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Guide to the Major Clinical Year 2007-2008

Class of 2009

I).  Dates

• June 18, 2007 to June 22, 2007 is Transition Week which marks the official beginning of the third year.  Attendance at all sessions is mandatory.
• June 22, 2007 is the Steven Z. Miller Student Clinician Ceremony.  Family members and guests are welcome to attend. 
• The Major Clinical Year clerkships begin June 25, 2007 and end June 20, 2008.

 
II).  Holidays and Vacations
All holidays in the third year are listed below.  Please keep in mind that some clerkships may require coverage by students during these times.  Course directors and site directors will dictate these needs to you.  When in doubt, consult them about attendance during the holiday. 

• Holidays
• Wednesday, July 4, 2007.
• Monday, September 3, 2007, Labor Day.
• Thursday, November 22, 2007, Thanksgiving Day is a holiday.  Friday, November 23, 2007 is a regular day and you are expected to attend. 
• Monday, January 21, 2008, Martin Luther King, Jr. Birthday. 
• Monday, February 18, 2008, President’s day.
• Monday, May 22, 2008, Memorial Day. 
• Vacations
• Saturday, December 15, 2007 to Sunday , January 1, 2008** .

January 2, 2008 is the first working day.

• One week vacation during Subspecialties I (SUB I), determined at the time of scheduling. 
• One week of vacation during Subspecialties II( SUB II), determined at the time of scheduling. 

II).  Rotations and Sites

• Students will rotate through 7 core clerkships.  All core clerkships are 5 weeks long, with the exception of Medicine, which is 10 weeks long.  Core clerkships include:
• Medicine:  Students are assigned to 5 weeks at New York Presbyterian Hospital, and 5 weeks at one of the affiliated sites (Allen Pavilion, Harlem, Roosevelt, St. Luke’s, or Stamford Hospitals).                                  
• Neurology:  Students are assigned to Harlem or New York Presbyterian Hospitals.
• OB/GYN:  Students are assigned to New York Presbyterian, St. Luke’s-Roosevelt, or Stamford Hospitals. 
• Pediatrics:  Students are assigned to Harlem or New York Presbyterian Hospitals.
• Primary Care:  Students are assigned to Bassett HealthCare, Concord Hospital, Harlem Hospital, Indian Health Services sites (Shiprock, Whiteriver, Zuni), Presbyterian/ACNC, Presbyterian/Adolescent Clinic, Presbyterian/Family Medicine, Roosevelt Hospital, St. Luke's Hospital, Stamford Hospital, Tully Family Practice, or the VA Medical Center.  All primary care site assignments are determined by a special lottery held in the Spring by the Primary Care office.  Stephanie Maher (x 59585, slm1@columbia.edu ) will coordinate all aspects of Primary Care assignments.      
• Psychiatry:  Students are assigned to Creedmoor, New York Presbyterian, Roosevelt or St. Luke’s.  All didactic courses are taught at New York Presbyterian.
• Surgery:  Students are assigned to Bassett, New York Presbyterian, St. Luke’s (some lectures and ER at Roosevelt), or Stamford Hospitals.                   
• Students will rotate through two 5 week for exposure to surgical subspecialties:
• Subspecialties I are one week long experiences, all at New York-Presbyterian Hospital, and include:
• Anesthesiology
• Neurosurgery
• Ophthalmology
• Otolaryngology
• Vacation week
• Subspecialties II are two week long experiences. 
• Orthopedic Surgery:  Students are assigned to New York Presbyterian or St. Luke’s-Roosevelt Hospitals. 
• Urology:  Students are assigned to New York Presbyterian Hospital. 
• Vacation week. 
• Students at Stamford and Bassett are given housing accommodations.  Bassett students must have a valid driver’s license.  Students at Creedmoor are provided a car parked at the New York State Psychiatric Institute and maintained by Creedmoor; students coordinate travel and driving amongst themselves.  

Additional Rules

• Students must rotate through three hospitals other than NYPH during the Major Clinical Year.  Primary care sites away do count as an away site.
• Students with children will rotate in New York City only.   
• Vacations during SUB I or SUB II cannot be swapped. 
• Attendance is expected on clerkships at all times.  If a student is ill or unable to attend a clerkship because of a family emergency, he/she must notify the clerkship director and the Office of Student Affairs (x 5-3806) promptly. 
  
