Internal Medicine
Medicine Student Programs
Assistant Director: Angie Wick
Phone: 206.543.3237
Email: angwick@uw.edu

Block Calendar:
All Medicine rotations are four (4) weeks in length. Your clerkship dates must correspond with our Clinical Elective Schedule . You must start at the beginning of the block(s) and finish at the end of the block(s).

Prerequisites for all Medicine Elective Clerkships listed below:
Basic Science courses, third or fourth year medical student standing, and completion of twelve weeks internal medicine rotation(s).

To Apply:
  1. Complete the VSAS application and upload all supplemental materials to VSAS. No action will be taken on an application until it is complete. Applications must be received at least 6 weeks prior to the start of the requested clerkship date.
  2. Availability cannot be given until 6 weeks prior to the rotation start date. Please do not send inquiries about availability.
  3. Scheduling is done on a first come, first served basis, in the order that complete applications are received. Departments may not "pre-enroll" or hold spaces for potential visiting students, regardless of their intent or qualifications.
  4. SPACE IS LIMITED. To increase chances of receiving an elective offer, students should apply for and rank multiple Medicine electives in VSAS. 
  5. If space is available, students will be matched to open elective rotations and notified via VSAS no earlier than 6 weeks prior to the beginning of the elective.
Cancelations:
You must withdraw at least 6 weeks before your starting date. Fees are non-refundable. All cancelations and changes must be made in writing to the department contact listed above.

 

Ward Medicine Subinternship - MEDECK 601 Seattle or MEDECK 671 Boise, Idaho 

Students will serve as interns on the medical wards under supervision of house staff and attending physicians. They will attend all regular medical rounds and conferences as their schedule permits. Students are given responsibilities commensurate with those of interns under supervision by the Resident and Attending Staff. At Seattle Veteran’s Administration Medical Center, University of Washington Medical Center, and Harborview Medical Center or at the Boise Veteran Affairs Medical Center in Boise Idaho (MEDECK 671, prerequisite – all MD students will be considered, all DO students will be considered if they have either taken and passed the USMLE Step 1 board exam or taken and received a COMLEX score > 520).

Conjoint 677 – Clinical Allergy and Immunology

Clinic and office experience in diagnosis and management of asthma and allergic diseases. Conferences and hospital consultations on clinical immunology and allergy.
NOTE: Means of transportation between various teaching sites will be necessary.

MEDECK 603 – Clinical Cardiology and Electrocardiography

Clerkship in clinical cardiology at University of Washington Medical Center, Harborview Medical Center, Seattle VA Medical Center.

The UWMC Cardiology team consists of three third- and fourth-year medical students, residents, fellows, and attendings. Students read electrocardiograms with an attending physician daily, see cardiology consultations, and observe cardiac catheterizations, angioplasties, and echocardiograms. They are invited to examine all patients who come in for catheterization or echocardiography, thereby increasing their knowledge of cardiovascular examination.

The HMC cardiology clerkship is intended to orient the student to the basics of cardiology. The students see consultations and present the cases to the residents and attending physician. Rounds are didactic in nature, but also cover daily practical care in cardiology problems. The students attend rounds in the coronary care unit and there is an option for one student to spend full time in the coronary care unit. Students are expected to gain insight into the utility of several invasive and non-invasive diagnostic tools. Each student reads a number of electrocardiograms each day with a daily ECG review session. Cardiology clinics and teaching conferences are held weekly.

A one-month cardiology clerkship at the Seattle VA Medical Center is available to three fourth-year medical students each period. Students see cardiology consults, follow patients on the medical ward and CCU and ready ECG’s nightly. The opportunity to review cardiac catheterization data and coronary arteriograms is also available. Ward and CCU rounds are held daily at the bedside. There are numerous teaching conferences and involvement in both invasive and non-invasive diagnostic procedures. 

MEDECK 604 – Clinical Dermatology

Participation in dermatology clinics and inpatient consultations at the in University of Washington Medical Center, Harborview Medical Center, and the Seattle VA Medical Center. Journal Club and clinical conferences are held each week with entire staff in addition to a continuing series of teaching seminars and weekly dermatopathology conferences.

