The University of Tennessee Graduate School of Medicine, Knoxville

The Department of Medicine

Medical Student Education

Third Year Clerkships

UT Medicine StudentsThe Department of Medicine sponsors up to six third year medical students from UT Memphis for their mandatory eight week block Internal Medicine Core Clerkship. Core Clerks are welcomed as an integral part of a team consisting of two interns (PGY-1), one upper level medicine resident (PGY 2 or 3) and one medicine attending. The students are assigned new patients from the Emergency Department following them throughout the hospitalization to discharge. Students also see patients who are transferred from the intensive care units to a medical unit. The student is expected to see his/her assigned patients on a daily basis. Patient assessments lead to the development of a differential diagnosis. Students learn proper evaluation and therapeutic plans while actively caring for patients. Close supervision allows one on one learning with mentoring physicians while adequate autonomy allows the student to develop skills needed that can only be learned via independent study/experience.

Students are scheduled for learning time in the Patient Simulation Center beginning with "Sterile Technique". "Basic Skills Lab" includes learning proper technique for canulation of peripheral veins for IVs/INT or phlebotomy; urinary catheter insertion; and NGT placement (if time allows) is the second scheduled lab. Students are encouraged to perfect basic skills of phlebotomy, arterial punctures and IV needle placement during this time. The student is encouraged to then return to the OR Holding room where R.N.s allow students to place catheters in pre-op patients. The third lab is "Ultrasound Guided Central Line Placement." The student is taught hands on operation of an ultrasound machine for noting proper landmarks prior to placing internal jugular vein catheter. The student is able to practice not only Internal Jugular but also subclavian vein insertion if time permits. The fourth regularly scheduled lab is for lumbar puncture. Opportunities to observe and often perform diagnostic procedures such as thoracentesis, paracentesis, and joint aspiration occur throughout the rotation but are not part of simulation learning at this time.

The Housestaff Medicine call schedule is presently twelve hours shifts every third day for each team. Students are assigned new patients corresponding to their assigned interns call schedule. Once a student has completed their H&P, the student is expected to follow the intern and/or resident throughout the remainder of the call period enhancing their learning through this experience. Students are required to remain in house during their assigned night call. Students follow work hours rules as established by UTHSC and UTGSM. One well-crafted history and physical should be given to the attending each week. Emphasis is placed on the history, physical and assessment including a detailed differential diagnosis.

The Core Clerkship is geared to inpatient medicine, but for those students who wish to see patients in the outpatient setting, there are several opportunities. Interested students may follow their assigned intern in their continuity clinic each week. Students may also shadow the upper level resident in clinic. In addition, students may take up to three days at the beginning or end of their block to see out patients with internists from Faculty Internal Medicine. The book "Lange Series for Medicine" is recommended for the first 2-4 weeks of the rotation followed by the "MKSAP for Students 3" for the remainder study period. Harrison's remains the printed textbook of choice for detailed reference. Preston Medical Library available 24/7 for access to Pubmed, Procedures Consult, etc.


Fourth-Year Electives

Course Coordinators: Drs. Karla Matteson and Ilse Anderson
Location: University of Tennessee Medical Center (Knoxville)
Maximum Class Size: 2 Students - (Course is not offered in Blocks 3, 7 and 8)

This elective course combines clinical experience in the evaluation of genetic disorders with basic understanding of medical genetics. The clinical experience involves assisting in obtaining family pedigree, physical examinations of patients, investigative tests, differential diagnosis and genetic counseling. The course includes a rotation through the CytogeneticsLaboratory and the Biochemical and Molecular Genetic Laboratory with emphasis on the application of new cytogenetics and molecular genetic discoveries to clinical genetic practice. The topics to be discussed are: 1) Clinical case reports; 2) Disorders of inborn errors of metabolism; 3) Chromosomal syndromes (cytogenetic, molecular cytogenetic diagnosis, and comparative hybridization arrays) and 4) Molecular diagnosis. A short presentation on a case of interest is required.

Course Coordinator: Dr. Janet L. Purkey
Location: University of Tennessee Medical Center (Knoxville)
Maximum Class Size: 1 Student

This clinical elective in internal medicine affords the visiting medical student opportunity to develop advanced skills in comprehensive patient evaluation and management under daily supervision of medical faculty through the care of patients admitted to the housestaff service at UT Medical Center.

Course Coordinator: Dr. Paul Branca
Location: University of Tennessee Medical Center (Knoxville)
Maximum Class Size: 2 Students

The objective of this course is to learn about pathophysiology, the appropriate diagnostic process, and the best management techniques for common medical problems and acute medical emergencies in the Critical Care Internal Medicine setting. Our goals include learning the technical and interpretative skills of common procedures performed in a Medical ICU (ventilator management, arterial lines, Swan Ganz catheters, etc.) The student will be expected to be the primary care provider for one or two critically ill patients under the supervision of an upper level medicine resident and critical care attending. The student will perform the admission history and physical examination and write the admission orders (under the supervision of the upper level resident). In addition, the student will present the patient on rounds in a problem and organ-oriented fashion. Daily orders will be written by the student on management rounds with the critical care attending. The student will also write problem-orientated daily notes and will be responsible for seeing that therapeutic plans are carried out.