  

Course Directors and Clerkship Descriptions

THE DEPARTMENT OF ANESTHESIOLOGY

The Anesthesiology clerkship is a one-week rotation. The student obtains clinical experience in the operating room under supervision, reinforced with didactic teaching sessions. The primary goals of the clerkship are to:

1. Increase capability of initiating appropriate therapy in acute problems which lead to respiratory and circulatory arrest.
2. Become familiar with the role of the anesthesiologist in the operating room, intensive care unit, as respiratory therapy consultant, and in pain management.
3. Help the student learn fundamental anesthetic technique, procedures and preanesthetic patient evaluation and preparation.
4. Learn techniques of IV placement and airway management.
5. Review pharmacology of vasoactive drugs and their physiologic effects.

THE DEPARTMENT OF MEDICINE

The Medicine clerkship is a ten-week rotation, five weeks of which are spent at The Presbyterian Hospital and a second five weeks at one of the following: Harlem Hospital, Roosevelt Hospital, St. Luke's Hospital, Stamford Hospital, or the Allen Pavilion. This course emphasizes the integration and application of pathophysiology to the diagnosis and management of patients, as well as the skills of history-taking, physical examination and case presentation. The course is an apprenticeship that focuses on the bedside care of patients. The student will work closely with house staff members and ward attendings - making daily rounds, admitting new patients and caring for them with the team. The student will also participate in Preceptor group - small case-based seminar sessions which meet regularly throughout each of the five week segments of the ten week clerkship.

THE DEPARTMENT OF NEUROLOGICAL SURGERY

The purpose of the Neurological Surgery week is to acquaint the student with neurosurgical problems and, in particular, to relate them to other fields of medicine, especially primary care, diagnosis, management referral and treatment. During the five days, the student will work up and observe or assist in neurosurgical operations, meet with the attendings daily at a special time for discussion of various neurosurgical topics, see private patients in the attending's office, attend Grand Rounds and other conferences and make rounds with the residents.

Topics covered will include CNS and spinal cord trauma, spinal herniated disc problems, subarachnoid hemorrhage, extracranial carotid vascular disease, brain tumors and hydrocephalus. A textbook of neurological surgery and a syllabus will be loaned to the student for their week.

THE DEPARTMENT OF NEUROLOGY

The clerkship in neurology is a five-week introduction to clinical neurology. The main objective is to enable students to develop skill at clinical localization and problem-solving in neurology. Additional goals for students are to refine neurological history-taking and examination skills, to develop a diagnostic and therapeutic approach to diseases of the nervous system, and to broaden a fund of knowledge relevant to common neurological problems and emergencies.

Students participate directly in the care of patients on the neurology services and out-patient clinics at Columbia University Medical Center and Harlem Hospital Center. Additional learning experiences include general and subspecialty conferences, daily preceptor rounds, weekly didactic sessions in clinical problem-solving, neuroradiology seminars, supervised neurological examinations and the educational resources of the Department of Neurology. Evaluation is based on all aspects of clinical performance, oral presentations, patient write-ups, a neurology portfolio assignment, and the NBME clerkship shelf exam.

OBSTETRICS AND GYNECOLOGY

The Obstetrics and Gynecology clerkship is a five-week rotation which is spent either at the Presbyterian Hospital, St. Luke's-Roosevelt Hospital Center or Stamford Hospital (Stamford, CT). The main objective is to familiarize the student with the signs and symptoms of normal and abnormal reproductive function and to teach the basic examinations in Obstetrics and Gynecology. The course will emphasize and reinforce skills of taking an appropriate history, performing a physical and pelvic examination, formulating a differential diagnosis, treatment plan and management of patients.

The student may gain exposure to the medical-surgical aspects in the subspecialty areas of gynecologic oncology, reproductive endocrinology and perinatology.

The primary didactic vehicles will consist of formal lectures with assigned readings. Small group preceptor sessions along with conferences will supplement the core.

THE DEPARTMENT OF OPHTHALMOLOGY

The Ophthalmology clerkship is a one-week rotation spent at The Edward S. Harkness Eye Institute.

