91Å®Éñ

Directors: Kimberly A. Schiel, M.D., and Kelly Everard, Ph.D.
Education Coordinator: Ashley Lewis

91Å®Éñ’s family and community medicine rotation is designed to enable you to establish competencies in the comprehensive approach to medicine.

The Family Medicine Clerkship provides strong clinical training for students interested in a future in family medicine and for students who desire to excel in other specialties.

During this clerkship, you will spend four days each week with a family medicine physician in an ambulatory care setting. Wednesdays will be spent in didactic learning sessions on campus.

The board specialty of family medicine is centered on lasting, caring relationships with patients and their families. Family medicine physicians integrate the biological, clinical and behavioral sciences to provide continuing and comprehensive health care. The scope of practice encompasses all ages and genders, organ systems, and disease entities.

Family medicine physicians work in a variety of clinical settings and professional areas. They have the flexibility to define their careers based on their own skills and preferences. By learning in a continuity setting, we hope you will appreciate the challenges of medical problem-solving and the immense rewards that longitudinal care and the development of meaningful patient relationships can bring.

Residents

The clerkship places students in the family medicine residency programs at HSHS St. Elizabeth's Hospital, Mercy Hospital St. Louis and SSM St. Mary's Family Medicine Residency. Residents at all programs have been informed of student learning objectives and goals and given instruction on teaching methods and learning theory.

Preceptors

Our family medicine preceptors are volunteer clinical faculty who practice in the community. We have a wide variety of preceptors located throughout the St. Louis region in urban, suburban and rural sites. All have been informed of the clerkship goals and objectives and given instruction on teaching methods and grading procedures.

Course Co-Directors Nora L. Porter, M.D., M.P.H. and Heather Eschbach, D.O.
Education Coordinator: Madeleine Rowe

91Å®Éñ’s eight-week clerkship in internal medicine offers students in year three an opportunity to function as an integral component of the medical team in the inpatient setting. It provides a strong foundation for students interested in a future in internal medicine and those interested in other specialties.

You will refine and apply skills and knowledge acquired during the first two years of medical school and to learn the basics of medical decision-making, diagnostics and therapeutics. You will find it to be an intense but challenging and rewarding experience.

A major goal of the year three clerkship in internal medicine is to develop the capacity to obtain a comprehensive medical history and to perform a detailed physical examination under the supervision of faculty attendings and resident physicians. You will be expected to participate in the care of your patients and will learn to identify patient problems based on findings in the history and physical examination.

For each problem, you will produce a differential diagnosis, identify a working diagnosis and develop a diagnostic and therapeutic plan. While on inpatient services, you will learn to give a concise, organized oral presentation of a patient's case. Developing a regular reading program will strengthen this knowledge base in internal medicine.

Clinical Sites

Clinical sites include SSM Health 91Å®Éñ Hospital, John Cochran Medical Center, SSM Health St. Mary's Hospital and Mercy Hospital St. Louis.

Orientation

You will be given detailed information about the clerkship’s goals and objectives, evaluation processes, evaluation instruments, hospital schedules and other information at an orientation session on the first day. Proper format for taking patient histories and performing physical exams are provided, along with an introduction to medical decision-making.

Team Assignments, Organization and Makeup

Inpatient teams comprise an attending physician, an upper-level resident team leader, first-year residents, and Year Three and Year Four medical students.

Description of a Typical Day

Teams begin each day by independently seeing patients before work rounds. Internal Medicine Grand Rounds are held at 7:30 a.m., Friday in the Learning Resources Center Pitlyk Auditorium. Each hospital site also provides a lecture series.

• 8 to 11 a.m.: Work and teaching rounds
• Noon to 1 p.m.: Noon conference
• 1 to 4 p.m.: Afternoon patient care
• 4 to 5 p.m.: Resident teaching conference

Students are allowed one day free of clinical responsibilities.

Call Schedule and Weekend Activities

There is no overnight call during the blocks on the general medicine inpatient service.

