Department of Internal Medicine - Nassau University Medical Center

Department of Internal MedicineThe electives in the Internal Medicine Department aredesigned to give the fourth-year medical student a longitudinalexperience in the outpatient setting. Teaching,supervision, and mentoring are provided by an InternalMedicine faculty clinician with whom the student worksclosely while being actively involved in patient care.The Department of Internal Medicine offers a broad rangeof research topics in preventive health care, medical decisionmaking, ethics, physical diagnosis, health care ofminorities, critical literature review, etc. Throughout theyear-long elective, the student has the opportunity to evaluatenew patients and develop appropriate managementand therapeutic approaches for the care of these patients.The student will also participate in follow-up care ofpatients with chronic illnesses for both new symptomsand for health maintenance and the well-being of theseindividuals. Additional exposure to topics central to outpatientinternal medicine as well as opportunities torefine evidenced-based medicine skills and reflect on thepractice of medicine are offered through didactic conferencesand other learning activities.We are pleased to offer exciting electives in theDepartment of Medicine. A large, public safety nethealth care organization, like NUMC is complex andcomplicated. Generally caring for ethic, poorer patientswith a myriad health vulnerabilities, conditions and accessbarriers, and adding to that, strained institutional resources,the services of busy community services or ambulatoryservices highlight these efforts by offering electives in thefollowing sub-divisions:• Cardiology• Community Medicine• Endocrinology• Gastroenterology & Hepatology• Infectious Diseases• Nephrology• Pulmonary- Pulmonary Consultation Services- Medical ICU- Pulmonary Care Unit• Rheumatology• Sub-internshipCARDIOLOGY CONSULT ELECTIVECourse Director: Israel Freeman, MDDuration: 4 WeeksGOALSThe Cardiology Consultation Service block is offered asan elective to fourth-year medical students. The purposeof this elective is to provide medical students with basicknowledge in cardiovascular diseases. The medical studentwill have the opportunity to be involved intimatelywith the primary evaluation, diagnostic studies, andtreatment of the patients. The experience obtained onthis rotation will assist in the development of a basicfoundation in cardiovascular medicine.OBJECTIVES• To gain skills and maturity in both clinical cardiology.• Learn cardiovascular history and physical examination.• Formulate a diagnostic and therapeutic plan.CLINICAL EXPERIENCEEach medical student will be expected to do one consultper day depending on the available caseload. The studentwill acquire skills and knowledge in providingcardiology consults for patients with known or suspectedcardiac disease throughout the hospital on both generalmedical and non-medical wards (such as the MICUand SICU as well as the general surgical, orthopedic,obstetrical, rehabilitation, and psychiatric services).The consult will be presented to the cardiology consultattending. All cardiovascular diagnostic testing performedon the patient will be reviewed, a discussion ofthe case will then ensue, and formal recommendationswill then be made. The student will be expected todevelop basic knowledge in the following areas:1. Pre-op and post-op management of cardiac patientsundergoing non-cardiac surgery2. Basic EKG interpretation with emphasis on rhythm,conduction abnormalities, and ischemic/infarctpatterns3. Heart disease and pregnancy4. Non-penetrating cardiac trauma5. Aortic dissection6. Infective endocarditis7. Congestive heart failure8. Valvular abnormalities particularly AS9. Atrial fibrillation10. Cardiovascular involvement in patients with AIDSDIDACTIC EXPERIENCEThe medical student will be expected to participate in alldepartmental lectures and conferences.EVALUATION METHODSFaculty will provide oral feedback to the student as casesare being presented and discussed. In addition, an evaluationform will be completed by the attending cardiologist ifrequired by the student’s medical/osteopathic school.

HOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.CARDIOLOGY AMBULATORY CARE CLINICELECTIVECourse Director: Rosalind Watman, DODuration: 4 WeeksGOALSThe ambulatory educational experience will allow the studentto participate in the care of patients having a widespectrum of cardiovascular disorders. In this setting,emphasis is placed on gathering information concerningthe patient’s past cardiac history and prior cardiac investigations.Utilizing this information, the student will beginto learn how to formulate a diagnostic and therapeuticplan and then arrange for its implementation in an appropriate,cost-effective manner.OBJECTIVESConcepts that the student will be expected to learninclude:1. Cardiovascular risk factor assessment2. Pharmacology of anti-anginal medications3. Treatment algorithms for hypercholesterolemia andhypertriglyceridemia4. Selection of grade exercise testing versus nuclearperfusion imaging techniques5. Coronary revascularization options6. Indications for and selection of vasodilators, betablockers,diuretics, and digitalis in heart failure7. General medical management and timing of surgeryin regurgitant and stenotic valve lesions8. Selecting the appropriate antihypertensive medicationswith respect to patient’s age, sex, race and comorbidclinical conditions as well as costs9. Evaluation of the cardiac patent undergoing non-cardiacsurgery including indications for nuclear perfusion imagingstudies in patients undergoing vascularsurgery10. Basic understanding of cardiovascular physiologyduring pregnancy and safety and utility of variousdrugs during pregnancy to treat maternal heart disease.EVALUATION METHODFaculty will provide oral feedback to the student as casesare being presented and discussed. In addition, an evaluationform will be completed by the attending cardiologist ifrequired by the student’s medical/osteopathic school.HOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.COMMUNITY MEDICINE ELECTIVECourse Director: Christine Brown, MDDuration: 4 WeeksGOALTo provide students with practice-oriented and/or service-orientedlearning opportunities related to communitymedicine. Students will learn about the types and functionsof the formal and informal medical, public health,and social support programs involved in communityhealth care.OBJECTIVES1. Focus on health promotion and disease prevention inthe community-based setting and as applied to populationsof patients.2. Demonstrate the importance of the physical environment,the social environment, and access to care in determiningthe health of populations.3. Enhance students’ understanding of the relationshipbetween culture and health, and improve their skillsin delivering culturally sensitive health care services.4. Expose students to the social, financial, and ethicalaspects of limiting and promoting access to health carefor vulnerable populations.5. Students should demonstrate an ability to evaluate andmanage common acute and chronic ambulatory illnessesin a well-reasoned manner.6. Students will be able to develop a patient-centeredapproach to the evaluation and management ofpatients commonly seen in ambulatory care setting.7. Students will be able to develop and refine the basicclinical skills of interviewing patients and performingan accurate physical exam.8. Students will be able to apply the principles of longitudinaland comprehensive health care, includingconsideration of familial, community, and culturalinfluences on health behavior.9. Students will be able to apply the principles of preventivemedicine in a primary care setting.10. Students will develop professional values and attitudes,and apply ethical principles to the physicianpatientrelationship.CLINICAL EXPERIENCEThe medical team comprises of two medical students,which will be “mentored” by a faculty member in theDepartment of Community Medicine. Each team isassigned at each of four [satellite] Community HealthCenters, and one at Nassau University Medical Center’sCenter for Hypertension, Diabetes and VascularMedicine, located within the Medical Center, but activelyinvolved in community outreach and linkages to ourcommunity health centers and private practitioners. Thestudents will be exposed to and understand the conceptsof “primary” and “specialty” care outpatient services,“medical homes,” referral patterns, follow-up issues anda host of other items including the challenges of cultural,ethnic and disparities in health care.

