Specialty: Internal Medicine

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MD2B Connect Physician ID # 272

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Where will this rotation take place: This inpatient and outpatient US clinical experience will take place in Miami, Florida (approximately 10 miles northwest of downtown).

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Hours: Monday - Friday 6 AM to 3 PM

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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: This rotation split between the inpatient and outpatient settings will be under the supervision of an internal medicine physician with years of experience as an educator as a faculty member at the Florida International University College of Medicine. Although no longer part of the faculty, this physician remains active in the teaching and mentoring of international medical students and graduates.

 

​Your day will start at 6 AM in the physician’s office where you will meet with the attending to go over new hospital admissions. On a typical day, this physician will receive 17-20 new patients on the service. Each student will be assigned several new patients to see and evaluate.

 

At approximately 6:30 AM, you will start prerounds. During this time, you will be responsible for taking the history and performing the exam in your assigned patients. Rotators will also find it useful to acquire relevant information from discussions with the nursing staff regarding overnight events, orders that have been placed, and consults that have been completed. Following your patient encounter, you will develop your assessment and plan and prepare to present the case to the attending.

 

These cases will be presented to the attending during teaching rounds which typically start at 8 AM and end at 11 AM. During these rounds, you will accompany the preceptor and other students to the ICU, CCU, Step-Down Unit, and medical wards. Please note that this attending prefers that you present your cases in the patient’s room at the bedside. After the patient is presented, the attending will ask you questions for clarification and to stimulate discussion among the team. The team will then see the patient to confirm the findings from your evaluation and finalize the day’s diagnostic and treatment plan.

 

Of note, while these new admissions may have been worked up by other providers (e.g., emergency department), this attending strongly believes that students should not be overly influenced by admitting diagnoses. In other words, this preceptor will expect you to not be biased by another doctor’s evaluation and assessment. Therefore, the preceptor will not give you access to all the information in the patient’s chart. Instead, you will be given a brief summary of the patient’s situation as the starting point for your own evaluation. This approach will allow you to form your own conclusions regarding the diagnosis and workup and help prevent you from making a common diagnostic error in medicine known as premature closure. Premature closure is defined by Dr. Croskerry of Dalhousie University as the following:

 

Premature closure: is a powerful bias accounting for a high proportion of missed diagnoses. It is the tendency to apply premature closure to the decision-making process, accepting a diagnosis before it has been fully verified. The consequences of the bias are reflected in the maxim ‘when the diagnosis is made, the thinking stops’.

 

Following teaching rounds, you will return to the physician’s office where you will work on your note writing. The emphasis will be on writing an accurate and thorough history and physical exam. Your documentation will be reviewed and edited by the preceptor and then added to the EMR. Please note that you will not be directly entering patient information into the Citrix EMR. As you are working on your notes, the attending may ask you questions about the patient’s conditions and what you feel is the next step in the evaluation and management.

 

The remainder of the day will be spent seeing patients in the preceptor’s office. These are patients with new symptoms as well as patients with chronic disease. You will perform medication reconciliation, take the history, and perform the exam. You will then present your findings and assessment and plan to the attending. Patient encounters will then be documented in the EMR (DrChrono EMR). No matter the reason for the visit, an emphasis will be placed on age-appropriate screening. This attending believes strongly in the practice of prevention and will emphasize healthy habits and screening during outpatient encounters.

 

Once per week, a student on the team will deliver a 15-minute PowerPoint topic presentation. Once the topic is selected, all students are expected to read about it so that they can maximize their learning from the talk. Students will be expected to ask the speaker questions to further their knowledge and understanding.

 

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 under supervision.

• Performing exams under the physician's supervision.

• Presenting patients.

• Writing notes

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

• Educating patients under supervision.

• Giving talks to the team.

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

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Of note, 60-70% of patients are Spanish speakers. For rotators who do not speak Spanish, taking the history when there is a language barrier present may be challenging. However, as you will encounter non-English-speaking patients frequently as a trainee in US-based residency programs, this rotation will help you discover strategies to more effectively communicate with patients when language barriers are present (e.g., family members, bilingual staff members, mobile translation apps). In addition, this will be an opportunity for non-Spanish-speaking rotators to practice their medical Spanish.

 

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

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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.