In three days, Erin Hennen, a medical student at the University of Minnesota will take the internal medicine shelf exam âÄî the culmination of her six week rotation at Abbott Northwestern Hospital.

Working at a hospital from 6:30 a.m. until as late as 9 p.m. six days in a row during the weeks leading up to the exam is âÄútiring and stressful,âÄù she said. But itâÄôs also exactly what Hennen and other third-year medical students in the required course Medicine Externship 1 have been working toward, she said.

Among about a dozen required courses in the UniversityâÄôs Medical School, the Medicine Externship 1 âÄî the fundamental hospital rotation where students learn how to treat diseases in adults âÄî has the highest rate of failure.

About five students out of 240 in the Class of 2011 failed and had to retake the course, said Dr. Theodore Thompson, director of clinical education for the Medical School.

The Medical School has not received any complaints about the course, said Academic Health Center spokesman Justin Paquette.

Internal medicine, the courseâÄôs topic, is a broad field with much information for medical students to absorb, said Dr. Sally Berryman, course director for an equivalent clerkship. It covers all the organs and often involves treating complex acute illnesses on top of chronic conditions.

Difficulty aside, there are multiple ways for students to fail the Medicine I course, said Phillip Radke, president of the Medical School Student Council. Students may fail in clinical performance or on the final knowledge examination, called the shelf exam.

âÄú[The clerkship] is overwhelming in the beginning to be completely honest âĦ you donâÄôt know where to look or who to ask,âÄù Hennen said.

Throughout the six weeks, however, there is a steep learning curve, Hennen said. Students encounter much of the material on the shelf exam in their patientsâÄô health conditions. They become accustomed to admitting patients, participating in procedures under supervision and reporting to a resident.

Although Hennen spent four years working long hours as a nursing assistant and two years in medical school before taking the course, she said itâÄôs a very different experience.

Each day on her rotation, Hennen checks in with her assigned patient until he or she is discharged. Being attached to patients instead of passing them off when the next shift arrives creates a higher level of responsibility, she said.

 âÄúItâÄôs physically and mentally taxing âĦ the demands of performing are intense,âÄù Berryman said.

One thing she did not worry about, Hennen said, was getting a surprise evaluation from her clinical adviser, a staff attending physician that she meets with for an hour daily. Both the adviser and resident on her team gave helpful feedback about her performance at the beginning of the course, she said.

Students from all over the country commenting on the Student Doctor Network forum dedicated to the internal medicine shelf exam said studying for the shelf brought on high anxiety.

âÄúMy stress level in the final seven-10 days of this rotation was terrible, to the point where I was vomiting up my breakfast several times in the week of the shelf exam,âÄù wrote one student.

Hennen said she studied in the evenings on âÄúshort callâÄù days when she got off around 3 or 4 p.m., or during breaks at the hospital.

The UniversityâÄôs medical education website lists conduct that will result in course failure for third and fourth year students in clerkships.

Students may fail if they are judged âÄúbelow expectations in professionalismâÄù or if they fail to turn in a paper or make-up work missed during an absence.

Students who fail Medicine I are referred to the Committee on Student Scholastic Standing so they can request permission to retake the course.

Permission is almost always granted, said Dr. Thompson, COSSS lead advisor.

âÄúWe think students should always have the opportunity to get through medical school,âÄù he said.