Director: Dr. Lee Tai (708) 346-4429
Coordinator: Nedra Cipcich (708) 346-4239

Director: Dr. Marc Fine (847) 723-6464
Coordinator: Kinga Nyckowski (847) 723-6464

Director: Dr. Michael McDonnell
Coordinator: Pat McMullin (312) 567-2167

Director: Dr. Z. Ted Lorenc
Coordinator: Nancy Shuler (815) 759-4206

Director: Dr. Alejandro Aparicio 773-878-7300 x1240
Coordinator: Val David, (773) 279-3153

Director: Dr. Kenneth Grumet
              Dr. Gary Novak
Coordinator:  Barbara Li (847) 316-6228

Director: Dr. Sunil Kalghatgi   (312) 413-3037, Page #2868
Coordinator: Veronica Guzman (312) 996-5998

Director: Dr. Bob Molokie (312) 666-2129, Pager 2687    

Christ Hospital

Location:             Department of Medicine, 319 South
Time:                8:30 AM on first Tuesday of each monthly block

Illinois Masonic Medical Center

Location:             Department of Internal Medicine
Time:              8:30 AM on first Tuesday of each monthly block

Lutheran General Hospital

Location:             6 South, Dept. of Medicine, report to Kinga Nyckowski
Time:               8:00 AM on first Tuesday of each monthly block

Mercy Hospital

Location:             Department of Medicine Office to meet Dr. McDonnell
Time:              9:00 AM on first Tuesday of each monthly block

Northern Illinois Medical Center (NIMC)

Location:             Lobby of the Hospital with Dr. Lorenc & Linnea Thennes
                            For location of hospital see the site guide that was handed out
                            or the on-line site guide
Time:               8:00 AM on first Tuesday of each monthly block

Ravenswood Hospital

Location:             Third floor, Special Car Pavillion, Department of Medicine
Time:              8:30 AM on first Tuesday of each monthly block

St. Francis Hospital

Location:             Medical Education, first floor, South End with Sylvia
Time:               9:00 AM on first Tuesday of each monthly block

University of Illinois Hospital

Location:             Internal Medicine Faculty Associates (IMFA)
                            Internal Medicine Center
                            UIC Outpatient Care Center, 3 South  Medicine Center OCC 3
Time:                   To be arranged on the first Core Curriculum Day, usually 9:00 AM on first Tuesday of each monthly block

West Side Veteran’s Administration Hospital

Location:          WSVA, Room B602-A (Internal Medicine Chief Resident’s Office).  Page Dr. Molokie, #2687

Time:               9:00 AM on first Tuesday of each monthly block  

1. Appreciate the range of illnesses and patient problems seen by general

internists in the ambulatory setting.

2. Understand the pathophysiology, diagnostic options, and treatment modalities

for the acute, sub-acute, and chronic presentations of common medical conditions. These diseases will not be limited to, but will include, the most common diseases and symptom complexes encountered in ambulatory Internal Medicine, ex: arthritis, asthma, bronchitis, congestive heart failure, COPD, diabetes mellitus, hypertension, ischemic heart disease, pharyngitis, sinusitis, upper respiratory infections, and urinary tract infections.

3. Define a medical problem and manage it over time in the context of the

patient’s other problems, his or her social circumstances, the importance of the problem, and the necessity for diagnosis.

4. Appreciate the need for effective time and cost management in the ambulatory

setting.

5. Effectively incorporate into practice age and gender-appropriate disease

prevention and health promotion practices.

6. Appreciate the importance of effective communication skills and the doctor-patient relationship in the successful implementation of medical care plans.

Sessions with the primary preceptor are fundamental to the success of the clinical experience of this course. Each preceptor and student will need to develop a slightly different model to accommodate their unique personalities, but there are some general principles, which are likely to improve the experience for both the student and preceptor:

Communication of expectations: Students should understand the general format for patient visits as well as the expectations for presentation of their patients, write-ups and following up on studies. You should understand your role in the clinic and the relationship that you have in the delivery of care by the preceptor. An issue which requires particular attention is the importance of working in a timely manner. Most students are generally not accustomed to time constraints in their interactions with patients, so this is an issue you need to concentrate on prior to patient interaction to ensure that you do not put undue strain on the preceptor and clinic’s schedule.

The student-patient interaction: Your preceptor should introduce you to the patient and explain to the patient that you will be seeing the patient first and then the preceptor will come in to see the patient. Presentations to the preceptor in front of the patient are encouraged to promote efficiency and to avoid a complete and tedious repetition of data collection by the preceptor.

Patient follow up: You are expected to follow up on your patients, taking on the role of a physician. You should keep track of pending diagnostic studies and may need to call patients with results. If patients get admitted, you should try when at all possible, to visit them in the hospital. You should conduct follow-up visits for such things as blood pressure checks, diabetic control and acute infections, rather than having the patients seen by a nurse. Students are responsible for reading and performing literature searches as necessitated by patient care and should then report back on their findings to the preceptor.

