Contact Information

Office of the University Registrar


Uniformed Services University of the Health Sciences
Office of the University Registrar
4301 Jones Bridge Road, A1041
Bethesda, Maryland 20814-4799

Fourth-Year Clerkship Coordinator

Ms. Jacqueline Drake
Program Administrative Specialist, Advanced Clerkship Program
Department of Medicine
Phone: (301) 295-9727
E-mail: jacqueline.drake@usuhs.edu

Course Descriptions by Department- Medicine

As a fundamental prerequisite for performing any Fourth-Year clerkship, clinics and consultation electives, or subinternship in the Department of Medicine, the student must have satisfactorily completed the third year clerkship in internal medicine, unless otherwise so directed, arranged, and approved by the Department of Medicine. Students may contact the Director of Fourth-Year programs who can be reached at (301) 295-9727 or autovon 662-4039.

Clinics and Consultation Objectives

Clinics and Consultation electives provide students with opportunities to expand their knowledge of particular subspecialties, work as consultants, and manage patients primarily in the outpatients setting. Much of a clinician's time is spent in office practice and consultation; these electives allow students to experience those aspects of practice as well as expose them to common diseases rarely seen on internal medicine wards. Students learn specialized history taking and examination skills of a particular subspecialty and learn how and when to use diagnostic tools of that specialty. Students are responsible for initial work-ups and notes as well as follow-up visits. After the initial evaluation of a patient, students present and discuss patients with fellow and staff attending. Each service is responsible for its own schedule of formal talks and rounds in which the students will participate.

Grading of clinics and consultative electives is on a Pass/Fail basis. The goal of these clerkships is to prepare the students for internship and enable students to serve as managers for their patients. Therefore using the RIME scheme (Reporter- Interpreter- Manager- Educator), fourth year clerks are expected to be competent reporters and interpreters and making movement toward being managers for their assigned patients in order to receive a passing grade. (In comparison, third year internal medicine clerks are expected to be competent reporters and making movement toward interpreters to receive a passing grade.)

Objectives common to all clinics and consultation rotations include the abilities to:

  • Present cases (orally and written) that are organized, succinct, and factual
  • Longitudinally track patient data using available resources
  • Coordinate clinical care with supervising physicians and other health care workers
  • Use electronic databases
  • Appraise literature and apply it to their assigned patients (Evidence Based Medicine)
  • Develop an individualized educational plan for the clerkship
  • Demonstrates respect, compassion, integrity, and honesty in interactions with patients, family, and health care professionals

Objectives unique to each subspecialty will be outlined under the individual clerkships. These electives are available throughout the year for students from USUHS (blocks 1-10) and other medical students unless otherwise specified. The USUHS Coordinator for clinics and consultations is LTC Brian Hemann, MC, USA. He can be reached at (301) 295-9727 or autovon 662-4039.

Subinternship (Descriptions, Goals and Objectives)

Subinternships in internal medicine are designed to provide senior students with an opportunity to manage acutely ill hospitalized patients under a high degree of supervision. Students will further develop their skills in history taking, physical examination, differential diagnosis, and the day-to-day management of both common and unusual illnesses. Fourth year students will function with intern-like responsibilities under the direction of a resident and staff internist. In certain subinternships, the student may also work with fellows. Students will provide comprehensive care for their assigned patients including their initial work-up, daily progress notes, and performing procedures under close supervision. Students will take night and weekend calls, thereby satisfying the requirements for the non-surgical portion of the required fourth year subinternship. Students will carry the full responsibility for his/her patients and is expected to develop their initiative in identifying issues in patients care and in proposing daily plans for his/her patients.

A letter grade (A, B, C, D, F) will be given for this rotation. The goals of the subinternship is two-fold: provide a forum in which students integrate internal medicine teaching from the entire four year curriculum and equip students with new knowledge, skills, and attitudes they will need to excel during internship. Therefore using the RIME scheme (Reporter- Interpreter- Manager- Educator), fourth year clerks are expected to be competent reporters and interpreters and making movement toward being managers for their assigned patients in order to receive a passing grade.

Objectives common to all clinics and consultation rotations include the abilities to:

  • Present cases (orally and written) that are organized, succinct, and factual
  • Longitudinally track patient data using available resources
  • Coordinate clinical care with supervising physicians and other health care workers
  • Prioritize "scut"/sign-out lists
  • Assessing patient decision-making capacity
  • Pharmacokinetics of common medication
  • Composing discharge summaries
  • Delivering bad news
  • Use electronic databases
  • Appraise literature and apply it to their assigned patients (Patient centered care)
  • Develop an individualized educational plan for the clerkship
  • Demonstrates respect, compassion, integrity, and honesty in interactions with patients, family, and health care professionals

Objectives unique to each subspecialty will be outlined under the individual clerkships. Subinternships are available throughout the year for students from USUHS and other medical schools unless otherwise specified. The USUHS Director for 4th Year programs is MAJ Brian Hemann, MC, USA. He can be reached at (301) 295-9727 or autovon 662-4039.

Clerkship (Descriptions, Goals, and Objectives)

Clerkships in internal medicine offer similar experiences as subinternship. While they are four weeks in duration, they do not fulfill the University's requirement for a subinternship, because students will not take night call and may not be required to write orders. However, the amount of primary patient management may be similar to the subinternships. The goals and objectives for clerkships is the same as those for the subinternships.

Objectives unique to each subspecialty will be outlined under the individual clerkships. Clerkships are available throughout the year for students from USUHS and other medical schools unless otherwise specified. The USUHS Director for 4th Year programs is MAJ Brian Hemann, MC, USA. He can be reached at (301) 295-9727 or autovon 662-4039.

MDR4400, Cardiology C&C
MDR4410, Cardiology Clerkship
MDR4415, Intensive Care Unit (ICU)
MDR4430, General Medicine Clerkship
MDR4450, MICU Clerkship
MDR4470, Oncology C&C
MDR4490, Hematology/Oncology C&C
MDR4510, Gastroenterology C&C
MDR4540, Endocrinology C&C
MDR4550, Infectious Disease C&C
MDR4560, Nephrology C&C
MDR4570, Pulmonary C&C
MDR4580, Rheumatology C&C
MDR4590, Allergy C&C
MDR4610, Cardiology Research
MDR4620, Clinical Pharmacology Research
MDR4630, Education Research
MDR4635, Medicine Education Informatics
MDR4640, Endocrinology Research
MDR4650, Gastroenterology Research
MDR4660, Infectious Disease Research
MDR4670, Rheumatology/Immunology Research
MDR4680, Clinical Pharmacology Consults
MDR4683, Medicine
MDR4690, Geriatric Medicine
MDR4720, General Medicine Clinics
MDR4730, Medicine Consult Service
MDR4770, NIH Research
 
MDR4420, Cardiology S.I. Coronary Care Unit
MDR4440, General Medicine S.I.
MDR4460, MICU S.I.
MDR4480, Oncology S.I.
MDR4500, Hematology/Oncology S.I.

