Medical Education

Clerkship/Post-Clerkship

The Clerkship and postclerkship years provide students with an immersive, firsthand experience as physicians-in-training at Brown's affiliated hospitals.

Beginning in the third year, clerkships immerse students in the experiences associated with a particular field of medicine. Students work full-time at a designated site during each six- to twelve-week rotation period and are assigned on-call duty on scheduled nights and weekends.

There are also a variety of elective opportunities at our affiliated hospitals or at other approved institutions, as well as the option to pursue independent study and advanced clinical mentorship electives.

Clinical Requirements

Students must complete a minimum of 80 weeks of clinical training throughout Years 3 and 4, 68 weeks of which must be taken at Alpert Medical School, including the following:

Core Clerkships

Students must complete 44 weeks of clerkships in the specialties listed below.

The Internal Medicine Clerkship is an 8-week clerkship experience, in which students spend time in both an inpatient and outpatient setting.  In the inpatient setting, students will be assigned to the medicine teaching service, in which they will admit and follow patients who are acutely ill.  In the outpatient setting, students will work with general and specialty internists on a range of diagnoses common to Internal Medicine.  Students will also participate in a range of didactic sessions on this clerkship, including teaching around electrocardiograms, radiology and small groups focused on important issues in Internal Medicine. 

Assessment Methods Grade Composition
Written Clinical Evaluations 50%
OSCE 25%
Shelf Exam 15%
Clinical Pathological Conference Submission 5%
History & Physical 5%

Objectives

  1. Describe the clinical features, differential diagnosis, work-up and management of common inpatient and outpatient medical conditions.
  2. Complete a patient’s history and physical examination in an organized and thorough manner.
  3. Order laboratory tests and radiologic studies, taking into account the appropriate evidence-based medicine and stewardship of resources.
  4. Formulate a differential diagnosis based on a patient’s history, prioritizing the most likely diagnoses.
  5. Devise an initial treatment plan for a patient, based on the available data, including a patient’s history, physical examination, and laboratory and radiology studies.
  6. Effectively communicate, both verbally and in writing, with patients and other health professionals around a patient’s illness.
  7. Identify gaps in knowledge and use available online resources to address those gaps.
  8. Work collaboratively with other healthcare professionals, including nurses, pharmacists, social workers, physical therapists and unit secretaries around the care of patients.
  9. Integrate health maintenance into patient encounters when appropriate.

The Surgery Clerkship is a 4-week clerkship experience, in which students spend time primarily in an inpatient setting, working with surgery residents and attending physicians, on the surgical management of disease.  Students will round with their assigned surgery team on a daily basis and then spend time in the operating room with both residents and attending physicians.  In addition, students are assigned to an outpatient surgical attending preceptor, in which students will assist in the outpatient management of surgical disease.  Finally, students will spend time in didactics, led by surgery attending and resident physicians as part of the clerkship. 

Assessment Methods Grade Composition
Written Clinical Evaluations 50%
Oral Exam 25%
Shelf Exam 20%
Quizzes 5%

Objectives

  1. Evaluate and manage common surgical problems.
  2. Evaluate and manage normal and abnormal surgical recovery.
  3. Participate in operative procedures.
  4. Describe operating room culture.
  5. Demonstrate basic technical skills.
  6. Describe general attributes as a career as a surgeon.
     

The Obstetrics and Gynecology Clerkship is a 4-week clerkship, in which students work on a number of different services in caring for women’s health.  Students will spend two weeks on Labor and Delivery working with attending and resident physicians, along with mid-wives in managing labor.  Students will also spend two weeks with attending and resident physicians in gynecology surgery, caring for the surgical needs of women.  Finally, students will spend one week on night float, caring for a wide variety of issues affecting women, including spending time in the Emergency Department. Students will also spend one week in specialty clinics.  Finally, students will participate in a didactic curriculum focused on the healthcare needs of women. 

Assessment Methods Grade Composition
Written Clinical Evaluations 50%
Shelf Exam 20%
OSCE 15%
Case Presentation 15%

Objectives

  1. Gather an accurate, thorough and culturally appropriate history from a patient presenting with common obstetric and gynecologic complaints.
  2. Perform a focused, pertinent physical examination for common presentations in Obstetrics and Gynecology.
  3. Formulate an appropriate differential diagnosis and initial diagnostic and therapeutic plan (considering patient preference and safety) for patients presenting in Obstetrics and Gynecology.
  4. Organize and succinctly summarize information from a patient encounter in an oral presentation and progress note.
  5. Apply principles of health promotion and disease prevention to the care of patients.
  6. Describe normal laboratory values in the care of patients presenting to an Obstetrics and Gynecology setting.
  7. Perform basic procedures such as suturing, interpretation of fetal heart monitoring, vaginal births, pelvic and breast examinations.
  8. Describe the role of an Obstetrician Gynecologist within the health care system.
  9. Reflect on encounters with patients, faculty and colleagues to understand the role of biases and to improve patient care.
  10. Use ethical principles in the care of patients.

The Pediatric Clerkship is a 4-week clerkship experience, in which students, under the supervision of attending and resident physicians, care for children in both inpatient and outpatient settings.  In the inpatient setting, students will work on the teaching service caring for acute illnesses of childhood requiring hospitalization.  Students will take histories, perform physical exams and counsel patients (and their families).  In the outpatient setting, students will again take histories, perform physical examinations and counsel patients while providing acute, chronic and preventive care.  In addition, students will participate in didactic sessions throughout the clerkship. 

