Saint Louis University

Internal Medicine (IM-301)

Welcome to the Internal Medicine Clerkship!


The Internal Medicine Clerkship provides you with an opportunity to refine and apply skills and knowledge acquired during the first two years of medical school and to learn the basics of medical decision-making, diagnostics, and therapeutics. You will find it to be an intense but challenging and rewarding experience.

The basic emphasis lies with improving skills in obtaining an accurate medical history and performing physical examinations under the supervision of faculty attendings and resident physicians. The student has opportunities to synthesize the data, create problem lists and logical diagnostic and therapeutic plans for patient care. Skills in accurate oral and written presentations are emphasized in small group sessions. The knowledge base in Internal Medicine is strengthened by development of a regular reading program.

The enthusiasm that medical students bring to patient care improves the learning environment for all involved. The Internal Medicine Clerkship provides a strong foundation for students interested in a future in Internal Medicine and for students who desire to excel in other specialties. This can be achieved only through a commitment to scholarship. The Internal Medicine faculty are available to facilitate progress toward these goals.


H. Douglas Walden, M.D., M.P.H.
Int. Med. Clerkship
Nora L. Porter, M.D., M.P.H.
Int. Med. Clerkship



Course Co-DirectorsEducational Coordinator
H. Douglas Walden, M.D., M.P.H.
Nora L. Porter, M.D., M.P.H.
Department of Internal Medicine
Division of General Internal Medicine
Desloge Towers, 12th Floor
(314) 577-6139
Madeleine Rowe
Department of Internal Medicine
Division of General Internal Medicine
Desloge Towers, 12th Floor
(314) 577-6139
Hospital Course DirectorsAdministrative Assistants
H. Douglas Walden, M.D., M.P.H.
Nora L. Porter, M.D., M.P.H.
Saint Louis University Hospital

Morey Gardner, M.D.
St. Mary's Health Center
(314) 768-8778

Patricia McKelvey, M.D.
John Cochran VA Hospital

Keith Starke, M.D.
Mercy Medical Center
(314) 251-5834

Joseph Flaherty, M.D.
Des Peres Hospital
(314) 966-9491

Madeleine Rowe
Saint Louis University Hospital
(314) 577-6139

Tamara Steffens
St. Mary's Health Center
(314) 768-8887

Tiffany Spight
John Cochran VA
(314) 289-6345

Michelle Kempf
Mercy Medical Center
(314) 251-6959

Karen Mebruer
Des Peres Hospital
(314) 966-9491


Clinical Sites Used for Third Year Clerkships
Saint Louis University Hospital 18-21 2
John Cochran VA 8-12


Des Peres Hospital 1


St. Mary's Health Center 5 2
Mercy Medical Center
2 2
Ambulatory Care
18-21 2


Clerkship Overview
The eight clerkship in Internal Medicine offers the Year 3 student an opportunity to function as an integral component of the medical team in both inpatient and outpatient settings. Students are expected to participate in the care of their patients.

A major goal of the Year 3 clerkship in Internal Medicine is to develop the capacity to obtain a comprehensive medical history and to perform a detailed physical examination. The student will learn to identify patient problems based on findings in the history and physical examination. For each problem, the student will produce a differential diagnosis, identify a working diagnosis and develop a diagnostic and therapeutic plan. While on inpatient services the student will learn to give a concise, organized oral presentation of a patient's case. Knowledge in internal medicine is obtained through an organized reading plan.

Hospital Assignments
Students in the Medicine clerkship will have an opportunity to participate in patient care in a variety of clinical settings. The clerkship is divided into two training sessions, each consisting of three two-week blocks divided as such:  two weeks on inpatient medicine service at Saint Louis University Hospital; two-weeks on an outpatient ambulatory general medicine rotation, and two-weeks on inpatient medicine at John Cochran VA Medical Center, Mercy Medical Center, St. Mary's Health Center or Des Peres Hospital.

Assignments will be published approximately four weeks before the beginning of each period. Once assignments have been made, no changes or trades by students will be permitted.

