Medical Electives and Acting Internships

Electives and Acting internships at MetroHealth are offered to 4th year medical students as 4-week rotations only.

Click the first letter of the elective area you want to know more about:

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Anesthesiology

The Anesthesiology Department at Case Western Reserve University's MetroHealth Medical Center Campus provides 24-hour anesthesia coverage for surgical procedures; obstetrical anesthesia, emergency resuscitation and pain management. To promote efficient and rapid patient care, the operating rooms are located adjacent to the emergency room and the surgical intensive care unit. Two anesthesiology staff members are in-house every night to ensure solid coverage for the residents on call.

MetroHealth residents treat unstable, critically ill and massively injured patients. Residents attain a high level of knowledge and confidence from frequent exposure to complex situations, yet training experience is balanced with routine cases. Despite intense training, the department staff maintains a relaxed atmosphere.

Aside from extensive "hands-on" experience, MetroHealth residents and students benefit from a strong didactic program, a multitude of research opportunities and the expertise of a devoted staff. The department is comprised of faculty anesthesiologists, residents, certified registered nurse anesthetists and anesthesiologist assistants.

Offered

All months, except July and December

Prerequisites

Completion of clerkships in Internal Medicine and Surgery

Description

This elective will provide the student with a broad and comprehensive experience in the area of anesthesiology.The student will gain an understanding of the physiology, pharmacology, and coexisting diseases that affect the perioperative management of patients. Students will become practiced in various techniques of airway management and IV access throughout the rotation. Each student will be involved with preoperative evaluation, induction, intubation, monitoring, emergence, and recovery of patients undergoing surgical procedures; all under close resident and attending supervision.

The student will spend the first two weeks of the rotation in the main OR, learning the basic principles and techniques of anesthesia. In the third week, the student will spend time rotating on the Obstetrical Anesthesia team, the Acute Pain Service, and in the Pre-Surgical Evaluation Clinic. The fourth week is designed as an elective week where the student can choose where they would like to spend their time. It is during this week that a student can rotate at the Chronic Pain Management Clinic or Ambulatory Surgical Center.

Objectives

  1. Gain knowledge of the commonly used drugs in anesthesia
  2. Describe the role of medical management of systemic illnesses in changing anesthetic risk
  3. Compare and contrast various anesthetic techniques and formulate a basic anesthesia plan
  4. Evaluation of airways and demonstration of basic airway techniques
  5. Describe how the physiologic changes during pregnancy affect anesthetic management
  6. Gain exposure to ultrasound guided upper and lower extremity peripheral nerve blocks

Didactics

Students will be expected to attend all resident lectures in addition to special lectures provided by the anesthesia attendings. They will also have an aggressive reading schedule; therefore, daily duties will end early to allow for this study. At the end of the rotation, students will take an examination.


Cardiology

Clinical Cardiology

Prerequisites

Completion of 3rd year Internal Medicine clerkship

Description

During this elective, the student will see and evaluate patients on the Cardiology consult service as part of a team that includes the cardiology attending, fellow and residents from various fields - including Internal Medicine, Emergency Medicine and Anesthesia. Students will be expected to closely follow their assigned patients and to be able to discuss the active, pertinent issues with the attending physician on daily rounds. The student will participate in scheduled daily conferences (pre-arranged didactic conferences) and a daily one hour ECG reading session. The student will observe cardiac diagnostic procedures (including heart catheterization, electrophysiologic testing, echocardiography and stress testing) during a scheduled half-day session in each of these areas.

Objectives

To introduce the student to patients with acute and chronic cardiac diseases. He/she will develop skills in performing the cardiovascular physical exam and in the interpretation of electrocardiograms. The student will become well-versed in the evaluation of patients with chest pain, the management of patients with heart failure, coronary and/or peripheral vascular disease, the diagnosis and treatment of patients with cardiac arrhythmias, and the basic evaluation of patients undergoing non-cardiac surgery. He/she will learn the indications for cardiac procedures (echo, stress testing, nuclear cardiology, electrophysiology testing, and cardiac catheterization).

Duties

The student will be expected to perform a history and physical exam on cardiac consultation patients and then formulate diagnostic and therapeutic plans dependent on the results of that evaluation. The student will present his/her patients as part of daily rounds with the supervising attending physician. The student will interpret electrocardiograms on a daily basis with a cardiology attending.

Acute Care Cardiology

Prerequisites

Completion of 3rd year Internal Medicine clerkship with experience in basic history taking and physical exam

Description

During this elective, the student will see and evaluate patients in the Cardiac Intensive Care Unit - under the close supervision of the house staff, fellow and attending physician on the CICU team. Students will be expected to actively participate during daily rounds in the unit. They will attend daily conferences and ECG reading sessions. They will learn the indications for, and be given an opportunity to observe, various diagnostic procedures and therapeutic interventions used in the field of cardiology.

Objective

To immerse the student in the dynamic world of acute cardiovascular intensive care. The student will gain knowledge in the management of patients with acute myocardial infarction, unstable angina, congestive heart failure and both stable and unstable cardiac arrhythmias. He/she will work in a closely supervised setting with a resident, cardiology fellow and cardiology attending to evaluate and acutely intervene in the treatment of patients with both acute and chronic cardiovascular diseases. He/she will be taught extensively in the areas of the cardiovascular physical exam and electrocardiography.

Duties

The student will be expected to perform a history and physical exam on patients admitted to the Cardiac Intensive Care Unit in conjunction with and under the supervision of a resident, fellow and attending. The student will present his/her patients as part of daily rounds with the supervising attending physician. He/she will formulate and implement the patient's daily plan with the help of the CICU team. He/she will be encouraged to participate in night call during the month - in association with the CICU house staff.


Dermatology

Prerequisites

Completion of 3rd year clerkships

Description

Teaching during this elective is based on the patient material available in both the outpatient and inpatient dermatology services at MetroHealth Medical Center, including the inpatient consultation services, and at the Clement Center for Family Health. Participation in twice weekly didactic sessions is expected: journal club, basic science and clinical conferences and city-wide grand rounds. For students that have a particular interest in dermatopathology, additional experience in histopathology is available.

