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MD Program:Years 3 & 4

Academic Success

Advanced Clinical Experience (3rd Year) / Clerkships

The third year is designed to ensure that students:

    • are placed where diagnostic reasoning occurs; i.e. in situations in which patients are, as yet, undiagnosed;
    • are experiencing illnesses from presentation through to diagnosis and treatment;
    • are provided opportunities for spaced, repetitive, and cumulative learning;
    • are evaluated by a robust and objective assessment process that drives learning; and
    • are offered the opportunity to explore areas of interest.

Each trimester includes 2 discipline-specific cycles in which students learn in both inpatient and outpatient settings related to 2 of the 6 the core disciplines. The clinical sites in New York City and Long Island are chosen to ensure that students evaluate patients in the settings in which they present with their initial chief complaints.

NBME Subject Exam Schedule

Clerkship Description and Goals

  • Medicine

    Medicine

    The Medicine clerkship is an 8-week inpatient rotation, with students assigned to one primary inpatient site (NSUH, LIJ, or LHH). Five weeks are spent as a member of the house staff medicine ward team, while two weeks are allotted for a sub-specialty selective of the student's choosing and one week is spent on a night rotation.
    On the medicine wards, students follow the house officers' daily schedule including pre-rounds, attending rounds, and most conferences, and adhere to their on-call schedule. Students typically work closely with interns (PGY-1), and follow between two (initially) and four (goal) of the interns' patients. Students are responsible for daily presentations, new patient evaluations, and routine wards work. Additionally, they are encouraged to write daily progress notes as a formative exercise (house officer notes complete the medical record).

    Clerkship Goals
    • To learn a comprehensive, as well as a focused, approach to the evaluation and care of the adult medical patient.
    • To understand the signs, symptoms, pathophysiology, diagnostic criteria, clinical course and treatment of common disorders of the discipline.
    • Understand what conditions in Internal Medicine constitute an emergency and have a basic understanding of diagnostic workup and treatment for those.
    • Develop skills in the following areas specific to the expectations for the Internal Medicine clerkship and inclusive of specific experiences within the discipline.
    • Integrate logic and problem-solving skills, with an increasing knowledge base in Internal Medicine, to generate a differential diagnosis and use it in the evaluation of a patient's symptoms and findings.

    Clinical Presentations
    A: Assist               P: Perform

    • Abdominal Pain
    • Acute Kidney Injury and Chronic Kidney Disease
    • Altered Mental Status
    • Anemia (various causes)
    • Back Pain
    • Cancer (Common - NOS)
    • Chest Pain (log under Chest Discomfort)
    • Cardiac Disease/Arrhythmias
    • COPD/Obstructive Airways Disease
    • Diabetes Mellitus
    • Fluid, Electrolyte and Acid-Base Disorders
    • Gastrointestinal Bleeding
    • Heart Failure
    • Immunocompromised patient (HIV, chemo, transplant)
    • Hypertension
    • Liver Disease
    • Nosocomial Infections
    • Pneumonia (log under Upper or Lower Respiratory Infection)
    • Rheumatologic Problems
    • Rule out Tuberculosis
    • Venous Thromboembolism or Pulmonary Embolism or Rule-out PE
    • Procedure: ABG
    • Procedure: Bag and Mask Ventilation
    • Procedure: Blood Culture
  • Surgery

    Surgery
    The Advanced Clinical Experience (ACE) in Surgery is a six-week rotation based at North Shore University Hospital (NSUH), Long Island Jewish Medical Center (LIJMC), Cohen Children's Medical Center (CCMC), and Lenox Hill Hospital (LHH). The Surgery ACE exposes students to multiple surgical specialties and subspecialties, including general surgery, trauma surgery, acute care surgery, surgical oncology, colorectal surgery, vascular surgery, bariatric surgery, minimally invasive surgery, hepatobiliary surgery, breast surgery, cardiothoracic surgery, surgical critical care, orthopedic surgery, plastic surgery, urology and otolaryngology. 
    Students remain at their designated site (NSUH, LIJMC, LHH) for all of their specific service rotations.  This aids in improving student integration into one surgical environment, enhancing their familiarity with staff and procedures, and to reducing burdensome travel time between sites.

    Clerkship Goals
    • Develop competence in initial evaluation and management of surgical patients.
    • Develop competence in pre- and postoperative management of surgical patients.
    • Develop technical and procedural skills.
    • Develop note writing and oral presentation skills.
  • Psychiatry

    Psychiatry
    ACE in Psychiatry is a six-week rotation consisting of a 4-week primary placement, followed by a 2-week secondary placement for all students. The Primary placement is either an Inpatient Unit at the Zucker Hillside Hospital or South Oaks Hospital, or with a Consultation-Liaison Psychiatry Team at LIJ or North Shore. Students who are with a Consultation-Liaison Psychiatry Team or on a subspecialty Inpatient Unit (Adolescent or Geriatric Psychiatry) as their primary placement will then be on an Adult Inpatient Unit for their secondary placement. Students who start on an Adult Inpatient Unit as their primary placement will then be on one of the following for their secondary placement: Consultation-Liaison Team, Emergency Psychiatry, or on a subspecialty Inpatient Unit.
    In addition, all students will attend the following: Case-based learning sessions devoted to critical topics that may not have received sufficient and/or systematic attention on the units, ACE Rounds, Observation of ECT, Motivational Interviewing session, and Clinical skills sessions at CLI.