Objectives
At the end of the clerkship, the student will be able to:

  • Evaluate patients seen in consultation with a member of the Dermatology Inpatient Consulting team.
  • Demonstrate basic approach to the diagnosis and management of the most common skin problems.
  • Discuss basic principles and practice of oral and topical dermatologic therapy with wet dressings, steroids, emollients and antipruritic therapy.
  • Recognize major life-threatening skin diseases and markers of systemic disease.
  • Utilize dermatologic vocabulary in order to generate clinical differential diagnoses and accurately describe a rash or a lesion when requesting consultative services.
  • Recognize common skin tumors, and understand appropriate diagnostics tests used in dermatology.
  • Demonstrate appropriate history-taking and general physical examination with special attention to examination and description of the skin.
  • Construct write-ups and oral presentations to be as precise and efficient as possible in communication about patients.
  • Perform special diagnostic procedures (KOH, Tzanck test, patch test, skin biopsy) to assist in delineating patients’ problems.

MEDECK 605 – Clinical Endocrinology and Metabolism

This clerkship makes use of a number of teaching sites in Seattle, including the University of Washington Medical Center, Harborview Medical Center, and the VA Medical Center. Students will see inpatient consults with an Endocrine Attending and Fellow, and attend a variety of outpatient clinics. The outpatient experience includes subspecies clinics in metabolic bone disease, intensive diabetes management, and atherosclerosis prevention. Students will also spend several half days per week in the office of an endocrinologist in private practice. Finally, each student will select a topic for a reading project in endocrinology. The results of the student’s literature review will be discussed at a post-clinic conference at some point during the month.

For any of the above rotations, the student should be able to perform and interpret a history and physical examination without instruction. Emphasis on rounds and in the clinic is on basic endocrine clinical pathological correlation and its application to the practical aspects of patient care.

NOTE: Means of transportation between various teaching sites will be necessary.

MEDECK 606 - Clinical Gastroenterology

Goals:
Students acquire in-depth experience in clinical gastroenterology, with close mentoring by members of the Gastroenterology faculty and are exposed to a broad range of state-of-the-art diagnostic and therapeutic endoscopic procedures.

Objectives:
At the end of the clerkship, the student will be able to:

  • Evaluate patients seen in consultation with a member of the Gastroenterology Inpatient Consulting team.
  • Discuss and identify underlying pathophysiologic mechanisms of GI diseases with GI illness and complaints.
  • Discuss the capabilities as well as limitations of endoscopy in clinical practice.
  • Discuss appropriate indications and contraindications for endoscopic procedures.
  • Discuss key elements for providing excellent consultative service in Inpatient medical care.

Description: Students join and become responsible members of the Gastroenterology Inpatient Consulting team at one of the three teaching hospitals of the University of Washington (UWMC, HMC, VA).

Schedule: Weekdays, work hours to be determined by Attending Physician. No night or weekend responsibilities.

Conferences: Teaching rounds with the Attending and Senior Fellow are held 5 days per week. Assigned cases are presented to the full team, and thereafter followed regularly by the student. Students are strongly encouraged to attend regularly scheduled GI educational conference (Fridays, 7:30-10 am).

Presentations: At the discretion of the Attending physician.

Readings/texts: A syllabus containing reading material reprints is available for purchase.

MEDECK 607 – Clinical Hematology/Oncology

This clerkship is taught at the University of Washington Medical Center, Harborview Medical Center, and the Seattle VA Medical Center. At each hospital the hematology-oncology elective consists of one month of training during which students work up patients in the inpatient and outpatient services under supervision of a clinical Fellow and the faculty of the Divisions of Hematology and Oncology. General hematology and oncology problems are evaluated at all hospitals but special opportunities for hemostasis problems and HIV-related disorders are available at Harborview and bone marrow transplantation at the VA Medical Center.

MEDECK 608 – Clinical Infectious Diseases

Inpatient consultation services at the three medical centers (UWMC, HMC, VAMC) are staffed by members of a large faculty and fellowship program. Students see 3 - 5 new patients per week and make daily rounds with an infectious disease fellow and/or medicine resident. Formal attending rounds are held 3 - 5 days per week with additional sessions for urgent patient problems and teaching. Medical microbiology conferences are held regularly at all sites, and there is a weekly interhospital clinical conference. Emphasis of the clerkship is on the varied diagnostic and therapeutic challenges prevalent in general hospitals. The Infectious Disease rotation at HMC involves inpatient consultations under the supervision of faculty, infectious disease fellows and residents, and may involve the opportunity to work with faculty and staff in the STD clinic, Hansen's Disease Clinic, and the TB clinic.