Several subspecialty exposures can be arranged (dermatologic and MOHS micrographic cancer surgery, laser surgery and contact dermatitis patch testing). Students on the UH/VAMC and on the MetroHealth electives attend the same didactic conferences and can exchange clinic sessions with each other as staffing permits. The student will be evaluated on the basis of his/her acquisition of basic dermatologic descriptive and diagnostic skills and his/her participation in other clinical and education sessions each day.

To be able to describe, recognize and treat the common dermatologic problems of adults and children. Students do not take night call. Toward the end of the rotation the students may evaluate and follow their own patients or do consultations if they desire.

Pediatric Dermatology

Prerequisites

Completion of 3rd year clerkships

Description

This elective will include time in the MetroHealth resident continuity clinics and time in the private clinic of our pediatric dermatologist. The goal of the rotation is to become familiar with the diagnosis and treatment of common pediatric dermatological conditions. Students are expected to act professionally, be punctual and involved in their learning.

Objectives

  1. Become familiar with a full skin examination in the pediatric population.
  2. Become familiar with the diagnosis and management of common skin conditions in pediatric patients.
  3. Learn appropriate steps for counseling and compliance monitoring in pediatric patients.
  4. Learn resources available for patients/parents/regarding etiology and treatment of common pediatric dermatological conditions.
  5. Maintain open communication with referring physicians and interact with all clinical and non-clinical personnel in a professional and respectful manner.

Electrophysiology

Prerequisites

Completion of 3rd year clerkships in Family Medicine, Internal Medicine, Aging/Geriatrics, Surgery and Emergency Medicine

Description

This elective is intended for students who are interested in a career in either Internal Medicine or Cardiology. Students will participate in Inpatient consults with the Cardiology fellow and the EP attending. They will also attend Outpatient EP clinic. They will have to option of assisting in Electrophysiology research as well.

There will also be weekly didactics during this elective rotation. This course will provide a strong arrhythmia and cardiac device foundation to support effective application in clinical practice and interpretation of the various electrical abnormalities of the heart. The Student will be able to recognize the various common electrical abnormalities of the heart in the inpatient and outpatient adult population, the most up-to-date methods of treatment, within the one month span of the course.

Additionally, the student will learn the interpretation of electrical abnormalities in ECGs, cardiac device interrogations, and holters. Students will be assessed based on team participation and basic knowledge of Cardiology.


Emergency Medicine

The Department of Emergency Medicine at MetroHealth Medical Center was established as an independent hospital department in 1981. Emergency Medicine faculty provide bedside supervision of patient care 24 hours each day to emergency medicine residents, resident physicians from related disciplines and to medical students.

More than 100,000 patients are treated annually, one-third age 19 years or under. The Emergency Department (ED) accounts for approximately 40 percent of the hospital's admissions. The ED is equipped to manage all levels of acute and sub-acute care. Included in the 80-bed ED is a six-bed resuscitation suite, four psychiatric seclusion rooms, four cast rooms and an ophthalmologic/ENT examination room. A 17-bed fast-track area and 14-bed observation area are also part of the ED.

Around-the-clock laboratory support is available within the department, providing services such as bedside troponin I and urinary BHCG testing.

Metro Life Flight's Communications Center is also housed in the ED, where the Emergency Medicine faculty and residents provide online medical command for Cleveland EMS and several suburban fire departments. Communications specialists coordinate the use of state-of-the-art equipment to dispatch Metro Life Flight aircraft to transport seriously injured or ill patients from accident scenes and referring and receiving hospitals.

EM Acting Internship

Offered

May through November

Listed as EMMD 4000B in Case School of Medicine course catalog

January - April: This rotation becomes an elective (EMMD 4001B), not an acting internship, during these months.

Prerequisites

Completion of all 3rd year clerkships – This AI is available to 4th year medical students only

Description

This acting internship will allow the student to learn the specialty of Emergency Medicine. Due to the popularity of this AI, a screening process must be implemented. Factors considered in granting students approval include: 1) planned career in EM; 2) USMLE Step I score; 3) AOC in EM, EMIG or having demonstrated dedication & genuine interest in the field of EM.

The student will be supervised by an Emergency Medicine faculty member and will work very closely with second- or third-year EM resident at all times. There will be a combination of clinical and educational time. The student will participate in activities of the EM residency. The student is required to give a brief lecture on a topic of his/her choice on the last day of the rotation. A ride-along shift with Cleveland EMS and Metro Life Flight or Cleveland Clinic Critical Care transport is available, but not required. There is ample opportunity for “hands on” procedures.

The student will work 14-16 shifts per rotation, 8-10 hours each shift. Weekly student-specific lectures are provided. A splinting/casting lab, bSimulation center session, slit lamp/eye exam workshop and ultrasound workshops are provided monthly.

Extras

Students rotating in July will be able to participate in the EM intern orientation month events that include a ballistics lecture, trip to the Cleveland Shooting range (yes, firing weapons is part of this), tour of Red Center, trip to the Fire Academy and opportunity to don full firefighting gear and enter mock-burning building and an extended two-day ultrasound training. Textbooks available for loan for rotation; other educational material available on password-protected web site.

EM Elective

Offered

January through April

Listed as EMMD 4001B in Case School of Medicine course catalog

May - November: This rotation becomes an AI (EMMD 4000B), not an elective, during these months.

Prerequisites

Completion of all 3rd year clerkships – This AI is available to 4th year medical students only

Description

This elective offers the student the opportunity to make critical decisions while participating in the emergency management of patients. The student will work in close association with emergency medicine residents and faculty. The student will learn to evaluate, diagnose and treat emergency medicine patients. We are a Level 1 Trauma Center, regional burn and pediatric/neonatal referral center and have one of the largest helicopter transport program in the country. Our emergency medicine residency is active, as is our faculty participation in SAEM and ACEP.