DIDACTIC EXPERIENCEThe medical student will be expected to participate in alldepartmental lectures and conferences.SUGGESTED READING MATERIAL:Community-Oriented Primary Care: Health Care for the 21stCentury, Edited by Robert Rhyne, MD American Public HealthAssociationEVALUATION METHODThroughout the rotation, there will be clinical observationand feedback by the mentor as well as other facultymembers.At the rotation’s end, based upon a patient seen duringthe month, a brief (10-15 minutes) case presentation,didactic discussion and Q&A will be presented to the student’scolleagues and Faculty.HOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.ENDOCRINOLOGY ELECTIVECourse Director: Salini Kumar, MDDuration: 4 WeeksGOALSDuring the four weeks of the elective, medical studentswill become familiar with the pathophysiology, diagnosis,and management of endocrine disorders. In order toachieve this goal they must:• Achieve basic knowledge of the normal physiology ofthe endocrine glands.• Become facile in obtaining a history specific toendocrine and metabolic disorders.• Learn to perform a physical examination with particularattention to the multi-system manifestations ofendocrine diseases.• Develop the ability to form a comprehensiveendocrinologic differential diagnosis.• Appreciate how to plan a logical, cost-effective work-up ofpatients with specific endocrinologic disorders.• Learn to interpret common endocrine laboratory testsand hormone measurements.• Have specific understanding of the long-term managementof patients with diabetes mellitus, thyroid disease,osteoporosis, and lipid disorders.OBJECTIVESDuring the elective, students will acquire in-depth skillsand knowledge by:• Performing endocrinology consultations supervised bythe endocrinology fellow and endocrinology attending.• Making formal consultations rounds five days perweek.• Attending the general endocrinology clinic weekly, thediabetes clinic at least once weekly, and the monthlymetabolic bone and hyperlipidemia clinics.• Attending and participating in the weekly endocrinedivision conferences, which include endocrine grandrounds, journal club, and nuclear medicine conference,and attending Department of Medicine grandrounds.• Observing the performance of fine- needle thyroidaspiration and thyroid ultrasound examinations at thethyroid biopsy clinic.• Reading general endocrinology with specific attentionto the disorders affecting the patients they are assignedand presenting a subject review during consultationrounds.• Learning about Diabetes mellitus type 1 and 2, ThyroidDisease, Disorders of Calcium Metabolism, Metabolic BoneDisease, Endocrine Hypertension and Lipid Disorders.SUGGESTED READING MATERIALHarrison’s Principles of Internal Medicine by Eugene Braunwald,Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser,J. Larry Jameson, Richard M. Stone.Cecil’s Textbook of Medicine by Lee Goldman, Dennis ArthurAusiello, William Arend, and James O. Armitage.Williams Textbook of Endocrinologyby Henry M. Kroneberg & al.CLINICAL EXPERIENCEThrough clinical experience, students will learn therudiments of:• Cortrosyn (rapid ACTH) test• Dexamethasone suppression test• Bone densitometry tests (DXA)• Hormonal responses to stress and hypoglycemia• Different modalities of thyroid gland imaging• The use of dynamic hormone testing and when imagingis indicatedDIDACTIC EXPERIENCEThe medical student will be expected to participate inall departmental lectures and conferences.EVALUATION METHODS• Clinical observation by attending physicians• Evaluation by endocrine fellows• Participation in rounds and conferencesHOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.

