Student Ambulatory Report
Internal Medicine Clerkship

Student Ambulatory Report is a twice-weekly meeting where all students in the ambulatory rotation of the clerkship will come together with a faculty facilitator to review clinical cases. The goals of this exercise are to:

1. Improve skills in case presentation,
   
2. Develop skills in clinical problem-solving, and
   
3. Learn about the diagnostic, preventive, and management approach to common ambulatory topics.

For 3 or 4 of the 6 sessions, a faculty preceptor will facilitate discussion. For 2 sessions each month, the department chairman, Dr. David Duggan, will facilitate discussion. Each session will be scheduled for 90 minutes. Activities will include:

1. Review of paper cases provided by the faculty member (especially during the first week, when students may not have seen many outpatients yet), and
   
2. Presentation of actual outpatients students have seen, and discussion of one or more aspects of the case (diagnosis, treatment, prevention, or mechanism of disease).

Expectations of Students:

1. Participation in case discussion.
   
2. An organized presentation of two cases per student during the month. The case presentation should be no more than 5 minutes, and should present questions or issues for discussion to the group. Following discussion, the student who presented the case should clearly summarize the take home points about the topic. The entire case, presentation, discussion, and summary should take no more than 25 minutes. Cases can be chosen from the list of topics outlined below or be a case about which you learned something you want to share with the group, or be a challenging case on which you would like some help/advise from the group.
   
3. Attendance is mandatory and constitutes 5 % of the final clerkship grade. Any absence must be excused (prior to the session) by the clerkship director.

Expectations of Faculty Facilitators:

1. Facilitate discussion without dominating.
   
2. Assist student in summarizing take-home points.
   
3. Keep the pace on schedule.
   
4. Provide feedback to students on their presentation skills.

Student Evaluation: See above re expectations. Student Ambulatory Report is designed to provide an enjoyable format to achieve the goals listed above, without the pressure of a grade. Students will be given formative feedback on their presentation skills by the faculty facilitator, but this will not be passed along to the clerkship office.

Guidelines for Case Presentation:

Choosing a Case
Cases should be chosen from actual ambulatory patients that students have seen during the Medicine clerkship. They should represent one of the topics on a list of common and important issues seen in the ambulatory setting outlined below, or represent a case about which you learned something you want to share with the group, or represent a challenge on which you would like advise or input from the group. The presentation should emphasize one or more of four aspects of the case:

1. Diagnosis
   
2. Prevention
   
3. Mechanism of disease, and
   
4. Treatment.

• Cardiovascular
  
• Coronary artery disease
  
• Hypertension
  
• Genitourinary
  
• Dysuria
  
• Erectile dysfunction
  
• Geriatric syndromes
  
• Dementia
  
• Falls
  
• Incontinence
  
• Metabolic
  
• Diabetes
  
• Hyperlipidemia
  
• Obesity
  
• Mental health
  
• Depression/Anxiety
  
• Insomnia
  
• Substance abuse
  
• Musculoskeletal
  
• Knee pain
  
• Low back pain
  
• Shoulder pain
  

• Health Maintenance and Prevention
  
• Screening for common diseases
  
• Immunizations
  
• Counseling and Behavior Modification
  
• Smoking Cessation

• Respiratory
  
• Obstructive lung disease (COPD/asthma)
  
• Pharyngitis/Bronchitis/Sinusitis
  
• Undifferentiated complaints
  
• Dizziness/Syncope
  
• Fatigue
  
• Headache
  
• Weight loss

Format for Presentation: