Tao T. Le, MD, MHS Associate Clinical Professor Chief, Section of Allergy & Immunology University of Louisville Senior Editor First Aid Board Series USMLERx Test Bank Series First Aid for the Wards: The Really Short Version

Overview n Common Ward Mistakes n The Team n A Day on the Wards n The Admission n Key Tasks n Survival Tips n Getting Off to a Fast Start n Q&A

Common Mistakes n Not understanding roles, responsibilities, expectations n Not seeking timely feedback n Not using appropriate texts and references n Not knowing how to be a team player n Inefficient organization and execution of daily work

The Team n Attending/Chief n Resident n Intern n Sub-intern n Nurse n Ward clerk n Pharmacist n Other staff n You

Typical Inpatient Medicine Day n Prerounds: 7-8 am n Work rounds: 8-9:30 am n Work time: 9:30-11 am n Attending rounds: 11-noon n Conference: noon-1 n Afternoon work: 1-? n Signing out

Typical Inpatient Surgery Day n Prerounds: 5-6 am n Work rounds: 6-7:30 am n Preop prep: 7:30-8 am n Surgery/floor work: 8-5 n Conference: noon-1 n “Afternoon” rounds: 4-5:30 n Postrounds work: 5:30+?

Taking Call n Overnight call n Short call n Typically Q4

The Admission n The “Call” n Reviewing objective data n Medical record review n Interviewing the patient n Physical exam n Putting it all together n Reviewing case with the resident/intern

Key Notes and Orders n Admit orders u Admit to u Diagnosis u Condition u Vitals u Allergies u Activity u Nursing orders u Diet u IV fluids u Medications u Special studies u Labs

Key Notes and Orders n Admission notes u Onset u Progression u Provocation u Palliation u Quality u Region u Radiation u Symptoms u Severity u Time course

Key Notes and Orders n Progress notes n Procedure notes n Daily orders n Prescriptions/DC orders

Documentation Tips n Get everything co-signed n No documentation = no reimbursement n Date/sign all pages n Illegibility = no documentation n Use only appr. abbrev. u “q.d." vs. “q.i.d” vs. “once daily” u To CYA, never CYOA!

Oral Presentations n Formal presentations u 5-7 minutes (surgery: 2-3 min.) u Should tell a story u CC/HPI/PE/Labs  sets the stage u A&P  delivers the climax n Bullet presentations u 1 minute u facts

Daily Ward Activities n Procedures n Patient/family communications n Consults n Data collection n Reading up on patients n “Walking supply cart”

Survival Tips

Efficient Time and Patient Management n Commit all tasks to a to-do list n Prioritize tasks n Organize tasks by location n Maximize hospital information system n Keep “scut” essentials on board n Always be early!!

Organizational Aids (“Peripheral Brains”) n Clipboard n Binders n Data sheets n Note cards n iPhone/iPad/Android

Evaluations n Critical for dean’s letter n Know the evaluation criteria u Clinical performance u Shelf exam? n Know who is evaluating you n Clarify expectations n Ask for feedback early on

Difficult Situations n Needlesticks n Abusive/inappropriate house officers n Inappropriate procedures n “Gunner” classmates n Patient death n Sexual harassment

Difficult Situations (cont.) n Difficult/violent patients n Difficult family members n “Narcolepsy” n Personal/family illness

Getting Off to a Fast Start

Scheduling Rotations n Avoid most likely specialty in first/last block n Avoid back-to-back tough rotations n Do easy rotation before desired specialty rotations

Choosing Rotation Sites n County n VA n Academic/university center n Community/private hospital n Outpatient clinic

Before the Rotation n Classmates n FA Wards specialty chapter n FA USMLE Step 2CK n FA Step 1 relevant content n FA Wards recommended pocketbooks/texts/software

Your “Secret Weapons” n Enthusiasm/hustle n Time n Basic science knowledge n “Low” expectations

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