GASTROENTEROLOGY & HEPATOLOGYELECTIVECourse Director: Paul Mustacchia, MDDuration: 4 WeeksGOALSThe goals of the elective rotation are to provide the studentwith an introductory inpatient and outpatient consultativeexperience; and to introduce them to the managementof gastrointestinal and liver disorders.Additionally, students will be trained to competentlyevaluate, manage, and follow common gastroenterologicillnesses.OBJECTIVESThe objectives of the Gastroenterology elective are toexpose medical students to:• Basic pathophysiology of gastrointestinal diseases.• Recognized common diseases of the tubular gut, gallbladder,pancreas, and liver along with appropriatediagnostic and therapeutic plans.Every patient evaluated by a student in either the clinicsetting or the inpatient consult setting will be examinedand reviewed in detail with the attending physician. Ata minimum, this review will include discussion of thehistory and physical examination findings, differentialdiagnosis, and diagnostic and therapeutic managementplans.CLINICAL EXPERIENCEClinical experience will include co-management of patientswith a wide variety of digestive and liver disorders, in boththe inpatient and outpatient settings. There will be anemphasis on the pathophysiology, clinical manifestations,and treatment of gastrointestinal disorders. Additionallythe medical students will observe endoscopy performed bythe gastroenterologists to gain knowledge of the appearanceof normal gastroenterologic anatomy and the appearance ofpathology.The medical students will demonstrate understandingof diagnosis, treatment, and long-term management ofthe following GI diseases:1. hepatitis, including evaluating abnormal liver functiontests2. pancreatitis3. peptic ulcer disease and nonulcer dyspepsia4. colon cancer5. cholelithiasis, cholecystitis6. irritable bowel syndrome7. inflammatory bowel disease8. ascites and its evaluation9. GERD10. GI bleeding11. hepatic cirrhosisDIDACTIC EXPERIENCE• Students are expected to attend all regularly scheduledprogram conferences, including morning report, coreconference, journal club, morbidity and mortality conference,and pathology conference.• Selected clinical review literature in gastroenterologyand hepatology is presented to the student for readingand discussion.• The student will also observe endoscopic proceduresincluding diagnostic and therapeutic EGD andcolonsocopy. The student can also arrange to observemortality studies, endoscopic ultrasound, ERCP, stentplacement and other advanced GI procdures.OBJECTIVESDuring their rotation, medical students will work withInternal Medicine residents to become familiar with thepathogenesis, diagnosis, and treatment of a wide varietyof infectious diseases. They will always be supervisedby an Infectious Disease attending on the consult service.The course objectives include:1. Obtain an accurate and thorough history from thepatient, patient’s family, and available records.2. Perform a complete and accurate physical examination.3. Being able to recognize dermatological manifestationsof different infectious diseases.4. Evaluate lab and diagnostic radiographic studies inpatients with infections.5. Develop a differential diagnosis, recognizing whichillnesses are most likely to be causing the specificproblem.6. Discuss appropriate antibiotic options, if indicated,including calculation and adjustment of dosage ofantibiotic therapy in patients with renal compromise.7. Interpret levels of antibiotics.INFECTIOUS DISEASES ELECTIVECourse Director: Shadab Ahmed, MDDuration: 4 WeeksCLINICAL EXPERIENCEPrinciples of host defense, microbial pathogenicity, preventionof infection, diagnosis of infection, and antimicrobialtherapy are covered. Students are an integral partof the consulting team for patients with infectious diseaseproblems. They prepare consult notes and participate inrounds, conferences, and seminars. Special sessions in theInfectious Diseases and Aids Clinic, the Venereal DiseaseClinic, and the clinical microbiology laboratory are provided.Small group seminars are held with the faculty onmajor topics. In addition, a tour of the microbiology laboratorywill introduce students to relevant diagnostic testsand their interpretation.

