Internal Medicine-for 22 week WRITE session
The internal medicine clerkship is a twelve week clinical experience: eight weeks are focused on care of hospitalized adults and four on primary care internal medicine. Students who are doing internal medicine as part of WRITE all spend six weeks learning inpatient medicine at a large hospital in Seattle or Spokane; most will have been at one of the three major teaching hospitals: University of Washington Medical Center (UWMC), Harborview Medical Center (the county hospital for the Seattle area), the Seattle VA Medical Center, or at Sacred Heart in Spokane. While at their WRITE sites, students will work with ambulatory internists for another six weeks to complete the primary care portion of their internal medicine training.
What students do in Seattle or Spokane
What they see
What students do in Seattle or Spokane
For students at the five academic hospitals, they will have been part of a resident team, usually made up of a faculty attending, a senior resident, one or two interns, and one or two medical students. On average, students admit 1-2 patients every 3-4 days and carry 3-5 patients at a time, although specifics vary widely based on the logistics of the hospital and the abilities of the students. Each hospital serves a different population: UWMC has more patients with organ transplants and other esoteric problems, while patients at Harborview are more likely to have illnesses associated with poverty or homelessness, and the patients at the VA are a mix of older and younger veterans with differing medical problems. While at Virginia Mason, students will see a broad range of patients, including many who have illnesses typical for a urban, academic medical center (pneumonia and CHF) as well as a significant number of patients who come from all around the region for tertiary specialty care (ERCPs, severe acute pancreatitis, pancreatic cancer). Sacred Heart in Spokane is a regional tertiary care center drawing from not only the Eastern Washington area, but also Idaho and Montana. They typically have at least one to two diagnostic dilemmas on each service a week. As the major community hospital for Spokane, the student receives an excellent perspective of the community internist’s scope of practice--ranging from COPD exacerbations to GI bleeds. Sacred Heart also functions as the county hospital for the Eastern Washington area, so there is also a fair amount of indigent patients and the accompanying medical diseases associated with drug use and other poverty related illnesses.
What they don’t see
Because of changes in residency work hours, most residents no longer take overnight call; many students will not have been in the hospital overnight despite having spent six weeks on an inpatient medicine rotation. They also will have seen very few patients with chest pain or heart disease, because cardiology is a separate service at the academic hospitals. A few students may have had exposure to the ICU but most won’t. Ambulatory experience will also be very limited.
Clerkship curriculum requirements
In addition to six weeks of inpatient care, students should have completed the cardio-pulmonary mini-CEX, 6 of the 12 required lectures (the remainder are online) and 9 of the 12 required PxDX logged patient encounters. Students are strongly encouraged to complete the 12 required online SIMPLE cases before leaving Seattle; they must complete them before taking the exam.
What students should do during WRITE
Primary care internal medicine
The core of the IM training experience during WRITE is working with a primary care internist. A WRITE student who spends one day per week working with a primary internist during their entire WRITE block will have a good opportunity to meet the educational goals for the primary care portion of the clerkship. Alternatively, 4 - 5 weeks full-time in an internist’s office would also satisfy this clerkship requirement.
We also hope students will have an opportunity to work with adult and geriatric patients in other settings, particularly by taking advantage of the opportunity WRITE offers to follow patients they meet in clinic. Seeing those patients in the hospital, making nursing home and home visits, and visiting subspecialists with patients can all be very high-yield. Students may also benefit from working directly with subspecialists, hospitalists, or in emergency department settings but this does not meet the core requirement for primary care internal medicine.
Clerkship requirements completed during WRITE
Students should complete both the required SIMPLE Cases and the online lectures before taking the final exam in March. They should also complete any remaining patient logging in E*Value before finishing the WRITE experience.
WRITE students must take their final exam during WRITE. Because the exam is created and monitored by the National Board of Medical Examiners, students must take it at a site where appropriate proctoring is available. Students who have not already been in contact with Carmelita to determine their site selection for the exam should contact her at firstname.lastname@example.org no later than 6 weeks into WRITE session to ensure sufficient time to make arrangements.
Web site and preceptor’s guide
The Department of Internal Medicine Clerkship web site is at http://tiny.cc/uw-ms3med. On the site you will find the core clinical concepts, expectations, grading using P/RIME, and educational resources. All IM physicians at WRITE sites should read the WRITE IM Guide.
Print textbook and online resources
Each WRITE student is responsible for bringing a copy of the course syllabus/orientation materials and Internal Medicine Clerkship Guide, by Paauw DS, Burkholder L, Migeon M, eds. 2007. They also have access to the full online content of the UW library system through the HealthLinks care provider toolkit, http://healthlinks.washington.edu/care_provider. We strongly recommend that preceptors encourage students to use their library access to look up relevant clinical topics when they see patients; we find that this real-time use of the literature both helps the student retain knowledge and encourages them to develop efficient search strategies that will serve them well later in practice.
Site preceptors: Our grading system (both in Seattle and at WRITE sites) relies on direct evaluations by the internists working with the students. Internal Medicine requests that the names and email addresses of the Internal Medicine preceptors who work with the students at each WRITE site be emailed to your regional office who will then forward to the student program manager in Seattle. During the first month of WRITE, please send the schedule for when the student works with internal medicine preceptors. The preceptors will receive prompts to do evaluations on their students (see printable pdf--available here as a tool. All evaluations must be entered online into E-Value) as prompted by the department throug E-Value--dependent on each site/student’s IM schedule. These progressive evaluations are then combined with the grades from Seattle to determine the final grade for the course.
Chris Knight, MD
Associate Clerkship Director for WWAMI & WRITE
Jenny Wright, MD
Associate Clerkship Director for Greater Puget Sound & WRITE