Deb Bynum, MD 2009
She is a really good student… One of the best I’ve worked with all year…. (from a third year internal medicine resident….)
WHY?
She was always available She always had a great attitude She didn’t disappear in the afternoon to read She always did things to help She looked up stuff about her patients She got really good information from patients and families that was important for their care She took feedback on her presentations and really improved She picked up more patients than assigned; even patients she did not pick up, she came to the ED with us to see the patient, learn, and just to help She understands the “big picture” She is great with patients and families
She got all honors for second year Her board scores were out the roof… She always out-answered the other student She knew all the answers
Attitude and energy can make or break you ◦ What you know is not as important as how you act ◦ Excellent first and second year medical students may not always have an easy time during third year (subjective evaluations) ◦ So –So students can shine during clinical years
1. Knowledge 2. Good ICM Skills 3. Kindergarten Skills
If you energetically try to provide the best care for your patients, you will be a good student and a good doctor
Know your patient well Read about your patient’s problems and learn how to take care of your patient Make sure your patient gets good care – be their advocate Communicate your patient’s needs to the team
There is NO scut work related to the care of your patient If your patient needs a lab draw, vital sign, form completed, help getting out of bed – then it is important The story of Dr. Parker….
Do not assume that what your patient needs will actually get done Do not assume that your team knows a piece of data/result that you do Do not assume that you know what your team expects of you
Ask about call Ask about pre-rounding Ask what patients to pick up on day number 1 Ask about conferences, schedules Ask about notes Ask how you can help
Be positive Be pro-active: Offer to do what is needed before you are asked Offer to do small presentations for the team Look up articles for the team and share Help interns, residents and other students on the team
Go and see and evaluate as many patients as you can – even those patients you will not be “following” Ask about call: If overnight call is not required, offer to stay late or overnight for at least one call night for each rotation
Dress neatly and appropriately Do not chew gum Do not carry food or beverages on rounds
Pay attention on rounds, even to other patients and other presentations If you are bored, do not look bored… Ask the right number of questions Be available Read about your patients Ask to help out with notes, orders, forms
Ask to help out with clinical “scut” work: ◦ Pulse oximetry with ambulation ◦ Make sure patient gets to their test (go with them if you can) ◦ If they need to be NPO, make sure they are ◦ Make sure a patient gets up out of bed to a chair ◦ Get orthostatics when needed ◦ Bring samples down to the lab in acute events
Make sure the plan for your patient is carried out ◦ Do not assume it will happen ◦ Ask the nurse ◦ Call down to the procedure site ◦ Make sure transportation happens ◦ Let your resident/intern know if there is a problem
Be on time for rounds, lectures, meetings Do not try to make the other student look bad Be nice to staff, nurses, HUC’s Be respectful to and of patients, families and visitors
What is needed will vary by clerkship Anticipate minutes per patient (longer initially) Information needed each morning: ◦ Vitals (include oxygen saturation and amount of oxygen patient is on and T max and T current) ◦ Overnight events (from nurse and overnight intern/float) ◦ Subjective issues from the patient ◦ Physical exam findings (for the day) ◦ Labs and other data ◦ Consult reports from prior day/evening ◦ Any radiology/tests that came back the day before ◦ Check the MAR for current medications
Develop your problem list with a plan for the day for each problem Use the Follow up sheet (handout) to record the above data each day – this can serve as a template for your morning presentation and progress note Meet with the intern/resident before rounds to review plans for your patient
Prepare your oral presentation (practice) Present to the team on rounds (3 minutes) Keep follow up sheets of data in large, spiral bound notebook so you have easy access to prior days, labs, medications, etc (It is NOT cool to have thousands of cards flying out of your pockets on rounds….)
KNOW MORE THAN YOU WRITE, WRITE MORE THAN YOU SAY…
Wear your white coat and badge Things to carry ◦ Notebook with patient information ◦ Rounds report for patients on your team (even patients that are not “yours”) ◦ Clinical “pocket” book for the rotation (ask) ◦ Sanford guide/pharmacopeia ◦ Scissors (esp on surgery) ◦ Reflex hammer ◦ Light ◦ Stethoscope ◦ Pens ◦ Monofilament, tuning fork
Use your gut – if someone looks really sick, call your resident Red Flags: ◦ Fever ◦ Increase pulse rate ◦ Shortness of breath ◦ Chest pain ◦ Increase in respiratory rate ◦ Decrease in oxygen saturation ◦ Change in mental status ◦ Decrease in blood pressure ◦ Severe pain
The nurse is really concerned or worried… ◦ Go get your resident or intern; trust the nurse’s instincts as well as your own