DIDACTIC EXPERIENCEIn addition to daily teaching rounds, students attendthe following conferences:Journal Club Case Presentations. Twice a month, theInfectious Diseases attendings, HIV scholars, and residents/medicalstudents critically review current journalarticles. All members of the Infectious Disease team aregiven copies of the articles prior to the meeting to encouragediscussion.Medical Grand Rounds are held on Thursday mornings; usuallya guest speaker presents a lecture. The speakers areselected for their ability as lecturers and the topics arechosen so as to cover a variety of important subjects inInfectious Diseases over the course of the year (3–4 timesa year).Morning reports. As needed.Mortality and Morbidity conferences are held about 3–4 timesper year when infectious diseases cases are presented.An HIV Primary Care Conference is held every Thursdaymorning with both hospital and community consultants.SUGGESTED READING MATERIALMandell, Douglas and Bennett's Principles and Practices of InfectiousDiseases; 6th editionEVALUATION METHOD100% clinical observation and case presentations.HOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.The medical student joins the renal consult team. Thestudent will be expected to see patients on his/her ownunder the guidance of the renal fellow. The case willthen be presented to the renal attending who togetherwith the student will speak with and examine thepatient, review the laboratory work and radiologicaltests as necessary, and then review the case with thestudent and fellow and any medical resident on theservice. The student will also attend the renal and peritonealdialysis clinics and see patients in conjunctionwith one of the fellows. The case will then be presentedto and seen by the attending and discussed with thestudent and fellow.DIDACTIC EXPERIENCEThe medical student will be expected to participate inall divisional lectures and conferences.Topics or articles may be assigned to students for presentation.EVALUATION METHOD100% clinical observation.HOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.NEPHROLOGY ELECTIVEDivision Chief: Leah Balsam, MDDuration: 4 WeeksGOALSStudents will understand the fundamentals related toacute, chronic, and end-stage renal disease (ESRD), includinghemodialysis, peritoneal dialysis, and renal transplantation.In addition they will be expected to learn aboutglomerular and tubulo-interstitial diseases, acid-base andelectrolyte abnormalities, and hypertension.OBJECTIVESThe medical student will develop knowledge in thediagnosis and management of inpatient and out-patientnephrologic conditions. Patients will be evaluated onthe medical, surgical, and (occasionally) obstetricfloors. Patients will be also evaluated on the medicaland surgical, and (occasionally) patient ICUs, as well astelemetry and PCU. In addition to general consults, themedical student will be exposed to acute hemodialysisand peritoneal dialysis in these settings.25 A GUIDE TO C LINICAL R OTATIONS

Pulmonary Outpatient and Consultation ServicesConsultation Services is designed to allow the medicalstudent to participate in outpatient and inpatient consultations,under the auspices of a medical resident and pulmonarystaff physician. The medical student will performoutpatient clinic evaluations and inpatient consultationevaluations and will interpret pulmonary function testing.He/she will also observe fiberoptic bronchoscopesand other special procedures when appropriate. He/shewill perform history and physical examinations andwrite-ups and discuss appropriate plans for patient care.The medical student will also participate in theDepartment of Medicine weekly conferences and allPulmonary subspecialty conferences.The program offers two pathways, one focused on clinicaltraining and research, and the other on clinical trainingand basic, bench-top research. Students rotating atNUMC provide primary and consultative care for patientswith a wide rangeof pulmonary disorders under thedirect supervision of a pulmonologist. There will beexposure to the Medical Intensive Care Unit, PulmonaryCare Unit, and general hospital pulmonary consultationsand procedures. The following description is a generalguideline for the elective. If you have any questions aboutour programs, please contact us. We will be happy toassist you.MEDICAL INTENSIVE CARE UNIT (MICU)ELECTIVECourse Director: Javed Iqbal, MD, MPH, FCCPDuration: 4 WeeksGOALSThe goals of the MICU elective is to provide medicalstudents with a suitable background in critical caremedicine and outpatient settings.OBJECTIVESMedical students are expected to learn:• Critical care physiology• Principles of managing respiratory failure• Basic as well as advanced modes of mechanical ventilation• Principles of managing various shocks; septic, cardiac,neurogenic, etc.