Combined Inpatient & Outpatient US Clinical Experience in Internal Medicine in New York

Information about this clinical experience:

This rotation split between the inpatient and outpatient settings will be under the supervision of a board-certified internal medicine physician. The preceptor has had extensive experience educating students in the U.S., and is a faculty member at Touro University and Zucker School of Medicine at Hofstra/Northwell. The attending physician has hospital appointments at Long Island Jewish Valley Stream Hospital and Mt. Sinai South Nassau Hospital.

Over 20 plus years as an internist, this physician has developed a system to integrate students into the full spectrum of care. Students will learn how to evaluate patients under supervision, including taking histories, reviewing and reconciling medication lists, ordering and interpreting tests, prescribing medications, documenting the visit in the written chart, and calling patients to provide results. Students will also learn how team members work together to operate the clinic with an eye towards maintaining patient flow and improving efficiency.

The doctor will educate you on best practices in medicine with respect to medication reconciliation and reporting test results to patients. For example, errors can easily occur when test results are communicated to patients without the use of well established processes. Patient safety can also be compromised with an inadequate medication reconciliation process. Since these activities will be an important part of your work as a future resident, this clinical experience will be an excellent opportunity to develop essential skills for optimal patient care. The resources below will help you better understand how to make the most of your learning in these areas:

Communicating Test Results to Patients

Medication Reconcilitation Process

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision:

• Taking patient histories.

• Performing physical exams under the physician's supervision.

• Presenting patients.

• Writing notes in the EMR (Practice Fusion)

• Have opportunities to research the literature to answer clinical questions at the point of care.

• May have opportunities to teach other team members.

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

Hospital rounds will take place typically once per week on Sundays for one to two hours. Rotators should ask the preceptor every Friday for when and where to meet for hospital rounds on the following Sunday.  Please note that the activities above will mostly take place in the outpatient setting. As a result of hospital policies, inpatient activities will be more observational.

Please note that this is a high-volume clinic with significant patient interaction. While the volume of patients will limit the amount of time that can be spent on teaching per patient and teaching points will be shared throughout the day, especially at quieter moments.

Of note, the patient population is diverse and underserved. Many patients are on Medicaid or Medicare. Most have experienced economic hardship that has limited their access to healthcare or medications. A significant percentage of patients have poor understanding of their medical situation. Given how frequently you will encounter such patients as a resident in the U.S., this will be an excellent opportunity to learn how to evaluate and manage patients with significant barriers to care.

As the practice is also staffed by a physician colleague and NP/PA, rotators will also have the opportunity to spend time with these other providers. This will give students the benefit of seeing clinicians with different styles, backgrounds, and perspectives.