The student will function as an integral part of the ED health care team. He/she will see patients primarily and be supervised by the emergency medicine senior resident and attending staff. Ample opportunity to perform supervised splinting, laceration repair, abscess drainage, medical resuscitation, and bedside ultrasound is the norm each month.

The student will work in the ED an average of 40 hours/week and attend the Department of Emergency Medicine conferences. An opportunity to ride along with Cleveland EMS is available, as is a paramedic-shadowing shift to gain proficiency in 12-lead EKG acquisition, phlebotomy and IV canulation.

Emergency Ultrasound

Prerequisite

Completion of 3rd year Emergency Medicine clerkship

Description

The Emergency Ultrasound elective is geared for the student who is planning on doing an Emergency Medicine residency. The elective will provide the student with a solid foundation in both the performance and interpretation of point-of-care ultrasound examinations. Students will be required to work five eight-hour shifts per week. A comprehensive on-line ultrasound curriculum is available to the student which includes multiple videos, interactive case studies and quizzes. The student will be expected to complete an assigned portion of the curriculum each day. In addition, the student will work closely with ED staff and will have ample opportunity to perform point-of-care ultrasounds. The student will be expected to perform a minimum of 100 examinations during the rotation. Types of examinations performed will include: eFAST exams (trauma), gallbladder, renal, 1st trimester OB (transabdominal and transvaginal), aorta, soft tissue, musculoskeletal, lower extremity DVT, ocular and ultrasound-guided procedures.

Objectives

At the end of the Emergency Ultrasound elective, the student will be able to:

  1. Discuss indications for performing point-of-care ultrasounds
  2. Demonstrate proper machine settings and maintenance
  3. Demonstrate the point-of-care gallbladder, renal, aorta, 1st trimester OB, aorta, soft tissue, musculoskeletal, lower extremity DVT, ocular and eFAST examinations
  4. Describe normal and pathologic findings of the point-of-care ultrasound examinations
  5. Demonstrate ultrasound-guided vascular access on a phantom

Medical Simulation

Prerequisite

Completion of all 3rd year clerkships

Description

MetroHealth Simulation Center (MHSC) conducts simulation programs involving healthcare providers from various disciplines. During this elective, the student with an interest in healthcare simulation will participate in the programs and activities of the MHSC under the direction of Thomas Noeller, MD. The student will have the opportunity to work with MHSC utilizing all facets of simulation including high-fidelity mannequins, procedural task trainers, and standardized patients.

Examples of educational opportunities include but are not limited to the following:

  1. Models and theories related to the use of simulation for evaluation, training, patient safety and disaster preparedness
  2. Programming and operation of high-fidelity mannequins (adult, pediatric, obstetrical, and neonatal)
  3. Effective use of procedural task trainers for education and evaluation
  4. Design and implementation of standardized patient programs (including education and evaluation principles, selection and training of standardized patients
  5. Design and implementation of multi-faceted/hybrid simulation programs
  6. Simulation center administration - The student will be responsible for helping to design and execute a simulation program. The student will be provided with appropriate references to augment the practical experience

Family Medicine

Family Medicine Acting Internship

Prerequisites

Completion of 3rd year clerkships in Internal Medicine, Pediatrics and OB/GYN –Available to 4tyear medical students only

Description

This experience offers the opportunity to incorporate the Family Medicine perspective into the care of inpatients. The acting intern will admit and manage patients under the supervision of senior Family Medicine residents and faculty. The acting intern will have the opportunity to assist in the care of women during labor and delivery as well as newborns delivered from the Family Medicine Services if interested. The acting intern will need to make this known to the senior and attending at the start of the rotation. Besides daily hands-on bedside teaching rounds, with the resident team, there are formal teaching rounds conducted during the week. The residency's family psychologist leads weekly psychosocial rounds, often including a bedside patient or family interview. The acting intern may have the opportunity to perform procedures such as paracentesis and joint injections under supervision. Our goal is an integrated approach involving all aspects of inpatient Family Medicine care.

Objective

To practice advanced inpatient management skills.

Innovative Primary Care for the Urban Underserved

Prerequisites

Completion of 3rd year clerkships in Internal Medicine, Pediatrics and OB/GYN – Available to 4th year medical students only

Description

This is an Urban Underserved Innovative Primary Care experience focused on Integrated team based care. The student will spend four weeks with the team working with patients in the urban underserved population. Each half day would be spent with various team members, including but not limited to physicians, nurse practitioners, care coordinators, social workers, psychologists, and others. During the rotation, the student will spend time at MetroHealth and off-site at various locations in the neighboring community. These sites include, but are not limited to, school-based health, county jail, recovery center, clinic for homeless patients, home visits, trauma survivors clinic, and a community hospice experience. This is a one-of-a-kind experience for a student interested in exploring urban underserved primary care.

Objectives

  1. Increase understanding of providing (innovative) care to underserved population
  2. Gain exposure to each component of the health care delivery system that the patient has to experience
  3. Improve understanding of the importance of the doctor-patient health care team relationship
  4. Understand how good primary care improves outcomes and efficiency
  5. Experience a unique type of interdisciplinary team-based health care delivery (i.e. home visits, group visits, etc.)
  6. Participate in behavioral health delivery and understand how it integrates with primary care

Gastroenterology

Prerequisites

Completion of 3rd year Internal Medicine clerkship

Description

The student will become a full member of a team consisting of eight faculty and six G.I. fellows; as such she/he will become familiar with the pathophysiology and clinical management of a wide variety of gastrointestinal problems. She/he will have similar responsibilities as the residents for inpatient and outpatient consultations and practical procedures. Students will also actively participate in regularly scheduled clinical management, radiologic, pathologic and surgical G.I. conferences. Duties will be similar to second year residents rotating t ough service with the exception that comprehensive teaching and observation will be employed.

Objective

To gain insight into the diagnosis and management of patients with liver, pancreatic and gastrointestinal diseases.