MEDECK 609 – Nephrology and Fluid Balance

A nephrology/fluid balance clerkship at University of Washington Medical Center, Harborview Medical Center, and the Seattle VA Medical Center. It is a one-month elective for third- and fourth-year medical students who will see clinical nephrologic problems under close supervision. They participate in nephrology rounds, see consults with renal fellow and attending, and work up patients in renal clinics. They also attend a series of seminars throughout the clerkship in which clerkships at all three hospitals participate.

MEDECK 610 – Clinical Respiratory Disease & Critical Care Medicine

Students are assigned to the consultation service in Respiratory Disease and Critical Care Medicine at one of three teaching hospitals (UWMC, HMC, and VAMC). They will gain training and experience in respiratory disease diagnosis and management with emphasis on x-ray diagnosis, pulmonary function testing and interpretation, and use of fiberoptic bronchoscopy. The services are fully integrated with Respiratory Therapy for management of continuous mechanical ventilation and use of inhalational and physical therapy. Patients are seen by the students under supervision of a Fellow, and presented to the Attending. Students from all hospitals will attend a weekly Chest Grand Rounds, a Respiratory/Critical Care teaching conference, and a series of eight student seminars covering basic topics in clinical respiratory medicine. Students will participate in pulmonary function testing and, at some sites, one half-day outpatient clinic. 

MEDECK 612 – Clinical HIV Care

The purpose of this elective is to provide students with an intensive one-month experience caring for HIV-1 infected patients. The development of potent antiretroviral therapy has led to marked reductions in morbidity and mortality due to HIV-1 and has shifted the care of infected patients from the inpatient to the outpatient setting. Nevertheless, individuals with limited access to medical care do not benefit from these therapies and often present late in the course of their HIV infection and require hospitalization. Institutions such as HMC that provide care for under-insured and uninsured patients still manage significant numbers of HIV infected inpatients with opportunistic infections and malignancies. The Madison Clinic at HMC provides outpatient care to HIV-infected persons with an emphasis on the management of antiretroviral therapy, prophylaxis of opportunistic infections and treatment of the complications of HIV infection. Students will split time between the Madison Clinic and the inpatient services each day. Exposure to inpatient HIV patients will take place by interfacing with the infectious diseases consult service for 1-2 hours most days. Students will split their time between the Madison Clinic (Harborview HIV Clinic) and the inpatient HIV consult service. Student will usually see patients and interact with providers and the attending physician in the Madison Clinic at the beginning (8:30 - 11:00 am) and end (2:30 - 5:00 pm) of each day. Mid-day (11:00 am - 2:30 pm) students will round on HIV+ inpatients and interact with the ID/HIV consult service. Daily schedules vary considerably depending on the activity of the inpatient consult service, the clinic and the particular interest of the student.

Students will have the opportunity to visit a Washington State prison 1-2 days during the month to learn about the care of incarcerated HIV+ patients and their transition back into the community. This activity is coordinated by Dr. Lara Strick who provides care for all HIV+ inmates in the Washington State Department of Corrections. Dr. Strick is a member of the UW clinical faculty and a regular provider at the Madison Clinic. Interested students should contact Dr. Strick at strick@u.washington.edu to discuss transportation to and the requirements for visiting one of the prisons.

Readings/texts:
Students will be provided an HIV manual constructed by the clinic. The manual contains reprints covering anti-retroviral therapy, treatment and prophylaxis of opportunistic infections and standard-of-care guidelines for HIV infected patients.

By the end of the rotation students are encouraged to have completed the online HIV case studies posted on the website: "HIV webstudy"

MEDECK 615 – Rheumatology

Elective provides third- or fourth-year students experience in the diagnosis and management of patients with rheumatic diseases. Students will attend outpatient clinics at the University of Washington Medical Center, including the Bone and Joint Center, Harborview Medical Center, or VAMC, and will participate in inpatient consultation. In addition to patient contact, four or five preceptorial sessions are held each week. These seminars cover rheumatic diseases in depth. The topics include: joint examination, laboratory tests in rheumatic diseases, examination of synovial fluid, radiology of rheumatic diseases, rheumatoid arthritis, hyperuricemia, gout, systemic lupus erythematosus, degenerative joint disease, spondylitis, vasculitis, and polymyalgia rheumatica. These sessions emphasize disease mechanisms as well as diagnostic and therapeutic aspects. During the 4-week period, students have ample time for independent reading. Students work closely with faculty and staff of the Division of Rheumatology throughout the 4-week elective.

