Internal Medicine Clerkship Guide
Internal Medicine clerkship can be a challenging, but incredibly rewarding experience for PA students. It is a core rotation that usually ranges between 4-6 weeks.
As a clinical clerk, you will have the opportunity to work closely with patients and other providers, putting into practice what you’ve learned in the classroom and developing your skills as a future PA!
Here we’ll cover:
What is Internal Medicine? Definition of the specialty, common conditions seen in Internal Medicine and practice settings.
Typical schedule in Internal Medicine: See an example of a typical daily and weekly schedule in Internal Medicine
Clerkship responsibilities in Internal Medicine: How to get started in your orientation, what you’ll do in Internal Medicine (expectations and responsibilities of clerks), opportunities for learning
What to Bring: Dress code, essential medical equipment and optional items.
Documenting Patient Encounters: Tips, and types of medical documentation in Internal Medicine
How to Study during your Internal Medicine rotation: How to review materials, background reading before the rotation, setting aside time to study, and reading around cases.
Favourite Resources in Internal Medicine: Recommended Apps, Books and Online Resources
I. What is Internal Medicine?
Definition of Internal Medicine
Internal Medicine is a medical specialty that focuses on the diagnosis, treatment, and management of adult medical conditions that require more close monitoring and treatment than in a primary care setting.
The Internal Medicine department is typically composed of several different subspecialties, including cardiology, pulmonology, endocrinology, gastroenterology, respirology, nephrology, rheumatology, and more. Clinical clerks will usually do the core rotation in General Internal Medicine (GIM).
Common Conditions/Presentations in Internal Medicine
Undifferentiated complaints/findings: chest pain, shortness of breath, abdominal pain, GI bleed, dizziness, altered mental status, fever, abnormal labs (e.g. anemia, electrolyte abnormalities such as hyponatremia, hypokalemia, acid-base abnormalities)
Cardiovascular disease: conditions such as chest pain, peripheral edema, hypertension, coronary artery disease, angina, heart murmur, syncope, valvular heart disease, vascular disease, heart failure, and arrhythmias (Atrial Fibrillation),
Pulmonary disease: shortness of breath, chronic obstructive pulmonary disease (COPD), asthma, pulmonary embolism, interstitial lung disease, pleural effusions, lung cancer and pneumonia.
Gastrointestinal disorders: conditions such as peptic ulcer disease, inflammatory bowel disease, and gastroesophageal reflux disease (GERD), splenomegaly, cirrhosis, pancreatitis, diarrhea, acute GI bleed
Endocrine disorders: conditions such as diabetes mellitus and related emergencies (diabetic ketoacidosis), thyroid disorders, and adrenal insufficiency.
Infectious diseases: conditions such as pneumonia, urinary tract infections, osteoyelitis, sepsis, infective endocarditis, meningitis and skin and soft tissue infections (e.g. cellulitis), and nosocomial infections (hospital-acquired infections e.g. C. Difficile). Learn your bugs and drugs - be sure to review general principles of antimicrobial therapy (empirical vs broad-spectrum antibiotics).
Neurological Disorders: headache, delirium, dementia, seizures, TIA and stroke
Renal Disorders: AKI, CKD, hematuria, glomerular disease
Hematological disorders: conditions such as anemia, thrombocytopenia, sickle cell anemia, work up of lymphoma or leukemia, venous thromboembolism, pulmonary embolism
Description of Practice Settings
Inpatient units: A GIM inpatient unit refers to a General Internal Medicine inpatient unit, which is an inpatient ward within a hospital. Conditions that patients present with here are usually higher acuity and require more close followup with hospitalization for diagnostic tests, treatments, and management of acute or chronic medical conditions.
GIM Outpatient Clinics: internists not only work on the ward, but can also run outpatient ambulatory clinics. These patients are often referred by a primary care provider for consult or ongoing management and follow-up for more complex conditions, or for followup after hospitalization at the GIM inpatient unit.