Infectious Disease

Prerequisites

Completion of 3rd year clerkships in Internal Medicine and Surgery

Description

This elective is a general experience on an active consultation service in infectious diseases at a large general hospital. Students will be assigned 3-5 new patients each week. With the help of the infectious disease fellows, each student will work up and follow new patients. The student will be expected to participate in daily attending rounds. The student will also be expected to participate at the weekly case conference by presenting patients he/she is following.

It is anticipated that students will acquire facility in examination and differential diagnosis of patients with various infectious diseases. The approach to the management of these patients and the rational selection of antimicrobial agents will be stressed. In addition, experience in the handling of clinical specimens and the interpretation of cultural results and a general exposure to clinical microbiology will be provided.

Student will follow his/her own patients under the supervision of both the Infectious Disease fellow and the attending physician. The level of responsibility will be variable and dependent on the student's willingness to participate. There are no night calls. Saturday morning rounds.


Informatics

Clinical Informatics

Prerequisites
Completion of at least one 3rd year clerkship

Description

Medical Informatics is a rapidly growing field in healthcare which involves the use of computer technology to improve healthcare. After a brief introduction to the overall field of medical informatics through a course pack, this rotation will focus primarily on clinical informatics. Clinical informatics is the sub-field of medical informatics concerned with how computer technology affects clinical care. Examples of clinical informatics topics include electronic medical records, clinical decision support, and personal health records.

Daily activities throughout the elective include shadowing the Chief Medical Informatics Officer (CMIO) of MetroHealth at administrative meetings and at his clinics. The focus of clinic will be the application of informatics to the outpatient clinician workflow. This rotation does not involve the student in direct patient care. In addition to shadowing the CMIO, medical students will be expected to complete a medical informatics project of approximately 20 hours in length that will be determined in the first half of the elective.


Intensive Care

Burn Unit Acting Internship

Prerequisites

Completion of 3rd year Surgery clerkship

Description

The Burn Unit is, in effect, a physiology laboratory in which the student can learn in-depth the interrelationships between fluid and electrolyte balance, shock, infection, sepsis, nutrition, wound healing, antibody host-responses as well as the management of respiratory insufficiency, cardiac failure, renal failure, hepatic failure and the clinical approach to their treatment.

In addition, the student will have an opportunity to learn techniques of wound isolation, debridement, skin grafting, cosmetic and functional reconstruction and the important role that the supportive medical and paramedical services offer in achieving these objectives. This rotation will provide for the inquisitive student an opportunity to integrate the multiple aspects of surgical-patho-physiology encountered in severe acute and prolonged life-threatening illness.

Surgical Intensive Care Unit Acting Internship

Prerequisites

Completion of 3rd year Surgery clerkship

Description

During this AI, the student will be involved in the management of critically ill surgical patients as a member of a multidisciplinary SICU service. Patients seen include those on the General, Trauma, Vascular, Neurosurgical, Thoracic, and subspecialty services. Emphasis is placed on hemodynamic and respiratory management, placement of arterial, central venous and right heart catheters, and nutritional/metabolic problems in the critically ill.

Objective

To learn the basic principles and skills required for care of the critically ill surgical patient.


Medicine

Internal Medicine Acting Internship

Prerequisites

Completion of all 3rd year clerkships – This AI is available to 4th year medical students only

Description

Fourth year students will be assigned to a ward where they will work with one or two interns and a supervising medical resident. The students will take regular night call and will assume direct responsibility for the care of 4-6 patients under the supervision of the senior resident and ward attending physician. The acting intern will be expected to take part in regular Attending Rounds and teaching conferences.

Consultation with subspecialty services will be routinely available either for educational purposes or for assistance in the management of patients with complex medical problems. Medical students function identical to interns, except Acting interns are paired with each other or an intern.

Objective

To expand knowledge of and competency in internal medicine by assuming direct responsibility for care of hospitalized patients.


Medicine-Pediatrics

Medicine-Pediatrics Ambulatory Elective

Prerequisites

Completion of 3rd year clerkships in Internal Medicine and Pediatrics

Description

Medical students will see patients as first contact and work side by side with residents and attendings. The practice of Med-Peds is learned in both urban hospital and community settings with preventative aspects emphasized. The student participates in hospital rounding on the group practice's inpatients.

Other duties include outpatient history and physicals, presentation of patients, cost-effective test ordering, use of evidence-based medicine, and documentation/reimbursement issues. Mornings are spent at MetroHealth in conference attendance and in the ambulatory clinics of the core disciplines. Afternoons are spent at the combined medicine/pediatrics practices of the MetroHealth satellite system.

PRIDE Clinic Elective

Prerequisites

Completion of 3rd year clerkships in Internal Medicine and Pediatrics and successful completion of USMLE Step 1 or COMLEX 1

Description

The PRIDE Clinic Elective rotation is a longitudinal experience in providing care to Lesbian, Gay, Bisexual, and Transgender people and their families. Students, residents and fellows are expected to review the health references and readings during the course of the clinical experience. The goals and objectives for the PRIDE Clinic experience keep in mind the ACGME (Accreditation Council of Graduate Medical Education) General Competencies of Patient Care (PC) Medical Knowledge (MK) Interpersonal and Communication Skills (IC) Practice Based Learning Improvement (PBL) Professionalism (PRF) Systems-Based Practice (SBP). Medical students are expected to see 1-3 patients per session and precept with the attending physician. Chart notes are completed in SOAP format using the electronic medical record. There will be a pre-test and post-test evaluation.

