BU Chobanian & Avedisian School of Medicine Clerkships & Subinternships

Clerkships

MED MS 310: Medicine Clerkship (eight weeks)

The Medicine Clerkship is an eight-week experience designed to enhance the student’s capacity to function as a caring, increasingly independent, but supervised, clinician on a multi-professional team. During the clerkship, students learn clinical medicine while working side-by-side with residents and faculty in providing care to a cohort of inpatients. A key principle that guides student learning is to provide graduated responsibility with supervision. Medicine introduces the clinical tools and perspectives of the internist that are appropriate regardless of the student’s career choice. This learning experience is complemented by a unique enrichment in which students also work closely in small groups with a clerkship director and hone essential clinical skills (including intermediate-level communications skills, physical diagnosis, and clinical reasoning). The clerkship is divided into two mini-blocks of four weeks each, and each student learns at two of the following sites: Boston Medical Center, the West Roxbury VA Hospital, MetroWest Medical Center (Framingham), Beth Israel Deaconess–Needham, Beth Israel Deaconess–Plymouth, Berkshire Medical Center (Pittsfield, MA), St. Elizabeth’s Medical Center, and Roger Williams Medical Center (Providence, RI). In addition, some students will take the entire eight-week clerkship at the Kaiser Health Care System in California.

MED MS 311: Surgery Clerkship (eight weeks)

The eight-week Surgery Clerkship is designed to provide instruction in the basic knowledge and skills specific to the field of general surgery, including emergent and nonemergent intraabdominal disease, traumatic injury, and surgically treated malignancies. Students are assigned to a four-week rotation in general surgery at one of the following sites: Boston Medical Center, the West Roxbury VA Hospital, Roger Williams Medical Center, Berkshires Medical Center, St. Elizabeth’s Medical Center, or Kaiser Santa Clara Medical Center. Students also do two rotations (two weeks each) of other surgical subspecialties such as diseases of the head and neck, the genitourinary system, the vascular system, and the musculoskeletal system, as well as anesthesiology. Each of these rotations includes experience in the OR. All rotations except anesthesiology include experience as part of the surgical team caring for patients on the surgical wards, and outpatient care in surgical clinics. Students work directly with faculty in the OR, in the clinic, and in regular meetings with their preceptors. All students (except those at Kaiser and the Berkshires) return to Boston Medical Center for didactics on Fridays, and they participate in educational conferences with the residents and attendings.

MED MS 312: Obstetrics and Gynecology Clerkship (six weeks)

An Obstetrics and Gynecology Clerkship is one of the core clinical rotations in the medical school curriculum due to its unique focus on female reproductive health and dysfunction. In addition, OB/GYN providers are Women’s Health advocates who promote education, safe pregnancy, health maintenance and prevention of sexually transmitted diseases, and reproductive cancers. This clerkship emphasizes the doctor-patient relationship, interviewing skills, mastery of the pelvic and breast examination, patient safety, and clinical problem solving in patient care. The foundation that students will gain—in obtaining skills and knowledge to become a comprehensive health provider for women—will be integral to their education in health care and policy, regardless of future specialty choice. For clerkship students interested in women’s health, there is ample opportunity to familiarize themselves with the wide variety of career choices available within the field of Obstetrics and Gynecology. We are very proud of the opportunities for the students to improve core skills in screening patients for lack of material resources. Your clerkship will anchor you in the context of safe care with workshops in learning from error. The locations available for the clerkships are: Boston Medical Center, BMC/Lahey Clinic (inpatient GYN), MetroWest Medical Center in Framingham (MWMC), Mt. Auburn Hospital in Cambridge, Lahey Medical Center in Burlington, Kaiser San Jose Medical Center, and St. Elizabeth’s Medical Center in Brighton.

MED MS 313: Pediatric Clerkship (six weeks)

During the six-week Pediatric Clerkship, students will gain experience in clinical pediatrics by rotating at one of the clerkship’s unique sites. At the clerkship sites, students may have the opportunity to participate in pediatric care on a number of clinical services, including: the inpatient ward, outpatient primary care and subspecialty clinics, emergency room, newborn nursery, and perhaps a NICU and/or PICU. Up to two students per block can elect to complete this rotation at Kaiser Permanente Santa Clara, a busy pediatric referral hospital for the Kaiser system in California, where students will see a broad variety of pediatric illness—from common to rare presentations—as well has have engaging ambulatory and nursery experiences.

