Med Student Electives

Allergy/Immunology
Duration: 4 Weeks

Rotation Description: Monday through Friday, 9 a.m. to 5 p.m. Students will see two new patients in the morning and one new patient in the afternoon scheduled for them on a regular basis. They will complete a history and physical examination, present the case and discuss their evaluations and plans with the staff physicians. Students will also see follow-up patients with ongoing allergy problems. Mechanisms of other various allergic disorders will also be discussed.

Clerkship Objectives: To provide medical student with skills in:
  1. Diagnosis and management of allergic and immunologic disorders;
  2. Improving and learning to apply basic scientific knowledge in a clinical setting.


Anesthesiology
Duration: 4 weeks

Rotation Description: Attend weekdays 6:30 a.m. to 4 p.m. Make rounds with the staff in preoperative assessment, anesthetic management and early preoperative care of surgical patients.

Clerkship Objectives: To learn the basic anesthesia concepts and skills.

Content Covered: Direct involvement in preoperative assessment, intraoperative management and postoperative respiratory care with staff members on a one-to-one basis. ICU care and pain management are also available if the student is interested. At least one hour of the day will be spent in a didactic teaching arrangement with a staff member. Specific aspects of patient care in terms of physics, pharmacology and physiology are emphasized. There is an Anesthesiology Complications Conference the last Wednesday of each month from 6:15 to 7:45 a.m. There is a teaching conference the second Tuesday of the month from 4:30 to 5:30 p.m. A student may learn skills like intubation and insertion of arterial lines, central venous lines and spinal puncture.
Behavioral Medicine
Duration: 4 weeks

Rotation Description: The student will spend each weekday from 9 a.m. to Noon and 2 to 5 p.m. on the Psychiatric Unit or with one of the Gundersen staff. Attendance at the noon general medical education conferences is expected. Visits to other types of treatment facilities, court hearings, etc. will be included as available. Each student will have the opportunity to do the admission history, physical examination and follow through with the treatment of several inpatients; sit in on group therapy and on individual outpatient evaluations; and help with consultations for patients on the general medical-surgical units.

Clerkship Objectives: To acquaint the student with behavioral medicine as it is practiced in a multispecialty group setting; and to give initial experience in doing clinical interviews and mental status exams, in formulating diagnoses and planning treatment and disposition.

Content Covered: An overview of psychiatric practice with children, adolescents and adults, covering a wide range of diagnoses and treatment methods. Cardiology
Duration: 4 weeks

Rotation Description: The student will be responsible for admitting certain patients to the hospital cardiovascular service. The student is expected to perform a complete history and physical examination as well as clinical assessment, including any diagnostic or therapeutic plans. The workup and evaluation of each patient can be the responsibility of the medical student along with either the house staff or attending staff cardiologist. The student is expected to make rounds daily on his/her own patients and, in addition, participate with daily teaching rounds. The student will have the opportunity to assess hemodynamic measurements, cardiac arrhythmia and other pertinent cardiac laboratory information, then incorporating that knowledge into the pathophysiology of cardiovascular disease and clinical management of hospitalized patients. The student may, when patients with interesting clinical problems are admitted in the evening or weekend hours, have the opportunity for participation in the patient’s management as well as evaluation. The student is expected to attend and participate in Friday afternoon Cardiology Teaching Conferences and attend other clinical conferences, when possible, such as Hypertension, Vascular, Lipid Conference and the Echo Conference. In addition, there are monthly EKG Grand Rounds and Cardiology Core Curriculum Conferences.