Medical students who take this elective are required to attend (10) clinical sessions and complete a scholarly activity that addresses some aspect of LGBT health. The scholarly activity can be, but is not limited to:

  1. A formal presentation about a patient care issue related to LGBT health
  2. A formal presentation about an aspect of LGBT health disparities
  3. A proposal for a clinical or public health intervention to improve LGBT health
  4. Developing a patient care tool or educational resource to improve LGBT health
  5. Developing a patient care tool in collaboration with Netwellness.org

Objectives

  1. Understanding the difference between sexual orientation, gender identity and gender expression. (MK)
  2. Understanding the impact of sexual orientation, gender identity, and gender expression on the health care experience. (MK, SBP)
  3. Understanding the interaction between gender identity, and gender expression and other social determinants of health. (PC, MK)
  4. Recognizing health disparities in LGBT populations. (PC, MK)
  5. Recognizing unique aspects of LGBT health (transgender health and hormonal care, coming out issues, adolescent issues, parenting issues, elder issues, violence and hate crimes, etc.) (PC, IC)
  6. Recognizing the effect of homophobia and heterosexism on the doctor-patient relationship. (PC, ICS, PRF)
  7. Developing a culturally competent interviewing style for LGBT patients. (PC, IC, PRF)
  8. Working with a multi-specialty team of providers for socially complex patients. (PC, PBL)
  9. Identifying and utilizing local, state, and national resources for LGBT Health. (PC, SBP)
  10. Understand how to practice high quality health care for LGBT patients in the health care system (SBP)
  11. Demonstrating adherence to ethical principles, and sensitivity to diversity. Maintain a patient's confidentiality when indicated. (PRF)

Nephrology

Prerequisites

Completion of all 3rd year clerkships

Description

This elective is designed to allow the student the opportunity to provide care to both hospitalized and ambulatory patients through its consultation service, Hypertension and Nephrology Outpatient Clinics and Renal Dialysis Center.

The student will assess and manage hospitalized patients with acute renal failure from all causes, with fluid and electrolyte abnormalities and with hypertension. In addition, the student will encounter hospitalized End Stage Renal Disease patients and learn unique aspects of the care of common medical problems in these patients. The student will attend an outpatient nephrology clinic and learn the outpatient evaluation, diagnosis and management of patients with chronic renal insufficiency, patients with hypertension and patients with stable acid-base and electrolyte disorders.

Patients requiring dialysis are not generally seen at this time. At the end of the rotation, the student should be able to interpret a urinalysis, appropriately order urine electrolytes and initiate a diagnostic work-up for acute and chronic renal insufficiency and sodium, potassium and acid-base disorders.

Students will be responsible for the primary evaluation of no more than five inpatients per week who have been referred to the Nephrology Consult service. After preliminary discussions with the nephrology fellow, the case will be presented to the attending. The goal of these presentations is not only to suggest appropriate management of the patient to the primary service, but also to use the case material for didactic teaching.

The student, if time allows, will be expected to have accomplished some background reading about the case prior to the presentation. After the initial discussions, the student will be responsible for primary follow-up of the patient. Specifically, the student will collect pertinent data to devise a subsequent management plan and present this information on rounds with the attending nephrologists.

The daily schedule starts with morning work rounds with the fellow and any Medicine residents rotating on the elective. Attending rounds generally begin in the afternoon. No night or weekend call is required, although students are welcome to participate in weekend rounds or after hour emergent patient management as they desire. The students will attend a weekly afternoon nephrology clinic. Limited exposure to an outpatient Dialysis clinic is also possible. Conferences include weekly clinical Nephrology Conferences and a monthly discussion of renal biopsies with Metro nephrology and renal pathology faculty.

Appropriate text, journal and internet resources are available within the Divisional offices and should provide adequate material for any necessary background reading. In addition, a collection of basic core articles is provided by the Division at the beginning of the rotation.


Obstetrics and Gynecology

Maternal-Fetal Medicine Acting Internship

Prerequisites

Completion of all 3rd year clerkships

Description

The student will partake in management of the High-Risk obstetric antepartum service. The student will be involved in the activities on Labor and Delivery including vaginal deliveries, cesarean sections, triage and management of the high-risk patients who are being monitored. The student will participate in the obstetric High-Risk Clinic and Diabetic Clinic. The student will shadow private Maternal-Fetal Medicine attendings in their offices, participating in examinations and observing the many medical complications of pregnancy. The student will also participate in ultrasound evaluation of pregnant patients.

Objectives

  1. Improve skills and prepare the medical student to become a resident in OB/GYN
  2. Improve skills in organization and presentation of high-risk complications affecting high-risk OB patients
  3. Improve skills in vaginal delivery as well as surgery
  4. Obtain hands on skills in performing basic ultrasounds

Gynecologic Oncology Acting Internship

Prerequisites

Completion of all 3rd year clerkships

Description

This rotation will allow the student to partake in the educational rounds of the GYN/Oncology service. The student will attend to the Operative suites to observe and assist with the surgeries of this area of Gynecology. The student will partake in several colposcopy clinics to learn about pap smear and cervical pathology. The student will attend Tumor board conferences to discuss diagnoses and management of complex GYN tumors/diseases. The student will attend GYN/Oncology clinic with the residents and GYN Oncologist.

Objectives

  1. Participate in diagnosis, management and treatment of gynecologic oncology patients (daily clinical rounds and outpatient clinics)
  2. Observe surgical procedures
  3. Attend conferences in gynecologic oncology, pathology and cytology
  4. Improve clinical competence in diagnosing, managing and treating gynecologic oncology patients

Urogynecology Elective

Prerequisites

Completion of all 3rd year clerkships

Description

The student will have the opportunity to be in the operating room with the Urogynecologists and/or the Minimally Invasive GYN surgical specialist (laparoscopist). The student will also shadow the Urogynecologist in their outpatient clinic.

Objectives

  1. Learn the office evaluation of the incontinent female patient
  2. Gain exposure to advanced benign gynecologic surgery
  3. Learn indications for referral to a Urogynecologist

Ophthalmology

Prerequisites

Completion of all 3rd year clerkships

Description

During this elective, the student will attend clinic both in the morning and in the afternoon, and is available for attendance in the operating room on all surgical procedures. The student will have the opportunity of following patients from the initial examination in the eye clinic to its resolution, whether by medical or surgical means. The student may be able to see patients independently depending on interest and level of knowledge.