Course #: MDR4400, Cardiology C&C
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: This rotation is designed to evaluate and develop management plans for both outpatients and inpatients with a wide range of cardiovascular disease including congestive heart failure, arrhythmias, valvular heart disease, coronary artery disease, and hypertension. The primary focuses are cardiac history and physical diagnosis; interpretation of EKGs, stress testing, and basic radiographic procedures; preoperative assessment; and outpatient consultation.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common cardiac signs and symptoms, interpret common cardiac diagnostic testing, develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or cardiologist).

Unique Objectives:
1) Correctly interpret EKGs on assigned patients
2) Identify common bradyarrhythmias, tachyarrhythmias, and myocardial ischemia/infarct on EKGs
3) Attain fund of knowledge and skills in order to enable the students to initiate care for patients who present with acute chest pain, hypertensive emergencies, and arrhythmias
Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Chest Discomfort and Palpitations; Heart Failure and Cor Pulmonale; Valvular Heart Disease; Prevention and Treatment of Atherosclerosis; Ischemic Heart Disease; Unstable Angina and Non-ST Myocardial Infarction; ST-Segment Elevation Myocardial Infarction; Hypertensive Vascular Disease

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: KEMC, MGMC, PMMC, SDMC, TAMC, WBMC, WHMC, WPMC, WRMC

Course #: MDR 4410, Cardiology Clerkship
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: This course is designed primarily to care for inpatients. Senior students will function as an intern on the inpatient cardiology team. They will provide comprehensive care for assigned patients including their initial work-up, daily progress notes, interpretation of EKGs and other diagnostic tests, and performing procedures under the supervision of senior members of the team. The primary focuses recognition and management of arrhythmias, heart failure, and acute coronary artery syndromes.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common cardiac signs and symptoms, interpret common cardiac diagnostic testing, develop diagnostic and management plans for their assigned patients, and ultimately develop a rationale initial approach to caring for similar patients in the future (prior to referring patients to an internist or cardiologist).

Unique Objectives:
1) Correctly interpret EKGs on assigned patients
2) Identify common bradyarrhythmias, tachyarrhythmias, and myocardial ischemia/infarct on EKGs
3) Attain fund of knowledge and skills to enable the students to initiate care for patients who present with acute chest pain, hypertensive emergencies, and arrhythmias

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Chest Discomfort and Palpitations; Heart Failure and Cor Pulmonale; Valvular Heart Disease; Prevention and Treatment of Atherosclerosis; Ischemic Heart Disease; Unstable Angina and Non-ST Myocardial Infarction; Hypertensive Vascular Disease.

Comments: For further info, consult Clerkship objectives at beginning of this section.

Sites: MAMC, NNMC

Course #: MDR4415, Intensive Care Unit (ICU)
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Students participate in managing patients in the ICU setting in which the CCU and MICU may be combined. This rotation focused on diverse conditions including acute renal failure, shock, respiratory failure, acid-base disorders, congestive heart failure, arrhythmias, hypertensive emergencies, and acute coronary syndromes.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common signs and symptoms in critically ill patients, interpret common diagnostic testing in the ICU, develop management plans for their assigned patients, and ultimately recognize signs and symptoms of critical illness in future patients who require admission in ICUs.

Unique Objectives:
1) Correctly interpret diagnostic studies including laboratory and EKGs on assigned patients
2) Develop management plans for their patients who present with electrolyte, acid base, and fluid disturbances
3) Attain fund of knowledge and skills to enable the students to initiate care for patients who present with acute gastrointestinal bleeding, acute renal failure, arrhythmias, acute chest pain, electrolyte disorders, hypertensive emergencies, respiratory arrest, and shock

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Palliative and End-of-Life Care; Fluid and Electrolyte Disturbances; Acidosis and Alkalosis; The Bradyarrhythmias: Disorders of Sinus Node Function and AV Conduction Disturbances; Heart Failure and Cor Pulmonale; Unstable Angina and Non-ST Myocardial Infarction; ST-Segment Elevation Myocardial Infarction; Respiratory Failure; Acute Respiratory Distress Syndrome; Mechanical Ventilatory Support; Severe Sepsis and Septic Shock; Cardiogenic Shock and Pulmonary edema; Cardiovascular Collapse, Cardiac Arrest, and Sudden Cardiac Death; Acute Confusional Sate and Coma; Acute Renal Failure; Poisoning and Drug Overdosage

Comments: For further info, consult Clerkship objectives at beginning of this section.

Sites: MAMC, SDMC

Course #: MDR4430, General Medicine Clerkship
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: This clerkship provides a supervised inpatient and outpatients experience evaluating and managing major diseases encountered in specialty and primary care settings. The clerkship offers the opportunity to present patients cases to a staff attending. Although the majority of patients seen in this clerkship are inpatients, depending on the specific site, patients may be seen in outpatient clinics, self-referral emergency or walk-in clinics, or on an inpatient consult service.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common adult signs and symptoms of disease, interpret diagnostic testing used in caring for their patients, develop diagnostic and management plans for their assigned patients, and ultimately develop a rationale initial approach to caring for similar patients in the future (prior to referring patients to an internist or other subspecialists).

Unique Objectives:
1) Correctly interpret diagnostic studies including laboratory and EKGs on assigned patients
2) Attain fund of knowledge and skills to enable the students to initiate care for patients who present with abdominal pain, acute gastrointestinal bleeding, acute renal failure, altered mental status, arrhythmias, chest pain, electrolyte disorders, fever, glycemic control, nausea and vomiting, pain management, respiratory distress, and seizures

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Palliative and End-of-Life Care; Chest discomfort; Abdominal Pain; Gastrointestinal Bleeding; Fluid and Electrolyte Disorders; Approach to the Acutely Ill Infected Febrile Patient; Heart Failure and Cor Pulmonale; Hypertensive Vascular Disease; Acute Confusional States and Coma; Diabetes Mellitus; Seizure and Epilepsy; Alcohol and Alcoholism; Poisoning and Drug Overdose.

Comments: For further info, consult Clerkship objectives at beginning of this section.