On the first day of the clerkship, students spend the morning in an orientation session. At this session, detailed information about the goals and objectives of the clerkship, evaluation processes, copies of evaluation instruments, hospital schedules and other information is distributed. Proper format for the history and physical exam and an introduction to medical decision-making are provided.

Team Assignments, Organization, and Makeup
Inpatient teams are comprised of an attending physician, an upper-level resident team leader, first-year residents, and Year 3 and Year 4 medical students.


Description of a Typical Day
Inpatient Rotations
Begin day by independently seeing patients before work rounds
Time Activity
7:30 a.m. - 9:00 a.m.
Work Rounds
9:00 a.m.- 9:45 a.m.
Morning Report
10:00 a.m. - 11:30 a.m.
Attending Rounds
12:00 p.m. - 1:00 p.m.
Noon Report
7:30 a.m. - 8:30 a.m.
Grand Rounds on Friday
Afternoon Patient Care
As scheduled by Preceptor

Preceptor Rounds

Students are allowed at least two days free of clinical responsibilities during each two-week block.

Outpatient Rotations
The ambulatory rotation generally begins at 8:00 a.m. and usually concludes at 5:00 p.m. each day.

Medical Grand Rounds are held each Friday at 7:30 a.m. in the Learning Resources Center Main Auditorium. Each hospital site also provides a lecture series.

Each Friday afternoon there are required didactic sessions. Sessions cover essential clinical skills, physical diagnosis, and clinical problem-solving and evidence based medicine.

Students are required to read each day about problems identified in their patients—a comprehensive text such as Harrison's Principles of Internal Medicine is recommended. Cecil's Essentials of Medicine or a similar text can be used for general medical reading. In addition, reading from a physical diagnosis text such as Sapira's The Art and Science of Bedside Diagnosis and from a pharmacology text may be necessary.

Quizzes and Tests
On the last Friday of the clerkship, students take an online examination supplied by the National Board of Medical Examiners.

Projects and Papers
Each student must satisfactorily submit one complete written history and physical to the clerkship directors by the date assigned for the student's clerkship. These will be expected during an inpatient service block, and will evaluated on a pass/fail basis.

Evaluation and Grading
Evaluation of the student comes from several sources: clinical performance evaluations from each hospital and ambulatory site, written examinations and successful completion of the written history and physical. The clinical performance ratings account for the bulk of the clerkship grade.

At the end of each clerkship, the clerkship directors review the student performance and assign grades. A narrative summary of each student's performance on the clerkship is prepared for the individual student's file.  The student will receive a copy of the narrative to ensure accuracy.

A grade of PASS will be awarded to those who have received satisfactory ratings in all clinical categories, passed the written examination, and successfully completed the written history and physical in a timely fashion.

A grade of HONORS will be awarded to those who have received above average to superior ratings in all clinical categories, and have successfully completed all of the requirements of the clerkship.

A grade of FAIL will be given to those who have not exhibited an acceptable performance, or who fail to complete required coursework.

A mark of IMCOMPLETE may be issued in the event the student has successfully completed only part of the clinical work or has failed the end-of-clerkship examination.

Students will have the opportunity to complete an evaluation of their experience in Internal Medicine. All replies remain confidential and are important to the department in efforts to evaluate the clerkship.

Typical Weekly Schedule

Hour Sunday Monday Tuesday Wednesday Thursday Friday Saturday
A.M.   7:30-9:00 a.m. Work Rounds 7:30-8:30 a.m. Grand Rounds  
    9:00-9:45 a.m. Morning Report  
    10:00-11:30 a.m. Attending Rounds  
P.M.   12:00- 1:00 p.m. Noon Reports  
    Patient Care  
    Preceptor Rounds  
            1:00- 5:00 p.m. Required Didactic Sessions  

Patient Care

Outpatient Rotations:
The ambulatory rotation generally begins at 8:00 a.m. and concludes at 5:00 p.m. each day.

Call Schedule and Weekend Activities:
There is no night call and no weekend work during the outpatient ambulatory general medicine rotation.

There is no overnight call during the blocks on the general medicine inpatient service.

Additional Comments and Other Special Requirements:
On the first day of the rotation, students spend the morning in an orientation session.

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