Inpatient and Outpatient US Clinical Experience in Internal Medicine in Richmond

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 with years of experience practicing both hospital and outpatient medicine. The physician holds hospital appointments at Sentara Health. The preceptor has experience as an educator through an affiliation with the VCU School of Medicine.

Hospital rounds will take place in the morning before clinic. As more hospitals are moving to the hospitalist model for inpatient care, fewer physicians are involved in the care of both inpatients and outpatients. This preceptor feels strongly that hospitalized patients experience continuity of care when they are hospitalized. Therefore, the preceptor has maintained a hospital practice along with clinic duties. The typical hospital census is 2-3 patients.

In the clinic, you will see patients with both acute complaints and chronic disease. On a typical day, approximately 25 patients are seen. This will be an excellent opportunity to see how a physician with several decades of practice skillfully deals with all sorts of challenging issues. You will see how strong relationships between patients and physicians can enhance compliance, increase satisfaction, and improve outcomes. This physician is well regarded for providing patients with personalized care and believes in taking the time necessary to listen to patients and make them feel heard. Patients have consistently praised this preceptor for being genuine, devoted to their care, and having unlimited patience.

One day per week, you will accompany the preceptor and the nurse practitioner to a retirement community where you will see patients who are residents of either independent living or assisted living. Assisted living provides residents with the necessary support for personal care, dressing, eating, mobility, and medical management. In addition to rounding on select patients living there, you will also see patients in their attached clinic.

Please also note that you will be assigned topic presentations to deliver through the course of this clinical experience. This will be good practice for your role as an internal medicine resident when you will be expected to present topics in morning report and other conferences.

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

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• Taking patient histories under supervision.

• Performing exams under the physician's supervision.

• Presenting patients.

• Accessing the EMR (eClinicalWorks).

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

• Giving topic presentations.

• 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.