Sites: BAMC, MAMC, MGMC, NNMC, SDMC, TAMC, WPMC

Course #: MDR4450, MICU Clerkship
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: This course is designed primarily to care for inpatients. Senior students will function as an intern on the Intensive Care Unit team. They will provide comprehensive care for assigned patients including their initial work-up, daily progress notes, interpretation of EKGs and other diagnostic tests, and performing procedures under the supervision of senior members of the team

Goals: At the end of this elective, senior students will be able create differential diagnoses of common signs and symptoms in critically ill patients, interpret common diagnostic testing in the ICU, develop management plans for their assigned patients, and ultimately recognize signs and symptoms of critical illness in future patients who require admission in ICUs.

Unique Objectives:
1) Correctly interpret diagnostic studies including laboratory and EKGs on assigned patients
2) Develop management plans for their patients who present with electrolyte, acid base, and fluid disturbances
3) Attain fund of knowledge and skills to enable the students to initiate care for patients who present with acute gastrointestinal bleeding, acute renal failure, arrhythmias, acute chest pain, electrolyte disorders, hypertensive emergencies, respiratory arrest, and shock

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Palliative and End-of-Life Care; Fluid and Electrolyte Disturbances; Acidosis and Alkalosis; The Bradyarrhythmias: Disorders of Sinus Node Function and AV Conduction Disturbances; Heart Failure and Cor Pulmonale; Unstable Angina and Non-ST Myocardial Infarction; ST-Segment Elevation Myocardial Infarction; Respiratory Failure; Acute Respiratory Distress Syndrome; Mechanical Ventilatory Support; Severe Sepsis and Septic Shock; Cardiogenic Shock and Pulmonary Edema; Cardiovascular Collapse, Cardiac Arrest, and Sudden Cardiac Death; Acute Confusional Sate and Coma; Acute Renal Failure; Poisoning and Drug Overdosage

Comments: For further information, please see common goals of clerkships at the beginning of this section

Sites: MAMC, MGMC, NMMC, PMMC, WBMC, WHMC

Course #: MDR4470, Oncology C&C
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Clerks will evaluate patients with solid and liquid tumors on the oncology inpatient throughout the hospital and will see both new and follow-up patients in the outpatient clinic.
 
Goals: At the end of this elective, senior students will be able create differential diagnoses of common cardiac signs and symptoms, interpret common cardiac diagnostic testing, develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or oncologist).

Unique Objectives:
1) Correctly interpret findings on peripheral blood smears, other laboratory results, and radiographic procedures on their assigned patients
2) Develop diagnostic and management plans for their patients who present with signs or symptoms suggestive of an underlying malignancy
3) Attain fund of knowledge and skills to enable the students to care for their patients with malignant disease, including treatment options, management of treatment-induced complications, and end-of-life issues

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Palliative and End-of-Life Care; Approach to the Patient with Cancer; Prevention and Early Detection of Cancer; Principles of Cancer Treatment: Surgery, Chemotherapy, and Biologic Therapy; Principles of Radiation Therapy; Neoplasms of the Lung; Breast Cancer; Gastrointestinal Tract Cancer; Pancreatic Cancer; Hyperplastic and Malignant Diseases of the Prostate; Gynecologic Malignancies; Metastatic Cancer of Unknown Primary Site; Oncologic Emergencies; Acute and Chronic Myeloid Leukemias; Malignancies of the Lymphoid Cells; Plasma Cell Disorders

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: NNMC

Course #: MDR4490, Hematology/Oncology C&C
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Working closely with other members of the consult service, clerks will have responsibility for providing initial consultation as well as daily follow-up on their assigned patients. In addition, clerks will see both new and follow-up patients in the outpatient clinic. The focus of this elective is to expose the subintern to a wide variety of hematologic and sold malignancies, their consequences, and effects of therapy as well as the diagnosis, treatment, and management of non-malignant hematologic disorders such as anemia, cytopenias, and coagulation disorders.
 
Goals: At the end of this elective, senior students will be able create differential diagnoses of common presentations of malignant and hematologic disease, interpret common diagnostic testing (both laboratory and imaging), develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or hematologist/oncologist).

Unique Objectives:
1) Correctly interpret findings on peripheral blood smears, other laboratory results, and radiographic procedures on their assigned patients
2) Development diagnostic and management plans for assigned patients who present with non-malignant hematologic disease (i.e. anemia, cytopenias, coagulation disorders, etc.)
3) Develop diagnostic and management plans for their patients who present with signs or symptoms suggestive of an underlying malignancy or have a known malignancy
4) Attain fund of knowledge and skills to enable the students to care for their patients with hematologic and malignant disease, including treatment options, management of treatment-induced complications (i.e. pancytopenia, fevers, etc.), and end-of-life issues

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Palliative and End-of-Life Care; Approach to the Patient with Cancer; Prevention and Early Detection of Cancer; Principles of Cancer Treatment: Surgery, Chemotherapy, and Biologic Therapy; Principles of Radiation Therapy; Neoplasms of the Lung; Breast Cancer; Gastrointestinal Tract Cancer; Pancreatic Cancer; Hyperplastic and Malignant Diseases of the Prostate; Gynecologic Malignancies; Metastatic Cancer of Unknown Primary Site; Oncologic Emergencies; Iron Deficiency and Other Hypoproliferative Anemias; Hemoglobinopathies; Acute and Chronic Myeloid Leukemias; Malignancies of the Lymphoid Cells; Plasma Cell Disorders; Disorders of Coagulation and Thrombosis; Antiplatelet, Anticoagulant, and Fibrinolytic Therapy

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: KEMC, MAMC, MGMC, NNMC, PMMC, TAMC, WHMC, WPMC, WRMC

Course #: MDR4510, Gastroenterology C&C
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Working closely with other members of the consult service, clerks will have responsibility for providing initial consultation as well as daily follow-up on their assigned patients. In addition, clerks will see both new and follow-up patients in the outpatient clinic. The focus of this elective is to expose the clerk to a wide variety of important disease, such as cirrhosis, malabsorption, peptic ulcer disease, inflammatory bowel disease, pancreatitis, and esophageal dysfunction. The clerk will observe and/or participate in a variety of diagnostic procedures unique to the subspecialty.

Goals: At the end of this elective, senior students will be able create differential diagnoses for common signs and symptoms of gastrointestinal disorders, interpret common diagnostic testing (both laboratory and imaging), develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or gastroenterologist).