• Acid-base disorders and its clinical application• Manage fluid and electrolyte abnormalities• Basics of nutrition supplementation in critical careunits• Managing neurological disordersEXPERIENCEThe experience and knowledge gained during this electiveshould provide medical students with the backgroundto perform an initial evaluation in the treatmentof critically ill patients.DIDACTICS EXPERIENCEThe student will participate in didactic sessions includinggrand rounds, journal clubs, and lectures.EVALUATION METHODS: Clinical observation will be completedmainly by the course director.HOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.PULMONARY CONSULTATION SERVICEELECTIVECourse Director: Ashok Karnik, MD, FACP, FCCP, FRCPDuration: 4 WeeksGOALSTo acquire knowledge and have clinical experience witha broad range of pulmonary problems in an inpatientsetting, including obstructive lung diseases, pulmonaryinfections, occupational and environmental lung disease,acute and chronic respiratory failure, and geneticdisorders of the respiratory system.OBJECTIVESThe Pulmonary elective rotation provides students withthe opportunity to acquire knowledge of, and to have aclinical experience, with a broad range of pulmonaryproblems in inpatient and outpatient settings.To acquire knowledge of and to have a clinical experiencewith a broad range of pulmonary problems in inpatientand outpatient settings, including obstructive lung diseases,pulmonary infections, diffuse interstitial lung disease,pulmonary vascular disease, occupational and environmentallung disease, iatrogenic lung diseases, pulmonarymanifestations of systemic diseases, acute andchronic respiratory failure, disorders of the pleura andmediastinum, and genetic disorders of the respiratorysystem.CLINICAL EXPERIENCEMedical students will:• Learn outpatient consultation and management of awide range of pulmonary problems.• Learn inpatient management and care of the pul-

monary complications of surgery and postoperativerespiratory failure.• Acquire knowledge of and competence in the use ofoxygen therapy, CPAP, mechanical ventilators, weaningand respiratory care techniques, management ofpneumothorax, interpretation of sputum samples,BAL samples, pleural fluid, and lung tissue.• Learn and develop proficiency in interpreting theindications, contraindications, complications andlimitations of pulmonary functions tests, includingspirometry, flow volume loops, lung volumes, diffusingcapacity, and methacholine challenge studies.• Learn the indications, contraindications, complicationsand limitations of fiberoptic bronchoscopy,including lavage and biopsy.• Gain exposure and experience respiratory care techniquesand services, including respiratory physicaltherapy.Attending physicians who are board-certified in pulmonarydisease, directly supervise senior resident, oneor two medical students, and physican assistants.Consultation services are provided to medical or surgicalpatients with a full range of mild to severe problems.Examples include asthma, chronic obstructive pulmonarydisease, cough, pneumonia, tuberculosis andother infections, pre-operative evaluations, evaluationsfor dyspnea, infections in immunocompromised hosts,hemoptysis, drug-induced lung disease, pulmonary vasculardisease, interstitial lung disease, lung cancer, cysticfibrosis and pulmonary manifestations of systemic diseases.In addition, consultation and management ofmechanical ventilation, including the use of non-invasiveventilation, and weaning and respiratory care techniqueswill be provided by the service.Clinical encounters include: emergency room evaluationat the time of admission or upon request, full history andphysical examination at the time of consultation or clinicvisit, and daily work rounds for inpatients.Procedures most frequently performed by the attendingphysican assistants during this rotation include:fiberoptic bronchoscopy and related procedures, pulmonaryfunction testing and interpretation, thoracentesis,and pleural biopsy.During this rotation the student will also acquire knowledgeof, and the ability to interpret, imaging studies,including chest x-rays, thoracic CT scans, including CTangiograms, and