Objectives of the clerkship are for students to learn to perform a pediatric-specific history and exam for all ages (newborn, toddler, school-age, and adolescent), to understand child growth and development from birth through adolescence, to learn about and manage common childhood illnesses/disorders, and to enhance skills of patient/family-centered care and education.

Students at all clinical sites will participate (directly or remotely) in the core conference series held weekly at Boston Medical Center. During this busy clerkship, we expect students will learn a lot about the care of children and their distinct needs.

MED MS 314: Psychiatry Clerkship (six weeks)

In the Psychiatry Clerkship, medical students will gain experience in assessing, diagnosing, and treating patients with psychiatric disorders and associated behavioral health issues. Clinical and didactic experiences will focus on DSM-V diagnoses, psychopharmacology, basics of individual and group psychotherapies, and becoming an active member of a treatment team. In addition, students will participate in a weekly didactic seminar located at Chobanian & Avedisian SOM, where they will hear presentations covering important topics in psychiatry such as anxiety and mood disorders, schizophrenia, and substance use disorders. Medical students will learn how to diagnose various mental health disorders, they will learn evidence-based treatments, and they will gain a greater understanding of how mental health and social factors can influence health.

MED MS 315: Family Medicine Clerkship (six weeks)

In the Family Medicine Clerkship, students work in high-volume ambulatory care practices of family physicians and residency programs. Over the course of the clerkship, students learn to understand and promote a patient-centered model of care; to understand the Family Medicine approach to seeing and evaluating patients and families with undifferentiated problems, and develop the clinical reasoning that guides the definition and diagnosis of such problems; to develop skills in the management of frequently occurring acute and chronic problems; to understand the patient as part of a family and community; to understand and use a comprehensive and continuous approach to care; to understand and use the concepts of Information Mastery, including Patient-Oriented Evidence that Matters, the Usefulness Equation, and point-of-care EBM resources to guide patient care decisions; to understand and use techniques of evidence-based preventive medicine and health promotion; and to understand population health, health management, and the importance of primary care in the health care system.

MED MS 316: Neurology Clerkship (four weeks)

The Neurology clerkship provides the basics of neurological disease seen in General Neurology clinic and Specialty clinic. This clerkship prepares the student for any encounter of Neurological disease in their future career in any chosen specialty. Students will learn the basics of taking a neurological history and performing an examination with the goal of localizing the lesion in the nervous system as well as how to synthesize information from history and physical in order to produce a differential diagnosis and treatment plan. Students will be exposed to the outpatient clinic, where they will encounter chronic disorders, and to the inpatient, where they will be involved in treatment of acute neurological disorders. Students spend their clinical time in both the inpatient/consultation service and the outpatient clinics. Students are expected to spend most of their time on the adult services, but there is also opportunity to spend time with the Pediatric Neurology group. There are weekly didactic sessions with a senior faculty member that concentrate on clinical problem solving. Clinically relevant reading material and the cases to be discussed in the didactic sessions are provided on the clerkship’s Blackboard site. Students utilize the lumbar puncture simulator to increase their technical proficiency.

MED MS 410: Geriatrics Clerkship (four weeks)

This four-week clerkship provides students with the basic knowledge and skills to participate in the care of older adults. Students will learn about common geriatric syndromes; understand and use functional assessment in the evaluation of older adults; work with an interdisciplinary team including nurses, social workers, and community healthcare providers to develop care plans; and learn about home care and what is possible to provide medically for older patients living in the community. Experiences include working in a geriatric clinic, working at nursing homes, and going on house calls with clinicians to provide medical care for older patients. In addition to clinical activities, students will complete online assignments, attend lectures, visit an Adult Day Health program, and prepare a written case study.

Selectives

MED MS 403.5: Emergency Medicine Selective

Students spend four weeks working in the Emergency Department (ED) of Boston Medical Center, the busiest Level 1 trauma center in New England. Working as an integral part of the ED team, students take an active role in the initial evaluation and treatment of patients and gain exposure to a wide variety of illnesses, diagnostic approaches, treatments, and procedures. For many patients, the ED is their first entry into the medical system. This affords students the opportunity to follow “undifferentiated patients” from their initial presentation, through their workup, and on to their diagnosis and treatment. Students participate in weekly department conferences, as well as a student-focused curriculum (case discussions, “high-risk EKG” workshop, point-of-care ultrasound practice, and resuscitation simulation). The skills learned in the ED will benefit students no matter what specialty they ultimately choose.

