THE INTERNAL MEDICINE CLINICAL SKILLS PASSPORT

Nationally, there is a perceived need for medical students to better document the satisfactory mastery of clinical skills on each of the required clerkships. The Clinical Skills Passports provide one mechanism for such documentation.  The Liaison Committee on Medical Education, the group that certifies medical schools in the United States (and therefore the validity of your MD degree), has required that each Clerkship define those clinical experiences which each student should encounter.  These also are listed in the Passport and above in this handout.  Note that each encounter requires that you participate actively in the history, physical diagnosis, differential diagnosis, and plan of management.  You should also keep a running record of your progress toward these goal using the OASIS system.

The passport is a pocket-sized, trifold form identifying clinical skills that must be demonstrated successfully by each student on that clerkship and observed and documented by signature from a member of the resident staff (PGY-2 or -3) or faculty.  It is your responsibility to keep up with the passport and to ask housestaff or faculty to observe and sign off on specific skills while on the clerkship.  You have the entire two-month clerkship to complete the passport, and the completed passports must be turned in at the end of the clerkship.  Each skill should be performed in a satisfactory manner, without a value judgment on the part of the observer.  If a skill is performed in a satisfactory manner, the resident or faculty member can sign off on that skill.  If a skill is not performed satisfactorily during that observation, the resident or faculty member does not sign off on the skill but should give you some instruction in correct performance so that you can practice the skill before trying again, perhaps later in the clerkship.

Upper level residents (PGY-2 or -3) can sign off on specific clinical skills, however, faculty must sign off on the development of a differential diagnosis and plan of management, admission and follow-up notes, presentations, and, obviously, feedback.  Note that faculty in the Clinical Skills Educator Program at UVA or those conducting physical diagnosis rounds at Roanoke or Salem, are good sources of instruction and signatures. 

Although the passports are not graded, they must be completed for you to receive credit for the clerkship.  They do not directly influence your grade, however, observing your performing these skills may give the residents or faculty members better perspective on which to base their evaluations.

COMMON MEDICAL PROBLEMS

The range of patients that you will see over the two months of the clerkship cannot be predicted with precision.  University Hospital operates with a panel of Service Centers (e.g. Heart Center, Cancer Center, Digestive Health Center of Excellence) on which students can rotate in their fourth year.  Thus patients with some types of primary illness may not be seen during the required third year clerkship.  Still, some conditions are so common and basic that you should try to be involved in the care of at least one patient with each of the following clinical issues:

  • Abnormal mental status
  • Anemia
  • Assessing goals of care
  • Assessment of fluid status
  • Congestive heart failure
  • COPD
  • Heart Disease
  • Depression/somatization
  • Diabetes
  • Dyspnea
  • Edema
  • Electrolyte/acid-base abnormalities
  • Fever
  • Health maintenance
  • Hypertension
  • Pain
  • Thyroid disease
  • Urinary tract symptoms

You will note that the Internal Medicine Clerkship Passport requires that you be involved in the care of at least 80% of this list, however, you should be able to see, discuss, and read about all of these problems.  Seeing each problem more than once will increase your knowledge and understanding.