Internal Medicine – 12 weeks: Students gain knowledge of internal medicine, which includes health promotion, disease prevention, diagnosis and treatment of men and women from adulthood through old age, from times of health through all stages of acute and chronic illness. Additionally students develop skills in problem solving, decision making and an attitude of caring driven by humanistic and professional values. This rotation incorporates a consideration of human biology, behavior, and understanding of the epidemiology and pathophysiology of disease and the mechanisms of treatment. Students master clinical skills in interviewing, physical examination, differential diagnosis, diagnostic testing strategies, therapeutic techniques, counseling, and disease prevention. 
Pediatrics – 6 weeks: The objective of the pediatric rotation is to educate students about issues unique to the neonatal period, childhood, and adolescence. The clerkship uses both the hospital and ambulatory venues to focus on human development biology, the role of the family, community, and society of child health. There is a major emphasis on the impact of disease and treatment of the developing individual. During the rotation, the students develop the communication, examination, and problem solving skills that are required to evaluate the health status of pediatric patient. These skills are directed toward the diagnosis and management of acute and chronic illness in children. The students will develop an understanding of the physical growth and development from infancy through adolescence including the assessment of motor, language, and social development. They will learn to develop strategy for improving rapport with pediatric patients and their parents and to assess the physical changes that the child undergoes. The students will also develop and understanding of the importance of strategies for health promotion, disease, and accident prevention among pediatric patients.   

Obstetrics and Gynecology- 6 weeks: During this rotation, students will acquire a set of basis educational and technical skills related to the maintenance of women’s health. They will learn to take an obstetrical and gynecological history and physical with emphasis on the breast, abdomen, and pelvis. Students will develop a basic understanding of the pathophysiology in women as they occur from menarche through the reproductive years and menopause. This will include an appreciation of specific obstetric and gynecologic issues encountered at different stages of a women’s life. Inpatient obstetrical and gynecological admissions and surgical procedures, as well as ambulatory outpatient clinic or private practice experience, provides the necessary core fundamentals of the rotation.           

Family Medicine – 6 weeks: The objective of the rotation is to prepare medical students to engage in the delivery of comprehensive care to patients of all ages by addressing the diverse health needs of both individual and the family as a unit. The students will learn how the patients progress through the healthcare delivery system, to develop a holistic approach to the patient. Students should develop an understanding of mechanisms of disease process, inpatient care, referrals, consultations, and general resources.  

Students will be exposed to a broad spectrum of diseases. These include breast exams, dermatologic abnormalities, ophthamalgic and otorhinolaryngologic problems, respiratory and cardiovascular disorders, endocrinological abnormalities including diabetes, thyroid and adrenal disorders, a broad spectrum of gastroenterologic problems, neurological and musculoskeletal problems, psychiatric problems including substance abuse and eating disorders.        

Elective Rotations-
Each elective rotation is (4) weeks.

Anesthesiology: Management of patients rendered unconscious or insensitive to pain and stress during surgical, obstetric, and certain other medical procedures. Preoperative evaluation and evaluation of and treatment of patients in specialized care and pain management, cardiopulmonary resuscitation, respiratory care problems, and management of critically ill and or inert patients in special care units.  

Cardiology: Sub-specialty of internal medicine, provides an educational experience in evaluation and management of wide variety of patients with acute and chronic cardiovascular conditions including coronary heart disease, congestive heart failure, arrhythmia, acute myocardial infarction, and other acute aschematic syndromes, lipid disorders, hypertension, cardiomyopathy, vascular heart disease, pulmonary heart disease, peripheral vascular disease, infectious an inflammatory heart disease, and adult congenital heart disease.  

Critical Care: Sub-specialty of internal medicine. It is the training in managing critically ill patients and supervising critical care units. Students follow patients throughout patient’s stay in critical care units and monitor subsequent course of patients throughout remainder of their hospitalization. It covers various aspects of critical care. Clinical care medicine is multi-disciplinary and major. Students may obtain clinical experience with critically ill patients including surgical patients, shock trauma patients, neurological, neurosurgical patients, pediatrics, intensive care patients, burn unit patients, dialysis unit, anesthesia service, cardio catherization, and high-risk pregnancy intensive care patients, as well as transplant patients.  

Emergency Medicine:  The department of Emergency Medicine sees approximately 87,000 patients a year. There is a wide variety of medical, surgical, gynecologic, pediatric and psychiatric patients. Students are expected to work 15 assigned shifts as well as attend the Resident Conference each week. This Emergency Medicine elective is designed to introduce senior medical students to the specialty of Emergency Medicine and to provide them with the opportunity to assume primary responsibility for the diagnosis and management of acutely –ill patients. These goals are accomplished through daily rounds, EM conferences, exposure in the SIM lab and EM ultrasonography and direct patient care in the Emergency Department. Medical students will evaluate patients, complete the workups and perform various diagnostic and therapeutic maneuvers under the direct supervision of the Department of Emergency Medicine faculty. They will learn how to stabilize and care for a wide variety of patients and will learn many of the skills and procedures necessary to do so, including: IVs, NG tubes, Foleys, LPs, suturing, fracture and dislocation reduction, central lines and basic bedside ultrasound skills. Medical students are encouraged to see patients at a rate that is comfortable for them.  
** Must have completed all CORE rotations prior and a mimimum USMLE score of 210 or COMLEX of 500 required.
Ophthalmology: Care and treatment of broad range of ophthalmologic diseases. Introduction to major technical and patient care responsibilities in ophthalmic surgery.  

Orthopedic Surgery: Study and prevention of musculoskeletal diseases, disorders, and injuries and their treatment by medical, surgical, and physical methods. Clinical experiences includes: inpatient care, preoperative evaluation and post-operative follow up, as well as evaluation in treatment of patients not requiring surgery and alternatives to surgery as modality of treatment for those patients.  

Research Elective:  The Kaweah Delta Research Center directs research for all academic and clinical departments within the Kaweah Delta Health Care System. This unique arrangement, most individual departments have their own research program, allows for a truly integrated approach to research. Rotating medical students can arrange to spend all or part of their elective time in any of the participating departments (Emergency Medicine, Psychiatry, Family Medicine, Surgery, and Radiology) as most ongoing studies are multi-disciplinary. Students will work directly with the medical center’s research director and other faculty involved in research projects. Students are expected to arrange their project prior to their arrival in Visalia so that may be spend time here actively working on the project. Most students should expect to work five days a week while on the rotation with their time being divided between small group, discussions, study design, and the data collection and analysis. Schedules may be arranged and are designed to be flexible to fit the needs of the student and their research project. It is expected that the rotating student will be involved in the presentation and /or publication of date derived from their work sometime after their rotation. Thus, most students will be able to present at medical society meetings and will like have the opportunity to be published.