Unique Objectives:
1) Correctly interpret laboratory results and radiographic procedures on their assigned patients
2) When possible, observe and/or participate in endoscopic procedures performed on their assigned patients
3) Attain fund of knowledge and skills to enable the students to work-up and care for their patients with gastrointestinal bleeding, abdominal pain, nausea and vomiting, and solid tumors of the gastrointestinal tract

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Abdominal Pain; Nausea, Vomiting, and Indigestion; Gastrointestinal Bleeding, Peptic Ulcer Disease and Related Disorders; Inflammatory Bowel Disease; Approach to the Patient with Liver Disease; Acute Viral Hepatitis, Chronic Hepatitis, Alcoholic Liver Disease, Diseases of the Gallbladder and Bile Ducts; Acute and Chronic Pancreatitis

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: KEMC, MAMC, MGMC, NNMC, PMMC, SDMC, YAMC, WBMC, WHMC, WPMC, WRMC

Course #: MDR4540, Endocrinology C&C
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Working closely with other members of the consult service, clerks will have responsibility for providing initial consultation as well as daily follow-up on their assigned patients. In addition, clerks will see both new and follow-up patients in the outpatient clinic. The focus is to develop sophistication in history-taking and physical exam skills for recognizing endocrine diseases and become familiar with assaying hormones in the evaluation and management of important endocrine problems such as diabetes mellitus, osteoporosis, and thyroid disease. Opportunities to evaluate diseases of the pituitary, adrenal, and reproductive system are dependent on the availability of patients.

Goals: At the end of this elective, senior students will be able create differential diagnoses for common signs and symptoms of endocrinologic disorders, interpret common diagnostic testing (both laboratory and imaging), develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or endocrinologist).

Unique Objectives:
1) Correctly interpret hormonal assays and other laboratory results on their assigned patients
2) Attain fund of knowledge and skills to enable the students to work-up and care for their patients with diabetes mellitus, thyroid disease, and osteoporosis

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Disorders of the Anterior Pituitary and Hypothalamus; Diseases of the Thyroid Gland; Disorders of the Adrenal Cortex; Diabetes Mellitus; The Menopause Transition and Postmenopausal Hormone Therapy; Disease of the Parathyroid Gland and Other Hyper- and Hypocalcemic Disorders; Osteoporosis

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: KEMC, MAMC, NNMC, PMMC, SDMC, TAMC, WHMC, WPMC, WRMC

Course #: MDR4550, Infectious Disease C&C
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Working closely with other members of the consult service, clerks will have responsibility for providing initial consultation as well as daily follow-up on their assigned patients. In addition, clerks will see both new and follow-up patients in the outpatient clinic. Emphasis is placed on understanding basic pathogenic mechanisms as they relate to patient care and management, principles of antibiotic usage, HIV, and clinical microbiology.

Goals: At the end of this elective, senior students will be able create differential diagnoses for common signs and symptoms suggested of an infectious etiology, interpret common diagnostic testing (both laboratory and imaging), develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or infectious diseases physician).

Unique Objectives:
1) Correctly interpret laboratory results, microbial cultures, and radiographic procedures to optimize care on their assigned patients
2) Develop a rationale use of available antibiotics considering drug cost, side effect profiles, and individual patient data
3) Attain fund of knowledge and skills to enable the students to work-up and care for patients with fevers who are immunocompromised or hospitalized, properly evaluate fevers in both the outpatient and inpatient settings, and develop a basic understanding of the use of antiviral agents in the setting of HIV

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Fever and Hyperthermia; Fever of Unknown Origin; Approach to the Acutely Ill Infected Febrile Patient; Infectious Endocarditis; Hospital-Acquired Infections; Treatment and Prophylaxis of Bacterial Infections; Staphylococcal Infections; Streptococcal and Enterococcal Infections; Diseases Caused by Gram- negative Enteric Bacilli; Tuberculosis; Human Immunodeficiency Virus: AIDS and Related Disorders

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: BAMC, MAMC, MGMC, NNMC, PMMC, SDMC, TAMC, WBMC, WHMC, WRMC

Course #: MDR4560, Nephrology C&CC
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Working closely with other members of the consult service, clerks will have responsibility for providing initial consultation as well as daily follow-up on their assigned patients. In addition, clerks will see both new and follow-up patients in the outpatient clinic. Emphasis is placed on developing a basic understanding of acute renal failure, chronic renal diseases, electrolyte disorders, acid-base disorders, and hypertension as well as interpretation of urinalyses and other laboratory tests, pathology, and pathogenesis.

Goals: At the end of this elective, senior students will be able create differential diagnoses for common signs and symptoms of nephrologic disease, interpret common diagnostic testing (including urinalyses and other laboratory tests and imaging procedures), develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or nephrologist).

Unique Objectives:
1) Correctly interpret laboratory results, urinalyses, and radiographic procedures in order to optimize care on their assigned patients
2) Develop a rationale use of available hypertensive agents considering drug cost, side effect profiles, and individual patient data
3) Attain fund of knowledge and skills to enable the students to work-up and care for patients with acute renal failure, electrolyte disorders, hypokalemia/hyperkalemia, chronic renal failure, and possible adverse drug effects

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Azotemia and Urinary Abnormalities; Fluid and Electrolyte Disturbances; Acidosis and Alkalosis; Acute Renal Failure; Chronic Renal Failure; Glomerular Diseases; Tubular Disorders; Vascular Injury to the Kidney; Nephrolithiasis; Systemic Lupus Erythematosus; The Vasculitis Syndromes; Poisoning and Drug Overdosage

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: BAMC, MAMC, NNMC, PMMC, SDMC, TAMC, WHMC, WRMC

Course #: MDR4570, Pulmonary C&C
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Working closely with other members of the consult service, clerks will have responsibility for providing initial consultation as well as daily follow-up on their assigned patients. In addition, clerks will see both new and follow-up patients in the outpatient clinic. Emphasis is placed on gaining a more thorough understanding of the broad spectrum of pulmonary disease, chest radiograph interpretation, bronchoscopy observation, interpretation of pulmonary function tests, and management of acute and chronic respiratory disease.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common respiratory signs and symptoms, interpret common laboratory, spirometric and imaging used to diagnose and treat pulmonary disease, develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or pulmonologist).

Unique Objectives:
1) Correctly interpret laboratory results, microbial cultures, and radiographic procedures to optimize care on their assigned patients
2) Develop a rationale use of available medications to treat chronic lung conditions such as asthma and COPD considering drug cost, side effect profiles, and individual patient data
3) Attain fund of knowledge and skills to enable the students to work-up and care for patients with respiratory distress, acid-base disorders, lung cancers, pulmonary thromboembolism, and chronic lung disease

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Infections of the Upper Respiratory Tract; Dyspnea and Pulmonary Edema; Hypoxia and Cyanosis; Edema; Disturbance of Respiratory Function; Asthma; Pneumonia; Chronic Obstructive Pulmonary Disease; Interstitial Lung Diseases; Pulmonary Thromboembolism; Disorders of the Pleura, Mediastinum, Diaphragm, and Chest Wall; Disorders of Ventilation; Sleep Apnea; Respiratory Failure

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: BAMC, KEMC, MAMC, MGMC, NNMC, PMMC, SDMC, TAMC, WPMC, WRMC

Course #: MDR4580, Rheumatology C&C
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Through evaluation of patients primarily in the outpatient setting, students will develop skills in history-taking, musculoskeletal examination, interpreting laboratory results, and radiographic interpretation in order to establish a rationale to approach patients with a wide variety of musculoskeletal complaints.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common rheumatic signs and symptoms, interpret common serologic and immunologic testing used to diagnose and treat rheumatic disease, develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or rheumatologist).