Objective

Presentation of the basic knowledge of examination and diseases of the eye, the changes that take place with disease, and the available modes of therapy, both medical and surgical


Orthopaedics

Adult Orthopaedic Surgery

Prerequisites

Completion of all 3rd year clerkships

Description

This elective is designed to give the student broad exposure to disorders of the musculoskeletal system and the methods of treatment used. Orthopaedics is the medical specialty that includes investigation, preservation, restoration, and development of the form and function of the extremities, spine, and associated structures by medical, surgical and physical methods.

Students not only will observe but participate in the examination, evaluation and care of patients. Problems to which he will be exposed include fractures, congenital anomalies, amputations, art itis, sports injuries, and many others. Students will be directly supervised by an attending Orthopaedic surgeon or a chief resident. The participants will spend a significant portion of time in the outpatient setting.

Experience with closed reduction of simple fractures, emergency room evaluation of injured patients and Orthopaedic surgery will be obtained. The student should be an active participant. The degree of responsibility should fit the maturity of the student.

Objective

To provide a broad exposure to musculoskeletal problems in children and adults.

Musculoskeletal Trauma

Prerequisites

Completion of 3rd year Surgery clerkship

Description

The MetroHealth Center is the largest Level I Trauma Program in Ohio, with a very busy musculoskeletal trauma service. Patients suffering from musculoskeletal trauma will be seen by the student as part of the Trauma Team. The goal is to introduce the clerk to the principles of evaluation, diagnosis and care of injured patients. There will be a close relationship among student, resident, and attending orthopaedist. This will take place at the bedside, in the Emergency Department, operating room, conference room and clinic. In the process of caring for the acutely injured patient, the attending orthopaedist and resident will demonstrate first-hand how to examine and evaluate the total patient.

The student will see when other specialists are called on, and how to work as a team in helping the patient. Problems will be listed and priorities of treatment outlined. The actual management will be demonstrated to the student and he/she will be an active participant. The post-operative period in the intensive care unit and on the orthopaedic unit will serve to demonstrate day-to-day care while the patient is still hospitalized.

Participation in the clinics will provide insight into the long-term care, follow-up and rehabilitation. The degree of responsibility will fit the previous clinical clerkship experiences of the student.

Objective

To provide comprehensive exposure to principles of trauma care.


Otolaryngology 

Case Western Reserve University medical students that rotate at MetroHealth for their pediatrics core rotation will have the opportunity to spend half of a week with us. During this time, they will be able to observe and participate in a clinic, as well as the operating room.

Medical students from Case Western Reserve University and other schools are welcome to perform electives in our department for a broader look at the specialty of otolaryngology. These electives are arranged through the MetroHealth Graduate Medical Education Department. 

The Department of Otolaryngology/Head & Neck Surgery at MetroHealth Medical Center provides medical and surgical evaluation and treatment care for patients with ear, nose, and throat difficulties. The Department currently has four full-time, one half-time, and one part-time faculty members. The Department provides a full spectrum of modern otolaryngology care including treatment in the areas of otology, rhinology, allergy, and sinusology, head and neck cancer, and facial plastic and reconstructive surgery. 

Medical student rotations provide the opportunity for development of a basic framework for recognition and treatment of common disorders of the head and neck, initial management of head and neck emergencies, and indications for specialty referral. An additional goal would be to provide sufficient exposure to this specialty to assist in career planning.

For More Information, see Case Western Reserve University School of Medicine - ENT Residency Program

In addition to this partnership, we are fortunate to have osteopathic residents from Doctors Hospital in Columbus rotate with us for approximately eight months of the year.

 


Pathology

Anatomic Pathology

Prerequisites

Completion of 3rd year clerkships

Description

During this elective rotation the student will rotate in surgical pathology, cytopathology and autopsy service. The student will observe, examine and help dissect, under guidance, autopsy and surgical pathology material. The student will evaluate the microscopic slides with the resident and attending staff. The student will read about the disease entities discussed and correlate anatomic findings with clinical, radiologic and laboratory data.

The student is also expected to attend departmental conferences, review the available teaching sets, and make a short presentation on a topic of his or her choice.

Students will work with the fellow or senior resident, under guidance of the faculty, who will teach them gross pathology examination, frozen section examination, correct tissue sampling, and final microscopic and interpretations.

Objectives

  1. To introduce medical students to the practice of anatomic pathology (autopsy, surgical pathology and cytopathology) in a major hospital setting
  2. To observe and study the effect of disease process on tissue
  3. To understand structural and functional relationships of diseased organs, and to make anatomic and clinical correlations

Perinatal & Gynecological Pathology

Prerequisites

Completion of 3rd year clerkships

Description

The primary goal of this elective is clinical pathologic correlation of various pathology specimens, including perinatal autopsy, placentas, products of conceptions, cervical biopsies and gynecologic malignancies with their corresponding clinical presentation and subsequent patients' management and treatment.

Another goal is the introduction of additional ancillary pathological disciplines, such as the Pap smear, serology for HPV detection and cytogenetics and the understanding of their contribution to patients' management. The primary objective of this elective is to offer the student a "hands-on” approach of handling and examination of perinatal and GYN pathology specimens and correlation of the pathology findings with the clinical presentation and management of these cases


Pediatrics

Children with Disabilities

Prerequisites

Completion of all required 3rd year clerkships

Description

During this elective, students will participate in outpatient and inpatient programs including case conferences, rounds and seminars. The student will see the evolution of medical, educational, and social prescriptions for individual children and their families. Areas of emphasis include the diagnostic approach to the handicapped child, syndrome identification in pediatric practice, medical genetics (including cytogenetics) and the psycho-social assessment of the family. Visits to community agencies serving children with disabilities will be arranged.

Duties

Evaluation of outpatients and inpatients with faculty supervision. Participation in hospital consults on same basis. The elective will be of particular interest to students interested in Pediatrics, Family Practice, Neurology, Orthopaedics, Child Psychiatry, and Physical Medicine and Rehabilitation.