A few of the clinics can include:
Medical Consult Clinic: A specialized clinic where patients are seen by internal medicine specialists with expertise in the diagnosis and treatment of complex medical conditions. The focus is to provide expert advice and recommendations to other health care providers such as primary care providers or other specialists.
Ambulatory Care Medical Clinic: Ambulatory care medical clinics are outpatient clinics that provide medical services to patients who do not require hospitalization. An ambulatory care clinic provides primary care services, preventive care, and ongoing management of chronic conditions to patients.
Rapid Referral Clinic: Follow up with patients after they leave the Emergency Department with the goal of reducing number of patients returning to ED for follow-up care.
Discharge follow-up clinic: For patients previously admitted to inpatient GIM unit, who will receive follow-up after discharge.
II. Typical Schedule in Internal Medicine
GIM Inpatient Unit, Typical Day
Clinical clerks are typically assigned several patients (e.g. 1-4 to start) on their Clinical Teaching Unit (CTU). The number of patients assigned to you depends on the number of HCPs on your team to divide up the patients as well as your comfort level. You are expected to be the expert on these patients!
Morning Clinical Clerk GIM Responsibilities
Pre-Rounding/Morning Rounds (chart review and bedside assessment). Pre-rounding takes place before morning rounds, where you find out about overnight events, and assess each patient you will present at rounds. Clerks can do a review of the patient’s chart examining nursing notes, flow sheets, consultant notes, as well as checking in with the patient and overnight nurse. See the next section “III. Clerkship Responsibilities - Pre-rounding” on what to review!
Run the List. This is where you meet with the healthcare team to discuss status and progress. This goal is to ensure care is coordinated and to discuss any concerns or changes in the patient’s condition. There may also be a discussion of new admissions overnight. See the next section “III. Clerkship Responsibilities - Rounding” for tips on how to case present!
Interprofessional Rounds: Also known as bullet rounds. Interprofessional rounds are a collaborative approach to patient care that involves multiple healthcare professionals working together to make decisions and plan treatment for patients.
Lunch
Lunch Break
OR Lunch and Learn (Interspecialty Rounds): These are teaching rounds where medical professional can attend a presentation or discussion on a relevant medical topic to enhance their knowledge. This is common in academic hospitals/teaching hospitals.
Afternoon Clinical Clerk GIM Responsibilities
Afternoon Rounding/Team Bedside Rounds
This is where medical staff (including clinical clerks) visit GIM inpatient unit patients in their hospital rooms to assess their conditions, review their treatment plans, and make any necessary adjustments. This is to recap any patient issues. Clinical clerks provide case presentation providing an update and changes to treatment plan, and receive input from the team.
Complete outstanding tasks, which may include:
Written Communication through Patient Documentation: Catch up with writing progress notes of the patients you are overseeing. The progress note should be reflective of the patient’s current status and any updates to the plan. Be sure to acknowledge the plan for each of the different issues that each patient presents with.
Facilitating Patient Discharge: Here you will be planning and coordinating the release of a patient from the hospital to continue their recovery at home. This includes completing discharge orders, paperwork and prescriptions.
Family meetings/Updating patients and families means to provide them with the latest and most accurate information regarding the patient's condition, treatment plan, prognosis, and any other relevant details
Follow-up on results: Check and make sure that the results of any tests, procedures, or assessments performed on a patient have been received and reviewed. The information obtained from the results is then used to inform the patient's care plan and make decisions about their treatment and management.
Handover to the evening Team (at end of the day): Handover refers to the transfer of responsibility, accountability, and authority for a patient's care from one healthcare provider to another. This can be done in the morning (evening shift to morning shift HCPs) or evening (day shift to evening shift). This can sometimes be called “running the list”. It’s important to include clinically important issues (e.g. change in clinical status such as abdo pain, fever; abnormal labs, consultant recommendations, advanced directives, or adverse events).
IV. Clerkship responsibilities in Internal Medicine
Getting started in Internal Medicine
Familiarize yourself with the structure of the department and the medical team. How many clinical teaching units (CTU’s?)? How is each day structured?