Clerkship Objectives: Opportunity to learn emergency cardiac medical care of such conditions as acute myocardial infarction complicated by pulmonary edema or cardiogenic shock; life-threatening arrhythmias; malignant hypertension; and dissecting thoracic aortic aneurysm. The student is expected to complement clinical information with a prepared text of selected readings in cardiology. The student will have ample opportunity to correlate cardiac laboratory information, such as diagnostic coronary angiography, hemodynamic monitoring from Swan-Ganz catheterization and results of electrophysiologic testing. The student may desire experience in certain cardiac procedures, although this is entirely optional. Opportunities are available for the student to witness cardiac catheterizations, various types of stress testing, and echocardiograms (both transthoracic and TEE).
Dermatology
Duration: 4 weeks

Rotation Description: Monday through Friday, 8 a.m. to 5 p.m. Clerk will attend all morning and noon educational conferences. Each clerk in Dermatology will be assigned to a staff dermatologist and will see patients with that dermatologist as a preceptor. Emphasis will be on seeing new patients, where the clerk may do the initial dermatologic history and physical and determine a therapeutic course for the patient under the supervision of the staff dermatologist. Besides new patients, the clerk will have opportunities to follow patients with long-term dermatologic problems. There will be departmental didactic conferences emphasizing basic dermatological diagnosis and treatment in addition to the clinic teaching conferences at 8 a.m. and Noon. Breakfast and lunch are provided.

Clerkship Objectives:
To provide a fourth year student with:
  1. Detailed information and description of skin lesions;
  2. Skills in diagnosis and treatment of common dermatologic conditions;
  3. Skills in identification of cutaneous manifestations as they relate to systemic medical conditions;
  4. First hand experience in the use of consultants in a large multispecialty clinic;
  5. An appreciation of simple bedside diagnostic tests to aid in the clinical diagnosis of dermatologic conditions.

Emergency Medicine
Duration: 4 weeks

Rotation Description: Since Emergency Medicine is a specialty with 24-hour patient contact, the hours will be flexible. It is expected that the student will be involved in aspects of other scheduled house staff teaching, especially the morning and noon conferences as well as the in-department Emergency Medicine lecture series three times weekly. This is a clinical rotation with most work shifts in the early and late evening.

Clerkship Objectives: Emergency Medicine provides the fourth-year student with:
  1. The ability to initially assess a patient in an acute situation and to develop history and physical skills;
  2. Development of surgical techniques regarding wound closure and intubation as well as orthopaedic procedures;
  3. Skills in dealing with families of acutely ill patients;
  4. Skills involving psychiatric assessment in the acute situation.

Content Covered: The Emergency Department of Gundersen sees an average of 30,000 patients per year. This affords excellent exposure to medical, surgical and pediatric pathology. The department is the regional trauma center and is staffed 24-hours-a-day with physicians Board-Certified in Emergency Medicine. Double staffing allows one-to-one teaching of medical students with attending physicians, which is one of the strengths of the teaching program. Because the Emergency Department is one of the few settings where a fourth-year medical student may initially evaluate, set treatment goals and plans independently prior to consultation with the attending physician, this rotation allows development of the students’ decision-making skills in a structured setting.
Endocrinology
Duration: 4 weeks

Rotation Description: Monday through Friday, 8 a.m. to 5 p.m. The students will be involved in both the outpatient Endocrine Clinic and the inpatient consultative service. For new outpatients, students will do a complete history and physical examination under direct supervision and instruction. For follow-up patients, they will do a limited history and physical exam. On the inpatient consultative service the student will see consults together with the endocrine resident. Students will regularly attend daily morning and noon conferences, as well as the weekly Endocrine and monthly Diabetes Conference. The students will also have adequate exposure to the Diabetes Education Department.

Clerkship Objectives: To provide fourth year students with skills in:
  1. Evaluation and management of patients with diabetes, thyroid disease and lipid disorders;
  2. Evaluation and management of patients with other endocrinopathies as they present.

Gastroenterology
Duration: 4 weeks

Rotation Description: Monday through Friday, 8 a.m. to 5 p.m. The students will see patients by appointment scheduled for them on a regular basis. They will perform a complete history and physical examination under direct supervision and instruction. The students will also see follow-up patients. The students will regularly attend the daily morning and noon conferences as well as the subspecialty Gastroenterology conferences.