Objectives

  1. To enable the student to participate in an inter-disciplinary program serving children with disabilities and their families.
  2. To demonstrate coordination required to manage complex medical problems.

Pediatric Infectious Disease

Prerequisites

Completion of 3rd year clerkships in Pediatrics and Internal Medicine

Description

During this elective, the student will work up and follow infectious disease patients under the supervision of the attending physician. Major topics in pediatric infectious disease will be discussed. Laboratory projects will be available on an optional basis. The student's clinical work (primarily consultative) will be supervised. There are no night call duties. Students will attend all scheduled clinics.

Objectives

  1. Introduce students to pediatric clinical infectious disease as it presents on both the inpatient and outpatient services. The clinical service includes children with HIV infection.
  2. Provide the opportunity to learn the basic bacteriologic, virologic and serologic techniques utilized in diagnosing and evaluating various infectious diseases.
  3. Integrate clinical and laboratory data to understand disease process
  4. Offer an optional opportunity within the elective to carry out a limited objective research project in the pediatric infectious disease area.

Pediatric Hispanic Health

Prerequisites

  • Completion of 3rd year Pediatric clerkship
  • Student must be at an intermediate to advanced level of Spanish prior to taking this elective

Description

During this elective, students will work one-on-one with the attending at Oscar Clinic (Pediatrics outpatient setting) for the day. Students will learn to function at an intern level throughout the rotation. Students will interview patients in Spanish, devise a differential diagnosis and treatment plan, and present to the attending physician and discuss plans with the patients in Spanish.

Students will be responsible for performing outpatient procedures on their respective patients. Students are encouraged to draw blood or administer vaccinations to children a well when possible.

Medical students who take this elective are required to attend ten (10) clinical sessions and complete a scholarly activity that addresses some aspect of Hispanic health.

This scholarly activity must be approved by the attending physician. The scholarly activity can be, but is not limited to:

  • A formal presentation about a patient care issue related to Hispanic health
  • A formal presentation about an aspect of Hispanic health disparities
  • A formal presentation regarding any global health related topic of your choosing that involves Spanish-speaking groups
  • A project involving a health education that can be implemented with the Clinic to help better serve this population

Attending each clinic counts as 1 clinical session (e.g. attending morning, afternoon, and evening clinic on a Monday counts for 3 clinical sessions).


Physical Medicine and Rehabilitation

PM&R Elective

Prerequisites

Completion of 3rd year Internal Medicine clerkship

Description
This elective will consist of two rotations from the following areas (each two weeks in length): General Rehabilitation (orthopaedics, burn, and chronic diseases), Stroke Rehabilitation, Traumatic Brain Injury, Spinal Cord Injury, and Musculoskeletal Diseases (low back pain, sprains, amputation, electromyography, muscular dystrophy).

Attendance is required five days weekly, with the student responsible for 2-3 inpatients under the supervision of an attending physician. The rotation will provide exposure to the rehabilitation care for persons with disabling illnesses and injuries, including consultation of acute hospital patients, management in the rehabilitation hospital and treatment in an outpatient setting. The student will be exposed to the rehabilitation team setting, including the roles of the physician, physical, occupational and speech therapists.

During the elective, the student will be familiarized with the anatomy and pathophysiology appropriate to management of persons with disabilities. The student will participate in the initial evaluation and the care of rehabilitation inpatients, attend outpatient clinics, participate in team and family meetings and attend didactic lectures with optional topic presentation.

PM&R Acting Internship

Prerequisites

Completion of 3rd year Internal Medicine clerkship

Description

This acting internship will consist of a four-week rotation in either General Rehabilitation (orthopaedics, burn and chronic diseases), Stroke Rehabilitation, Traumatic Brain Injury or Spinal Cord Injury.

Attendance is required 5 days a week, with the student responsible for 3-5 inpatients under the supervision of an attending physician. Night call is optional. A comprehensive introduction to inpatient rehabilitation management in one of the inpatient rehabilitation units at MetroHealth Medical Center.

The student will be given an opportunity to present information regarding their patients at rehabilitation team meeting and in family meetings, be able to perform a rehabilitation History and Physical exam, with its emphasis on functional status and rehabilitation program goals and may gain an appreciation for the medical management of persons with disability and the interdisciplinary approach unique to Physical Medicine and Rehabilitation.

The student will participate in the initial evaluation and the care of rehabilitation inpatients (including daily progress notes), attend one outpatient clinic weekly, participate in team and family meetings and attend didactic lectures with optional topic presentation.


Psychiatry

General Psychiatry

Prerequisites

Completion of 3rd year Psychiatry clerkship

Description

During this elective, the student will participate in the initial evaluation and ongoing treatment of adults with developmental disability, and psychiatric and/or behavioral disorders, participate in a multidisciplinary specialty clinic comprised of dually-diagnosed patients, evaluate patients residing in a state developmental center for retarded persons, become knowledgeable with the psychological and pharmacological treatments available for such individuals and participate as appropriate in research involving dually-diagnosed patients.

Students will initially observe and later evaluate, adults with developmental disability, with psychiatric illness and/or behavioral disturbances.

Objectives

  1. To familiarize the student with the occurrence of psychiatric illness in persons with mental retardation
  2. To provide an in-depth clinical experience in the psychiatric diagnosis and treatment of such persons, as well as promote didactic knowledge regarding the epidemiology, phenomenology, psychosocial aspects and treatments of such disorders and individuals.

Consultation-Liaison Psychiatry

Prerequisites

Completion of 3rd year Psychiatry clerkship

Description

The goal of this elective is to prepare medical students for residency. Students will perform supervised psychiatric consultations of medical and surgical patients with increasing independence over time, communicate with primary services regarding impressions of patients and management, and provide follow-up care as needed.

Students are expected to give a 15-minute presentation on a topic of interest that may be developed further for presentation at a conference or submitted for publication.