Learn about the expectations for rounds and patient interactions. Discover the expectations that your residents and supervisors have of you, strive to meet and surpass those expectations, and ensure the completion of each assigned task.
Get to know your attending physician and other healthcare professionals you will be working with. Introduce yourself to all the staff you’ll be working with, identifying yourself as a PA student/clinical clerk.
Read about the conditions and issues your patients are facing. Whether that’s revisiting basic anatomy, pathophysiology to gain a better understanding of clinical presentation, physical exam, investigations, diagnosis and management. Supplement your learning with textbook review/case-based questions. You can then approach your patients with a more informed perspective and better address their needs!
Practice Clinical Reasoning: You will start with getting a complete history and physical of your patients. With time, go beyond memorizing checklists of questions to ask on history, or points on a physical exam.
What you’ll get to do in Internal Medicine
Patient Assessments: This includes history taking, physical examinations, interpretation of investigations, formulation of a differential diagnosis and treatment plan. You’ll be expected to develop clinical reasoning skills and diagnostic decision-making. You will also get practice with performing case presentations to your attending!
Pre-Rounding: Pre-rounding is where you as a clinical clerk check in on the patients you are tracking before formal patient rounds. You can do this through chart review and checking in with the patient and overnight nurse. Doing this will help you provide pertinent updates during rounds, and prioritize how much time you will spend with patients and in what order.
Here’s what to review and make note of:Any overnight events (you can find out from nursing notes from the chart, or speak to the overnight nurse).
This includes a review of vital signs and any overnight issues HR, RR, SaO2, Temp, BP)
Fluid Balance (daily weights, in and outs) for hydration status - IV fluids? foley catheters? nutrition (NPO status, eating/drinking well?), bowel movements
Check medications (regular and PRN meds)
Results from recent investigations (from the previous day such as labs, ECG, imaging)
Follow-up consults: See recommendations from other services, including specialty consults, allied health (physiotherapy, occupational therapy, social work, CCAC). Place requests for new consults as early as possible.
Check for new orders that have been placed overnight
This information helps you prioritize which patients need the most attention (e.g. critical patients, discharges before 11 am, then other issues).
Discharge Planning: identify barriers to discharge, clearance for discharge, start on your discharge summary.
Tip: You can use your scut sheet to keep track of your patients to present at rounds. We recommend MedFools Free Medicine Scutsheet!
Patient Rounds: Clinical clerks present a summary of the patient’s they oversee to the health care team. Case presentations should be brief and focus on pertinent positives and negatives.
Practice your case presentation for rounds:
Some rotations have a set format for their case presentation., which is typically more comprehensive than other specialties. Start by using the '“SOAP” mnemonic to present your case:
Subjective: Patient ID with relevant comorbidities/PMHx, symptoms, discuss changes
Objective: General appearance, Vital signs, pertinent positive and negative findings. For investigations/test results do not read out all the results, only those that are relevant.
Assessment: your overall assessment, and differential diagnosis.
Plan: plan of action listed by issue (not system e.g. Pneumonia, Atrial Fibrillation), which may include ‘to do’s’, such as further testing, treatment, consults, or facilitating referrals.
Discussion of your case will follow your case presentation, be sure to take notes during this time!
Aim to keep this presentation around 5-10 minutes.
Practice or rehearse your case presentation before presenting to the team. You may find you are reading off your notes in the beginning, but try to only reference your notes occasionally when case presenting.
Listen to how residents and attendings present their patients, and what questions other members of the team include.
Get feedback on your case presentations: ask residents and attendings for what you could improve on your case presentations, or ask them to identify what is important to note when case presenting.
When the team discusses your case take notes! Make sure you have a copy of the patient list with tasks (or make your own) and add any learning points, ‘to do’s’, outstanding tasks, and questions you may want to research or
Assist in procedures: Depending on the setting this may include lumbar puncture, paracentesis, thoracentesis, central venous catheter placement, abscess incision and drainage, laceration repair, wound debridement, and more!
Placing Orders: Clinical clerks may place tentative orders that are co-signed by a health care provider.