Unique Objectives:
1) Correctly interpret results of serologic and other laboratory tests and radiographic procedures to optimize care on their assigned patients
2) Develop a rationale use of available medications to treat pain and inflammation taking into account drug costs, patient demographics, underlying condition, and patient demographics
3) Attain fund of knowledge and skills to enable the students to work-up and provide initial care for patients with osteoarthritis, gout and other crystalline disorders, back pain, rheumatoid arthritis, fibromyalgia, soft tissue disorders, and the spondyloarthropathies

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Back and Neck Pain; Autoimmunity and Autoimmune Diseases; Systemic Lupus Erythematosus; Rheumatoid Arthritis; Systemic Sclerosis (Scleroderma) and Related Disorders; The Spondyloarthropathies; The Vasculitic Syndromes; Osteoarthritis; Gout and Other Crystal Arthropathies; Fibromyalgia, Arthritis Associated with Systemic Diseases, and Other Arthritides; Periarticular Disorders of the Extremities; Polymyositis, Dermatomyositis, and Inclusion Body Myositis

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: MAMC, NNMC, SDMC, WBMC, WHMC, WRMC

Course #: MDR4590, Allergy C&C
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Through direct observation and participation primarily in the outpatient setting, students will develop skills in history-taking and interpreting laboratory results in patients with allergic disorders in order to establish a rationale to approach patients with a wide variety of immunologic and allergic diseases.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common allergic signs and symptoms, interpret common immunologic testing in adults and children, develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or allergist).

Unique Objectives:
1) Correctly interpret diagnostic laboratory and other tests on assigned patients
2) Acquire an appreciation of the basic mechanisms of allergic disorders and asthma
3) Attain fund of knowledge and skills to enable the students to initiate a diagnostic work-up and management for patients who present with suspected immunodeficiency, apparent drug allergy, anaphylaxis, and asthma

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Asthma; Hypersensitivity Pneumonitis and Pulmonary Infiltrates with Eosinophilia; Primary Immune Deficiency Diseases; Allergies; Anaphylaxis, and Systemic Mastocytosis; Autoimmunity and Autoimmune Diseases

For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: KEMC, MGMC, WHMC, WRMC

Course #: MDR4610, Cardiology Research
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to perform either basic science or clinical research that may include the development, performance, interpretation of results, and writing of a specific research project by working with investigators and/or technical staff to learn the techniques and the rationale behind the study plans.

Goals: While the specific goals will depend on the project and faculty advisor, the primary goal is to expose the student the research method: developing hypotheses, study design, data collection, data analysis, and results. Some students may be able to prepare a short article or abstract for a suitable journal or meeting.

Unique Objectives: To be determined by research supervisor

Required Reading: To be assigned by research supervisor.

Comments: To schedule contact Dr. Haigney at (301) 295-3826.

Sites: USUB

Course #: MDR4620, Clinical Pharmacology Research
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to perform either basic science or clinical research that may include the development, performance, interpretation of results, and writing of a specific research project by working with investigators and/or technical staff to learn the techniques and the rationale behind the study plans. Specifically, students are involved in a clinical research project involving experimental therapeutics in the Division of Clinical Pharmacology and Medical Toxicology's Clinical Research Unit.

Goals: While the specific goals will depend on the project and faculty advisor, the primary goal is to expose the student the research method: developing hypotheses, study design, data collection, data analysis, and results. Some students may be able to prepare a short article or abstract for a suitable journal or meeting.

Unique Objectives: To be determined by research supervisor

Required Reading: To be assigned by research supervisor.

Comments: To schedule contact Dr. Cantilena at (301) 295-3240.

Sites: NNMC, USUB

Course #: MDR4630, Education Research
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to perform educational research that may include the development, performance, interpretation of results, and writing of a specific research project by working with investigators and/or technical staff to learn the techniques and the rationale behind the study plans. Typically, students may design their own project or participate in ongoing research related to the process of evaluation and modification of educational programs.

Goals: While the specific goals will depend on the project and faculty advisor, the primary goal is to expose the student the research method: developing hypotheses, study design, data collection, data analysis, and results. Some students may be able to prepare a short article or abstract for a suitable journal or meeting.

Unique Objectives: To be determined by research supervisor

Required Reading: To be assigned by research supervisor.

Comments: To schedule contact Dr. Pangaro or MAJ Brian Hemann, MC, USA at (202)782-4923 or (202)782-4039.

Sites: WRMC

Course #: MDR4635, Medical Education Informatics
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to perform either informatics research that may include the development, performance, interpretation of results, and writing of a specific research project by working with investigators and/or technical staff to learn the techniques and the rationale behind the study plans. Prior research involved developing an on-line internet site for collecting data on MSIII patient exposure and problem lists encountered in the third year.

Goals: While the specific goals will depend on the project and faculty advisor, the primary goal is to expose the student the research method: developing hypotheses, study design, data collection, data analysis, and results. Some students may be able to prepare a short article or abstract for a suitable journal or meeting.

Unique Objectives: To be determined by research supervisor

Required Reading: To be assigned by research supervisor.

Comments: To schedule contact Dr. Williams at (301)295-3568, then contact MAJ Brian Hemann, MC, USA at (202)782-4039.

Sites: USUB, WRMC

Course #: MDR4640, Endocrinology Research
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to perform either informatics research that may include the development, performance, interpretation of results, and writing of a specific research project by working with investigators and/or technical staff to learn the techniques and the rationale behind the study plans. Areas of interest include autoimmune thyroid disease, thyroid nodules, thyroid cancer, calcium homeostasis, and diabetes mellitus.

Goals: While the specific goals will depend on the project and faculty advisor, the primary goal is to expose the student the research method: developing hypotheses, study design, data collection, data analysis, and results. Some students may be able to prepare a short article or abstract for a suitable journal or meeting.

Unique Objectives: To be determined by research supervisor

Required Reading: To be assigned by research supervisor.

Comments: To schedule contact Dr. Burch at (202)782-6793.