MED MS 412: Radiology Selective (four weeks)

The purpose of the Radiology Selective is to expose students to all common imaging modalities, with emphasis on understanding strengths, weaknesses, appropriate descriptive terminology, organized approach to analysis of findings, and most appropriate use of various imaging modalities. Significant emphasis is also placed on appropriate use of image-guided diagnosis and treatment, the interpretation of radiologic reports, and communication, both with patients and with radiologists. Students have several opportunities to present findings in formal and informal conference settings, to gain experience in clear and logical use of the language of medicine and of imaging.

MED MS 102.3: Research Selective

The Research Selective gives students who have demonstrated interest in an area of extracurricular concentration to further develop research skills in that area. Areas of concentration include, but are not limited to, global health, advocacy, urban health, population medicine, business and law, ethics, and quality improvement. The student will develop a research plan with a concentration mentor who will serve as the project’s technical advisor. The student will meet weekly with the concentration director and Research Selective director to review deliverables. The goal of this elective is to train students to develop a research plan which can be used toward the development of a thesis or publication.

Subinternships

MED MS 030.1i: Subinternship in Family Medicine—Boston Medical Center

The students participating in this subinternship experience work as integral members of the Family Medicine Inpatient team. They will care for a wide variety of patients with acute and chronic medical conditions from the Boston HealthNet Community Health Center system. To allow students to enhance their capacity as increasingly independent, highly competent, and compassionate care providers, students will be acting interns responsible for the evaluation and continued management of their own patients under the direct supervision of the attending physicians and residents on the inpatient service. Students are also expected to attend educational conferences and participate in morning teaching sessions.

MED MS 050.3: Subinternship in Pediatric Emergency Medicine—Boston Medical Center (one month)

This subinternship in pediatric emergency medicine will provide students with experience in independent evaluation of pediatric patients, ages 0–21 years. The rotation will focus on clinical problem-solving, and will emphasize skills in the differential diagnosis and treatment of acutely ill children as well as provide experience with selected emergency procedures when available. There is no mandatory overnight call, but students may elect to have some weekend shifts in addition to weekday shifts to complete the required complement of shifts during the rotation. Approximately half of the shifts will be during the evening hours of 3–10 p.m. Students will be acting interns, with a schedule that approximates that of our interns; therefore, during a 4-week block there are 19 required shifts and during the 3-week block (block 14) there are 16 required shifts—all absences must be made up to meet this minimum. Attendance at the Department of Pediatrics conferences and twice-monthly resident conferences is encouraged. At the end of their rotation, students will be required to present a case-based, evidence-based medicine session to evaluate their ability to interpret and incorporate the medical literature into their practice. Note that for July through December, priority will be given to students applying for internship in Pediatrics.

MED MS 051.3: Subinternship in Pediatric Inpatient Medicine—Boston Medical Center (one month)

This clinical subinternship is a busy experience during which the student will have supervised responsibilities in the pediatric inpatient ward at a level that the inpatient team judges to be commensurate with an individual student’s abilities. The objective of the acting internship is for students to challenge themselves to become increasingly independent and highly competent members of the inpatient pediatric team. The student will admit patients and have responsibility for their own patients under the direction of the faculty and house staff on the inpatient service. They will be an integral member of the inpatient team participating in all levels of activity, rotating with BCRP residents on both day and night shifts, and have the opportunity to attend residency conferences.

MED MS 052.3: Subinternship in Pediatric Intensive Care Unit—Boston Medical Center (one month)

The PICU is a multidisciplinary six-bed unit caring for children and adolescents from newborns to 22 years; the subintern will work closely on a team with a senior pediatric resident from the Boston Combined Residency Program in Pediatrics (BCRP) and the PICU attending. The subintern will act as the primary provider for their assigned patients. Major teaching objectives of the rotation are the pathophysiology of childhood critical illness, pediatric advanced life support (PALS), and the various types of intensive care support (i.e., forms of mechanical ventilation, critical care nutrition, and coordination of care), as well as psychological and social support for patients and their families. Call is every fourth night including weekends until 10 pm.

MED MS 057.3: Subinternship in Neonatology—Boston Medical Center (one month)

The neonatal intensive care unit is a multidisciplinary 21-bed, level 3 unit caring for preterm and/or critically ill neonates. The subintern will work closely with the team and serve as the primary physician covering 1–2 infants during the first two weeks of the rotation and up to 3–4 infants during the last two weeks of the rotation, with support from the junior and senior resident. The subintern will participate in neonatal resuscitations in the delivery room, care of infants throughout the hospitalization, and discharge planning. Time is available for the student to read in depth about perinatal medicine and to participate in seminars with house staff and senior staff. Students will be expected to take three overnight calls during the week, and two weekend calls during the day only.