Lectures

Required didactic sessions are held weekly, covering essential clinical skills, physical diagnosis, clinical problem-solving, and evidence-based medicine.

Reading

Students must read daily about problems identified in their patients — a comprehensive text such as Harrison's Principles of Internal Medicine is recommended. Structured reading about common topics in internal medicine using Cecil's Essentials of Medicine or a similar text is also required.

Quizzes and Tests

On the last Friday of the clerkship, you will take an online examination supplied by the National Board of Medical Examiners. A written examination covering material from the didactic sessions is given during the seventh week of the clerkship.

Evaluation and Grading

At the end of each clerkship, the clerkship directors will review your performance and assign a grade. A narrative summary of your performance on the clerkship is prepared for your final evaluation.

Clinical performance evaluations from each hospital and ambulatory site, written examinations and successful completion of all clerkship requirements are considered. Clinical performance ratings account for the bulk of the clerkship grade. Grade possibilities include:

• Honors: Awarded to those who have received above average to superior ratings in all clinical categories and have successfully completed all of the clerkship requirements.
• Near Honors: Issued to those students who have received above average clinical evaluations and test scores and have successfully completed all other course requirements in a timely fashion.
• Pass: Awarded to those who have received satisfactory ratings in all clinical categories, passed the written examination and successfully completed all other course requirements.
• Fail: Given to those who have not exhibited an acceptable performance or who fail to complete required coursework.
• Incomplete: May be issued in the event that a student has successfully completed only part of the clinical work or has failed the end-of-clerkship examination.

You will have the opportunity to complete an evaluation of your experience in internal medicine. All replies remain confidential and are important to the department in efforts to evaluate and improve the clerkship.

Director: Sean Goretzke M.D.
Educational Coordinator: Samantha Peyton

91Å®Éñ’s four-week neurology clerkship allows you to apply all of the basic neuroscience information you learned in the first two years of medical school. Specific medical knowledge goals are detailed in the syllabus.

You will learn a logical method of evaluating and treating patients. No matter what complaint, this evaluation should proceed in a standard fashion, beginning with a review of the complaints and history and continuing through the general and neurological examinations. You will then formulate a tentative diagnosis, including localization of the process to a specific aspect of the neuraxis and estimation of the underlying pathogenesis.

Laboratory support will be used to prove or disprove the tentative diagnosis. Consistent application of this neurologic method will be invaluable to you in your future practice. You will also gain familiarity with neuroimaging and electrophysiological procedures.

Clinical Sites

Clinical sites include SSM Health 91Å®Éñ Hospital, SSM Health Cardinal Glennon Children's Hospital John Cochran Medical Center and SSM Health Physical Therapy’s Neurological Rehabilitation Program.

Orientation

On the first day of the clerkship, you will meet their assigned team at the hospital to which you were assigned in your introductory letter. If you cannot locate the neurology team to which you have been assigned, page the neurology resident on call.

Team Assignments, Makeup and Organization

The neurology team consists of an attending physician, neurology and rotating residents, and medical students. Students are assigned inpatients, for which they are responsible. Students attend daily rounds, present initial findings and daily developments to the attending physician, and participate in discussions about diagnostic and therapeutic maneuvers, discharge plans and follow-up programs.

Description of a Typical Day

• 7-7:30 or 8 a.m.: Work rounds with residents
• 7:30 or 8 to 11 a.m.: Ward rounds with the team
• Noon to 5 p.m.: Clinic afternoons (occasional)
• 3:30 to 5 p.m.: Lectures Mondays, Tuesdays and Wednesdays
• 4 to 5 p.m.: Grand Rounds Thursdays

Extra time is to be spent reading on patients and from text for the final exam.

Call Schedule and Weekend Activities

All students will take in-house call on two evenings and one weekend until 9 p.m. at SSM Health 91Å®Éñ Hospital and SSM Health Cardinal Glennon Children’s Hospital. You will be given a call schedule on the first day of the rotation.