Sites: USUB

Course #: MDR4650, Gastroenterology Research
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to perform either basic science or clinical research that may include the development, performance, interpretation of results, and writing of a specific research project by working with investigators and/or technical staff to learn the techniques and the rationale behind the study plans. Areas of interest include physiology of swallowing, pharmacology of esophageal peristalsis, sphincter function, gastric emptying, and biliary disease.

Goals: While the specific goals will depend on the project and faculty advisor, the primary goal is to expose the student the research method: developing hypotheses, study design, data collection, data analysis, and results. Some students may be able to prepare a short article or abstract for a suitable journal or meeting.

Unique Objectives: To be determined by research supervisor

Required Reading: To be assigned by research supervisor.

Comments: To schedule contact Dr. Wong at (202)782-6767.

Sites: USUB

Course #: MDR4660, Infectious Disease Research
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to perform either basic science or clinical research that may include the development, performance, interpretation of results, and writing of a specific research project by working with investigators and/or technical staff to learn the techniques and the rationale behind the study plans. Previous clinical trials have included investigational new drugs and biologics relating to infectious disease and biological warfare defense.

Goals: While the specific goals will depend on the project and faculty advisor, the primary goal is to expose the student the research method: developing hypotheses, study design, data collection, data analysis, and results. Some students may be able to prepare a short article or abstract for a suitable journal or meeting.

Unique Objectives: To be determined by research supervisor

Required Reading: To be assigned by research supervisor.

Comments: To schedule contact Dr. Aronson at (301)295-3621.

Sites: NNMC, USUB, WRMC

Course #: MDR4670, Rheumatology/Immunology Research
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to perform either basic science or clinical research that may include the development, performance, interpretation of results, and writing of a specific research project by working with investigators and/or technical staff to learn the techniques and the rationale behind the study plans. Ongoing basic science and clinic research included receptor-initiated signaling in lymphocytes in patients with systemic lupus, regulation of complement receptor genes, and regulation of B lymphocyte responses by complement.

Goals: While the specific goals will depend on the project and faculty advisor, the primary goal is to expose the student the research method: developing hypotheses, study design, data collection, data analysis, and results. Some students may be able to prepare a short article or abstract for a suitable journal or meeting.

Unique Objectives: To be determined by research supervisor

Required Reading: To be assigned by research supervisor.

Comments: To schedule contact Dr. Tsokos at (301)319-9911.

Sites: USUB

Course #: MDR4680, Clinical Pharmacology Consults
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to participate in the clinical pharmacology consultation services. Consultation experience frequently involves drug overdose, adverse drug reactions, and drug pharmacokinetics.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common allergic signs and symptoms, interpret common immunologic testing in adults and children, develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or allergist).

Unique Objectives:
1) Correctly interpret results of drug levels and other laboratory tests to optimize care on their assigned patients
2) Develop a rationale plan for treating common drug overdoses using available nomograms and knowledge of drug pharmacokinetics
3) Attain fund of knowledge and skills to enable the students to work-up and provide initial care for patients with drug-induced hepatitis, alcohol intoxication and withdrawal, recreational drug use, and drug poisoning

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Principles of Clinical Pharmacology; Complementary and Alternative Medicine; Toxic and Drug Induced Hepatitis; Alcohol and Alcoholism; Opiod Drug Abuse and Dependence; Cocaine and Other Commonly Abused Drugs; Heavy Metal Poisoning; Poisoning and Drug Overdosage

Comments: To schedule contact Dr. Cantilena at (301)295-3240.

Sites: NNMC, USUB

Course #: MDR 4683
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/ Pass/ Fail): P

Description: Students will live in officer's berthing aboard ship. They will work with the Medical Department and observe all facets of Medical and Dental Department operations. Typical workday import is 0630-1600, at sea is, essence, 24/7. Students will park at either Pier 12 or Pier 14 at Naval Station Norfolk. Students will be responsible for paying their mess bill prior to departure at the end of their rotation. In port, officers pay only for meals eaten at the following rates: Breakfast $1.95, Lunch $3.65, Dinner $3.65. At sea, officers pay a flat rate of $9.25/day.

Goals: Up to two students per month will spend four weeks working closely with a senior internal medicine physician stationed onboard the USS George H.W. Bush (CVN 77), based in Norfolk VA. Students will spend time in port or at sea, depending on ship's movement. Students will participate in a wide variety of shipboard operational medicine activities as outlined below.

Unique Objectives:

1) Orientation and exposure to shipboard medicine on the Navy's largest warship to include
2) Participation in daily sick call
3) Orientation to aerospace medicine and flight operations
4) Familiarization with the radiation health program (including a tour of the nuclear propulsion plant if possessing adequate clearances)
5) Overview and involvement with the various preventive medicine programs such as heat stress, food sanitation, TB control, etc.

Comments: Please contact, Mrs. Bomysoad, NNMC fourth-year programs assistant at KBomysoad@usuhs.edu or at 301-295-9327 to book this rotation.

USU Coordinator: CAPT GD Denton, via Mrs. Kathryn Bomysoad (kbomysoad@usuhs.edu or 301-295-9327)

On-site Coordinator: On-site coordinator: CAPT Lee R. Mandel, MC, USN, Senior Medical Officer or his assistant: LT Brad Johnson, MSC, UNS, Medical Administrative Officer. Mrs. Bomysoad will forward electronic evaluation forms to the on-site coordinator, who will complete and return them.

Sites: USS GORGE H.W. BUSH (CVN 77), home port: Norfolk VA.

Course #: MDR4690, Geriatric Medicine
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: This rotation provides in-depth exposure to geriatric medicine and gerontology by working closely with faculty and residents. Students may take part in nursing home care, physician house call, and outpatient geriatric evaluation.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common problems affecting the elderly, perform geriatric outpatient assessments, evaluate mental status alterations in the elderly, develop diagnostic and management plans for their assigned patients, and ultimately develop a rationale initial approach to caring for elderly patients in the future (prior to referring patients to geriatrics specialist).