radionuclide studies, particularly ventilation-perfusionscans.Nassau University Medical Center has a full range ofservices available for participation in patient careincluding a full mix of surgical, anesthesia, and medicalsubspecialty consultation. NUMC also has a full pulmonarydiagnostic laboratory for pulmonary functiontesting and full radiologic imaging services.TimeMONDAYSAMPLE SCHEDULE8:00-9:30 Pre-rounding and new consultations with PA9:30-10:30 Procedures if any scheduled10:30-12:00 Attending rounds12:00-1:30 Lunch teaching conference / Dept of Medicine1:30-3:00 Asthma Clinic3:00-5:00 New consults, PFT interpretation, roundsTUESDAY8:00-9:30 Pre-rounding and new consultations9:30-10:30 Procedures if any scheduled10:30-12:00 Attending rounds12:00-1:00 IM Conference1:00-5:00 New Consults, PFT Interpretation, RoundsWEDNESDAY8:00-9:30 Pre-rounding and new consultations9:30-10:30 Procedures if any scheduled10:30-12:00 Attending rounds12:00-1:30 Lunch teaching conference / IM1:30-3:00 Attending teaching rounds3:00-5:00 New consults, PFT interpretation, roundsTHURSDAY8:00-9:30 Pre-rounding and new consultations9:30-10:30 Grand rounds - Amphitheater10:30-12:00 Attending rounds12:00-1:00 Pulmonary conference,3rd Floor conference room1:00-5:00 New consults, PFT Interpretation, RoundsFRIDAY8:00-9:00 Pre-rounding and new consultations9:00-12:00 Pulmonary Clinic area 3 – ground floor12:00-1:30 Lunch teaching conference (IM)2:00-3:00 Attending teaching rounds3:00-5:30 New consults, PFT Interpretation, RoundsDIDACTIC EXPERIENCEFormal teaching conferences occur every Thursdaybetween 12:00-1:00 p.m.; at which topics pertinent toPulmonary Medicine are discussed, student and residentare assigned journal articles, as well as cases for presentationand discussion. In addition, there are informal teachingconferences where pulmonary function tests, exercisetests, or problems pertinent to the patients being currentlyseen are discussed on daily basis. Rounds with allmembers of the team occur at least once daily on all consultationfollow-ups and patients on mechanical ventilatoron the primary service.

EVALUATION METHODSClinical observation will be completed mainly by coursedirector.HOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.PULMONARY CARE UNIT(PCU) ELECTIVEDuration: 4 WeeksGOALSThe general goal for medical students on this rotation isto have patient care responsibility for inpatients with awide variety of pulmonary disease with an educationalemphasis on pulmonary physiology and its correlationwith clinical disorders. Medical students will developskills in rounding and communicating with primarycare physicians, other members of the health care team,and patient family members, under the supervision ofan attending physician.EDUCATIONAL OBJECTIVESStudents in the pulmonary care elective will develop anunderstanding of:• The weaning process from ventilator support.• Advance directives and end-of-life care issues.• Quality care measures, including the prevention ofblood stream infections, pressure ulcers, and ventilator-associatedpneumonia.CLINICAL EXPERIENCEThe clinical experience provided by the departmentincludes:• Daily pre-rounds with residents.• Daily teaching rounds with the attending.• Following assigned patients and writing progressnotes.• Assisting procedures.EVALUATION METHODSAt the end of the rotation, students are evaluated inwriting. An exit interview provides feedback to the studentand solicits feedback regarding the student’s experiencein the elective rotation.DIDACTIC EXPERIENCEDidactic experience includes:• Daily medicine morning report.• Daily medicine noon conference.• Weekly pulmonary lectures and journal club.RECOMMENDED READINGThe Washington Manual: Pulmonary Medicine SubspecialtyConsult.Online resources:www.thoracic.org/copd/ is an excellent online resource for practiceguidelines, treatment algorithms, pharmacology and consensusstatements• www.chestnet.org. Go to educational resources.