Clerkship Description

Overview of Advanced Clerkship in Medicine

The Advanced Clerkship in Medicine is a one-month rotation on the inpatient medicine service which provides 4th-year medical students additional training and experience in managing complex inpatient care. Students often elect the Advanced Clerkship to better prepare for an internship year in Medicine, to make a decision about internal medicine residency, or as a last opportunity to study Internal Medicine and the approach to care of the complex patient prior to residency training in another field. In fact, the Department of Medicine encourages all students to take a Medicine Subinternship prior to graduation, as it is an outstanding preparation for any post-graduate training.

The Department of Medicine is committed to providing students with opportunities beyond the Basic Inpatient Experience, and so has structured the Advanced Clerkship in Medicine to approximate the role of the intern. Typically two subinterns (advanced clerkship students) will take the place of one intern on a ward team, assuming almost all of the care responsibilities for a fewer number of patients, but engaged in similar activities of an intern: taking overnight call, admitting patients, writing orders, performing ward procedures, etc.

Pre-requisite:
Successful completion of the Basic Inpatient Clerkship is required for all of the subinternships offered by the Department of Medicine.

Ward Experiences:

At Johns Hopkins Hospital and affiliate Bayview Hospital, there are 6 ward experiences which are used for the Visiting Student Advanced Clerkship:

1. Nelson 4 service. This is a private/managed care service which is staffed by Osler housestaff and a General Internal Medicine teaching attending from the Medical Services Organization. Since the teaching attending is the attending of record, there are daily work and teaching rounds with a faculty member and the team. The breadth of patient problems is quite diverse on this service, and housestaff have appreciated working with faculty knowledgeable in health care systems approach to care. Feedback from students has been extremely positive.

2. Polk Unit. This is the inpatient AIDS service, which has been a model for the hospital for team care of complex patients. Attending faculty on this service are from the Division of Infectious Disease; in addition, clerks will be working with the I.D. fellow, and a full multidisciplinary team on a daily basis. If you have a particular interest in HIV disease, please state your preference for this service.

3. Advanced Clinical Clerkship in Medicine – Bayview Medical Center
The student serves as intern under the supervision of the assistant residents and attending physician on one of the medical units. The student will admit patients in rotation, make an evaluation of these patients and directly supervise appropriate therapy (about one patient per student is admitted each 24 hours). Students participate fully in the activities of the unit.

4. Advanced Clinical Clerkship in Coronary-Intensive Care – Bayview Medical Center
The student functions as a member of the medical team at the level of an intern with close supervision by the senior housestaff, cardiology fellow, and attending physician. Experience is gained in: the evaluation and management of critically ill cardiac patients; dysrhythmia diagnosis and management; the interpretation of non-invasive studies; invasive procedures such as line placement and hemodynamic monitoring; and cardiovascular pharmacology. A sound understanding of cardiac physiology and hemodynamics is desirable.

5. Clinical Clerkship in Medical Intensive Care - Bayview Medical Center

During this rotation medical students learn an approach to the critically ill patient, enhance their knowledge of respiratory and circulatory physiology and pathophysiology, and build on their abilities to evaluate and manage patients with complex and/or critical problems, as well as medical patients in general.

Students will see patients with other problems including endocrine emergencies, hyper- and hypothermia, cardiac arrhythmias, CNS hemorrhage, etc. Most patients’ problems are complex, involving several organ systems.

Each MICU team consists of an attending physician, the MICU nursing staff, four house officers, and a critical care fellow. Medical students may take call with the housestaff 2-3 nights a week, obtain histories and perform physical examinations, gather and integrate laboratory data and pertinent information from literature, participate in decision making, write admission and progress notes, etc. Students will observe various critical care procedures such as managing multiple intravenous lines, Swan-Ganz and central venous catheters, proper administration of medications such as antibiotics and pressors. Under the supervision of the resident or the attending, students will perform certain procedures.

6. Chemical Dependency and HIV Medicine – Johns Hopkins Bayview Medical Center

This one-month long rotation exposes senior medical students to expert faculty and innovative treatment facilities for patients with chemical dependency and HIV infection on the Bayview campus. It is based on the existing chemical dependency unit/ comprehensive care practice rotation for internal medicine residents, a unique mix of inpatient and outpatient care of patients with substance abuse and/or HIV infection. The chemical dependency unit is a 26-bed inpatient service which admits patients for detoxification as well as substance abusing patients with acute but not severe medical illnesses. Many of those patients are also HIV positive. The Comprehensive Care Practice is an associated primary care practice which provides ambulatory care for patients with substance abuse and HIV infection. These integrated inpatient and outpatient sites are supervised by three general internist faculty, and provide state-of-the-art clinical protocols and educational curricula. Students and residents spend mornings on the inpatient unit, and afternoons are devoted to seeing patients in the outpatient practice. The fourth year medical student who takes this elective will function as a sub-intern in both the inpatient and ambulatory components and work closely with the faculty and residents. This rotation provides an opportunity to follow patients across inpatient-ambulatory transitions, and thus exposes trainees to important issues in continuity of care often lacking in traditional medical education.

