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DEPARTMENT OF MEDICINE
PULMONARY CLERKSHIP

MAXIMUM NUMBER OF STUDENTS ROTATING ON SERVICE AT ONCE.  Two (2).

LENGTH OF ROTATIONS.  Four (4) weeks.

WILL TAKE STUDENTS FOR TWO WEEKS ONLY?  No.

LEVEL OF STUDENTS ACCEPTED  Last half of third year and first half of fourth year.

TIME OF YEAR OFFERRED.  Flexible start dates throughout the year, excluding December.

PRIOR APPROVAL (FROM DEPARTMENT REQUIRED) AND ELIGIBILITY.

  • Yes.
  • Offered primarily to medical students with an Army obligation (HPSP and USUHS)
  • Students from other uniformed services and civilian students from mainland schools are welcome on a space-available basis from November to May (excluding December).
  • All students (except USUHS and University of Hawai'i) will apply using the Clerkship Application form.
  • USUHS fourth year students will apply using USUHS Form No. 1304.
  • The Student Coordinator will obtain permission from the appropriate clerkship official upon receipt of the application/form and will then inform the student of approval/disapproval via e-mail.

OBJECTIVES/DESCRIPTION OF CLERKSHIP.

  • While on this rotation, the student will experience the wide breadth and challenge of evaluating patients with respiratory complaints such as dyspnea, cough, and hemoptysis.
  • This clinical clerkship is associated with the General Medicine Residency Program and is divided evenly between the Pulmonary Disease Inpatient Consult Service and the Pulmonary Disease Clinic.
    • Pulmonary Disease Inpatient Consult Service:
      • While on the inpatient consult service, the student will initially interview, examine, evaluate, and synthesize a differential diagnosis, typically in patients with a respiratory complaint.
      • Each student will be required to see no more than one consult per day; the student will be expected to follow his/her patient(s) until the patient's discharge.
      • Consults will be assigned by the attending pulmonologist and will be seen as soon after the consult is received as possible.
      • He/she will be expected to present the patient to attending pulmonologist, write daily progress notes, and follow up all diagnostic tests.
      • Students will work closely under the direct supervision of the staff pulmonologist and, if present, the rotating general medicine resident.
    • Pulmonary Disease Outpatient Clinic:
      • Students will see one or two patients each Tuesday and Thursday afternoon and will see walk-in patients as assigned in the clinic.
      • The student will interview, examine, formulate a differential diagnosis, and develop a diagnostic and therapeutic plan.
      • He/she will then present the patient to the outpatient pulmonologist.
      • The staff physician will be responsible for teaching the student based on cases seen in the clinic.
      • The student will spend at least two half days each week seeing patients with the outpatient pulmonary physician.
      • The student will be responsible for scheduling tests, following up tests, and arranging appropriate follow-up with patients.
      • In addition, the student will see patients, every 15 minutes, in the tuberculosis exposure clinic, held every second and fourth Friday afternoon.

FREQUENCY OF CALL.  There is no night or weekend call required during this rotation.

REQUIRED READINGS.

  • Each student is expected to augment his/her clinical teaching experience by reading appropriate portions of an appropriate level pulmonary disease text.
  • There is a library of books and a syllabus of readings in the clinic that will be available to the student.
  • In addition, a syllabus of articles has been compiled on CD-ROM for rotators to keep.

OTHER REQUIREMENTS.

  • The student will be expected to observe and/or participate in as many pulmonary procedures as possible during the rotation.
    • Procedures include: flexible bronchoscopy, thoracentesis, thoracostomy, nasolaryngoscopy, Stage I cardiopulmonary exercise testing, arterial blood gas draw.
    • At the end of the rotation, the student should have a basic understanding of pulmonary function testing (including the methacholine challenge test) and chest radiograph and CT scan of the chest interpretation.
  • Each student is expected to attend all general medicine and pulmonary conferences, to include medicine morning report, Thoracic surgery conference, and Journal Club, whenever feasible. The student will be expected to present a case at a monthly management conference (downtown Honolulu) or give a 15-minute presentation on an appropriate pulmonary disease topic.

HOW ARE STUDENTS EVALUATED?

  • There will be a pre-test at the beginning of the rotation and a post-test at the end.
  • The student's evaluation will be based on performance on both the inpatient consult and outpatient experiences as well as on the results of the posttest.
  • This evaluation will reflect not only his/her fund of knowledge, ability to gather information and synthesize an appropriate plan, but also his/her motivation, work habits, and interpersonal skills.

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