The Clinical Examination & Reasoning (CER) course is divided into three components. The first component consists of a series of half-day organ-based teaching modules which combine large group instruction (lecture/demonstration) and small group practice sessions. During some of these small group sessions, students examine each other; during others, they examine volunteer and/or standardized patients.

After completing the initial didactic portion of the course, students are assigned to work with a clinical preceptor for the History and Physical (H&P) component of the course. During the H&P session, students perform a minimum of four (4) comprehensive history and physical examinations and record their findings in a concise and logical manner. Records are then evaluated by the clinical preceptor to provide formative feedback. At the end of the course, students submit their "best" write-up to the course director for inclusion in the student's portfolio.

The Case Presentation and Clinical Reasoning (CPCR) component of CER divides students into groups of six (6) who work with a clinical preceptor to formulate and present clinical case presentations. Each student meets individually with their preceptor to obtain feedback and refine their presentation. Groups then meet as a whole for students to individually present their cases.

The primary objective of the Internal Medicine Clerkship is to provide students with an intensive exposure to the practice of internal medicine in the inpatient setting. During the clerkship, students complete two one-month rotations on an inpatient general medicine ward service. Students receive teaching daily within the context of patient care and with emphasis on bedside teaching to facilitate learning while performing patient care.

The Internal Medicine Clerkship focuses on the basic competencies of general internal medicine, developing knowledge and skills in history and physical examination, diagnostic decision making, case presentation, communication and relationships with patients and colleagues, test interpretation, and therapeutic decision making. The clerkship follows national curricular objectives developed by a Clerkship Directors in Internal Medicine (CDIM) working group.

M4 students complete a one-month Ambulatory Medicine rotation blending outpatient general internal medicine, subspecialty clinics, and inpatient consultation service experiences. The Ambulatory Medicine clerkship allows students to continue to develop clinical skills and gain confidence in the diagnosis and management of medical problems commonly encountered in an adult ambulatory population. In addition, students develop skills in the application of preventive medicine principles and current practice guidelines for patients with common diagnoses including asthma, COPD, smoking, diabetes, hyperlipidemia, hypertension, back pain, and obesity.

Students are encouraged to use this month as an opportunity to prepare for internship and residency, especially in the following areas:

• Become more independent in using clinical reasoning skills in diagnostic and therapeutic plan development.
• Improve efficiency without detracting from detail-oriented and compassionate patient care.
• Continue to refine medical communication skills including patient counseling, oral case presentations, and written documentation in the medical record.

All M4 students complete a one-month medically-based sub-internship in Internal Medicine, Pediatrics, or Family Medicine. The General Medicine Acting Internship allows students to master their history and physical examination skills, refine oral presentation skills, reinforce evaluation and management of common medical disorders, and practice communication skills including coordination of patient care discussions with ancillary staff and discussions with patients and their families regarding diagnoses, evaluation, and treatment options. In addition, students become familiar with triage and assessment of common cross-coverage issues, dictation/typing of discharge summaries, and performing procedures such as ABG, thoracentesis, and paracentesis under supervision.

Students are encouraged to use this month as an opportunity to prepare for internship and residency, especially in the following areas:

• Become more independent in using clinical reasoning skills in diagnostic and therapeutic plan development.
• Improve efficiency without detracting from detail-oriented and compassionate patient care.
• Continue to refine medical communication skills including patient counseling, oral case presentations, and written documentation in the medical record.
• Serve as a guide and role model to help teach junior students and peers on history taking, physical examination, and case assessment skills.

Students interested in internal medicine can choose from over 20 elective courses offered throughout the Department of Medicine's divisions. M4 electives are also open to visiting students.

Elective options for the 2012-13 academic year include:

Course Number, Course Title, Location

• 311-M4123, Cardiology Consults, Froedtert Hospital
• 311-M4117, Cardiology, Clement J. Zablocki VA Medical Center
• 311-M4124, Inpatient Cardiology, Froedtert Hospital
• 311-M4127, Endocrinology-Metabolism, Froedtert Hospital
• 311-M4128, Endocrinology/Diabetes, Endocrinology Center at North Hills
• 311-M4129, Endocrinology, Zablocki VA
• 311-M4131, Gastroenterology & Hepatology, Froedtert Hospital
• 311-M4132, Gastroenterology, Zablocki VA
• 311-M4187, Geriatric Medicine, Zablocki VA
• 311-M4134, Hematology/Oncology Consults, Zablocki VA
• 311-M4135, Hematology/Oncology, Zablocki VA
• 311-M4148, Inpatient Neoplastic Diseases, Froedtert Hospital
• 311-M4136, Outpatient Hematology/Oncology, Froedtert Hospital
• 311-M4138, Infectious Diseases, Froedtert Hospital
• 311-M4139, Infectious Diseases, Zablocki VA
• 311-M4137, Medical Consultation, Froedtert Hospital
• 311-M4208, Medical Intensive Care Unit, Froedtert Hospital
• 311-M4209, Medical Intensive Care Unit, Zablocki VA
• 311-M4144, Pulmonary Medicine Consults, Froedtert Hospital
• 311-M4145, Pulmonary Medicine, Zablocki VA
• 311-M4142, Nephrology Consults, Froedtert Hospital
• 311-M4143, Nephrology, Zablocki VA
• 311-M4194, Inpatient Nephrology, Froedtert Hospital
• 311-M4147, Rheumatology, Froedtert Hospital/Zablocki VA
• 311-M4120, Technology in Medicine: Telemedicine & Medical Informatics, Zablocki VA