Welcome to Harborview’s Required Clerkship clinic rotation!
Please take a few minutes to review this information before your first day.

Background and General Goals

For the next four weeks, your instruction in Internal Medicine will occur in clinics, classrooms and other care areas affiliated with Harborview Medical Center. Our goals are to give you an appreciation of the challenge and excitement of primary care internal medicine, the opportunity to see and learn from patients with a variety of general and subspecialty problems, and to provide didactic instruction in topics related to ambulatory care. Whenever possible, you will receive individualized bedside instruction in patient evaluation from faculty. We hope you will find these four weeks particularly valuable in improving your problem solving, physical diagnosis and patient evaluation skills.

Administration

The ambulatory clerkship began in July 1994 and has changed several times in response to feedback from your predecessors. Please bring any questions, problems or concerns to us quickly. We welcome your constructive criticism.

Ethan Babcock, M.D.
Chief Medical Resident, Ambulatory Care
Phone: 744-4928
Pager: 680-1819

Genji Terasaki, M.D.
Ambulatory Clerkship Coordinator
Attending Physician, General Internal Medicine
Pager: 680-0543

Clerkship Overview

Your ambulatory care experience will consist of four general activities scheduled into 10 half-day sessions per week. Attached you will find your complete schedule or clinics, teaching sessions, conferences, and miscellaneous activities.

I. Primary care clinics

3-4 Sessions / week
In the Adult Medicine Clinic, and DESC, you will be the first person to enter the exam room to interview and examine your patients. Under typical circumstances you will see 2 or 3 patients per session and have time to review the patient’s chief concern with your Attending physician prior to entering the room. Once you have performed your evaluation and presented this information to the Attending, you will be responsible for implementing your plan and arranging follow-up. These clinics should provide exposure to a broad variety of patient problems and direct instruction in physical diagnosis. We encourage you to schedule your patients for follow up with you throughout the month so that you can get a flavor for continuity of care in the outpatient setting.

II. Subspecialty clinics

3 Sessions / week
In Diabetes/Endocrine Clinics, Chest, Gastroenterology, and Madison, you will work directly with an Attending physician as they see their patients. As the month goes on, you may have the opportunity to see patients by yourself, space permitting. The educational goals of these exercises are summarized at the end of this handout.

III. Didactics

3 Sessions / week
Monday afternoon – Physical Diagnosis with Ethan Babcock, M.D.
Monday afternoon – Sheffield Rounds with John Sheffield, M.D.
Friday afternoon – Didactics with Ethan Babcock, M.D.

In addition to these student teaching sessions, you are encouraged to attend the regularly scheduled Medical Service lunch conferences at Harborview. Weekly conference schedules are emailed each week.

IV. Medic One Ride-Along

Experience medicine from a paramedic’s perspective and to get a sense of our patients’ home and community settings. Schedule at the least one 5-hour ride-along during the rotation. Shifts generally go from 4 PM to 9 PM. Please dress professionally: no jeans, sneakers or scrubs. Finally, please keep a list of the runs that you go on, including the gender, age and reason for the call, and submit to the chief medical resident before the end of your clinic rotation. To schedule a shift, call Carolyn Barton at 386-1483.

V. Parking & ID Badges

Please try to arrange your parking ahead of time. The Parking office is located on the 8th floor of East Hospital via the Center elevators. The phone number is 744-3254, and the office hours are 7:00 AM to 4:30 PM on weekdays. It is strongly recommended you use public transportation or the Health Sciences Shuttle Bus for this rotation. Metro Bus routes #3, 4, and 60 come directly to Harborview, and the Shuttle Bus runs between the UWMC and Harborview every 15 minutes.

It is necessary that you stop by the Badging office to pick up your Harborview ID badge; it will provide you access to the ER and building after hours. We have provided the Badging office, which is located in 8EH-69 (next to the Parking office) with the required forms and information.

VI. General Information and Teaching Goals for Clinic Sessions

PRIMARY CARE CLINICS

Adult Medicine Walk-in Clinic

Attending: Ethan Babcock, M.D.
Location: 3 West Clinic
Time: Monday 8:30 AM

Attending: Genji Terasaki, M.D.
Location: 3 West Clinic
Time: Tuesday 8:30 AM

Attending: TBA
Location: 3 West Clinic
Time: Friday 8:30 AM

Goals:

• Learn how to perform a directed evaluation of patients presenting with a variety of problems.
• Learn how to efficiently review a chart to compile pertinent clinical information.
• Refine presentation skills.
• Learn how to chart clinic notes in an organized and succinct fashion.
• Be observed by your attending as you provide clinical care so that directed feedback can be given as well as instruction in physical exam skills.
• Develop an appreciation for continuity of care and outpatient management for primary care patients.

 

SUBSPECIALTY CLINICS

Note: Please introduce yourself at the start of each clinic session and be assertive in your goals for your sessions, ask if you can see a patient on your own and then present to an attending/fellow. These clinics are included to give you exposure to the variety of outpatient care that is provided in Internal Medicine.

Endocrinology and Diabetes Clinic

Director: Scott Weigle, M.D.
Location: 3 West Clinic (Med Specialties)
Time: Wed 8:30 AM

Goals:

Thyroid:

• Learn how to examine the thyroid and obtain a history directed toward possible thyroid illness.
• Understand the use and interpretation of basic tests of thyroid function.
• Understand the therapeutic approach the hyper- and hypothyroidism.

Diabetes:

• Learn how to do a directed history and physical exam on the diabetic patient.
• Attend at least one patient teaching session with the diabetes nurse educator and nutritionist.
• Learn how to interpret self-glucose monitoring records.
• Understand the basics of oral hypoglycemic and insulin therapy.
• Understand how to screen for and treat diabetic complications.

Other:

• Learn current guidelines for the diagnosis and treatment of the hyperlipidemias.
• Appreciate the diversity of endocrinologic disease by discussing patients with adrenal, pituitary and reproductive disorders as they present to clinic.

Chest Clinic

Director: Shawn Skerrett, M.D.
PCC: Kirsten Moe 744-3123
Location: 3 West Clinic (Med Specialties)
Time: Friday 12:30-6:00 PM (includes lunch and post-clinic conference)

Goals:

• Understand the role of the pulmonary sub specialist and general indications for referral.
• Understand chest radiograph interpretation.
• Understand interpretation of simple spirometry / peak flow testing.
• Understand the diagnosis and management of asthma, COPD, and lung cancer.
• Understand the evaluation of common respiratory symptoms such as chronic cough and dyspnea.
• Understand preventive measures in pulmonary medicine (TB skin testing, smoking cessation, environmental modification).

Madison Clinic

Director: Bob Harrington, M. D.
PCC: Jack Fisher 744-5155
Location: 2 West Clinic
Time: 8:30 AM Weds

Goals:

• Participate in evaluation and management of patients seen in clinic.
• Review HIV teaching materials and learning objectives with Attending.

Gastroenterology Clinic

Director: Christina Surawicz, M.D. 341-4634
PCC: Carla Cummings 744-4929
Location: 3 West Clinic (Med Specialties)
Time: 1:30 PM Weds

Goals:

• Evaluation and Treatment of common GI disorders.
• Witness common GI procedures. (Endosopies)

Medic One

Contact: Carolyn Barton 386-1483
Location: Medic One Annex, 1EH
Attire: White lab jacket, casual clothes.

NO SCRUBS, JEANS OR TENNIS SHOES.