in this teaching program. A student is assigned to one group of internists for a six-week block of time and generally will spend three weeks with one internist. The intent is to have the student participate in internal medicine as it is practiced in this community, with time spent seeing patients in the hospital, office, emergency room, and as necessary in nursing homes. It is hoped that this will provide a good education in internal medicine and also allow students to understand what the practice of internal medicine is like in a Rocky Mountain community of this size.
The clinical unit provides a house shared with other WWAMI students. Public transportation is not very helpful in Billings, so a car is necessary, though one can easily bike in summer. Click here for more information on housing.
Boise VA Medical Center
Clerkship coordinator: Jim Branahl, M.D.
For 23 years, the VA Medical Center in Boise has offered an internal medicine experience for adventurous UW students. The 12-week clerkship includes eight weeks of inpatient medicine, four weeks of ambulatory care medicine, and a weekly continuity clinic. On inpatient medicine, each student is assigned to a team consisting of an intern, a second-year medicine resident (from the Seattle/Boise UW Primary Care Internal Medicine Residency Program), and a UW faculty attending physician. Since there are no inpatient subspecialty services at the Boise VA, students care for patients with a wide spectrum of medical problems and also gain experience in ICU medicine. During the ambulatory care block, students see patients in the ER, the Urgent Care Clinic, and a variety of subspecialty clinics (e.g., Dermatology, Infectious Disease, Nephrology). A full schedule of conferences rounds out the busy educational experience.
The Boise VA Medicine faculty are highly regarded for their teaching acumen and for their personal interest in their students. This site is part of the UW Internal Medicine Residency Program and offers a full program of lectures, rounds, and addresses by visiting professors. The addition of psychiatry and surgery clerkships at the Boise VA, as well as fourth-year medical electives, has further enhanced the educational environment. On-campus housing and meals are provided for students (family housing is not available in the dormitories). A weekly conference at the VA brings together all the UW students in Boise. Boise has great skiing in the winter and plenty of sunshine throughout the year.
Housing is provided in Boise. Click here for more information.
Dillon, Montana
Clerkship coordinator: Ron Loge, M.D.
Broad-based comprehensive general internal medicine in a community where the internist is also the sub-specialist. One of the few opportunities to see and be involved in rural internal medicine. The student is assigned two or more patients morning and afternoon. Will admit and follow several of the hospitalized patients. Participate in nursing home visits and house calls (some to ranches 60 miles away). Follow and manage patients they admit. Paricipate in rounds on others and may be involved in consulting internal medicine problems for ER providers. Collaboration with surgical specialists and radiologist (for example,. follow patient to OR for cholecystectomy after student initially sees the patient and makes the diagnosis). Call-ins at night are not common. Recreational opportunities include skiing, hiking, fishing, water sports, bicycling. Housing is provided by the School of Medicine. The automobile drive is 14 hours. Click here for more information on housing.
Douglas, Wyoming
Clerkship coordinator: James Morgan, M.D.
Douglas, WY in Southeast Wyoming is located 50 miles from Casper with a popluation of 5,800 within the city limits. Students work with the general internal medicine group affiliated with Memorial Hospital of Converse County. Students will have opportunities to be involved with many aspects of care (like nuclear stress testing, endoscopy, OB medical complications, Psychiatry, and being not just a referral source but also a practicing "partner" with many sub- specialists ( since rural patients can't travel to or call their distant specialist as easily as they can their rural primary care physician). There are a multitude of recreational activities, summer, fall and spring, include a 18 hole golfcourse, fishing in both lake Glendo (23 miles away) and the North Platte River, as well as many "secret" streams, horseback-riding, camping, mountain hiking including 10,000 foot Laramie Peak, rock climbing, and every sort of rodeo event. Winter sports include skiing cross-country and downhill (50 miles away). Casper International Airport is 50 miles from Douglas and is served by United and Skywest, usually through either Salt Lake City or Denver. Dr. Morgan will arrange to pick up and drop off the student. Click here for more information on housing.
Jackson, Wyoming
Clerkship coordinator: Martha Stearn, M.D.
Jackson, with a population of 5,000, is located at the foot of the Grand Tetons and is two hours from Yellowstone Park. The internal medicine group consists of four internists with a busy but relaxed practice that ranges from wellness care to ICU care. Students see two to three patients per half-day in the outpatient clinic and round daily on their own inpatients and on the preceptors' patients at the adjoining St. John's Hospital & Living Center. Students will participate in procedures as appropriate, work with the ER physicians, and spend time working with subspecialists and the radiology attendings. Weekly didactic sessions are held, and the student has access to the hospital library. Housing will be provided in a nearby apartment. Click here for more information on housing. The Jackson Hole ski area is several miles away. Delta Airlines flies into Jackson Hole daily via Salt Lake City. A car would not be needed for the rotation, but if you wish to see Yellowstone or ski at Jackson Hole it might be advisable to drive (it's a two-day drive from Seattle).
Missoula, Montana
Clerkship coordinator: Peggy Schlesinger, M.D.
The Missoula WWAMI site offers experience with general medicine and subspecialty instruction in both office and hospital settings. We have an excellent medical faculty and many conferences and educational offerings on a wide range of topics. The Institute for Medicine and the Humanities, an International Heart Institute, and a Neurosciences Institute provide opportunities for further study. Students spend four weeks with a general internist and two weeks with a specialist during their clerkship in Missoula. Free meals, an excellent library, lots of outdoor recreation, and a very devoted clinical staff make this an excellent choice. Students stay in a three-bedroom apartment with laundry facilities and internet access. Please come with transportation - either car or bicycle, and bring your laptop computer and your hiking boots, skiis, kayak, etc. Click here for additional information on housing.
