Medicine 665 Clinic Rotation Orientation
Harborview Medical Center
Welcome to Harborview’s Med 665 clinic rotation! Please
take a few minutes to review this information before your first
day.
Background and General Goals
For the next four weeks,
your instruction in Internal Medicine will occur in clinics,
classrooms and other care areas affiliated with Harborview
Medical Center. Our goals are to give you an appreciation of the
challenge and excitement of primary care internal medicine, the
opportunity to see and learn from patients with a variety of
general and subspecialty problems, and to provide didactic
instruction in topics related to ambulatory care. Whenever
possible, you will receive individualized bedside instruction in
patient evaluation from faculty. We hope you will find these four
weeks particularly valuable in improving your problem solving,
physical diagnosis and patient evaluation skills.
Administration
The ambulatory clerkship began in July
1994 and has changed several times in response to feedback from
your predecessors. Please bring any questions, problems or
concerns to us quickly. We welcome your constructive criticism.
Travis Baggett, M.D.
Chief Medical Resident,
Ambulatory Care
Phone: 744-4928
Pager: 680-0115
Genji Terasaki, M.D.
Ambulatory Clerkship Coordinator
Attending Physician, General Internal Medicine
Pager: 680-0543
Clerkship Overview
Your ambulatory care experience will
consist of four general activities scheduled into 10 half-day
sessions per week. Attached you will find your complete schedule
or clinics, teaching sessions, conferences, and miscellaneous
activities.
I. Primary care clinics
3-4 Sessions / week
In the Adult Medicine Clinic, and DESC, you
will be the first person to enter the exam room to interview and
examine your patients. Under typical circumstances you will see 2
or 3 patients per session and have time to review the
patient’s chief concern with your Attending physician prior
to entering the room. Once you have performed your evaluation and
presented this information to the Attending, you will be
responsible for implementing your plan and arranging follow-up.
These clinics should provide exposure to a broad variety of
patient problems and direct instruction in physical diagnosis. We
encourage you to schedule your patients for follow up with you
throughout the month so that you can get a flavor for continuity
of care in the outpatient setting.
II. Subspecialty clinics
3 Sessions / week
In Diabetes/Endocrine Clinics, Chest, Gastroenterology, and
Madison, you will work directly with an Attending physician as
they see their patients. As the month goes on, you may have the
opportunity to see patients by yourself, space permitting. The
educational goals of these exercises are summarized at the end of
this handout.
III. Didactics
3 Sessions / week
Monday afternoon – Physical Diagnosis with Travis Baggett,
M.D.
Monday afternoon – Sheffield Rounds with John Sheffield,
M.D.
Monday afternoon – Didactics with Travis Baggett, M.D.
In addition to these student teaching sessions, you are
encouraged to attend the regularly scheduled Medical Service
lunch conferences at Harborview. Weekly conference schedules are
emailed each week.
IV. Medic One Ride-Along
Experience medicine from a
paramedic’s perspective and to get a sense of our
patients’ home and community settings. Schedule at the
least one 5-hour ride-along during the rotation. Shifts generally
go from 4 PM to 9 PM. Please dress professionally: no jeans,
sneakers or scrubs. Finally, please keep a list of the runs that
you go on, including the gender, age and reason for the call, and
submit to the chief medical resident before the end of your
clinic rotation. To schedule a shift, call Carolyn Barton at
386-1483.
V. Parking & ID Badges
Please try to arrange your
parking ahead of time. The Parking office is located on the 8th
floor of East Hospital via the Center elevators. The phone number
is 744-3254, and the office hours are 7:00 AM to 4:30 PM on
weekdays. It is strongly recommended you use public
transportation or the Health Sciences Shuttle Bus for this
rotation. Metro Bus routes #3, 4, and 60 come directly to
Harborview, and the Shuttle Bus runs between the UWMC and
Harborview every 15 minutes.
It is necessary that you stop by the Badging office to pick up
your Harborview ID badge; it will provide you access to the ER
and building after hours. We have provided the Badging office,
which is located in 8EH-69 (next to the Parking office) with the
required forms and information.