The program consists of eleven hours of clinically-oriented lectures, twenty-five hours of closely supervised instruction in clinical history-taking and ophthalmic examination, two hours in laser photocoagulation, two hours in ultrasonography, twelve hours in the operating theatre, and two hours of anatomy and globe dissection. In small groups, students spend three hours in the private offices of attendings. The clinical experience is amplified by student attendance in a variety of subspecialty clinics including laser, retina, neuro-ophthalmology, uveitis, orbit and plastics, glaucoma and pediatric ophthalmology. Students are encouraged to attend seminars and Grand Rounds and an on-call schedule has been devised to enhance clinical exposure. A multiple-choice examination is given based upon formal lectures and assigned readings.

THE DEPARTMENT OF ORTHOPEDIC SURGERY

Medical students spend a didactic two-week rotation on Orthopedic Surgery. The primary teacher is an attending, with some lectures and demonstrations by the resident staff. Students attend subspecialty conferences, rounds and patient clinics, and participate in some surgical procedures.

At the end of the rotation, the student should be able to:

1. Take an orthopedic history and perform an orthopedic physical examination.
2. Understand the pathophysiology of the more common orthopedic disorders.
3. Identify the basic diagnostic and therapeutic approaches to common musculoskeletal disorders (both medical and surgical).
4. Leave with a sense of how an orthopedic service is administered and its relationship to other medical disciplines.

THE DEPARTMENT OF OTOLARYNGOLOGY/HEAD AND NECK SURGERY

Students spend one week on the service being introduced to the various aspects of the specialty, including Otology/Neurotology, Head and Neck Surgery, Facial Plastic and Reconstructive Surgery and Pediatric Otolaryngology. Emphasis is on developing a basic fund of knowledge in the specialty and in acquiring the skills of the Otolaryngologic examination. This is achieved through selected conferences, and the active participation in patient care in the ENT Clinic, the Speech and Hearing Department, the private offices and in the operating room.

THE DEPARTMENT OF PEDIATRICS

Third year medical students spend five weeks on Pediatrics. Students have both an inpatient and outpatient experience. The emphasis is on learning to care for children and families and experience the challenge of a variety of patient care settings. The role of primary care and specialty care is also emphasized. Attendings and house officers emphasize normal child development and the role of illness on the growing child and the family. Patient care experience is supplemented with daily rounds, conferences and lectures.

PRIMARY CARE

This five week clinical clerkship provides an exciting opportunity for students to have clinical experiences in ambulatory practices in rural, suburban and urban settings. Students will learn the core skills and knowledge essential to the practice of Primary Care: diagnosis and treatment of common outpatient complaints, management of chronic medical conditions and strategies for health promotion and disease prevention. Students will be precepted by faculty in general medicine, general pediatrics and/or family medicine at the following teaching sites: Sites for the five-week clerkship are: Bassett HealthCare (Cooperstown, NY), or The Tulley Center (Stamford, CT), or Stamford Hospital (Stamford, CT), or Harlem Hospital Center, or St. Luke's/Roosevelt or Presbyterian Hospital, or NH-Dartmouth Concord, or Indian Health Service sites in Arizona and New Mexico.

THE DEPARTMENT OF PSYCHIATRY

Students spend their five-week Psychiatry clerkship assigned to one of the following clinical sites: Presbyterian Hospital/Psychiatric Institute, Creedmoor Psychiatric Center/Presbyterian Hospital, Stamford Hospital (Stamford, CT), St. Luke's Hospital or Roosevelt Hospital. All students evaluate and follow patients on inpatient and outpatient services, child psychiatry and the psychiatric emergency room, participating in their patients' care with close attending and resident supervision. The acquisition of clinical skills is emphasized: conducting an interview to obtain a psychiatric history and mental status examination; organizing, recording and presenting the findings to generate a differential diagnosis; and formulating a treatment plan in accordance with the biopsychosocial model. Seminars complement the clinical experience by enhancing the knowledge base necessary to master these skills.