Course Coordinators: Drs. James Cox and Stuart Bresee
Location: University of Tennessee Medical Center (Knoxville)
Maximum Class Size: 2 Students

This is a clinical elective offering the student an intensive experience in clinical cardiology under a single preceptor cardiologist for a four to five week period of time. During that time, the student will evaluate and follow a number of the cardiologist's patients, participate in their care, and accompany them to the cardiovascular laboratory and cardiac surgery as indicated.

Students will attend cardiology conferences, twice-weekly teaching rounds, weekly EKG teaching sessions and review a prepared sampling of the literature. Other literature reviews will be suggested as clinical material warrants.

Course Coordinator: Bill Law, Jr. M.D., FACE/FACP, Chief, Section of Endocrinology
Location: University of Tennessee Medical Center (Knoxville); clinical experience occurs in the private office of Endocrinology Consultants of East Tennessee, located 5 miles from University of Tennessee Medical Center
Advance registration required - students must call Knoxville Student Affairs at least 3 blocks prior to registering.

This elective is designed to provide an opportunity for students to observe the outpatient evaluation and management of patients with a wide variety of endocrine disorders, including thyroid and parathyroid disease, osteoporosis, multiple endocrine neoplasia, pituitary disorders, etc. Students will work under the direct supervision of nine BC practicing clinical endocrinologists. Students can observe patients undergoing thyroid ultrasounds, U/S-guided fine needle biopsies of thyroid nodules, radioactive iodine therapies, and bone density testing. Additional experience in evaluation and intensive outpatient management of diabetic patients using insulin pumps, continuous glucose sensing, and multiple daily injection regimens will be incorporated through time spent with several specialized physician extenders and Certified Diabetes Educators in our office.

Course Coordinator: Dr. Thomas Young
Location: University of Tennessee Medical Center (Knoxville)
Maximim Class Size: 2 Students

This elective is designed to acquaint the student with the clinical approach to the patient presenting with a GI illness including a pertinent history and physical, intelligent selection of laboratory, x-ray, and endoscopic studies to the ultimate culmination of diagnosis. Clinical management of the patient and therapy will be emphasized.

Course Coordinator: Dr. Wahid T. Hanna
Location: University of Tennessee Medical Center (Knoxville) -
Maximum Class Size: 1 Student

This elective introduces the student to disease of the hematopoietic system/Oncology, their diagnosis and management by combining clinical experience and introduction to relevant research in hematology oncology. Students will spend part of their time on the clinical service and part in the laboratory.

Course Coordinator: Drs. Russell Smith, John Narro and Mark Rasnake -
Location: University of Tennessee Medical Center
Maximum Class Size: 1 Student

This elective will be to teach the student how to be an effective consultant and assist the student in improving his/her knowledge of infectious diseases. Upgrade the student's knowledge regarding the use of antimicrobial agents, and improve the student's understanding of the diagnosis and management of commonly encountered infectious diseases with attention to the use of the history and readily available laboratory tests. The student will be responsible for five new patients workups per week. Attending rounds will be held at least five days per week. At attending rounds the student will present his/her new patients to the attending physician. At the time of presentation the student should also have formulated an assessment and plan. The student will see new patients, make daily rounds on his/her old patients and be present at attending physician rounds. He/she will be responsible for a daily update of his/her patients to the attending. Faculty and residents will review patient assessments and plans of therapy. Students will participate in the outpatient clinics for HIV, TB, and STDs at the Knox County Health Department. Each student is given assigned reading materials. In addition, books on antimicrobial agents are given to each student for them to keep.

Course Coordinator: Dr. Tina Dudney
Location: University of Tennessee Medical Center (Knoxville)
Maximum Class Size: 2 Students

This is a clinical preceptorial type elective in pulmonary disease. The student will have opportunity to evaluate, follow, and participate in the management of patients in the office and when admitted to the University of Tennessee Medical Center by the faculty of the University Pulmonary and Critical Care Physicians. . In addition to improving clinical skills in history taking and physical examination, the student will have an intensive experience in the application and interpretation of blood gases, pulmonary function testing, radiologic study, and other diagnostic modalities in medical chest diseases. Lectures on Pulmonology topics will be available.

Course Coordinator: Dr. Gary Klipple
Location: University of Tennessee Medical Center (Knoxville)
Maximum Class Size: 2 Students

Medical clerks in their senior year may elect a one or two month rotation in University Rheumatology.  The purpose of this elective is to develop an approach to the assessment and management of articular diseases such as osteoarthritis or rheumatoid arthritis and of systemic rheumatic disease such as systemic lupus erythematosus.    This includes an understanding of and proficiency in the musculoskeletal exam.  

The format of this rotation is that of a clinical preceptorship.   Students will have the opportunity to evaluate, present, discuss, document and participate in the management of private patients in the office setting and  hospital consults.  In these activities students work one on one with experienced faculty.

Teaching will include brief clinical lectures, case discussions, musculoskeletal x-ray reviews and demonstration of routine joint procedures such as aspiration and injection.   At the beginning of the rotation, students will be given the 700 page Primer on the Rheumatic Diseases with suggested reading selections.  In addition, students will participate in the Department of Medicine conference schedule including noon didactic lectures.   


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