Paper:
All students will be expected to do a 3-5 page paper on a topic approved by the rheumatology consult attending. In addition, students will be expected to present a weekly topic during inpatient rounds for 5 minutes that is literature based and pertains to a patient issue approved by the consult fellow.

Evaluation:
The grade of Honors will require an honors level paper and presentations and agreement of faculty and fellows in addition to honors level clinical performance.

NOTE:  Be prepared to travel between UW Medical Center, Harborview Medical Center, and VA Medical Center.

MEDECK 618 – Medical Consultation

At Harborview Medical Center, this full-time elective in peri-operative medical consultation will involve both inpatient and outpatient care. Students will see patients in the Medicine Consult Clinic and follow patients daily when they come in surgery. The student will operate as a member of the consult team, working closely with residents and attending to evaluate surgical and psychiatric patients on a consultative basis in the emergency room, as outpatients and inpatients.

MEDECK 620 - Critical Care Subinternship

Goals:

 

  • To learn how to evaluate and manage patients with different forms of critical illness including respiratory failure, hypotension, sepsis, organ failure and gastrointestinal hemorrhage
  • To learn how to initiate and manage invasive and non-invasive modes of mechanical ventilation
  • To learn how to interpret and apply the results of arterial blood gas analysis
  • To learn how to protect patients from complications associated with stays in the intensive care unit
  • To learns about the application of palliative care medicine principles in the intensive care unit setting
  • To learn to work as part of a multidisciplinary care team

Objectives:
At the end of the clerkship, the student will be able to:

  • Evaluate and manage patients with various forms of respiratory failure including COPD and asthma exacerbations, pneumonia, acute respiratory distress syndrome and pulmonary edema
  • Evaluate and manage patients with sepsis and severe life-threatening infections
  • Evaluate and manage patients with severe organ failure including renal, hepatic and coagulation failure
  • Evaluate and manage patients with gastrointestinal hemorrhage
  • Evaluate and manage patients with severe hypotension
  • Evaluate and manage patients with severe metabolic and endocrinologic disturbances
  • Initiate appropriate empiric antibiotic coverage for patients with severe infections
  • Initiate and titrate vaso-active medications
  • Initiate and manage both invasive and non-invasive modes of mechanical ventilation
  • Interpret arterial blood gases and apply this information in the care of patients
  • Initiate appropriate measures to prevent complications associated with ICU care
  • Apply the principles of palliative care medicine to patients in the intensive care unit

Schedule: 7:30 am - 5:00 pm Sign out rounds. Overnight call every fourth night.

Presentations: Students are expected to write all admission and daily progress on their patients and to communicate with consultants and other providers that are part of the multidisciplinary MICU team.

Readings/texts: There is no required reading for the clerkship. Sub-interns are, however, expected to read materials relevant to the care of their patients and other patients on the service as time permits during their rotation. Available sources of reading materials include:

  • The MICU team has a small library maintained by the Section of Pulmonary and Critical Care Medicine located in the MICU team room. There is also a hospital library available 24 hours a day. The Division syllabus containing selected articles relevant to the rotation is maintained there.
  • Electronic Syllabi: Two electronic syllabi are available for use by the sub-intern. Each syllabus contains a variety of primary research and review articles pertinent to pulmonary and critical care medicine
  • Students may also access the website that has been created for MEDECK 610, the 4th year student clerkships in Pulmonary Medicine which contains a large volume of teaching materials relevant to critical care medicine. The URL for this website is:  http://courses.washington.edu/med610/index.html
  • Suggested textbooks:
    • Principles of Critical Care, 3rd Edition: Hall JB, Schmidt GA and Wood LDH eds. New York: McGraw-Hill. 2005. This is a large comprehensive textbook that is good for looking up specific topics. It is too expensive to consider purchasing for this rotation but is available in the MICU team room.
    • The Intensive Care Unit Manual. Lanken PN, Hanson W, Manaker eds. Philadelphia: W.B. Saunders. 2001. This is a much smaller textbook and something that is worth considering for purchase. It is an excellent source of condensed information.