Order (e.g. labs, imaging such as x-ray, MRI, CT scan, etc, peripheral vascular studies, )
Admission Orders: an electronic or written order for patient to be admitted to the GIM inpatient service. It specificies the most responsible physician (MRP), reason for admission, intended length of stay, and medical needs.
Discharge Orders: an electronic or written order for patient to be released from the GIM service or hospital. It outlines patient’s status and follow-up, as well as instructions.
Diet orders: For example, NPO, clear liquids only, modified diet (e.g. low salt, low fat), TPN, enteral nutrition.
Activity orders: Non-weightbearing (NWB), TTWB (toe touch weightbearing), WBAT (weightbearing as tolerated), etc.
Medication Orders: placing orders for medications to be administered in the hospital including name, dose, frequency, route of administration and duration.
Consults: A written or electronic order to request a consult from another service or allied health (e.g. Dietitian Consult for TPN, Physiotherapy Consult for clearance prior to discharge, Acute Pain Service, etc.)
Take an active role in patient care and management.
Keep accurate and up-to-date records of patient care.
Attend educational sessions and conferences.
On-Call Responsibilities
Here, clinical clerks (along with a resident, fellow and on-call staff physician) hold the pager and provide coverage to respond to clinical issues on the ward that occur outside of working hours, or provide internal medicine consults to other services in the hospital (E.g. from the Emergency Department, or Orthopaedic Surgery ward).
Floor Issues/Ward Management
Being available for phone or in-person consultations with patients, families, and other members of the healthcare team.
Managing the patients who are admitted to the hospital after hours. Addressing new issues on the floor (e.g. patient fall, presentation of delirium, urinary incontinence, order clarifications and requests for PRN medications). Be sure to write a progress note for any new issues that arise in the patient’s medical record.
Coordinating patient care with the daytime GIM teams, especially in circumstances where there are developments overnight. Participate in handover to the daytime team.
Reviewing and responding to test results that are called in from the nurses on the floor, including abnormal lab results (e.g. unusually low hemoglobin, elevated sodium, etc.), radiology images, and other diagnostic tests in a timely manner.
“Running the list”: sometimes the nurses will ‘run the list’ to the on-call clerk to provide a summary of important or outstanding tasks.
Performing GIM Consults
GIM serves as a consultation service on-call (through the on-call pager). Here, another service in the hospital (e.g. another specialty, floor, or the Emergency Department) requests a second opinion or specialist advice on a patient. Usually the senior resident will page the clinical clerk to go down to see the patient. The clinical clerk will go down and evaluate the patient, review their PMHX, perform a physical exam, review relevant tests, and formulate a diagnosis, and recommendations. In other circumstances, sometimes the patient will be admitted under the GIM service and GIM will take over the patient’s care. See
Responsibilities in GIM Outpatient Clinics
Perform consults and follow-ups of GIM patients who present to ambulatory care
Formulate a diagnosis and management plan in collaboration with the supervising physician/PA.
Opportunities for Learning in Internal Medicine
Participate in interdisciplinary rounds and team meetings. These rounds include different healthcare professionals involved in patient care including: physicians, PAs, NPs, pharmacists, social worker, physiotherapists and more. It is an opportunity for the team to consider all aspects of a patient's health, including their physical, social, and psychological needs to ensure nothing is overlooked and that all members of the healthcare team are on the same page. Make note of how each health care provider and allied health (RN, social work, physiotherapist, pharmacist, specch language pathologist, dietitian, etc.) contribute to patient care. These health care professionals also serve as tremendous resources as well!
Learn about patient safety and quality improvement initiatives. You’ll notice initiatives around antibiotic stewardship, medication reconciliation, pressure ulcer prevention, falls prevention, and hand hygiene compliance.
Formal and Informal teaching sessions with your attending: Informally this can occur when running the list and topics for learning. Otherwise sometimes the CTU will dedicate some time during the day for formal teaching (e.g. white board, powerpoint, etc.).