Literature Search Assignments: All students are to perform 2 mandatory literature search assignments. These are formal searches where you choose a clinical problem, formalize a relevant search question and perform a literature search. You will then explain the potential impact of the results on the care of the patient. This will be submitted on a form . The results should be  discussed with your preceptor.

Patient Load: The patient load will start out light, maybe 2 patients per shift, but will then increase as you improve your efficiency and get comfortable in the clinic. The appropriate number of patients to see in a typical half day of clinic is difficult to gauge, but a good guess may be 3-4 patients by the end of the month, depending on the complexity of the care. You will need to discuss the numbers of patients assigned to you with your preceptor if you think that it is too light or too heavy.

"Teaching": A busy clinic is not necessarily the best time for your preceptor to sit down and give a lecture to you. Teaching will need to be done in small doses when time allows between patients. The most important teaching will be in the explanations of the plan of care and in the demonstration of pertinent physical exam findings. More lengthy discussions may need to occur after clinic has ended, with the student being responsible for keeping track of issues that need to be addressed.

Core Curriculum

Students will return to UIC each Monday for a mandatory weekly core curriculum. The core curriculum will include the educational elements outlined below. The schedule of the core curriculum for each rotation may vary.

Many of the commonly seen diagnoses in Internal Medicine present with similar symptomatology. These diseases can be compared and contrasted in the context of a common clinical scenario. Cases will unfold in a problem-based learning format, requiring students to define learning agendas and solve problems throughout the course of the case. Each case will require students to use the medical literature to determine the appropriate approach to diagnosis and management.

Tutorial groups will be facilitated by a General Internist who has been trained in problem-based tutoring. You will be responsible for defining and answering the important questions brought out by the case. Each case will occur over two core curriculum days. You will be responsible for a certain amount of research between the two halves of the cases. Please bring whatever textbooks you might find helpful to the sessions, as much of the material to be discussed by the group can be found in standard medical textbooks. Some suggested references to bring along are:

The 2 cases are outlined below:

Shortness of Breath: This case will be developed to promote an understanding of the differential diagnosis of shortness of breath and the characteristic features of some common causes. The initial assessment will be emphasized. The first page of the case is included in the syllabus.

Weight Loss in the Elderly: This case will be developed to promote an understanding of the differential diagnosis of weight loss and the characteristic features of some common causes. The initial assessment and management will be emphasized. The first page of the case is included in the syllabus.

The following would be a useful reference to read prior to the first session:

Harrison’s Principles of Internal Medicine Chapter #43 on "Gain and Loss in Weight"

Actual patients seen by students will be discussed with a faculty preceptor. Students will present patients with defined medical problems in order to further their knowledge about the disease process and/or management. The case discussions will last approximately 30-45 minutes. The following topics will be used as an outline for the types of cases to be discussed;

GERD/Dyspepsia
Chest Pain
Managed Care Issues
Hypertension
Congestive Heart Failure
Diabetes Mellitus
Lower Abdominal Pain
Women's health Issues

Didactic presentations will emphasize important topics in ambulatory medicine. The format for each session will be faculty dependent, but interactive elements will be strongly encouraged. A list of possible sessions includes:

Asthma
Diabetes Mellitus
Hypertension
Medical Ethics & Managed Care
Preventive Medicine
Women’s Health

Students will get hands-on experience with procedures common to the practice of Internal Medicine, including:

Pulmonary Function Testing: performance, indications and interpretation

Treadmill Stress Testing: performance, indications and interpretation

Internet Based Literature Searches: introduction and examples of using resources such as PubMed, Ovid and Grateful Med.

Students will receive a course on the cardiac physical exam using a cardiovascular mannequin called Harvey at the University of Illinois. Harvey is a life size Cardiology Patient Simulator (CPS). Harvey is able to simulate twenty-seven different cardiovascular diseases. Variations in blood pressure, jugular venous pulses, carotid pulses, peripheral arterial pulses, and precordial evaluation may be assessed. Additionally, cardiac auscultation in the four primary auscultatory areas using infrared sound systems may be conducted. Harvey is part of the Cardiovascular Teaching Center Harvey is taught by Dr. George Kondos . For more information regarding Harvey feel free to contact  Ms. Cathy  Vanerka  or Dr. Kondos (312) 996-9347 visit

Students will be graded using the usual University of Illinois clinical rotation grading scheme of Outstanding, Advanced, Proficient or Needs Remediation for the entire 12-week Rotation. The ambulatory course will be included as a portion of the clinical grade, which is 2/3 of the whole clerkship grade. The remaining 1/3 of the clerkship grade will be dependent on the end-of-clerkship exam. The ambulatory grade will be a combination of the preceptor evaluations and the core curriculum evaluations. Attendance will be required at all core curriculum and clinical sessions and poor attendance will be counted against the students in the evaluation of their professional behavior. Submission of literature searches is also mandatory, but will not be graded.