VI. General Information and Teaching Goals for Clinic
Sessions
Primary Care Clinics
Adult Medicine Walk-in Clinic
| Attending: |
Travis Baggett, M.D. |
| Location: |
3 West Clinic |
| Time: |
Monday 8:30 AM |
| Attending: |
Genji Terasaki, M.D. |
| Location: |
3 West Clinic |
| Time: |
Tuesday 8:30 AM |
| Attending: |
TBA |
| Location: |
3 West Clinic |
| Time: |
Friday 8:30 AM |
Goals:
- Learn how to perform a directed evaluation of patients
presenting with a variety of problems.
- Learn how to efficiently review a chart to compile
pertinent clinical information.
- Refine presentation skills.
- Learn how to chart clinic notes in an organized and
succinct fashion.
- Be observed by your attending as you provide clinical care
so that directed feedback can be given as well as instruction
in physical exam skills.
- Develop an appreciation for continuity of care and
outpatient management for primary care patients.
Subspecialty Clinics
Note: Please introduce yourself at
the start of each clinic session and be assertive in your goals
for your sessions, ask if you can see a patient on your own and
then present to an attending/fellow. These clinics are included
to give you exposure to the variety of outpatient care that is
provided in Internal Medicine.
Endocrinology and Diabetes Clinic
| Director: |
Scott Weigle, M.D. |
| Location: |
3 West Clinic (Med Specialties) |
| Time: |
Wed 8:30 AM |
Goals:
Thyroid:
- Learn how to examine the thyroid and obtain a history
directed toward possible thyroid illness.
- Understand the use and interpretation of basic tests of
thyroid function.
- Understand the therapeutic approach the hyper- and
hypothyroidism.
Diabetes:
- Learn how to do a directed history and physical exam on the
diabetic patient.
- Attend at least one patient teaching session with the
diabetes nurse educator and nutritionist.
- Learn how to interpret self-glucose monitoring
records.
- Understand the basics of oral hypoglycemic and insulin
therapy.
- Understand how to screen for and treat diabetic
complications.
Other:
- Learn current guidelines for the diagnosis and treatment of
the hyperlipidemias.
- Appreciate the diversity of endocrinologic disease by
discussing patients with adrenal, pituitary and reproductive
disorders as they present to clinic.
Chest Clinic
| Director: |
Shawn Skerrett, M.D. |
| PCC: |
Kirsten Moe 744-3123 |
| Location: |
3 West Clinic (Med Specialties) |
| Time: |
Friday 12:30-6:00 PM (includes lunch and post-clinic
conference) |
Goals:
- Understand the role of the pulmonary sub specialist and
general indications for referral.
- Understand chest radiograph interpretation.
- Understand interpretation of simple spirometry / peak flow
testing.
- Understand the diagnosis and management of asthma, COPD,
and lung cancer.
- Understand the evaluation of common respiratory symptoms such as chronic cough and dyspnea.
- Understand preventive measures in pulmonary medicine (TB
skin testing, smoking cessation, environmental
modification).
Madison Clinic
| Director: |
Bob Harrington, M. D. |
| PCC: |
Jack Fisher 744-5155 |
| Location: |
2 West Clinic |
| Time: |
8:30 AM Weds |
Goals:
- Participate in evaluation and management of patients seen
in clinic.
- Review HIV teaching materials and learning objectives with
Attending.
Gastroenterology Clinic
| Director: |
Christina Surawicz, M.D. 341-4634 |
| PCC: |
Carla Cummings 744-4929 |
| Location: |
3 West Clinic (Med Specialties) |
| Time: |
1:30 PM Weds |
Goals:
- Evaluation and Treatment of common GI disorders.
- Witness common GI procedures. (Endosopies)
Medic One
| Contact: |
Carolyn Barton 386-1483 |
| Location: |
Medic One Annex, 1EH |
| Attire: |
White lab jacket, casual clothes. |
NO SCRUBS, JEANS OR TENNIS SHOES.