Medicine Inpatient Acting Internship

Faculty: Leigh Watson-Ramirez, M.D. - AI Director

Institution: Greenville Hospital System

Location: Greenville, South Carolina

Duration: 4 weeks

Course Offered: Periods 2-10

Number of Students: 4 Per Period

Students Report To:

Maggie D. Stricker, M.Ed.

USC Medical Student Services Coordinator

GHS University Medical Center

Phone: 864-455-9808 Pager: 864-390-0555 Fax: 864-455-5267

Clinical Objectives - Skills to be Mastered

  1. Assume leadership of the medical care of patients, under the supervision of the upper level resident and attending physician
  2. Refine the basic techniques learned as a third-year medical student for the medical interview, physical examination, and case presentation, with emphasis on improving accuracy and efficiency
  3. Refine diagnostic decision-making skills to include prioritizing problems, constructing a differential diagnosis, selecting diagnostic tests, proposing and initiating treatment plans, and adjusting plans based on patient response
  4. Design practical treatment plans that consider the patient's financial resources, home environment, personal and cultural beliefs, cognitive or physical limitations, and preferences
  5. Assist patients and their families in complicated ethical and social issues, such as estimating prognosis, determining advance directives, and making end-of-life decisions
  6. Develop the interpersonal and communication skills necessary to establish an effective therapeutic relationship with patients and their families
  7. Triage patients according to medical acuity and to determine which patients require hospitalization and which patients may be treated in the outpatient environment
  8. Determine when it is safe and appropriate to discharge a patient from the hospital, and coordinate the transfer of the patient's care to the outpatient environment without a lapse in treatment
  9. Recognize those disorders requiring joint management with or referral to a medical subspecialist
  10. Refine techniques for performing inpatient clinical procedures
  11. Interact effectively with patients and their families and with other members of the inpatient healthcare team, including nurses, medical technicians, respiratory technicians, dietitians, social workers, chaplains, and risk management personnel
  12. Improve medical knowledge through self-directed reading of texts, journals, and on-line references
  13. Research the medical literature for answers to clinical questions arising in patient care and apply the findings to management of patients

Acting interns are assigned to an inpatient general medicine team composed of one attending physician, one PGY-2 or PGY-3 resident, one to two PGY-1 residents, and at times one third-year medical student. Acting interns care for patients as their primary caregivers, under the direct supervision of the upper level residents. Together with their teams, acting interns take in-house overnight call every fourth night, admitting patients with all types of medical illnesses. Acting interns usually admit 2 to 3 new patients each call night, with a maximum census of 6 to 8 patients for ongoing care; patient load may be adjusted as needed based on student comfort and patient complexity. Acting interns evaluate all assigned patients, completing and recording the medical interview, physical examination, diagnostic assessment, and management plan. Acting interns reevaluate their patients daily, reassessing their diagnoses and therapeutic plans. Acting interns present their patients and discuss their impressions on daily rounds and in teaching conferences with the Internal Medicine residents and faculty. Acting interns learn to interpret laboratory data, chest x-rays, and electrocardiograms and to perform procedures, which usually include central line placement, lumbar puncture, paracentesis, stress testing, and thoracentesis.

Clinical learning is supplemented by self-directed reading and required conferences. Conferences include informal discussions, lectures, grand rounds, and bedside rounds.

Acting interns take in-house overnight call with their team every fourth night and receive one day free of patient care duties per week.