MED MS 100.1: Subinternship in Medicine—Boston Medical Center

The Subinternship in Medicine is designed to challenge and enhance the capacity of the student to work as an increasingly independent, highly competent, and compassionate caregiver and contributing team member. To achieve this goal, the subintern will work as an advanced care provider under the direct supervision of the inpatient team resident and assume increasing responsibility for the initial evaluation and integration of the total care of assigned patients. The student is expected to integrate medical knowledge with clinical and interpersonal skills in order to demonstrate independent thought and develop a plan of action. A central challenge for the student is to develop a balance between acting independently and acknowledging their limitations and seeking help as appropriate. The clinical work is complemented by conferences offered by the Department of Medicine.

MED MS 101.1: Medical Intensive Care Unit Subinternship

The Medical Intensive Care Unit (MICU) subinternship is available to selected fourth-year medical students and provides an introduction to the diagnosis and management of critically ill patients with single and multisystem organ failure. Students are exposed to a large spectrum of clinical problems including, but not limited to, respiratory failure with or without mechanical ventilation, ARDS, shock, sepsis, gastrointestinal hemorrhage, diseases related to alcohol or drug excess, HIV-related conditions, pulmonary edema, pulmonary emboli, renal, hepatic or cardiac failure, DKA, fluid, electrolyte or thermic disturbances, CVA, or complications of malignancies. Students participate on daily work rounds, and contribute to the management of patients by collecting, interpreting, and assimilating data for presentation to the attending, arranging consults and tests, and by placing orders and performing common procedures under direct supervision.

MED MS 201.3: Inpatient Gynecology

The student participates as a subintern in all aspects of the inpatient gynecology service, assisting in minor and major gynecologic surgical procedures and following patients postoperatively. The student will also participate with inpatient and Emergency Room consults. Students will prepare a case-based presentation at a GYN noon conference and are expected to participate in educating the third-year clerkship students. The student will be evaluated on their teaching skills as part of the final grade.

MED MS 202.3: Maternal Fetal Medicine

The student works with the Maternal Fetal Medicine faculty and resident staff caring for high-risk pregnant patients in both ambulatory and inpatient settings. The student will function as an acting intern for patients on the antepartum service. The student will attend the high-risk prenatal clinics and spend one day per week on the labor floor. They will attend conferences run by the High Risk Department and are expected to present at a MFM Thursday noon conference. To receive honors in the clerkship, the student will write a paper or create a teaching tool for clerkship students.

MED MS 403.3: Subinternship in Emergency Medicine

Four weeks are spent working in the Boston Medical Center Emergency Department, a Level 1 trauma center. Students take an active role in the initial evaluation and treatment of patients, work alongside our senior residents, attendings, and nursing staff, and are exposed to a wide variety of patients, illnesses, and procedures. For many patients, the ED is the first exposure that they have to the medical system, and students will gain valuable experience as they are able to follow patients from presentation, through their workup, and on to their diagnosis and treatment. Field exposure to the pre-hospital care system is given with observation on a Boston EMS ambulance.

Students participate in daily teaching sessions and weekly departmental conferences, as well as a didactic lecture series designed specifically for them. The skills learned are as applicable to those going on to a career in EM as to those entering other specialties.

All BU students interested in Blocks 9–16 must speak with Dr. Mayo prior to beginning the rotation.

Please note that students must be present for the orientation session on the first day of the rotation, as well as for an IBEX (computer tracking, order entry, documentation) training session on the first Tuesday of the rotation.

Surgery Subinternships

The Department of Surgery offers fourth-year students the opportunity to be subinterns at a variety of our major teaching hospitals. The student will be assigned patients to admit and follow during their hospital course. The student will work with the resident and attending staff in managing the patient’s surgical problems in the operating room, on the inpatient wards, and in the ambulatory setting. Attendance at morning and afternoon rounds, morbidity and mortality conferences, and other teaching conferences is an important part of the rotation as well as being on call with residents. Instruction will focus on principles and pathophysiology of surgical disease, pre- and postoperative care, indication for surgical intervention, and procedural skills. This rotation is especially suitable for any student interested in more intensive training in surgery than is possible during the required third-year surgery clerkship.