Unique Objectives:
1) Correctly interpret laboratory results and radiographic procedures to optimize care on their assigned patients
2) Develop a rationale approach to prescribing drugs in the elderly
3) Attain fund of knowledge and skills to enable the students to work-up and care for elderly patients who present with dementia, depression, incontinence, falls, polypharmacy, end-of-life issues, and other common disease affecting the elderly

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Geriatric Medicine; Palliative and End-of-Life Care; Complementary and Alternative Medications; Syncope, Faintness, Dizziness, and Vertigo; Malnutrition and Nutritional Assessment; Prevention and Treatment of Atherosclerosis; Ischemic Heart Disease; Vascular Diseases of the Extremities; Acute Confusional States and Delirium; Osteoarthritis; Osteoporosis; Cerebrovascular Diseases; Alzheimer's Disease and Other Dementias; Parkinson's Disease and Other Movement Disorders

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites:

Course #: MDR4720, General Medicine Clinics
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Clerks will see follow-up, walk-in, semi-urgent, and 72 hour consultations referred to the internal medicine clinic. While the bulk of the patients will be outpatients, consultations from inpatient services may also be seen while working together with a resident and faculty internist. Clerks are responsible for the complete evaluation and disposition for required follow-up procedures and other diagnostics.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common cardiac signs and symptoms, interpret laboratory and other diagnostic testing, develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist).

Unique Objectives:
1) Correctly interpret diagnostic studies including laboratory and EKGs on assigned patients
2) Provide recommendations on surgical patients referred for preoperative assessment
3) Attain fund of knowledge and skills to enable the students evaluate patients who present with hypertension, headaches, abdominal pain, acute gastrointestinal bleeding, acute renal failure, altered mental status, arrhythmias, chest pain, electrolyte disorders, fever, glycemic control, nausea and vomiting, pain management, respiratory distress, and seizures

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Decision-Making in Clinical Medicine; Screening and Prevention of Disease; Medical Evaluation of the Surgical Patient; Geriatric Medicine; Chest Discomfort and Palpitations; Abdominal Pain; Headache; Back and Neck Pain; Diarrhea and Constipation; Weight Loss; Gastrointestinal Bleeding; Fluid and Electrolyte Disturbances; Nutritional Requirements and Dietary Assessment; Prevention and Early Detection of Cancer

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites:

Course #: MDR4730, Medicine Consult Service
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Clerks will consult on inpatients with medical issues on the surgery, psychiatry, gynecology, neurology, and other services working closely with a resident and faculty internist. Consultations often involve hypertension management, preoperative clearances, emergency room follow-ups, and semi-acute problems referred from other clinics.
 
Goals: At the end of this elective, senior students will be able create differential diagnoses of common cardiac signs and symptoms, interpret laboratory and other diagnostic testing, develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist).

Unique Objectives:
4) Correctly interpret diagnostic studies including laboratory and EKGs on assigned patients
5) Provide recommendations on surgical patients referred for preoperative assessment
6) Attain fund of knowledge and skills to enable the students evaluate patients who present with hypertension, headaches, abdominal pain, acute gastrointestinal bleeding, acute renal failure, altered mental status, arrhythmias, chest pain, electrolyte disorders, fever, glycemic control, nausea and vomiting, pain management, respiratory distress, and seizures

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Decision-Making in Clinical Medicine; Screening and Prevention of Disease; Medical Evaluation of the Surgical Patient; Geriatric Medicine; Chest Discomfort and Palpitations; Abdominal Pain; Headache; Back and Neck Pain; Diarrhea and Constipation; Weight Loss; Gastrointestinal Bleeding; Fluid and Electrolyte Disturbances; Nutritional Requirements and Dietary Assessment; Prevention and Early Detection of Cancer

Comments: For further information, please see common goals of clinics and consultations at the beginning of this section.

Sites: WRMC

Course #: MDR4770, NIH Research
Course Type: C
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): P

Description: Provide senior student with the opportunity to perform either basic science or clinical research that may include the development, performance, interpretation of results, and writing of a specific research project by working with investigators and/or technical staff to learn the techniques and the rationale behind the study plans.

Goals: While the specific goals will depend on the project and faculty advisor, the primary goal is to expose the student the research method: developing hypotheses, study design, data collection, data analysis, and results. Some students may be able to prepare a short article or abstract for a suitable journal or meeting.

Unique Objectives: To be determined by research supervisor

Required Reading: To be assigned by research supervisor.

Comments: To schedule contact Clinical Electives Coordinator at (301)496-2427.

Sites: NIH

Course #: MDR4420, Cardiology S.I. Coronary Care Unit
Course Type: S
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): L

Description: This course is designed primarily to care for inpatients. Senior students will function as an intern on the inpatient cardiology team. They will provide comprehensive care for assigned patients including their initial work-up, daily progress notes, interpretation of EKGs and other diagnostic tests, and performing procedures under the supervision of senior members of the team. Senior students will take night and weekend call. The primary focuses recognition and management of arrhythmias, heart failure, and acute coronary artery syndromes.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common cardiac signs and symptoms, interpret common cardiac diagnostic testing, develop diagnostic and management plans for their assigned patients, and ultimately develop a rationale initial approach to caring for similar patients in the future (prior to referring patients to an internist or cardiologist).

Unique Objectives:
1) Correctly interpret EKGs on assigned patients
2) Identify common bradyarrhythmias, tachyarrhythmias, and myocardial ischemia/infarct on EKGs
3) Attain fund of knowledge and skills to enable the students to initiate care for patients who present with acute chest pain, hypertensive emergencies, and arrhythmias

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Chest discomfort and Palpitations; The Bradyarrhythmias; The Tachyarrythmias; Heart Failure and Cor Pulmonale; Prevention and Treatment of Atherosclerosis; Ischemic Heart Disease; Unstable Angina and Non-ST Myocardial Infarction; ST-Segment Elevation Myocardial Infarction; Percutaneous Coronary Revascularization; Hypertensive Vascular Disease

Comments: For further information, please see common goals of subinternships at the beginning of this section.

Sites: KEMC, NNMC, SDMC, WHMC, WRMC

Course #: MDR4440, General Medicine S.I.
Course Type: S
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): L

Description: This clerkship provides a supervised inpatient experience evaluating and managing major diseases encountered on an inpatient service. Students will serve as a member of the medicine ward team with "intern" level responsibility including taking call, writing initial orders, and providing daily care to their assigned patients. Emphasis will be placed on developing skills necessary to become successful interns.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common adult signs and symptoms of disease, interpret diagnostic testing used in caring for their patients, develop diagnostic and management plans for their assigned patients, and ultimately develop a rationale initial approach to caring for similar patients in the future (prior to referring patients to an internist or other subspecialists).

Unique Objectives:
1) Correctly interpret diagnostic studies including laboratory and EKGs on assigned patients
2) Attain fund of knowledge and skills to enable the students to initiate care for patients who present with abdominal pain, acute gastrointestinal bleeding, acute pulmonary edema, acute renal failure, altered mental status, arrhythmias, chest pain, electrolyte disorders, fever, glycemic control, hypertensive emergencies, nausea and vomiting, pain management, respiratory distress, shock, and seizures

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Palliative and End-of-Life Care; Chest Discomfort; Abdominal Pain; Gastrointestinal Bleeding; Fluid and Electrolyte Disorders; Approach to the Acutely Ill Infected Febrile Patient; Heart Failure and Cor Pulmonale; Hypertensive Vascular Disease; Acute Confusional States and Coma; Diabetes Mellitus; Seizure and Epilepsy; Alcohol and Alcoholism; Poisoning and Drug Overdose

Comments: For further Information, please see common goals of subinternships at the beginning of this section.

