MEDI D675

Students Report To: Natalie Carey, Medical Student Coordinator, (864) 455-5494, Main Lobby of Greenville Memorial Hospital, 9:30 a.m.

1.	Assume leadership of the medical care of patients, under the supervision of an 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 the appropriate follow-up for problems managed in the outpatient environment
9.	Recognize those disorders requiring joint management with or referral to a primary care physician or medical subspecialist
10.	Provide the appropriate preventive healthcare services to maintain patient health and prevent disease
11.	Interact effectively with other members of the outpatient medical team, including nurses, medical technicians, dietitians, social workers, and home health providers
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

Students are assigned to a general medicine clinic, where they act as primary caregivers for their patients under the direct supervision of a faculty physician. Students provide comprehensive care for patients in all stages of illness, including initial diagnosis of disease, chronic management of established medical problems, acute management of decompensated chronic diseases, and follow-up after hospitalization. Students evaluate 4-6 patients every day, completing and recording the medical interview, physical examination, diagnostic assessment, and management plan. Students present their patients and discuss their impressions in teaching conferences with the attending physician. Students learn to interpret laboratory data, chest x-rays, and electrocardiograms.

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

Work hours will usually be 8:00 a.m. to 5:00 p.m., Monday through Friday, with students remaining after 5:00 p.m. when necessary to complete work in progress. No overnight call is required for this ambulatory rotation.