Students attend rounds six days per week, with either Saturday or Sunday free. Weekend days should be divided so that half of the students attend Saturday and the other half Sunday.

Lectures

Didactic sessions regarding principal neurological diseases are given in the conference room on the fifth floor at 91Å®Éñ Hospital from 1 to 3:30 p.m. or 3:30 to 5 p.m. on Mondays, Tuesdays and Wednesdays.

Readings

• Blueprints, Neurology by Drislan, et al. (Lippincott, Williams, and Wilkins, 2006)

and either

• Blueprints, Neurology Clinical Cases by Sheth, et al. (Lippincott, Williams, and Wilkins)
• Case Files - Neurology by Toy, et al. (McGraw-Hill, 2008)

Quizzes/Tests

An educational slide quiz is given on the third Thursday at 1 p.m. in the conference room on the fifth floor of SSM Health 91Å®Éñ Hospital. A final written examination is given on the fourth Friday at 9:45 a.m. in the Learning Resource Center.

Evaluation and Grading

Sixty percent of the final grade is based on clinical and 40 percent on the NBME exam components. Honors is given to the top 25 percent and near honors to the next 15 percent. Pass is given to all others with satisfactory performance.

If you fail the clinical component, you must repeat the rotation. Failing the written exam will require passing a second written exam.

Director: Amy Ravin, M.D., and Shannon Grabosch, M.D.
Education Coordinator: Sarah Mennerick

91Å®Éñ’s Phase 3 Obstetrics and Gynecology rotation incorporates a wide range of medical care. It offers obstetrics, gynecological surgery, elements of primary care, preventive medicine, and psychiatric and psychological problems. The course highlights are bringing a new life into the world and providing health care for women.

Our goals and objectives coincide with those of the Association of Professors in Obstetrics and Gynecology (APGO). In addition, Gynecological Teaching Associates (GTAs) are used to teach pelvic and breast examinations during the first week of the rotation.

Clinical Site and Hospital Assignments

SSM Health St. Mary's Hospital is the clinical base for the 91Å®Éñ Department of Obstetrics and Gynecology. St. Mary's offers good experience in obstetrics, including high-risk obstetrics, general gynecology and gynecological oncology, as well as a rich outpatient experience.

Students spend two weeks on obstetrics (one week during the day, one week during nights), two weeks on gynecological surgery and two weeks on a subspecialty service.  Each student is also assigned to one day of weekend call on labor and delivery. Students are also assigned to a half-day clinic each week on their gynecological surgery and subspecialty blocks.

Orientation

A general orientation conducted by Michael Thomure, M.D. and Becky Lynn, M.D., occurs at SSM Health St. Mary's Hospital from 8 a.m. to 4 p.m. in Kohler Auditorium. Students should wear professional attire, their white coat and 91Å®Éñ ID badge. Bring a notebook or other means for taking notes. Students must bring $7 (cash and exact change) as a deposit for a St. Mary's access card. St. Mary's access cards give students access to the parking garage, library and the fifth and sixth floors, including elevators. These cards are purchased at the Security window on the ground floor near the entrance to the east parking garage.

Description of a Typical Day

During your OB rotation, you will work with the day and night call resident teams, the low-risk faculty attending, and the high-risk (Maternal-Fetal Medicine) faculty attending. Students should get involved with all patients on Labor and Delivery and the triage unit (Women's Evaluation Unit, also called WEU) unless specifically asked not to do so by the resident or nurse. Because of the unpredictable nature of obstetrics, students should always be on the unit so that the residents and attendings can find them when necessary.  One of the most important things you can do on your shift is to be visible and present.  OB days are 6 a.m. to 5 p.m., and OB nights 7 p.m. to 7 a.m.

Call Schedule and Weekend Activities

During your rotation, you will have one day of Labor and Delivery occurring on either a Saturday or a Sunday from 9 a.m. to 5 p.m., and should occur only once on your schedule (unless you have been notified of a reason why you have been assigned multiple days of weekend call).