Assessment Methods Grade Composition
Written Clinical Evaluations 60%
OSCE 20%
Shelf Exam 20%

Objectives

  1. Develop effective communication skills (oral and written) with peers on their medical team, parents, attendings as well as oral presentations skills in a variety of settings such as work rounds, patient consultations, family meetings, etc.
  2. Obtain a pediatric history from the parent and when appropriate from the child. In addition, the student will learn how to perform a complete physical examination on patients from infancy through adolescence.
  3. Develop a clinical assessment and plan, demonstrating critical thinking skills and integration of previous basic science and clinical knowledge into management of pediatric problems.
  4. Obtain an overview of pediatric medicine.
  5. Describe the varieties of careers available in pediatrics.

 

The Clinical Neurosciences Clerkship is an 8-week, combined clerkship experience in Psychiatry and Neurology.  Students spend 4 weeks in Psychiatry and 4 weeks in Neurology.  In psychiatry, students are assigned to one site for the full 4-week experience, which may be in an inpatient, partial hospital, consult, or children’s hospital setting.   In Neurology, students spend two weeks on one service and two weeks on a different service.  These service settings may include inpatient neurology, consult neurology, and neurosurgery.  Students also participate in an integrated didactic series as part of this clerkship. 

Assessment Methods Grade Composition
Psychiatry  
Written Clinical Evaluations 50%
OSCE 20%
Shelf Exam 20%
Observed Clinical Interview 10%
Neurology  
Written Clinical Evaluations 50%
OSCE 20%
Shelf Exam 20%
History & Physical 10%

Objectives

  1. Recognize and diagnose the major neurological and psychiatric disorders.
  2. Conduct a comprehensive history and exam for patients with these disorders.
  3. Formulate a differential diagnosis of the major neuropsychiatric syndromes based upon history and examination findings.
  4. Describe the clinical features, differential diagnosis, evaluation, and treatment of common neuropsychiatric syndromes – in both the emergency and maintenance settings.
  5. Recognize and select from the available treatment settings for optimal psychiatric care – inpatient, outpatient, partial hospital, residential.
  6. Compare and contrast the role of family, community supports, and the courts (certification, guardianship) in neuropsychiatric disease and treatment.
  7. Recognize the central role of biopsychosocial and neuropsychiatric formulation in assessment and treatment of patients across settings.

The Family Medicine Clerkship is a 4-week clerkship experience, in which students spend their time in an ambulatory clinic setting caring for patients ranging from the newborn to geriatric population.  Students, in working with family medicine physicians, will take histories, perform physical examinations and counsel patients on a myriad of common chronic medical problems such as diabetes, hypertension and depression.  Students will also provide care for acute medical issues and counsel patients on preventive care.  Finally, students will engage in didactic experiences, ranging from lectures, small groups and team-based learning on issues important to Family Medicine. 

Assessment Methods Grade Composition
Written Clinical Evaluations 45%
Didactic Session Performance 15%
SACC Project 15%
Final Exam 25%

Objectives

  1. Gather accurate and thorough histories from a patients presenting for common presentations in ambulatory family medicine.
  2. Perform a focused, pertinent physical exam for common presentations in ambulatory family medicine.
  3. Formulate appropriate differential diagnoses and initial diagnostic and therapeutic plans for patients presenting with acute and chronic conditions in an ambulatory family medicine office.
  4. Organize and succinctly summarize information from a patient encounter in an ambulatory family medicine setting in an oral presentation.
  5. Organize and succinctly summarize information from a patent encounter in an ambulatory family medicine setting in a progress note.
  6. Apply relevant clinical evidence to develop preventive care interventions and acute and chronic disease diagnostic and treatment plans for patients in an ambulatory family medicine setting.
  7. Demonstrate advanced patient communication skills regarding the interpretation of tests and guidelines, the pathophysiology of disease and chosen interventions.
  8. Reflect on encounters with patients and colleagues to understand role of biases and improve clinical care
  9. Describe the critical role of family physicians within any health care system
  10. Design a community based intervention addressing the social and community context of a particular health issue affecting the community surrounding an outpatient health center.
  11. Describe the indications, contraindications, and complications of common ambulatory procedures and perform the procedures in a simulated environment.

Electives

Students must complete a minimum of 36 weeks of clinical electives, 24 weeks of which must be taken at Brown. The 36 weeks of electives must include the following:

  • 4 weeks of a sub-internship
  • 6 weeks of a surgical elective. A 4 week surgery sub-internship can fulfill both the sub-internship requirement as well as count as 4 out of the 6 weeks of the surgery-related electives.

Locations

Clerkships put students to work full-time at affiliated institutions and clinical rotation sites during a six- to twelve-week rotation period. Student are assigned on-call duty on scheduled nights and weekends. In addition, as part of the Primary Care-Population Medicine Program, students have the opportunity to work in Longitudinal Integrated Clerkships (LIC). 

Clerkship Duration Hospital Sites
Medicine 8 weeks Memorial Hospital, The Miriam Hospital, Rhode Island Hospital, Providence VA Medical Center, Kent Hospital, Newport Hospital
Surgery 4 weeks Rhode Island Hospital, The Miriam Hospital, Providence VA Medical Center, Kent Hospital, Newport Hospital
Pediatrics 4 weeks Hasbro Children's Hospital, Women and Infants Hospital, Milford Hospital, St. Luke's Hospital
Obstetrics/Gynecology 4 weeks Women and Infants Hospital, Kent Hospital
Psychiatry/Clinical Neuroscience 4 weeks Butler Hospital, Providence VA Medical Center, Rhode Island Hospital, Bradley Hospital, The Miriam Hospital
Family Medicine 4 weeks Kent Hospital of Rhode Island