THE DEPARTMENT OF SURGERY

The clerkship in General Surgery is given ten times continuously through the calendar year. Students are divided into four groups for their clinical work, presenting the general surgery services in the Milstein, Allen Pavilion, Stamford Hospital and Bassett or St. Luke's-Roosevelt Hospital. There, in concert with senior and junior surgical house officers, they participate in the care of hospitalized patients. The students are assigned patients for whom they have primary care responsibility, provide day to day follow-up, and participate in operative procedures. Night call is usually every fourth night. A call room is provided in the hospital.

An attending surgeon acts as preceptor for each group, meeting one hour each day, five days a week, and conducts seminars on assigned topics of general surgical interest. Attending specialists are brought in for guest lectures on curriculum topics as well. In addition, there are weekly departmental seminars in Pediatric Surgery, Surgical Radiology and Pathology.

Students are assigned to the emergency room once to learn skills needed to provide care in trauma. Students are also encouraged to participate in the ambulatory surgery clinics which meet daily.

THE DEPARTMENT OF UROLOGY

The Urology Clerkship is a two week experience. Common urologic problems will be discussed during lectures and at bedside clinical teaching seminars, in clinics and in the operating rooms.

Emphasis will be placed on recognizing, diagnosing, and teaching common diseases of the genito-urinary system. All students will be assigned patients for individual evaluation. Each student will be required to write a short paper during the rotation.

Clinical Practice-III

The goal of Clinical Practice-III is to foster the continuing development of physician patient communication skills, holistic integration skills, conflict resolution skills, and lifelong professional development skills in the context of the third year clinical rotations. Discussion sessions co-led by Clinical Practice and clerkship faculty focus on the emerging concept of the doctor-patient relationship (Medicine clerkship), professional values and the culture of the operating room (Anesthesiology clerkship), the appreciation of multiple perspectives in situations of conflict (Pediatrics clerkship), and the phenomenon of countertransference (Psychiatry clerkship). Students are asked to prepare brief written reflections prior to the shared group reflection.

Clinical Assessment Program/The Morchand Center

All third-year students participate in a day-long Clinical Assessment Program designed to evaluate their mastery of the skills of the clinical transaction. Students are excused from their clerkships for the one day during the Spring on which they are assigned to attend the Clinical Assessment (held at a facility at the Mount Sinai Medical School). Using standardized patient methods, each student performs a focused medical evaluation on seven patients. The patients present with symptoms of medical, psychiatric, pediatric, surgical, gynecological, or neurological diseases, and they are seen in such settings as the Emergency Room, the CCU, a private doctor's office, or a walk-in clinic. In fact, to achieve standardization, all patients are actors who have been coached to portray reliably the clinical aspects of each case.

After the interaction, the student completes questions about the differential diagnosis, tests to be ordered, and given the results of the tests – test interpretation and clinical management. Meanwhile, the patient fills out information about the student's history-taking skill, performance of the physical examination, and communication skills. The entire proceedings are videotaped for review later by the student and a faculty member. Students generate scores throughout the day on the individual cases as well as the individual skills assessed.

The results of this assessment are not used as a pass/fail exam (as they are in other schools), nor are the results part of the student academic record in the Dean's Office or the Dean's Letter or transcript. Rather, P&S believes that the chief dividend is obtained when the student reviews his or her videotape to learn what kind of doctor he or she is becoming, and to receive guided feedback about ways in which to improve clinical performance. Accordingly, once the entire class has completed the assessment, each student must sign up for an hour-long one-on-one review of his or her videotape with a P&S faculty member who has been trained to give feedback on this clinical performance.

Participation in the Clinical Assessment Program is a requirement for promotion to the fourth year, and all Clerkship Directors release students from their clerkship duties on their assigned day. Students who fail to attend the Clinical Assessment on their scheduled day will be required to attend at a later date and to pay the not inconsiderable cost of the assessment themselves.

The Morchand Center

Academic Year 2007/2008
Regulations/Guidelines

1. Participation is required by all 3rd year P&S students for graduation. (No grade)
2. You may NOT switch your assigned day with other students (even if you are doing Surgery).
3. If you miss your assigned day, you must be rescheduled AND pay Columbia University the cost of your open space which is approximately $400.
4. Upon completion, you will be required to review your video/performance with an assigned faculty member to obtain appropriate feedback.

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