Objectives

  1. To acquire skill in evaluation and management of psychiatric disorders in the medically ill, psychiatric manifestations of medical illness and psychological distress in the medically ill.
  2. To acquire skill in communicating with non-psychiatric physicians, nurses, social workers and other staff.
  3. To be introduced to outpatient consult-liaison psychiatry including the psychiatry of people living with HIV.

Pulmonary

Pulmonary Consult Service

Prerequisites

Completion of 3rd year Internal Medicine clerkship

Description

The consultation service is involved with the diagnosis and management of patients with pulmonary disorders on medical and surgical wards, coronary care unit and surgical intensive care unit. During this elective, students will work under the direct supervision of a pulmonary medicine fellow. The interpretation of chest radiographs and the evaluation of pulmonary function tests will be emphasized.

The principles and practice of antimicrobial therapy for pulmonary infections, including pulmonary tuberculosis, will be stressed. Students will also be introduced to specialized procedures including thoracentesis, pleural biopsy and bronchoscopy and will be familiarized with respiratory therapy devices including mechanical ventilators. This is a full-time commitment with no night-call.

Objectives

  1. To provide clinical experience in the diagnosis and management of patients with respiratory disorders.
  2. To provide further understanding of the basic pathological and physiological abnormalities underlying lung diseases and respiratory disorders.

Radiology

Introduction to Radiology

Prerequisites

Completion of all 3rd year clerkships

Description

The student will be assigned to individual staff members throughout the elective and will participate in a representative sample of basic diagnostic situations. He/she will assist in the planning and interpretation of various radiologic investigations (for both inpatients and outpatients), which include plain film, intervention, pediatric, as well as ultrasound, CT, nuclear medicine and mammography.

The student will compare gross and radiological anatomy with the intention of identifying those radiologic modifications produced by disease. Weekday attendance, 8 a.m. - 5 p.m. Limited call assignment.

Objectives

  1. Gain familiarity with choice and selection of appropriate examinations and their expected accuracy
  2. Develop an understanding of contemporary practice of radiology, its methodology, and its limitations.

Rheumatology

Prerequisites

Completion of all 3rd year clerkships

Description

During this elective, students are instructed in the recognition, diagnosis and treatment of various arthritic disorders. The appropriate use of diagnostic tests, physical and rehabilitation therapy, rheumatology referral, and surgical treatment are emphasized.

Acute and chronic conditions affecting joints, muscles, tendons and bursitis are managed in outpatient clinics, which are held daily Monday through Friday. Musculoskeletal procedures are carried out in these clinics. Daily rheumatology consultation rounds are conducted on the inpatient services. A range of conferences are provided weekly.

Objective
To enable the student to acquire skill and confidence in her/his ability to evaluate, diagnosis, and manage acute and chronic musculoskeletal disorders.


Surgery

Neurosurgery

Prerequisites

Completion of 3rd year clerkships in Internal Medicine and Surgery

Description

During this elective, the student attends daily rounds with the team. The student will spend time in the Operating Room for selected patients. He/she will also spend approximately three evenings per month on late call to get an idea of the complete management of the neurological surgical patient.

The main responsibility of participants in this elective is to learn to examine the neurological patient. The secondary responsibility is to obtain an understanding of the surgical management of neurological disease. The student is required to have two written write-ups. The student is also be required to make a short, five to seven minute presentation towards the end of the clerkship on the topic of neurosurgical interests.

Plastic Surgery Elective

Prerequisites

Completion of 3rd year clerkships in Internal Medicine and Surgery

Description
During this elective, students will gain an understanding of the basic principles and techniques available in plastic surgery, including management of traumatic, oncologic, and congenital problems. Students will learn the principles of wound healing and options available for management of difficult wound situations. They will develop their surgical skills, including dissection and suturing, while scrubbed in the operating room and emergency ward.

These individuals will have the opportunity to practice and enhance their diagnostic capabilities during a twice-weekly clinic experience encompassing both general plastic surgery, facial trauma, and hand surgery. The students are considered an integral part of the Plastic Surgical Team and will actively participate in the conferences, rounds, and operating room.

Plastic Surgery Acting Internship

Prerequisites

Completion of 3rd year clerkships in Internal Medicine and Surgery

Description

During this AI, students will gain an understanding of the basic principles and techniques available in plastic surgery, including management of traumatic, oncologic, and congenital problems. Students will learn the principles of wound healing and options available for management of difficult wound situations. They will develop their surgical skills, including dissection and suturing, while scrubbed in the operating room and emergency ward.

These individuals will have the opportunity to practice and enhance their diagnostic capabilities during a twice-weekly clinic experience encompassing both general plastic surgery, facial trauma, and hand surgery. The students are considered an integral part of the Plastic Surgical Team and will actively participate in the conferences, rounds, and operating room.

Surgery Acting Internship

Prerequisites

Completion of 3rd year clerkships in Internal Medicine and Surgery

Description

This opportunity is provided for the student who is particularly interested in surgery and anticipates ultimately entering a surgical discipline. It will best serve the student who wants to gain a head start in this direction. The student will in all respects serve (except from a legal standpoint) as a full-fledged first year house officer. He/she will be a member of the surgical team and by doing so will be given far more responsibility than is possible for a clerkship student. This AI will be a full time, intensive commitment.

Being an integral part of the team means that the student takes on significant responsibility for patients on the wards, in the OPD and in the operating room. It is anticipated that the student will have an abundance of experience in all settings. To provide an opportunity for students particularly interested in surgery to assume significant responsibility for the care of surgical patients. The responsibilities will be equivalent to those of a first year surgical House Officer, under the supervision of the attending staff.

Trauma Surgery Acting Internship

Prerequisites

Completion of 3rd year clerkships in Internal Medicine and Surgery

Description

Students will function as Acting Interns on the Trauma Service. They will spend two weeks on the day team and two weeks on the night team. Students will respond to all traumas and actively participate in the trauma bay, operating room, SICU, and floor.