The Internal Medicine rotation promotes development of knowledge, skills, and attitudes appropriate to the management of the adult medical patient. This experience builds on learning in the pre-clerkship years. It may occur in a variety of settings including the Emergency Room, hospital and out-patient clinics.

Rotation Information
Students may complete the 10-week Internal Medicine rotation either at the St. John's sites, Grand Falls-Windsor or in New Brunswick. Attendance at all clinical rotations is mandatory. 

St.John's site rotation: 4 week internal medicine at HSC, 4 week internal medicine at SCM, 2 week cardiology/neurology/oncology/hematology. 

Grand Falls-Windsor site rotation: 8 week rotation internal medicine at Central Newfoundland Regional Health Centre.

Saint John site rotation: 6 weeks CTU, 2 weeks CCU, and 2 weeks *geriatrics.

*Geriatrics is covered at both sites in New Brunswick. For smaller rotations, clerks are given the option to do Neurology instead of Geriatrics (pending preceptor availability).  This preceptor must hold a MUN faculty appointment.
 

Leave
A clerk seeking leave (e.g. vacation, conference, sickness) during the Internal Medicine rotation must complete a leave request form and obtain written approval from their preceptor and/or Clerkship Director (signature on leave request form; email from MUN/Regional Health Authority accepted in lieu). All forms are to be submitted to the UGME office to seek final approval for the leave request from the Phase 4 Lead. For more details about leave, refer to the Leave Requests section in the handbook.  

Call Coverage
As on call coverage in Internal Medicine is deemed essential for learning, on call rotations cannot be missed, with the exception of vacation time.
Should you need to change your schedule for personal reasons, your call has to be covered.
You cannot miss regular work days without taking vacation leave. As per Internal Medicine policy all vacation requests must be submitted six weeks prior to the date of leave.

Mandatory Teaching Sessions

1. Academic Half Days: Academic half day sessions are scheduled each week on Wednesday mornings from 8am to 11am (NL time). For clinical clerks completing rotations in New Brunswick, they are to attend via Real Presence (through their Desire2Learn account). The associated objectives tied to the topics discussed during the academic half days are linked to the CanMEDS competencies. For a copy of the academic half day schedule, please refer to the One45 calendar.
2. Morning and Noon Rounds: Weekly rounds are scheduled at both Eastern Health sites (St. Clare’s and the Health Sciences Centre). For a copy of the rounds schedules, please refer to the academic calendar on One45.
3. Medical Grand Rounds: Weekly grand rounds are scheduled every Friday from 12pm to 1pm at the Health Sciences Centre (HSC) and 12:30pm -1:30pm at St. Clare’s Mercy Hospital (SCM). Information regarding the Grand Rounds sessions are available via the One45 calendar.

Objectives
Clinical objectives are linked to EPAs (Entrustable Professional Activity); refer to the Entrustable Professioanl Activities (EPA) Assessment section for more detail.

The EPAs for Internal Medicine are as follows:
 

• EPA 1: Obtain a history and perform a physical examination adapted to the patient's clinical situation.
• EPA 2: Formulate and justify a prioritized differential diagnosis.
• EPA 3: Formulate an initial plan of investigation based on the diagnostic hypotheses.
• EPA 4: Interpret and communicate results of common diagnostic and screening tests.
• EPA 5: Formulate, communicate and implement management plans.
• EPA 6: Present oral and written reports that document a clinical encounter.
• EPA 7: Provide and receive the handover in transitions of care.
• EPA 8: Recognize a patient requiring urgent or emergent care, provide initial management and seek help.
• EPA 9: Communicate in difficult situations.
• EPA 10: Participate in health quality improvement initiatives.
• EPA 11: Perform general procedures of a physician.
• EPA 12: Educate patients on disease management, health promotion and preventative medicine.
• EPA 13: Collaborate as a member of an interprofessional team.

Clinical clerks are responsible for obtaining feedback on all EPAs (as stated above) by the end of the rotation.

Internal Medicine Education Program Objectives
Upon completion of the Internal Medicine rotation, clinical clerks will be able to demonstrate they have acquired general competencies and are able to demonstrate the skills necessary to be competent, practicing physicians – including clinical skills, procedural skills, interpretative skills and problem based skills, in their approach to the diagnosis and management of many common and life threatening medical problems.
Internal Medicine program objectives are based on the CanMEDS Key Competencies as outlined below:

• Medical Expert
• Communicator
• Collaborator
• Leader
• Scholar
• Professional
• Health Advocate

Assessment Methods
Clinical clerks are evaluated regularly by way of evaluation forms called In-Training Assessment Reports (ITARs), Mini-CEX forms, Student Clinical Assessment Cards, T-Res Reports and SIMPLE cases. Refer to the Assessment during Core section of this handbook for more details.