Clerkships & Subinternships

Clerkships

MED MS 102.1: Advanced Internal Medicine II (four weeks)

This clerkship, designed primarily for fourth-year medical students, provides students with training in advanced internal medicine skills. Students are posted in a variety of clinical sites in primary care, urgent care, and specialty ambulatory practices and related clinical programs with direct supervision by attending physicians. This intensive clinical experience is complemented by a variety of didactic sessions including seminars, workshops, and presentations designed to strengthen the core skills necessary for excellence in the practice of medicine: interviewing and communication skills, physical diagnosis, the use and interpretation of data in the care of patients, clinical decision making, coordination of care, working effectively in clinical teams, professionalism, note writing, teaching skills, evidence-based practice, reflection, and self care.

MED MS 310: Medicine Clerkship (eight weeks)

The Medicine 1 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 multiprofessional 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 1 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 students learn at two of the following sites: Boston Medical Center, the West Roxbury VA Hospital, MetroWest Medical Center (Framingham), Jordan Hospital (Plymouth), and Roger Williams Medical Center (Providence, RI).

MED MS 311: Surgery Clerkship (eight weeks)

During the eight-week Surgery Clerkship, students are assigned to a four-week rotation in general surgery at one of three sites: Boston Medical Center, the West Roxbury VA Hospital, or Cape Cod Hospital. Students also do two rotations (two weeks each) of either vascular surgery, thoracic surgery, anesthesiology, minimally invasive surgery, or acute care/trauma surgery. 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 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)

The six-week Obstetrics and Gynecology Clerkship offers instruction in the knowledge and skills specific to the reproductive health maintenance and disorders of women. Emphasis is placed on the doctor–patient relationship, interviewing skills, appropriate physical exams, and clinical problem-solving and patient safety principles in caring for patients. Instruction sites integrate both ambulatory and hospital-based experiences including the labor floor and operating room. Student didactics are case-based, including procedure- and skills-based simulations.

MED MS 404.1: Surgery Clerkship Surgical Subspecialty (four weeks)

All students must complete the surgery subspecialty requirement in either their third or fourth year. The Surgical Education Office offers a four-week rotation consisting of two subspecialty rotations (two weeks each). Students select the subspecialties they wish to do, limited by capacity. Student choices may not be guaranteed. Options include: Anesthesia (BMC or VA), Neurosurgery (BMC), Ophthalmology (BMC or VA), Orthopedics (BMC or VA), Otolaryngology (BMC), Plastic Surgery (BMC), and Urology (BMC or VA).

MED MS 313: Pediatric Clerkship (six weeks)

During the required Pediatric Clerkship, students will experience clinical pediatrics by rotating at one of the clerkship’s eight sites. At the clerkship sites, students may rotate on a number of clinical services, including their site’s inpatient ward, outpatient clinics, emergency room, newborn nursery, and perhaps a NICU and/or PICU. Students at all clinical sites will participate 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 special needs.

MED MS 314: Psychiatry Clerkship (six weeks)

During the Psychiatry Clerkship, medical students have the opportunity to see and interview patients who are suffering from many different types of mental health disorders. In a weekly three-hour Wednesday-afternoon seminar, students are taught about general topics in psychiatry such as personality disorders, schizophrenia, child mental disorders, and substance abuse. Medical students will learn how to diagnose various mental health disorders and will gain a greater understanding of evidence-based treatments for these disorders.

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. In the course of the clerkship, students learn to understand and promote a patient-centered model of care; to understand Family Medicine approaches to seeing and evaluating patients and families with undifferentiated problems, and the clinical reasoning that guides the definition and diagnosis of such problems; skill in the diagnosis and 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 and health management.

MED MS 316: Neurology Clerkship (four weeks)

Students at Boston University School of Medicine are required to participate in a four-week Neurology Clerkship in the third year. The goal of the clerkship is to teach students how a neurologist thinks about disease, gaining a solid foundation in the neurological history and examination, and the interpretation and significance of, neurological examination findings. Much attention is devoted to clinical-anatomical correlation and refining the skills of “lesion localization.” 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 are integrated into the daily resident schedule of special seminars and teaching conferences.

MED MS 410: Geriatrics Clerkship (four weeks)

This clerkship teaches students basic geriatrics knowledge and skills to recognize and manage common geriatrics issues, such as dementia, delirium, falls, incontinence, and pressure ulcers. The students learn the presentation and management of common geriatric syndromes, practice interviewing and examining patients with multiple disabilities, and demonstrate the use of common geriatrics screening tools. They participate in a multidisciplinary approach to the care of the frail elderly in the community and in nursing homes, learning about community resources and the roles of the various team members. Students work under the direct supervision of geriatric attending and nurse practitioners in the clinical, home care, and nursing home settings. The students are expected to demonstrate independent learning with an evidence-based paper and during independent home visits.