    Clerkship Goals
    • Perform diagnostic assessments (by means of history gathering, review of symptoms, mental status examination) of patients with core psychiatric disorders in adults (major depression, schizophrenia spectrum disorders, bipolar disorder), geriatric adults (major depression, dementia), adolescents (autism spectrum disorders, affective disorders, psychosis), patients with addiction disorders (alcohol, opiate, cocaine), and patients with co-occurring medical conditions (depression, delirium, drug and alcohol withdrawal).
    • Describe the pathophysiology and clinical course of patients with core psychiatric disorders.
    • Demonstrate clinical interviewing skills appropriate to level of training, including performance of the mental status examination.
    • Develop and defend a clinically meaningful differential diagnosis and demonstrate an understanding of treatment principles and develop a rudimentary treatment plan.
  • Neurology

    Neurology
    The neuroscience component of the Advance Clinical Experience (ACE) is a six-week rotation, which includes inpatient/outpatient neurology, physical medicine and rehabilitation (PM&R) and neurosurgery.  Students rotate through four weeks of neurology.  For students at North Shore University Hospital / Long Island Jewish Hospital, the rotation includes: one week of stroke; one week of general neurology ward service; and two weeks of consultation service at North Shore University Hospital or Long Island Jewish Medical Center.  For students at Lenox Hill Hospital, the rotation includes: one week of stroke; one week of general neurology consultation; one week of neurology outpatient clinics; and one week of a combined epilepsy / ICU rotation.  All students will complete one week of neurosurgery and one week of Physical Medicine and Rehabilitation.
    In addition, all students will attend the following: Pain didactic session, weekly ACE Rounds, and Clinical skills sessions at CLI.

    Clerkship Goals
    • Students will learn how to take a complete neurologic history and perform a comprehensive neurological examination.
    • Students will be able to describe the pathophysiology, clinical course and management of patients with common neurologic conditions and key neurologic emergencies.
    • Students will develop skills in neurologic differential diagnosis and treatment.
    • Students will understand the full treatment course of a patient with neurologic disease, including rehabilitation and surgery.
    • Students will perform a directed history and physical examination on patients requiring rehabilitation and perform a mobility assessment.
    • Students will understand what constitutes a neurosurgical emergency and have a basic understanding of neurosurgical diagnostic workup and treatment.
    • Students will develop the ability to interpret CT scans and MRIs of the central nervous system.
  • Pediatrics

    Pediatrics
    The Pediatrics ACE experience is six-week rotation, which includes three weeks of inpatient pediatrics, including 1 week of evening shifts, one week of newborn medicine, one week of Pediatrics Emergency Medicine, and one week of Outpatient Clinic.

    Clerkship Goals
    • Acquire a working knowledge and appreciation of normal and abnormal growth and development.
    • Recognize, understand the signs and symptoms, pathophysiology, diagnoses, and treatment of common disorders of infancy, childhood, and adolescence.
    • Develop an understanding and appreciation of children's and families' perspectives of being cared for within our healthcare system through participation in family-centered patient care.
    • Further develop the skills necessary for creating effective therapeutic relationships with patients and families (utilizing principles of the 3 function model emphasized during the 1st 100 weeks), and acquire increased understanding and appreciation for the importance of this therapeutic relationship in health outcomes.
    • Further develop skills of cultural competence in healthcare, and increase appreciation for the utilization of these skills in overcoming health disparities, and improving health outcomes for children.
  • OB/GYN

    OB/GYN
    The obstetrics and gynecology component of the Advance Clinical Experience is a six-week rotation based at NSUH, LIJMC, or Southside Hospital, which will expose students to inpatient and outpatient obstetrics, gynecology, urogynecology, maternal fetal medicine, and gynecologic oncology.

    Clerkship Goals
    • Develop competence in the medical interview and physical examination of women and incorporate ethical, social, and diversity perspectives to provide culturally competent health care.
    • Describe the physiology, pathophysiology, clinical course and management of patients with common OB/GYN conditions and key OB/GYN emergencies, including the development of skills in OB/GYN differential diagnosis and treatment.
    • Develop skills in intrapartum and postpartum care of the mother and newborn.
    • Demonstrate knowledge of perioperative care and familiarity with gynecologic procedures.
    • Develop skills in the counseling and care of women throughout the lifespan in the ambulatory setting, including recommended prevention strategies.
    • Understand what constitutes an OB/GYN emergency and, through direct observation of and by attending physician staff, develop an enhanced awareness of an OB/GYN diagnostic workup and treatment plan.

Curriculum Cards