Rotation Description
The academic year is composed of four 12-week block rotations. In each 12-week block, four weeks are spent at Thomas Jefferson University and two four-week blocks on separate floors are spent at Lankenau Hospital.

The third-year medical students are assigned to a team that includes four first-year medical residents and two second- or third-year medical residents. The senior medical residents are responsible for assigning the third-year students to their own patients and for their supervision.

The senior residents make daily rounds with the students and review the third-year students’ patients. Upon completing rounds the residents meet with the students to discuss a topic pertinent to one of the student’s patients. Articles from current medical journals are also discussed at this time. During one of the eight weeks at Lankenau, the student will spend one week on an outpatient rotation at a primary care internal medicine physician’s office at or near the hospital.

Lecture Series
Each day the student will attend a noon teaching conference. Half of these conferences are specifically intended for the third-year medical students on topics chosen from the Jefferson Medical College curriculum. The lecture is given by one of the attending physician sub-specialists in his or her field of expertise. For the other half of the noon conferences, junior and senior students join medical residents for a didactic lecture by an attending sub-specialist on a specific medical topic.

Average Patient Load
Third-year medical students are assigned to three patients not followed by other students or interns. The student is responsible for the performance and recording of a detailed medical history and physical examination. This remains in the patient’s chart permanently. The senior resident reviews the history and physical of the patient with the student and assists the student with writing orders. The student follows the patient daily and writes progress notes relative to the interval history and physical examination. The senior resident and the attending physician review this.

Preceptorship
Each third-year medical student is assigned to a preceptor for tutorial instruction during each four-week block. Two students are assigned to each preceptor. The students meet with the preceptor twice a week to discuss the patients assigned to them by the residents. Emphasis is placed on the quality and detail of medical history taking. Physical findings are reviewed at bedside. Discussion then takes place regarding diagnosis and the approach to patient management.

Work Hours
Due to the full daily educational schedule, it is wise for the student to begin the day at 7:00 a.m. The usual teaching schedule finishes around 5:00 p.m. Monday through Friday. Students do not have to come to the hospital on Saturdays or Sundays unless they are on call. However, students are given the opportunity to come in on Saturday morning to see their three patients with the resident.

Night Call
Night call usually occurs once a week. When on call the third-year student is assigned to a new patient in the mid-afternoon and performs the complete work-up including history, physical examination and order writing. This patient is then added to the student’s list of patients to follow. When this experience is complete, the student is assigned to a first-year resident, working in tandem until approximately 10:00 p.m. The student can then leave or continue working with the resident. Overnight sleeping quarters are available should the student prefer to stay overnight.

Number of Students on Rotation
During each four-week block there are usually eight third-year Jefferson medical students on the internal medicine rotation. There may be as many as 30-40 students at Lankenau at any one time on various rotations. These may include senior students on internal medicine rotations or on any number of the many subspecialty medical electives. Jefferson students also rotate through Lankenau on ob/gyn, surgery and surgical subspecialty rotations. There are also electives in radiology, neurology, physical medicine, critical care, dermatology, and outpatient medicine.

Procedure Exposure
Students will observe and then perform supervised procedures such as thorocentesis, paracentesis and lumbar punctures. They will be able to accompany their patients to echocardiography, electrophysiology, pulmonary function labs and cardiac catheterizations. Third-year students are encouraged to attend the weekly radiology teaching conferences for the medical house staff.

Description of a Typical Day
A typical day for a third-year student begins at 7:00 a.m. The student is invited to attend Morning Report at 7:15 a.m. Rounds are then held with the senior resident to review the student’s patients. Teaching rounds are held Monday through Thursday at 8:45 a.m. for each team on each floor with an attending physician. The student will have his or her tutorial instruction twice each week and attend daily noon conferences. A national authority on a medical subject presents grand rounds each Friday morning at 8:00 a.m. At 9:30 a.m. this expert meets with the medical house staff, who present cases in that field of expertise until 11:00 a.m. The afternoon involves completing unfinished morning responsibilities or working up patients. The afternoon ends with sign out on each floor at 4:00 p.m., whereupon the group discusses all patients on the team. Once a month the student joins all members of the Department of Medicine for morbidity and mortality case discussions.

Contact Information

Cheryl Gibbs, Medical Student Clerkship Coordinator

(610) 645-2008 or gibbsc@mlhs.org