MED MS 412: Radiology Clerkship (four weeks)

In the Radiology Clerkship, there is an overview of diagnostic imaging with emphasis on multiple imaging modalities and the development of a systematic approach to image interpretation. Significant emphasis is also placed on image-guided diagnosis and treatment, the interpretation of radiologic reports, and evidence-based imaging.

Subinternships

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

Students will work as members of the Family Medicine team on the East Newton Campus at BMC. The patient pool will be from the HealthNet Rounder system. Students will be acting interns working with second- and third-year Family Medicine residents. They will be responsible for evaluation and management of patients. Residents and the Family Medicine ward attending will provide daily supervision, support, teaching, and feedback with respect to subinterns’ patients—including the history obtained, physical exam findings, and management plans.

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

The subinternship in the Pediatric Emergency Department (PED) at Boston Medical Center is available to fourth-year students. The rotation will focus on clinical problem solving, with emphasis placed on differential diagnosis and treatment of acutely ill children. Each student will have an opportunity to directly care for children in the PED, supervised by an attending physician and/or fellow, and perform basic procedures when/where appropriate. Shifts are seven to eight hours in length during the daytime or evening hours of weekdays only. Each student is expected to attend teaching conferences during the rotation, in addition to an optional case presentation.

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 student will admit patients and have responsibility for his/her own patients under the direction of the faculty and house staff on the inpatient service. He/she 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.

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

On the Pediatric Intensive Care Unit (PICU) service, a multidisciplinary six-bed unit caring for children and adolescents, the PICU subintern will work closely on a team with a BCRP senior resident and PICU attending. The subintern will be the primary provider for all assigned patients. Major teaching objectives of the rotation include the pathophysiology of childhood critical illness, pediatric advanced life support (PALS), and understanding of intensive care support, as well as psychological and social support for patients and their families. Students will be expected to take calls until 10 p.m. approximately every fourth night (including weekends).

MED MS 053.0: Subinternship in Pediatric Inpatient Medicine—MassGeneral for Children at North Shore Medical Center (one month)

The primary goal of this clinical subinternship is to gain experience and develop skills in a supervised setting in the care of pediatric inpatients with a variety of acute medical conditions. Students will gain experience in communicating with primary care physicians and other clinicians regarding the care of the hospitalized pediatric patient, and develop strategies for transferring pediatric patients for tertiary care.

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

During this clinical subinternship, students will participate in the evaluation and care of acutely ill neonates from the time of their delivery on the maternity floor through their NICU course and followup in clinic. 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 calls until 10 p.m. approximately every fourth night (including weekends).

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. The student is expected to develop a balance between acting independently and acknowledging his/her limitations and seeking help as appropriate.

MED MS 100.11: Advanced Acting Internship in Medicine—Boston Medical Center

The Advanced Acting Internship (AAI) builds upon and is a more intensive version of the traditional subinternship. Two AAI students are paired on an inpatient team that has no interns, and together they work under the direct supervision of the team resident and assume care of assigned patients. The student is expected to integrate book knowledge with clinical and interpersonal skills in order to demonstrate independent thought and develop a plan of action. The student is expected to develop balance between acting independently and acknowledging his/her limitations and seeking help as appropriate. The clinical work is complemented by conferences offered by the Department of Medicine. Because of space limitations, the AAI cannot accommodate all students.

Students who are interested should apply and will be selected by a lottery that is weighted by clinical performance during the third year. The AAI experience is open only to BUSM students.

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 is designed to provide an introduction to the diagnosis and management of critically ill patients with single and multisystem organ failure. Students participate on daily work and radiology rounds, and contribute to the management of patients by collecting 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 and ambulatory gynecology service, assisting in minor and major gynecologic surgical procedures and following patients postoperatively. The student will primarily work with the East Newton GYN service. Students will prepare a case-based presentation at a GYN noon conference and are expected to participate in educating the clerkship students. To receive honors in the clerkship, the student will write a paper or create an academic project.

MED MS 202.3: Maternal Fetal Medicine

The student works with the Maternal Fetal Medicine 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. He or she will attend conferences run by the High Risk Department; additionally the student is 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.

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 wishing for more intensive training in surgery than is possible during the required third-year clerkship.

• MED MS 400.00: General Surgery, Cape Cod
• MED MS 400.1a: General Surgery, Vascular Service
• MED MS 400.1b: Oncology Service
• MED MS 400.1c: General Surgery, GI Service
• MED MS 400.2: General Surgery and SICU, VA Boston Healthcare System
• MED MS 400.3: General and Trauma Surgery, Menino Pavilion
• MED MS 403.1: Surgical Intensive Care Unit