Lectures

On Friday mornings, students have academic time from 7:30 a.m. to noon OB/GYN Grand Rounds are held from 7:30 a.m. to 8:30 a.m. in Kohler Auditorium at St. Mary's Hospital and clerkship student didactic lectures are held from 9 a.m. to noon. This academic time is mandatory, except for students who are on their Career Exploration Elective. Clerkship didactics are based on cases written by the Association of Professors of Gynecology and Obstetrics (APGO), and utilize a flipped classroom method. Students receive a lecture schedule and materials in advance and are expected to prepare for lectures, which will be primarily discussion- and question-based. After lectures, on their own time, students complete online quizzes on the APGO uWISE platform as assigned.

Students receive a lecture schedule on the day of orientation and will be advised of any changes by the educational coordinator. You are expected to attend Grand Rounds at 7:30 a.m. on Fridays at St. Mary's Health Center in Kohler Auditorium. In addition, you will be expected to access internet sites, electronic databases and other computer programs as integral components of your learning experience. A newsletter will be distributed that will include articles and announcements pertinent to the rotation.

Readings

The recommended text is Beckmann, Obstetrics and Gynecology. Other suggested readings are:

• Fundamentals of Gynecology and Obstetrics, Dunnihoo (suggested use to study for the OB/GYN NBME-format examination)
• Williams' Obstetrics and Gynecology, 19th ed., Cunningham, et al
• Novack's Textbook of Gynecology, 10th ed., Jones and Jones
• Principles and Practice of Clinical Gynecology, Kase and Weingold
• Instructional Objectives for a Clinical Curriculum in Obstetrics and Gynecology, 4th ed.;
• Obstetrics and Gynecology: The Clinical Core, Wynn
• Obstetrics and Gynecology, Danforth
• Obstetrics and Gynecology, Beck
• Clinical Gynecologic Oncology, DiSaia and Creasman
• Novak's Gynecologic and Obstetric Pathology, Novak and Woodruff
• Clinical Gynecologic Endocrinology and Infertility, Speroff, Glass, Kane
• High Risk Pregnancy and Delivery, Arias
• Essentially OB/GYN, Nevill Hacker

Suggested journal references are American Journal of Obstetrics and Gynecology ("gray journal"), Journal of Obstetrics and Gynecology ("green journal") and the Obstetrical and Gynecological Survey. These texts and journals are available at the hospital library.

Quizzes/Tests

On the final Thursday of the rotation, students will take a summative OSCE covering four common complaints in obstetrics and gynecology. The last Friday of the rotation is the NBME subject exam. Both of these exams are part of the final clerkship grade.

Evaluation and Grading

The final grade is based on :

• Clinical performance evaluation by OB/GYN faculty and residents
• National Board of Medical Examiners’ Subject Exam
• OSCE Scores
• Required APGO uWise quiz scores

Students must also complete all required documents, such as observed history and physical forms, to receive a final grade.

Inappropriate behavior at any time on this rotation will prompt corrective action up to and including removal from the service.

Director: Melanie Trenkamp, M.D
Education Coordinator: Madeline Gregory

Children are constantly growing, developing and changing. During your pediatric clerkship, you will learn what is normal for children at various ages. You will help care for children with common illnesses and learn how to diagnose and treat these illnesses. You will also see a variety of less common illnesses.

91Å®Éñ’s eight-week pediatric rotation at SSM Health Cardinal Glennon Children’s Hospital includes experience in inpatient wards, ambulatory pediatrics and the newborn nursery. In addition, there are a series of didactic lectures and conferences.