Preceptors should evaluate students in the areas of history taking, physical examination, problem list formulation, disease management skills, preventative care, communication with patients, note writing, relationship with patients, relationship with the staff, professional behavior and educational initiative. In addition, a written statement of student strengths and weaknesses will be requested. (Evaluation form). Evaluation from preceptors other than the students primary preceptor can be given to the students for the purpose of feedback and will be included in their final evaluation, but are not required.

Students are expected to attend all clinics assigned to them. Any absence must be pre-arranged with their preceptors. The course coordinator should be notified about any unexplained absence. Attendance should be included in the evaluation of professional behavior.

All students will be required to evaluate their primary preceptor as well as their ambulatory site. These evaluations can be made anonymously if the student chooses to do so. A summary of these evaluations will be made available to the site directors periodically. (Preceptor and Site evaluation forms)

"Doc, I’m worried about her." Mr. Cotter says. She has just not been herself lately. She seems to get short of breath quickly, and has not had much of an appetite. I am afraid she has pneumonia."

You look carefully at Mrs. Cotter, your patient for the past 5 years. Pneumonia could be a serious complication for her. A 66-year-old woman with chronic obstructive pulmonary disease, hypertension, and a history of migraines, Mrs. Cotter did not have the reserves to withstand a serious pneumonia.

"Don’t worry Mr. Cotter, I will check her out. If its pneumonia, I will take care of it."

As you approach Mrs. Cotter, you first notice her posture. She is sitting on the examination table, bent over slightly at the waist and breathing quietly. She does not seem to be in any respiratory distress, but does not look too happy about the situation, a deep frown line wrinkling her brow. She does appear to have lost some weight. She has always been thin, but now seems almost gaunt.

"How have you been feeling, Mrs. Cotter?" you ask.

"Not too well, doctor. I’m having trouble eating. My husband keeps pestering me to eat more, but I just don’t feel like it. I think it is because I am having trouble breathing all the time. It’s not horrible, but eating makes me more short of breath. Plus, I have to use all those inhalers and they leave a bad taste in my mouth. It ruins my appetite. I wouldn’t mind putting on a few pounds, but I just don’t seem to be able to do it."

You settle in your chair as you ask Mrs. Cotter some more questions. She tells you that about 6 months ago she had the flu and that is when all this began. She lost about 10 pounds at that time, and seemed to recover very slowly from the flu. She has not regained the weight she lost. She has been coughing lately, although she does not bring that up as a serious concern. She brings up sputum that is whitish in color, but there is never very much of it. She denies coughing up blood and exertional chest pain. She tells you that sometimes she is more short of breath than other times, but is unable to elaborate much on the details. She says that moving around sometimes makes her more short of breath, and sitting still improves this, but sometime she also feels short of breath while resting. Mostly it’s just a deep sense of fatigue and having no energy to do things. She sheepishly admits to starting smoking again, just a cigarette every now and then, when you ask.

You note that Mrs. Cotter’s vital signs, taken by the nurse before you saw her, are: Pulse = 86; Respiration = 16; BP = 130/92. Temp. = 97.8 F. She weighs 83 pounds and is 4'11" tall. As you are flipping through Mrs. Cotter’s old record, you ponder the possibilities.

Mr. Ricardo Pena is a 35 year-old newly hired factory foreman who is seeing you as part of an occupational health routine physical examination. You have a contract with the Reynolds Aluminum Factory to provide health evaluations for all new employees. You are working with a 3^rd year medical student, Julie Chandler, whom you ask to interview and examine Mr. Pena. She provides you with the following historical information:

Mr. Pena was born in Mexico and emigrated at age 13 with his family to the United States. He is married and has 3 healthy children. He reports that as an adult he has never seen a physician, but that he did have a prolonged illness as a child that was characterized by a sore throat, high fevers and 3-4 months of prescribed bedrest. He was not told any more about this illness and has been well since.

On review of symptoms, he admits to exertional shortness of breath, which he thinks might be getting worse over the past year. When the student offers no additional information about this symptom, you turn to Mr. Pena to ask a few questions.

"Doctor, what are you worried about? I’m just getting old and out of shape. I used to do more heavy labor and was in better shape."

You’re not so sure that this symptom can be so easily explained away and continue to pursue it.

The effect of intensive treatment of diabetes on the development of long-term complications in insulin dependent diabetes mellitus (DCCT). N Engl J Med. 1993;329:977-86.

General Ambulatory Medicine

The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. @Arch Intern Med. 1997; 157:2413-2444. Outline Form

Hansson L, et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet. 1999 Feb 20;353(9153):611-6.

Hansson L, Zanchetti A, Carruthers SG, et al, for the HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351: 1755-62

Obesity

NIH Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults 99'

Preventive Medicine

Hardcastle JD, Chamberlain JO, Robinson MH. Moss SM, Amar SS, Balfour TW, et al. Randomised controlled trial of fecal-occult-blood screening for colorectal cancer. Lancet, 1996;348:1472-7.

Grodstein, F et al.. Postmenopausal Hormone Therapy and Mortality, N Engl J Med, 1997; 336(25):1769-1775

Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E, for the Heart and Estrogen/progestin Replacement Study (HERS) Research Group. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA. 1998;280:605-613.