V. What to Bring
Dress code
Scrubs: you will obtain hospital issued scrubs that you can wear on the ward!
White Coat (optional): The PA school issued white coat is sufficient, and helpful because of its pockets. You can wear this over your scrubs or business casual outfit.
Professional business or business casual attire: clean shirt or blouse, dress pants or skirt that falls below the knee.
Closed toe, comfortable shoes: No crocs with holes in them. These help decrease your risk of exposure to bodily fluids, infectious disease, dropping of objects onto the foot or when tripping.
Essential tools
Stethoscope
Notepad and pen: : You'll need to take notes. Although many students use their phone or tablets to take notes, it may come across as distracting and disrespectful during patient encounters.
Smart Phone with point-of-care apps (e.g. Medscape and MdCalc)
VI. Documenting Patient Encounters
One of the key responsibilities of a PA student in Internal Medicine clerkship is to document patient encounters accurately and effectively.
This helps to ensure that the patient's medical record is up-to-date and provides a clear picture of their presenting complaint and overall health status. Other health care providers rely on notes to make critical decisions.
Your medical documentation should follow guidelines outlined by the CMPA as it is important for patient safety.
Different types of Documentation
Admission Note
Rounding Note
Discharge Note
Scut Sheets
A scut sheet is a quick reference tool that is a concise and organized summary of the most important information about a patient to help you stay organized and top of patient’s current status, plan and discharge planning. We recommend Medfools Scutsheets (free downloads!).
Scut sheets typically include:
Patient's name and demographic information
Chief complaint and reason for admission
Current medications and dosages
Allergies
Relevant lab results and imaging studies
Diagnosis and current treatment plan
Key findings from physical exams and assessments
Plan for the day and any upcoming procedures or tests
On-Call GIM Consult Note
Patient Identification (ID): This includes the patient's name, medical record number (MRN), date of birth, age, gender, and admission date. Identity of interpreter of substitute decision maker (if applicable). An assessment of patient capacity.
Reason for Referral (RFR): This section includes the reason why the patient was referred for a GIM consult, such as symptoms or a change in condition. Be sure to include 2-3 relevant comorbidities.
History of Presenting Illness (HPI): history of presenting illness is a detailed account of the symptoms, signs, and health problems that a patient is experiencing and has experienced leading up to the current medical encounter. It typically includes information about when the symptoms started, how they have changed over time, any related or exacerbating factors, as well as any previous medical conditions or treatments. Be sure to include pertinent positive and pertinent negative symptoms as relevant to their presenting complaint. Include a review of systems (ROS).
A "pertinent positive" complaint refers to symptoms or findings that are directly relevant to the current medical condition or problem being evaluated.
A "pertinent negative" complaint refers to symptoms or findings that are not present, but are important to mention in the context of evaluating a specific medical condition or problem (absence of red flags).
Past Medical History (PMHx): This section includes a brief summary of the patient's medical history, including any relevant medical conditions, surgeries, past hospitalizations and active treatments.
Current Medications (Meds): This section includes a list of the patient's current medications, dosages, and administration frequencies.
Allergies (All): Any drug, environmental or food allergies? Include reactions as well (e.g. Penicillin - anaphylaxis, Tetracycline - hives). Include other side effects if relevant (e.g. cannot take NSAIDs due to CKD, GI intolerance with Codeine, etc.)
Social History (SocHx): Occupation. Living situation. Support persons. Smoking, EtOH use, and recreational drug use. Patient’s baseline functioning (e.g. was patient ambulatory with no walking aids, and independent with ADLs? receiving PSW care once per week for baths?).
Physical Examination (O/E): This section includes the patient's vital signs (e.g., blood pressure, heart rate, respiratory rate) and a summary of the relevant physical examination findings.
Investigations (Ix): This section includes a summary of any laboratory tests or imaging studies that have been ordered or performed.
Assessment (A&P): This section includes a list of potential diagnoses that are being considered based on the patient's symptoms and test results.