The course aims to acquaint you with general aspects of growth, development, physical and mental health, and illness of infants, children and adolescents. At the end of the course you should be cognizant of:

• The normal patterns of growth and development and assessment thereof
• Effective techniques of history-taking in the pediatric setting
• Techniques of physical and neurological examination of infants, children and adolescents
• Common pediatric disease processes and their evaluation, management and expected outcome

Clinical Site and Hospital Assignments

91Å®Éñ’s Department of Pediatrics assigns students to each of the following experiences:

• Inpatient Clinical Experience: A four-week floor service. You will be a member of one of the inpatient ward teams composed of one or two attending physicians, a senior pediatric resident, and two to three first-year pediatric residents or rotating interns. During this time, you will participate in the evaluation and management of patients one day to 18 years of age who require hospitalization for a variety of acute and chronic disease processes. While on the inpatient rotation, you will have one weekend day off.
• Ambulatory Clinical Experience: A four-week experience held in the Ambulatory Care Center (University Pediatrics) and selected pediatricians' offices. You will be able to participate in well-baby examinations and care for common acute illnesses. In addition, several half-day sessions in various subspecialty clinics will allow you to become familiar with these subspecialties. Also, you will be allotted time to work through computer-based patient cases during the ambulatory rotation.
• Neonatal Clinical Experience: A five-day experience during the Ambulatory Clinical Experience block. You will be assigned to the newborn nursery and participate in evaluating and managing normal and premature newborn infants. You will have an opportunity to attend cesarean sections with a resident or attending and to learn the delivery room management of stressed infants.

Orientation

Orientation is held at 9 a.m. on the first day of each rotation in Danis Auditorium at SSM Health Cardinal Glennon Children’s Hospital. A letter regarding orientation will be emailed before the rotation.

Typical Weekend Activities

Inpatient: One weekend day off (coordinated with other team members) with the expectation to round with the inpatient team one weekend day per week.

Outpatient Clinic: No weekend duty.

Nursery: Five-day experience during the Ambulatory Clinic block of the rotation.

Lectures

91Å®Éñ’s pediatrics faculty will give a series of lectures in General Pediatrics. Lectures take place at noon. The lecture schedule and outlines for most lectures are part of the syllabus. Grand Rounds take place at 8 a.m. Wednesdays in Danis Auditorium.

Reading

The department provides Nelson's Pediatrics for students to use while on service. Should a book become lost or stolen, you will be responsible for replacing it. Additional resources are provided in the online course syllabus.

Quizzes and Tests

A National Board of Medical Examiners' written subject examination will be given on the last day of the rotation. A minimum of 25 CLIPP cases and quizzes are required during the ambulatory experience.

Projects and Papers

Two written admission histories and physicals are completed during the inpatient rotation and are given to the attending for critique. It is expected that you will present to the attending six days per week. Daily progress notes are to be submitted to residents/attendings. An observed history and physical are completed for the inpatient, outpatient and nursery rotations. A FACTS form must also be completed during your six-week pediatric rotation.

Evaluation and Grading Procedures

Grades for the clerkship are based on scores for five evaluation components: the shelf exam, CLIPP cases quizzes, the evaluation forms, filled out by faculty attendings and senior residents, and the outpatient evaluations.

91Å®Éñ’s psychiatry clerkship offers two primary clinical settings: SSM Health 91Å®Éñ Hospital and Jefferson Barracks VA. 91Å®Éñ Hospital (West Pavilion) has an adult psychiatry inpatient setting and a geriatric psychiatry inpatient setting. The consultation/liaison team (psychiatric conditions and complications in medically ill patients) is also a 91Å®Éñ primary setting and serves all hospital areas, including the emergency department and transplant. The Jefferson Barracks VA is a complete inpatient and outpatient setting where veterans are treated for a variety of psychiatric issues.

Clinical Sites

Clinical sites used for third-year clerkships include VA Saint Louis Health Care System - Jefferson Barracks Division and SSM Health 91Å®Éñ Hospital.

Orientation and Lectures

An orientation will be held on the first day of the clerkship.

All students are expected to meet as a group one day a week or as scheduled for clinical case conferences. There are lectures on Moodle to view at your convenience. You are expected to learn psychiatric disorders and their treatments and effective communication skills. You should have an understanding of personality development from childhood through adulthood. In addition, you will be able to attend optional learning activities.

Typical Weekly Schedule

The psychiatry core experience involves several settings and hospitals. You will have experience in a variety of settings with exposure to a variety of ages.