Clinical Clerkships in Medicine

Four week electives in certain specialty services within the department of medicine are offered. Students usually see patients in the outpatient clinics as well as participate on the inpatient consult service. No night call is required.

Johns Hopkins Medical Center

Consultation Service in Endocrinology
Department/Division: Endocrinology and Metabolism
Description: This elective offers students an introduction to clinical endocrinology and metabolism by participating in the patient care, teaching, and laboratory activities of the Division. Students see inpatient consultations referred for endocrine evaluation, and review them with the faculty on daily teaching rounds. Outpatients are seen in the daily clinics (General Endocrine, Metabolic Bone Disease, Neuroendocrine-Pituitary, Diabetes and Thyroid Clinics). In both settings, students perform the primary assessment.

By the end of the experience, students will have seen at least 25 new patients with diabetes, thyroid disease, metabolic bone, lipid pituitary, adrenal and gonadal disorders. The organization of the rotation ensures that students come into contact with all divisional faculty and every facet of our discipline.

In addition to attending all the Division’s regular conferences (Endocrine Grand Rounds, Journal Club, Research Conferences and Endocrine Clinical Conferences), students participate in a special lecture series (3 per week) presenting core topics in clinical endocrinology and metabolism.

Clinical Clerkship in Gastroenterology
Department/Division: Medicine/Gastroenterology and Hepatology
Description: Students participate in evaluating inpatients and outpatients with a wide variety of gastroenterology and hepatologic complaints and problems. Interpretation of radiologic procedures, biopsies, and tests of physiologic function are stressed. Students participate in ward rounds, the activities of the Swallowing Center and the Inflammatory Bowel Disease Center, the weekly GI clinical conference, daily didactics, and journal club.

Clinical Clerkship in Hematology
Department/Division: Clinical Immunology
Description: Students will participate in three to five half day outpatient clinical sessions and two to three hours of inpatient consultations and consult rounds during each week. Attendance at teaching conferences each week is required. Divisional research conferences and Journal Clubs provide an opportunity to learn the research interests of the staff. Clinical experience in pediatric allergy and immunodeficiency clinics can also be provided if desired. Because of the importance of longitudinal follow-up in outpatient medicine, this clerkship is taken as a 9 week block.

Clinical Clerkship in Infectious Diseases
Department/Division: Medicine/Infectious Diseases
Description: A clinically oriented clerkship devoted to the management of infectious diseases. Students answer consultation requests, review findings with fellows, and present cases to the attending in afternoon rounds held daily. There is extensive interaction with the microbiology laboratory, including group teaching sessions held 3-5 hours per week in bacteriology, virology, parasitology and mycology. The goals of the elective are to provide guidelines to an approach to patients with established or suspected infections on the medical and surgical services. Also emphasized is a basic understanding of antibiotic usage, infection control HIV/AIDS, antibiotic resistance, bioterrorism, newly discovered pathogens.

Clinical Clerkship in Pulmonary Diseases and Clinical Pulmonary Physiology
Department/Division: Pulmonary and Critical Care Medicine
Description: Students participate in the consultation service of the Respiratory Division at Johns Hopkins Hospital. Students will evaluate, under the supervision of a fellow and an attending physician, patients with a wide variety of lung diseases, recommending diagnostic and therapeutic options, and following patients during the course of their conferences and seminars of the Division and may participate in the activities of the Pulmonary Function Laboratory.

Clinical Clerkship in Nephrology
Department/Division: Medicine/Nephrology
Description: This clinical elective is designed to provide the student with practical clinical work in nephrology including diagnostic evaluations on inpatients; participation in dialysis and the management of chronic renal disease; management of electrolyte disorders, management of acute renal failure. The student works closely with the resident on the renal service, the fellow, and the attending physician, rounds daily on inpatient consults (which average 4-5 per day), and evaluates patients in thee renal outpatient clinic.

Clinical Clerkship in Rheumatology
Department/Division: Medicine/Rheumatology
Description: This elective teaches a general approach to the different diagnosis of rheumatic diseases, the rheumatology physical exam, and the principles of treatment of common rheumatic disorders. Students will actively participate in the in-patient consultation service by working with fellows and attending rheumatology consultant. There will be significant opportunity for one-to-one teachings. Students will also attend journal clubs and teaching conferences.

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