Clerkship Objectives: To provide the fourth year student with:
  1. Skills in diagnosis and management of a large variety of gastroenterological illnesses;
  2. Experience through observation of a variety of gastroenterology procedures.


General Medicine
Duration: 4 weeks

Rotation Description: The students are assigned to a general medicine inpatient service. They will be assigned new patients each day as a subintern, be responsible for their management, and participate in daily rounds with the intern, resident and staff physician. Students will be expected to participate in morning report and attend the core curriculum lectures, weekly grand rounds and weekly house staff case report sessions. Teaching conferences in general medicine, oncology, geriatrics, endocrinology, cardiology, pulmonary medicine, hematology, rheumatology, nephrology, gastroenterology, infectious disease, neurology, psychosomatic disease and medical pathology are held each month. 

Clerkship Objectives: To provide the fourth year student exposure to a variety of illnesses in the field of Internal Medicine and to see that the student serves as an integral member of the team of physicians caring for these patients.
General Surgery
Duration: 4 weeks

Rotation Description: Each student will be assigned to two attending surgeons and work with them for the entire rotation. The student will be working with one or two general surgical residents. The student will, during the time of his/her assignment, be responsible for preoperative and postoperative care of patients, and will participate in surgery with the staff surgeons. The student has an opportunity to follow patients in the clinic.

The student on Surgery ICU will work with a senior resident in the ICU. This rotation is a concentrated experience with trauma and surgical patients who require intensive care. The student will participate in critical care procedures.
Students will be assigned to general surgery unless, upon request and approval of Dr. Thomas Cogbill prior to starting the rotation, they can be on surgery ICU.

Clerkship Objectives: To introduce the student to preoperative and postoperative care and to allow the student to observe surgical procedures. To provide experience in suturing and minor surgical procedures.

Content Covered: The full breadth of general surgery including vascular, endocrine, oncology, gastrointestinal and laparoscopic surgery.
Infectious Disease
Duration: 4 weeks

Rotation: Gundersen for inpatient infectious disease consultation, and common outpatient infections, including HIV infected patients.

Rotation Description: After the morning teaching conference, students will attend rounds with the attending staff and resident for inpatient infectious disease consultation. During these rounds, histories, physicals, diagnoses and therapies of people who have infections will be reviewed. Often at the end of rounds, a brief didactic session will be held on topics of interest and there is a weekly infectious disease case presentation rounds. For those very interested in infectious diseases, there are periodic microbiology inservice literature reviews and a monthly Infection Control Committee meeting.

Clerkship Objectives: To provide the fourth year student with:
  1. Skills in diagnosis and management of common community and hospital infections;
  2. Enhanced knowledge of clinical microbiology and its relationship to infectious disease practice;
  3. Improved general knowledge of infectious disease;
  4. Increased knowledge of preventive health measures including health maintenance such as immunizations;
  5. An introduction to some common outpatient infections and their cost-effective management.

Neonatal/Pediatric Intensive Care
Duration: 4 weeks

Rotation Description: This rotation will consist of admitting, rounding on, and managing patients in the Gundersen Pediatric and Neonatal Intensive Care Units. Rounds in the Peds ICU are generally between 9 and 10 a.m., followed by rounds in the Neonatal Intensive Care Unit. There will be opportunities for managing patients in the emergency department, delivery room and possibly on transport. Call is flexible; it will be worked out with a paging system so that the student can participate in off-hours admissions.

Educational opportunities include the general clinic-wide noon conferences, specific pediatric conferences once per week, monthly OB reviews, and specific topic presentations in the Neonatal or Pediatric Intensive Care Unit.

Clerkship Objectives: The student will:
  1. Observe and participate in the initial evaluation and stabilization of critically ill neonates or pediatric patients;
  2. Participate in the complex decision-making and ongoing management of these patients;
  3. Learn and perform neonatal or pediatric procedures based on interest and skill level.