Plan: This section includes the steps that will be taken to diagnose and manage the patient's condition, such as ordering additional tests, starting new medications, or referring the patient to a specialist/consultant. This is usually broken up into different issues. Include your rationale for the plan and expectations of outcomes. If you consulted a service, be sure to include the consultant’s recommendations.
Follow-up (F/U): This section includes instructions for follow-up care, such as when to schedule the next appointment or when to repeat certain tests.
Signature: This section includes the signature, your level of training, designation of the clinical clerk that has written the note, and the most responsible physician (e.g. In service of Dr. X).
VII. How to Study during your Internal Medicine rotation
Set Learning Objectives:
Utilizing the clerkship curriculum to get an understanding of what topics you need to know and areas you need to focus on.
Also reflect on what you hope to get out of the clinical rotation. What do you want to learn and do? What would you like to be more comfortable with? Do this at the start of your rotation, and check in each week to ensure you are meeting each of your goals.
Master your ability to interpret investigations:
Read and interpret EKGs, Chest x-rays, abdominal x-rays
Lab interpretation (CBCs, Electrolytes, ABGs, renal and liver markers, etc.)
Approach to Antibiotics (bugs and drugs)
Review common conditions:
Read relevant textbooks and resources: Internal medicine textbooks, such as Harrison's Principles of Internal Medicine, and online resources, such as UpToDate, can provide a comprehensive overview of the subject matter.
Brush up on common conditions seen in internal medicine, such as hypertension, diabetes, and heart disease.
Read around cases:
For the patients you are following, select 1-2 issues to read around each day: Do a deep dive into medical literature, textbooks or online resources (e.g. UpToDate, AccessMedicine).
Use a clerkship prep source like Case Files: Internal Resources to review 1-2 cases a day.
VIII. Favourite Resources in Internal Medicine
Internal Medicine GIM Apps
UptoDate: If your school or institution has access, see if you can get this set up on your phone!
MDCalc (free): Over 275 calculators for health care providers to calculate algorithms, scores and risk.
Firstline (Institution specific antimicrobial approach/Antibiotic Steward): An app which provides guidelines on which antibiotic to use against certain pathogens based on profile of your area. You can look up data and guidelines including biogram data by antibiotic, dosing (afdults and peds), and by pathogen. (e.g. Firstline is used by a few hospitals in Alberta Health Sciences, Manitoba, CHEO - Ottawa, SickKids - Toronto, Joseph Brant Hospital - Burlington and more).
Handbooks/Pocket References for Internal Medicine
Case Files: Internal Medicine: includes high-yield cases which illustrate principles in internal medicine. Aim to review 1-2 cases a night. Each case includes a complete discussion, clinical pearls, clinical approach, tables, definition of key terms and review questions to test your comprehension.
Medicine Recall: rapid fire Q&A covering essential knowledge in internal medicine.
On-Call Principles and Protocols: A great reference that covers common issues you will get called for when holding the pager during your internal medicine rotation.
Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine
Resident Survival Guide: McMaster Housestaff Red Book: for internal medicine
RxFiles.ca Drug Comparison Flipbook Chart: This is a handy flip chart that organizes medications by category. The drugs are presented in tables to make it easier to compare drugs side by side. It contains Canadian names and prices. This one is super handy for Internal Medicine rotations.
GIM Textbooks
In general, you do not have to obtain large textbooks on Internal Medicine to get through GIM your rotation.
However if you do have access to these books through your university or hospital library (electronic or physical copies), try to find these texts!:
Journals
Journal of the American Academy of Physician Associates (JAAPA)
American College of Physicians: Annals of Internal Medicine (AIM)
Online Resources
Online Med Ed - Internal Medicine Shelf Exam Resources: Free videos with registration for students. Covers a wide range of subspecialties within Internal Medicine (Cardiology, Pulmonology, Nephrology) to review principles and management.
CMPA Medical Documentation and Record Keeping: includes guidelines on what to document in patient notes from the Canadian Medical Protective Association.