• www.uptodate.com• www.harrisonsonline.com• www.cancer.gov for cancer of the lungs and the most up-todatetreatment modalities.Additionally, the Pulmonary Division has a small library in thePulmonary Conference Room, 3rd floor of B Building. A computerproviding direct access to literature searches is also locatedin the Conference Room.HOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.RHEUMATOLOGY ELECTIVECourse Director: Prachi Anand, MD, FACPDuration: 4 WeeksThe Winthrop-University Hospital and Nassau UniversityMedical Center (WUH-NUMC) integrated RheumatologyFellowship strives to produce exceedingly well-trainedconsultants in rheumatic and immunological disorders.The wide spectrum of pathology seen at NUMC and ouraffiliate hospitals serve as a foundation for our clinicaleducational curriculum. Our didactic basic and clinicalscience along with research program enhances the clinicalcurriculum by emphasizing the pathophysiology andimmunology of rheumatic diseases and by encouragingcreative approaches to the diagnosis and therapy of rheumaticdisorders.GOALS• Familiarize trainees with the management of commonproblems in rheumatology• Improve their proficiency in the performance of selecteddiagnostic and therapeutic interventional techniquescommonly performed in the practice of generalmedicine• Increase medical students’ and residents’ confidenceand ability to educate and manage patients with rheumaticdiseases

OBJECTIVES• Enhance history taking and physical examinationskills• Increase understanding of the use of the laboratory inthe diagnosis and follow-up of patients with rheumaticdisease• Develop an approach to initial management of patientswith rheumatic diseaseCLINICAL EXPERIENCEMedical students will be able to perform a detailed physicalexamination of the joints and musculoskeletal systemas well as interpret laboratory tests diagnostic ofrheumatologic disease in the context of the clinical findings.Typical daily activities:1. Monday: Grand rounds at Winthrop- University Hospitalat 8:30 a.m. Afternoon rounds at NUMC.2. Tuesday: Arthritis clinic at 8:30 a.m. to 12:30 p.m.Afternoon rounds.3. Wednesday: Lupus clinic at 9:00 a.m. to noon.Afternoon rounds.4. Thursday: Medical Grand Rounds 10:00 a.m to 11:00a.m. Afternoon rounds.5. Friday: Morning clinic at WUH. Afternoon rounds.RECOMMENDED READING MATERIALSPrimer on Rheumatic Diseases: John H. Klippel, John H. Stone,Leslie J. Crofford, and Cornelia Weyand.DIDACTIC EXPERIENCEThe medical student will be expected to participate inall departmental lectures and conferences as scheduledpermits.HOW TO APLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.SUB-INTERNSHIP IN INTERNAL MEDICINECourse Director: Deepti Gupta, MDDuration: 4 WeeksGOALSThe educational goals of the Acting Internship in InternalMedicine are to provide fourth year medical studentswith advanced clinical and cognitive abilities requiredfor problem solving and decision-making in clinical medicine.These goals are to be accomplished with supervisedclinical experiences in the inpatient setting andwith critical reading.OBJECTIVESStudents gain broader experience and knowledge in clinicalmedicine and be able to:• Obtain patients’ history and with emphasis on behavioral,psychosocial and environmental aspects of thedisease as well as the medical illness.• Demonstrate proficiency in advanced physical diagnosisincluding but not limited to assessment of the febrilepatient, change in mental status and fluid balance.• Analyze the data and develop a problem list with anappropriate differential diagnosis for every problem.• Request and interpret problem-specific and cost-effectivediagnostic tests.• Present data concisely in both the verbal and writtenformat.Acting interns have responsibilities similar to those offirst year postgraduate (PGY-1) internal medicine residents.The student is assigned to a floor Medical Team orthe Medical/Cardiac Intensive Care Team. The team willconsist of a faculty attending, residents and third yearmedical students. Although the goals and objectivesremain the same, the approach to achieving these goalsvary as follows:• Obtain history, physical and laboratory studies on hospitaladmissions using the problem-oriented record.This is done under the supervision of a senior residentand attending.• Outline the diagnostic and therapeutic plans forpatients worked up in the hospital or ambulatory settings.• Present patients to the senior resident and faculty andobtain a copy of discharge summaries on respectivepatients.• Generate patients’ encounter at morning reports and/orconference rounds.• Basic knowledge of clinical information pertinent toproper diagnosis and treatment.EVALUATIONThroughout the rotation, there will be clinical observationand feedback by the Mentor as well as other FacultyMembers.DIDACTIC EXPERIENCEThe medical student will be expected to participate in alldepartmental lectures and conferences as scheduled permits.HOW TO APPLYIf you are interested in applying, please call 516-572-5399 or visit us at www.numc.edu.