Sites: BAMC, KEMC, MAMC, NNMC, PMMC, SDMC, TAMC, WBMC, WHMC, WPMC, WRMC

Course #: MDR4460, MICU S.I.
Course Type: S
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): L

Description: Clerks will have "intern" level responsibility under the close supervision of the ICU staff, fellows, and residents with exposure to both medical and surgical critical care patients. A multi-disciplinary approach to Critical Care medicine will be emphasized. Clerks will take night call will regular housestaff teams.
 
Goals: At the end of this elective, senior students will be able create differential diagnoses of common signs and symptoms in critically ill patients, interpret common diagnostic testing in the ICU, develop management plans for their assigned patients, and ultimately recognize signs and symptoms of critical illness in future patients who require admission in ICUs.

Unique Objectives:
1) Correctly interpret diagnostic studies including laboratory and EKGs on assigned patients
2) Develop management plans for their patients who present with electrolyte, acid base, and fluid disturbances
3) Attain fund of knowledge and skills to enable the students to initiate care for patients who present with acute gastrointestinal bleeding, acute renal failure, arrhythmias, acute chest pain, electrolyte disorders, hypertensive emergencies, respiratory arrest, and shock

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Palliative and End-of-Life Care; Fluid and Electrolyte Disturbances; Acidosis and Alkalosis; The Bradyarrhythmias: Disorders of Sinus Node Function and AV Conduction Disturbances; Heart Failure and Cor Pulmonale; Unstable Angina and Non-ST Myocardial Infarction; ST-Segment Elevation Myocardial Infarction; Respiratory Failure; Acute Respiratory Distress Syndrome; Mechanical Ventilatory Support; Severe Sepsis and Septic Shock; Cardiogenic Shock and Pulmonary Edema; Cardiovascular Collapse, Cardiac Arrest, and Sudden Cardiac Death; Acute Confusional Sate and Coma; Acute Renal Failure; Poisoning and Drug Overdosage

Comments: For further Information, please see common goals of subinternships at the beginning of this section.

Sites: BAMC, MAMC, PMMC, SDMC, TAMC, WHMC, WRMC

Course #: MDR4480, Oncology S.I.
Course Type: S
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): L

Description: Subinterns will have "intern" level responsibility for managing patients on the inpatient oncology service with and will see both new and follow-up patients in the outpatient clinics. The focus of this elective is to expose the subintern to a wide variety of hematologic and sold malignancies, their consequences, and effects of therapy. The subintern will take night call with their team.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common presentations of malignant disease, interpret common diagnostic testing (both laboratory and imaging), develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or oncologist).

Unique Objectives:
1) Correctly interpret findings on peripheral blood smears, other laboratory abnormalities, and radiographic procedures on their assigned patients
2) Develop diagnostic and management plans for their patients who present with signs or symptoms suggestive of an underlying malignancy or have a known malignancy
3) Attain fund of knowledge and skills to enable the students to care for their patients with malignant disease, including treatment options, management of treatment-induced complications (i.e. pancytopenia, fevers, etc.), and end-of-life issues

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Palliative and End-of-Life Care; Approach to the Patient with Cancer; Prevention and Early Detection of Cancer; Principles of Cancer Treatment: Surgery, Chemotherapy, and Biologic Therapy; Principles of Radiation Therapy; Neoplasms of the Lung; Breast Cancer; Gastrointestinal Tract Cancer; Pancreatic Cancer; Hyperplastic and Malignant Diseases of the Prostate; Gynecologic Malignancies; Metastatic Cancer of Unknown Primary Site; Oncologic Emergencies; Acute and Chronic Myeloid Leukemias; Malignancies of the Lymphoid Cells; Plasma Cell Disorders

Comments: For further Information, please see common goals of subinternships at the beginning of this section.

Sites: BAMC, NNMC

Course #: MDR4500, Hematology/Oncology S.I.
Course Type: S
Department: MDR
Duration: 4
Hours: 5
(Letter/Pass/Fail): L

Description: Subinterns will have "intern" level responsibility for managing patients on the inpatient hematology/oncology service and will see both new and follow-up patients in the outpatient clinics. The focus of this elective is to expose the subintern to a wide variety of hematologic and sold malignancies, their consequences, and effects of therapy. The subintern will take night call with their team.

Goals: At the end of this elective, senior students will be able create differential diagnoses of common presentations of malignant and hematologic disease, interpret common diagnostic testing (both laboratory and imaging), develop management plans for their assigned patients, and ultimately develop a rationale approach to caring for similar patients in the future (prior to referring patients to an internist or hematologist/oncologist).

Unique Objectives:
1) Correctly interpret findings on peripheral blood smears, other laboratory results, and radiographic procedures on their assigned patients
2) Development diagnostic and management plans for assigned patients who present with non-malignant hematologic disease (i.e. anemia, cytopenias, coagulation disorders, etc.)
3) Develop diagnostic and management plans for their patients who present with signs or symptoms suggestive of an underlying malignancy or have a known malignancy
4) Attain fund of knowledge and skills to enable the students to care for their patients with hematologic and malignant disease, including treatment options, management of treatment-induced complications (i.e. pancytopenia, fevers, etc.), and end-of-life issues

Required Reading: Read the following sections from current Harrison's Textbook of Medicine: Palliative and End-of-Life Care; Approach to the Patient with Cancer; Prevention and Early Detection of Cancer; Principles of Cancer Treatment: Surgery, Chemotherapy, and Biologic Therapy; Principles of Radiation Therapy; Neoplasms of the Lung; Breast Cancer; Gastrointestinal Tract Cancer; Pancreatic Cancer; Hyperplastic and Malignant Diseases of the Prostate; Gynecologic Malignancies; Metastatic Cancer of Unknown Primary Site; Oncologic Emergencies; Iron Deficiency and Other Hypoproliferative Anemias; Hemoglobinopathies; Acute and Chronic Myeloid Leukemias; Malignancies of the Lymphoid Cells; Plasma Cell Disorders; Disorders of Coagulation and Thrombosis; Antiplatelet, Anticoagulant, and Fibrinolytic Therapy

Comments: For further information, please see common goals of subinternships at the beginning of this section.

Sites: WRMC