IX. Key terms in Internal Medicine
Alternative Level of Care (ALC) is a term used to describe a patient who has completed their acute care in a hospital but is not yet ready to return home. They may still need ongoing rehabilitation, medical management, or other services that cannot be provided at home. Patients in ALC are typically transferred to another healthcare facility for continued care, such as a rehabilitation center or long-term care facility.
Convalescent Care refers to the care provided to patients who are recovering from an illness or injury. The care is designed to support physical and emotional recovery and help patients regain independence. Convalescent care can be provided in various settings like rehabilitation facilities, nursing facilities, or at home and involves physical, occupational, and speech therapy and medical management. The goals of convalescent care are to improve physical function, manage medical conditions, promote independence, and improve quality of life. An interdisciplinary team works together to develop a personalized plan of care for each patient.
Family meetings: Family meetings in internal medicine are meetings between healthcare providers and the families of patients to provide information about their loved one's condition, treatment options, and prognosis, and to involve them in decision-making about their care. The meetings are an important aspect of patient-centered care, allowing for open and honest communication and ensuring that families have a clear understanding of their loved one's condition and what to expect. Family meetings typically involve a lead clinician who presents information about the patient's condition, with other healthcare providers providing additional information as needed.
Code Status: Code status is a term used in healthcare to describe a patient's status regarding resuscitation and life-saving measures in the event of cardiac or respiratory arrest. Full code status means that all appropriate life-saving measures will be taken in the event of cardiac or respiratory arrest, including cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS). DNR status means that resuscitation will not be attempted and that the patient will receive comfort measures only.
End of Life Care (EOL): End of life care refers to the medical, emotional, and practical support provided to patients and their families during the last stages of a terminal illness. The focus of end of life care is on improving quality of life, managing symptoms, and providing comfort and support to patients and their families. It may involve working with a interdisciplinary team of healthcare professionals, including doctors, nurses, social workers, and hospice or palliative care specialists. The goal is to help patients and their families make informed decisions, cope with their illness, and manage the symptoms, pain and distress associated with the end of life process.
Goals of Care (GoC): Goals of care refer to the overall objectives that a patient and their healthcare team have established for the patient's treatment and care. These goals can encompass a range of objectives, including managing symptoms, preserving quality of life, preventing and treating disease, and ensuring that the patient's wishes and values are respected and upheld. Examples of goals of care in internal medicine include managing pain and other symptoms, controlling and treating medical conditions, preserving functional ability and independence, preventing complications, and preparing patients and families for end-of-life care, when necessary.
Home Care refers to the provision of health and personal care services to patients in their own homes. The goal of home care is to help patients recover from an illness or injury, manage a chronic condition, or maintain their independence and quality of life. Home care services can include nursing care, personal support, rehabilitation, respite care, and more.
LHIN or CCAC: In Ontario, CCAC stands for Community Care Access Centre, this agency has also had other names (most recently LHIN which stands for Local Health Integration Network). It is a government-funded organization in Ontario, Canada that is responsible for coordinating and delivering community-based health and social services. The CCAC works with a range of health and social service providers to ensure that patients receive the care they need in the community/at home. CCAC is responsible for managing a variety of services, including nursing care, personal support, rehabilitation, respite care, and more (e.g. IV medicaiton administration, dressing changes/wound care).
Medical assistance in dying (MAID) refers to the practice of providing terminally ill patients with a medically assisted means of ending their life. This can include the administration of a lethal dose of medication or the provision of a prescription for self-administration of medication. MAID is typically only considered as an option for patients who are suffering from a serious and incurable condition, are in an advanced state of decline, and are experiencing unbearable suffering that cannot be alleviated through other means. In many countries, MAID is subject to strict legal and ethical guidelines and is only available to eligible patients who have given informed consent and meet certain criteria.
Final notes
Remember to be proactive and take advantage of opportunities for learning and growth! Ask questions, participate in rounds, and engage with your patients and colleagues. Most importantly, be patient with yourself and don't be afraid to make mistakes.
The learning process is not always easy, but with hard work and dedication, you will emerge from your internal medicine rotation more confident and capable than when you started!