Nephrology
Duration: 4 weeks

Rotation Description: The student will make hospital and dialysis rounds weekdays between 8 a.m. and noon. In the afternoon between 1 and 3 p.m., the student will spend time with the instructor seeing a few of the renal patients in the clinic.

Clerkship Objectives: To learn "basic" nephrology.

Content Covered: In the period of four weeks, the senior medical student will see patients with a variety of nephrology/renal disorders. Some didactic instruction and teaching will be given in the following fields, among others:
  1. Assessment of hematuria
  2. Assessment of proteinuria/nephrotic syndrome
  3. Assessment and treatment of hypertension
  4. Assessment and treatment of hypo/hyperkalemia
  5. Assessment and treatment of hypo/hypernatremia
  6. Acid base disorders
  7. Assessment and treatment of urinary tract infections
  8. Basic instruction covering dialysis, both hemo- and peritoneal

Neurosurgery
Duration: 2-4 weeks

Rotation Description: Full-time Monday through Friday, 7:30 a.m. to 6 p.m. Emergency call hours will be arranged according to the wishes of the students. Depending on the length of their rotation, students will rotate with the staff neurosurgeons and nurse practitioner. When in the office, students will see patients, go to the operating room, and if they wish, attend emergency cases when the neurosurgeon is called for emergencies. It is expected that this will be a very close one-on-one teaching relationship. At the beginning of the rotation, students will be given an outline of what they are expected to learn by the end of the rotation.

Clerkship Objectives: To provide fourth year medical students with:
  1. A general overview of the concepts of medical and surgical management of common neurosurgical problems;
  2. An opportunity to pursue specific clinical problems in-depth with one-on-one tutelage from the staff.

Orthopaedic Surgery
Duration: 2-4 weeks

Rotation Description: Full-time, every day, 24-hours-a-day. The student will be assigned to one of the orthopaedic surgeons in blocks of two-week rotations. The exact mixture of the rotations will depend upon the interest of the student. At least one rotation must be in general orthopaedics. The students, along with the orthopaedic surgeon, will see patients. These patients have appointments, arrive as extras or arrive through the Emergency Department. Initially, this will be observational learning, but soon, the student will be expected to gather the history, do a physical exam and formulate a plan of management—to be reviewed by the orthopaedic surgeon. The student will also be expected to do preoperative history and physical exams for patients undergoing surgery and participate in the surgical operations scheduled by that particular orthopaedic surgeon. Schedule permitting, the student can attend the Noon luncheon conferences, but usually not on surgical days.

In addition to completing a two-week rotation on General Orthopaedics, the student will be given the option of taking a one- to two-week rotation in any one of the Orthopaedic Surgery subspecialty areas (hand, pediatrics, sports medicine, reconstructive and/or foot and ankle). The student may elect to spend the entire rotation in General Orthopaedics.

Clerkship Objectives: To provide the fourth year student with:
  1. Skills in diagnosis and management of a large variety of musculoskeletal diseases and injuries;
  2. Skills in obtaining a history and physical exam and integrating it with a plan of management. This includes the use of X-rays and laboratory tests;
  3. Improved knowledge of musculoskeletal terminology;
  4. Experience in applying and removing casts. This includes the safe operation of cast tools and cast care management;
  5. First hand experience in outpatient and Emergency Department management of musculoskeletal disorders;
  6. Knowledge of the management of common fractures, dislocations, sprains and strains;
  7. Exposure to one or more subspecialty areas to meet the same objectives as outlined above for General Orthopaedics;
  8. First hand experience in the practical aspects of both outpatient and inpatient orthopaedic surgery including interactions with the paramedical personnel and administrative relationships.

Otolaryngology
Duration: 2-4 weeks

Rotation Description: The student will be assigned to a staff person on a weekly basis and will be responsible to that staff member. He/she will accompany the staff member on rounds, assist and participate in surgery, as well as assume increasing responsibility in the outpatient clinical evaluation of patients. He/she may be requested to present patients during weekly grand rounds and may be invited to participate in emergency situations where appropriate, although no night call is required.