Montesano/Aberdeen, Washington
Clerkship coordinator: Ki Shin, M.D.
The Montesano/Aberdeen WWAMI site offers experience in general internal medicine with a great deal of hands-on experience managing medically complicated patients. Students will spend time in two private practices, one based in Montesano, Washington, and one in Aberdeen, Washington. They will be exposed to both inpatient and outpatient care. Students may also spend some time with local gastroenterologists adn oncologists.
This site is run by a dedicated core group of internists, three of whom are recent graduates of the UW School of Medicine. An interesting group of patients populates the practices in Montesano and Aberdeen. Click here for more information on housing.
Sheridan, Wyoming
Clerkship coordinator: Wendell Robison, M.D.
The Sheridan VA Medical Center, once a frontier cavalry fort (Fort Mackenzie), offers state-of-the-art health care with new or newly remodeled facilities to veterans throughout a large rural area. The medical center is recognized as an up-to-date neuropsychiatric, medical, and nursing home care facility with staff specialists in psychiatry, acute and subacute medicine, long-term care, substance abuse treatment, and a full range of ancillary services, including diagnostic laboratory, echocardiography, radiology, respiratory therapy, and physical and occupational therapy. The rotation consists of working in parallel with a friendly group of VA-based and community internists in a community-like setting in a busy outpatient clinic where pathology abounds. This is primary care at its best; the student learns to take care of the whole patient, often from start to finish, as specialists are not always readily available in this rural setting. Students follow inpatients when patients are admitted to the hospital and have exposure to important procedures, such as exercise treadmill tests and upper and lower endoscopies. Comfortable housing is available on the VA site. Click here for more information on housing.
Sheridan is a historic town in the heart of the Old West in northern Wyoming, at the foot of the majestic Big Horn Mountains. The mountains begin with rolling green foothills that ascend over 13,000 feet to the top of the majestic Clouds Peak, offering spectacular vistas of canyons, wildflower meadows, alpine lakes, and other peaks. Weekend activities might include nearby hiking, backpacking in the nearby wilderness area, mountain biking, studying fascinating geological formations, fly-fishing, snowmobiling, and downhill and crosscountry skiing. If none of the above appeals, one could attend the local theater, play at one of three first-class golf courses, catch a polo match at the local equestrian center, or explore one of the local battlefields, including the site of Custer's Last Stand.
Soldotna, Alaska
Clerkship coordinator: Jonathan McDonagh, M.D.
Students will obtain a broad exposure to a rural internal medicine practice. This will include primary care through ICU level acute care. You will have the opportunity to perform H+Ps and develop their assessment and management skills on a wide variety of patients with varied and interesting medical problems. Students will be exposed to multiple different procedures in internal medicine including needle aspiration of pleural fluid, ascites fluid, GI endoscopy and echocardiography. Focused efforts will be placed on teaching and refining ECG interpretation skills and chest film interpretation. The student will develop increasing autonomy and independent thinking and management skills.
We are a rural practice serving the internal medicine needs of the entire Kenai peninsula in Alaska with a catchment of about 30 thousand people. There are no medical subspecialists here which means that much of the specialty and consultative works falls on us to perform. As a consequence we have a very diverse patient population with many interesting and challenging medical problems. The context of rural Alaska makes life even more interesting. Many recreational activities: hiking, biking, nordic skiing, alpine skiing, fishing, hunting, canoeing, dog mushing, soccer, hockey, ping pong, wildlife viewing. Lots to do. Housing will be provided for student by the School of Medicine. Would recommend flying to Anchorage and flying or driving to Soldotna. Click here for more information on housing.Spokane, Washington
Clerkship coordinator: George Novan, M.D.
The Spokane Medicine clerkship is based at two hospitals less than a mile apart: Deaconess Medical Center and Sacred Heart Medical Center. Without a county hospital in Spokane, these hospitals not only provide primary medical care to underserved patients within the county, but also receive transfers from rural hospitals. For inpatient training, students are assigned to the housestaff teams at the hospitals. Outpatient training occurs in a variety of outpatient clinics to include the residency clinic, a general internist's clinic, subspecialty clinics (nephrology, dermatology, or oncology clinic) and a community charity clinic.
Didactic conferences consist of resident teaching sessions, Medicine 665 lecture series weekly, student case presentations with the clerkship coordinator weekly, and daily noon lectures.
Students receive meals free of charge at the hospital. Housing is provided in two-bedroom apartments 2.8 miles from Sacred Heart Medical Center. Click here for more information on housing. Medline searching of the literature is available in our offices and clinics, and students have free photocopying privileges for articles.
Wenatchee, Washington
Clerkship coordinator: Xiomara Villa
The WWAMI Wenatchee site provides a third-year internal medicine clerkship administered by the Wenatchee Valley Clinic. Outpatient general internal medicine is emphasized along with exposure to selected subspecialties. Students typically spend six weeks in Wenatchee working with individual preceptors. Didactic sessions are provided as well. Hospital experience takes place at Central Washington Hospital, the major referral hospital for north central Washington. There are 33 University of Washington Department of Medicine clinical faculty members at the Wenatchee Valley Clinic.
Housing is provided in Wenatchee. Click here for more information.