MED MS 400.1a: General Surgery, Vascular Service

MED MS 400.1b: Surgical Oncology Service

MED MS 400.3: Acute Care Trauma Surgery, Menino Pavilion

MED MS 403.1: Surgical Intensive Care Unit

MED MS 404.2: Minimally Invasive Surgery

MED MS 404.3: Colon & Rectal Surgery

MED MS 410.2: Thoracic Surgery

MED MS 465.2: Plastic & Reconstructive Surgery

Plastic & Reconstructive Surgery will consist of a two-week period with exposure to general plastic surgery with an emphasis on the aesthetic aspects of the field. This will provide the student with a broad basis in the area of elective plastic surgery.

All arrangements for electives must be made through the Medical Student Coordinator at Boston Medical Center.

MED MS 551.3: Orthopaedic Surgery

The Orthopaedic Sub-I will take place at the Boston Medical Center at both the inpatient and outpatient settings that comprise six total subspecialties:

• Orthopaedic Trauma—Fracture Care
• Hand and Elbow Surgery
• Spine
• Sports Medicine and Shoulder Surgery
• Foot and Ankle
• Arthroplasty (Hip and Knee)

The Sub-I will have the option to choose which subspecialty will fit their clinical interest and career goals. Please go to https://www.bumc.bu.edu/orthopaedics/ to read about the description of each specific subspecialty. The Sub-I on the Orthopaedic service will be responsible for the following:

• Assist in the care for patients in the emergency room, clinics, and operating room who have orthopedic injuries.
• Learn the preoperative and postoperative management of patients undergoing orthopedic procedures.
• Learn how to evaluate patients in the clinic setting, including taking pertinent orthopaedic history and performing an appropriate physical examination.
• Obtain introductory training in orthopedic procedures, such as casting, splinting, joint aspirations, wound closure, wound management, management of wound vacs, management of external fixation devices, principles of surgical stabilization of fractures, and basics in arthroplasty and spine fixation.
• Function as an Acting-Intern with responsibilities commensurate with this educational requirement:

• • Function as acting intern responsible for the evaluation and continued management of patients under supervision of residents and attendings.
  • As part of the care team, perform initial H&Ps, assist in coordinating care, assist with or perform supervised procedures appropriate for the sub-intern, present cases, use evidence-based medicine principles to help guide patient care, etc.
  • All Sub-I will be required to present a 12-minute talk on the third Wednesday of the month during grand rounds on a case or topic of interest. Three minutes for questions at the end.
  • It is expected that the Sub-I will prepare for every single OR case by obtaining the patient history, indications for surgery, anatomy, surgical approach, steps to the procedure, and read two pertinent articles related to each case.
  • It is expected that the Sub-I will read daily on the consults seen in the ED, patients seen in clinic, and the OR cases.

Sub-I will meet with their respective supervisor and the senior resident on service for the subspecialty at the beginning, at two weeks, and at the end of the month for formal feedback.

MED MS 560.1: Otolaryngology—Head & Neck Surgery

This elective provides an intense learning experience for students interested in a career in Otolaryngology—Head & Neck Surgery, and for others with specific interest in head and neck cancer, facial plastic and reconstructive surgery, allergy involving the nose and sinuses, and the auditory system. Students observe and work with faculty and residents in the Department of Otolaryngology—Head and Neck Surgery at the Boston Medical Center. Approximately half of the time is devoted to learning how to evaluate and treat ambulatory outpatients with otolaryngologic disorders. The other half of the time is spent observing and assisting in the operating room and evaluating hospitalized patients. Students are expected to attend weekly teaching conferences, including Friday morning case conference, Pathology conference, Radiology conference, Audiology conference, Tumor Board conference, and structured Wednesday afternoon didactic lectures.

Student Responsibilities

Fourth-year medical students are required to do the following:

•  Be present and on time for clinics, rounds, surgeries, and conferences.
•  Acquire specified knowledge and skills (as delineated in “Otolaryngology Student Knowledge/Skills Checklist”).
•  Assist residents in providing patient care.
•  Prepare and present an eight-minute PowerPoint presentation on a chosen topic.

Participation, Expectations of Performance, and Grading

The Department of Otolaryngology uses elements adapted from the ACGME Residency Review Committee Guidelines for General Competencies in Medical Education as a basis for student evaluations. Because the clinical rotation can be considered an opportunity to begin learning skills that a medical school graduate will be expected to acquire, we shall judge student performance in the categories of the six ACGME1 competencies listed below:

• Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
• Medical knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patient care.
• Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care.
• Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals.
• Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds.
• Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal healthcare.