Specialty: Internal Medicine

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MD2B Connect Physician ID # 224

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Where will this rotation take place: This inpatient and outpatient US clinical experience will take place in Jacksonville, Florida. Because the preceptor visits multiple locations, including the hospital, clinic, and nursing homes, a car is highly recommended. 

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Hours: Monday - Friday 10 AM to 5 PM (please note that the preceptor often sees patients late into the evenings, sometimes as late as 10 PM; however, the student is not expected to keep these late hours. Students who are interested in staying later than expected should notify the preceptor)

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Hours have been provided by the preceptor. Hours are subject to change at the preceptor’s discretion, but the minimum total hours will remain approximately the same.

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What you will do: You will be under the supervision of a board-certified internal medicine physician who is committed to providing personalized care to a multicultural patient population in diverse settings, including the hospital, outpatient clinic, and nursing homes. The physician holds a staff appointment at HCA Florida Orange Park Hospital as well as several nursing homes where he serves as medical director. Of note, while the hospital has several residency programs, including internal medicine, this preceptor is not involved in the teaching of internal medicine residents. 

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This physician is a solo practitioner and continues to fulfill the duties of a traditional internist, including the care of patients in the hospital, outpatient clinic, and nursing home. You will have the opportunity to spend time in each of these settings. You will accompany the physician to the hospital for hospital rounds, see patients in the clinic with a variety of complaints, and evaluate and manage nursing home residents with acute and chronic medical problems. 

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Please note that the clinic hours will take place two days per week. The rest of the time will be spent in the hospital and in various nursing homes. You can expect to visit multiple locations on the same day. 

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An important part of this rotation is learning how to provide high-quality care to nursing home residents. In recent years, nursing home patients have become more medically compex due to the agring of the population, presence of multiple coexisting medical problems, and faster discharge from the hospital to the nursing home. Many educators and leaders have indicated a need for additional training in geriatrics among internal medicine residents. Time spent in the nursing home during this clinical experience will allow you to develop the essential geriatric skills needed to evaluate and manage elderly patients. 

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You will be exposed to highly complex patients and will learn how an internal medicine physician who serves as medical director of the nursing home oversees and coordinates the care of these patients as part of an interdisciplinary team. You will gain an understanding of the role and responsibilities of the medical director in the admission of new patients to the home, assessment of patients with changes in their health status, and transfer of patients to the hospital when a higher level of care is required. You will learn how to:

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• Assess status of chronic medical conditions and identify acute issues requiring attention

• Determine the extent to which the patient's medical problems are affecting function, quality of life, nutrition, mobility, and cognition

• Evaluate patients, review their plan of care, and assess reasons for changing or maintaining current treatment plans

• Partner with physical, occupational, speech therapy, nursing, and social work to meet the psychosocial and medical needs of patients

• Review medications, assess for adverse drug reactions, and determine whether the continued use of each medication is warranted 

• Obtain collateral information from non-physician staff and family members

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After a few days of observation, you will take on an increasing role in patient encounters and learn the following under the preceptor’s supervision:​

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• Taking patient histories.

• Performing physical exams under the physician's supervision.

• Presenting patients.

• Reviewing notes in the EMR (entering notes in the EMR is not permitted)

• Researching the literature to answer clinical questions at the point of care.

• Spending time with other healthcare professionals to understand their roles and responsibilities. 

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The activities above will mostly take place in the outpatient setting. As a result of hospital policies, inpatient activities will be more observational.

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You will receive regular feedback on your performance. 

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​​Who should consider this rotation: International medical graduates (IMGs) and students seeking US clinical experience in internal medicine. 

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​How to obtain a letter of recommendation: The rotator should ask the preceptor for a LOR near the conclusion of the rotation. Dr. Desai has provided the physician with guidelines about best practices in letter writing that meet residency program requirements. In some cases, the preceptor may ask the rotator to write a letter of recommendation draft. 

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​During the rotation: Our team will be checking in periodically with you to ensure that you are having an optimal experience. We encourage you to contact us if you have any questions during the rotation.