Clerkship Objectives: The minimal objective is to have the student achieve proficiency in the physical examination and management of common otolaryngologic problems. In addition, he/she will have exposure to clinical and surgical otology, head and neck oncology, as well as facial plastic surgery.
Podiatric Medicine and Surgery
Duration: 4 weeks

Rotation Description: Each day the student is invited to attend educational conferences sponsored by Gundersen Medical Foundation from 7:30 to 8:30 a.m. and from 12:15 to 1 p.m. At 9 a.m., the student reports to the Department of Podiatric Medicine, where patients are seen in the clinic until approximately Noon. In the afternoon, the student will either report back to Podiatric Medicine to see clinical patients or will be involved with surgical patients. Each student spends one week with each of the instructors and may also spend time with the senior resident. The student will eventually provide completed evaluation of patients and will also perform certain procedures such as digital blocks, phenol and alcohol procedures, posterior tibial nerve blocks, cast application, and will certainly be exposed to the biomechanical evaluation. During the last week of the rotation, the student is responsible for a 15-minute presentation with slides. The topic will be assigned during the rotation. This is generally based on an interesting case he/she has seen during the time spent here.

Clerkship Objectives: To provide fourth year podiatric and medical students with surgical and clinical skills, to expose them to as much podiatric pathology as possible, and to teach current treatment regimens.
Pulmonary Medicine
Duration: 4 weeks

Rotation Description: The student will participate in the care of critically ill patients with pulmonary problems in the Intensive Care and Coronary Care Units as well as those on the general hospital wards. Attending physician rounds will be made twice daily. Consultations and admissions to the Pulmonary Service will be seen by the student, in conjunction with a member of the house staff, and presented to the attending physician. Orders may be written by the student and countersigned by the house staff. Physical diagnosis will be stressed at the bedside. The student will gain experience in the management of critically ill patients and ventilator-dependent patients. Daily rounds will incorporate instruction at the bedside followed by an informal didactic session on selected topics as time allows. Reference, suggestions and library time will be provided. The student will be encouraged to attend one afternoon Chest Clinic per week, during which time he/she will see outpatients with pulmonary disorders as well as patients with a variety of sleep disorders. The student will be expected to attend weekly chest and sleep conferences. There will also be a monthly lung cancer conference and a pulmonary rehabilitation conference. The student will also be provided with the opportunity to spend one afternoon per week in the pulmonary physiology laboratory and instruction on the interpretation of pulmonary function tests and review of studies. Arterial blood gas interpretation will be covered on a clinical patient basis. The student is encouraged to be on call along with the senior resident for nighttime critical care coverage.

Clerkship Objectives:
  1. To acquaint the student with a wide variety of pulmonary disorders and enable the student to improve his/her skills in the clinical and laboratory assessment and management of patients seen on an active pulmonary service. All of the common and a great many of the not-so-common pulmonary diseases will be seen during the four weeks. Experience in acute care is included. Workups are evaluated by house staff and by attending staff. Daily attending rounds are held with didactic discussions;
  2. Perform procedures such as thoracentesis and arterial puncture. Other procedures that may be done or observed by the student include: pleural biopsy, endotracheal intubation, indirect laryngoscopy, fiberoptic bronchoscopy (teaching scope available), needle biopsies and chest tube thoracostomy. Sputum analyses and skin testing are also performed;
  3. To provide a better understanding in the interpretation of chest X-rays, lung scans, CT scans, arterial blood gases, pulmonary function testing and pulmonary exercise testing;
  4. To enable the student to become more adept in the treatment of acute and chronic pulmonary diseases by having a better understanding of therapeutic methods including home care programs, the use of oxygen, antibiotics, bronchial hygiene, IPPB, ventilatory support, bronchodilators and chest tube thoracostomy.
  5. To provide exposure to sleep disorders medicine including sleep-disordered breathing and other common conditions.

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