Daily activities will vary by clinical assignment. This will be explained during orientation to the clerkship. Generally, students on inpatient units are assigned outpatient clinics in the afternoon.

There are also opportunities to sign up to visit other specialty sites. You will be expected to be at your site from about 8 a.m. to at least 4:30 p.m. Feel free to bring reading.

Weekend duties vary by clinical site. If days are missed, they can be made up on weekends.

Reading

We require the students to obtain two texts. The first is to assist in establishing a knowledge base in psychiatry and must be one of the following:

• Psychiatry, latest edition by David A. Tomb
• High Yield Psychiatry by Barbara Fadem and Steven Simring
• Blueprints in Psychiatry, USMLE Steps 2 and 3 Review Series

Some students have found Kaplan and Sadock’s Synopsis of Psychiatry useful. The full DSM-IV-TR also gives a lot of good information.

The purpose of the second text is to allow you to test your knowledge base. You may choose one of the following:

• Psychiatry Pretest Self-Assessment and Review, latest edition by Shawn Woods
• Psychiatry latest edition, National Medical Series for Independent Study by James Scully
• Appleton and Lange’s Review of Psychiatry, latest edition by Ivan Oransky

The National Board of Medical Examiners (NBME) multiple choice examination in psychiatry is required.

Evaluation and Grading

Grades are determined from the NBME examination and the clinical performance evaluation forms completed by attendings/residents.

Co-Directors:  Katie Farrell, M.D., Jennifer Keller, M.D. and Joe Platz, M.D.

Education Coordinator: Samantha Peyton (temporary)

91Å®Éñ’s eight-week surgery clerkship is an essential part of your medical education regardless of what specialty you choose to enter. In addition to the hours spent in the operating room, you are expected to attend core lectures and be on all rounds and clinics with your assigned teams. You will also study and read extensively.

The surgery clerkship experience focuses on general surgery, offering you the opportunity to function as a surgical team member. The basics of general patient evaluation are adapted to the surgical setting to include assessing patients pre- and post-operatively. Building on general pathophysiology and clinical medicine, you will apply problem-solving and critical thinking skills in determining surgical risks and indications for a range of common surgical procedures.

You will learn the importance of sterile technique in minor procedures and in the operating room. You will also learn basic suturing, wound closure and wound management skills, and have the opportunity to accompany patients and teams to the OR.

Clinical Sites

Clinical sites used for third-year clerkships include the VA Saint Louis Health Care System - John Cochran Division, SSM Health 91Å®Éñ Hospital and SSM Health Cardinal Glennon Children's Hospital.

Team Assignments, Makeup and Organization

Each eight-week rotation is divided into four two-week sections. Approximately four students are assigned to each section.

Each service is organized generally around morning rounds, daily operating room cases and clinics, and scheduled teaching rounds and conferences.

Students are assigned cases to follow in the hospital and are to actively participate in patient care. Ideally, the patient's initial evaluation and each step in the diagnosis and treatment process up to discharge, and then follow-up in clinic, can be observed.

Description of a Typical Day

Anticipate making early morning rounds on patients and plan to be in the operating room often.

Mornings are dedicated to rounds, clinics, operating room assignments, reading, and Grand Rounds on Wednesdays. Afternoons feature rounds, patient follow-up, core lectures/presentations, and clinical Grand Rounds. 

Lectures

Lectures are offered during the clerkship at 3 p.m. on Tuesdays, Thursdays and Fridays. All students on the surgical service should also attend the Surgical Grand Rounds. Held from 7 to 9 a.m. Wednesdays in Medical School Lecture Hall A, it is a conference where cases from the last week are reviewed and students may ask questions.

Evaluation and Grading

Your final grade is comprised of the following components: the National Board of Medical Examiner's exam and clinical performance. Clinical performance is a subjective evaluation composite from faculty interacting with you on their services. The evidence log book and the areas of surgical emphasis are also part of clinical performance.