Transition Clerkship June 29 – July 2, 2009 Please fill out pre-clerkship survey if not already done

Challenging Transition Preclinical world –Challenge: memorize / process tons of info –Stable, predictable environment –Know what you know –Know what you do not know

Challenging Transition Preclinical world –Challenge: memorize / process tons of info –Stable, predictable environment –Know what you know –Know what you do not know

Challenging Transition Clinical World –Constantly changing environments –Different cultures –Not only what you know Apply what you know Recognize what you don’t know Know how to learn / where to get information

Challenging Transition Clinical World –Constantly changing environments –Different cultures –Not only what you know Apply what you know Recognize what you don’t know Know how to learn / where to get information –Different focus of attention

Myocardial Infarction 1979 vs. 2009

Challenging Transition Clinical World –Constantly changing environments –Different cultures –Not only what you know Apply what you know Recognize what you don’t know Know how to learn / where to get information –Different focus of attention

Challenging Transition How can I survive this transition to the clinical world? What is best way to learn in this new world? How can I excel in this new world?

Three Keys to Success Knowledge ICM skills Kindergarten skills –How to behave / basic rules of society

Three Keys to Success Knowledge ICM skills Kindergarten skills –How to behave / basic rules of society –CQ + PQ > IQ

Three Keys to Success Knowledge preclinical experiences ICM skills Kindergarten skills –How to behave / basic rules of society –CQ + PQ > IQ

Three Keys to Success Knowledge ICM skills student angst Kindergarten skills –How to behave / basic rules of society –CQ + PQ > IQ

Goals/Objectives The overall goal: to help smooth the transition from the preclinical to the clinical years. It is hoped that at the conclusion of the Transition Clerkship students will feel better prepared and less anxious to start their clinical clerkships More specific goals: see schedule and website

Monday Broad intro to clinical world & culture (CK) Some ICM skills review (Bynum) Scavenger Hunt Lunch Student Mistreatment, Professionalism and Self Care (Cross, Stewart, Steiner) Small Groups – “Situations” Regroup for info on next few mornings

Tues-Thurs Mornings Each morning, 1/3 of the class will do: –Basic Life Support (BLS) training –Procedures training –On the Wards training With 4 th year students WebCIS review

Tues Afternoon Basic radiology –CXR and ABD x-ray interpretation –Characteristics of other imaging modalities Taking a history (CK)

Wed Afternoon Infection Control Patient Safety Professionalism in the Clinical Environment Small groups –Oral presentations –Progress notes

Thurs Afternoon Health Sciences Library Final Advice one45 Clerkship evaluation Rising 4 th Year Student Panel

Clinical World The Doctor

Roles / Responsibilities Attending –Legally responsible for all aspects of patient care –Teach all members of the team –Evaluate and give feedback to all members –Interact with other services as needed –Address any team issues

Roles / Responsibilities Resident –Organize and run the team –Make many final management decisions (decide which need to be reviewed by attending) –Supervise intern work –Teach interns and students –Evaluate and give feedback to interns and students

Roles / Responsibilities Intern –Execute day-to-day patient management activities –Formulate assessment and management strategies –Document care –Teach students –Evaluate and give feedback to students

Roles / Responsibilities Student –Do all scut work –Otherwise, do not interfere with the work of others

Student Responsibilities Be the team “expert” on all your patients and participate actively in all aspects of their care –Know all relevant clinical data –Contribute to all diagnostic/treatment planning –Speak for team when patients are discussed –Write orders –Write notes –Perform procedures –Research interesting patient-related topics and present results to team

Student Responsibilities Be the team “expert” on all your patients and participate actively in all aspects of their care –Know all relevant clinical data –Contribute to all diagnostic/treatment planning –Speak for team when patients are discussed –Write orders –Write notes –Perform procedures –Research interesting patient-related topics and present results to team

Student Responsibilities Be the team “expert” on all your patients and participate actively in all aspects of their care –Know all relevant clinical data –Contribute to all diagnostic/treatment planning –Speak for team when patients are discussed –Write orders –Write notes –Perform procedures –Research interesting patient-related topics and present results to team Learn how to do the above activities

Student Responsibilities Be the team “expert” on all your patients and participate actively in all aspects of their care –Know all relevant clinical data –Contribute to all diagnostic/treatment planning –Speak for team when patients are discussed –Write orders –Write notes –Perform procedures –Research interesting patient-related topics and present results to team Learn by doing the above activities !!!!

Student Responsibilities Help your patients and their families Help all others on the team Provide team with: –energy and enthusiasm –curiosity and passion (CQ + PQ) –fresh humanitarian spirit

Typical Ward Schedule 6:30-7:30 Prerounds 7:30-10 Work rounds Morning report / Hour of Power 11 ish -12:00 Attending rounds 12:00-1:00 Noon conference 1:00-??? Afternoon work (consults, procedures, test results, communicate with family, paperwork, notes) ???? Clerkship activities 6 ish Signout rounds

Typical Surgery/OBGYN Schedule 3:30-4:30 Prerounds 6:00-7:30 Work rounds 7:30-8:00 Preop preparation 8:00-??? Surgery 8:00-5:00 Floor work and/or clinic 5:00-??? Postop rounds ???? Clerkship activities

Typical Surgery/OBGYN Schedule 5:00-6:00 Prerounds 6:00-7:30 Work rounds 7:30-8:00 Preop preparation 8:00-??? Surgery 8:00-5:00 Floor work and/or clinic 5:00-??? Postop rounds ???? Clerkship activities

Clinical World Kane 9

How to Learn Be the team “expert” on all your patients and participate actively in all aspects of their care –Know all relevant clinical data –Contribute to all diagnostic/treatment planning –Speak for team when patients are discussed –Write orders –Write notes –Perform procedures –Research interesting patient-related topics and present results to team Go to conferences / lectures Read

Conferences Clerkship sessions –whole group –tutor group –with ward attending

Conferences Clerkship sessions –whole group –tutor group –with ward attending Morning report Noon conferences Grand Rounds M&M

What to Read Read in context (about your patients) Read broadly (clerkship list) Skeleton, flesh, skin books Pocket books / survival manuals

What to Read Differential diagnosis of common presenting conditions (clerkship list) Signs/symptoms of major diagnoses (list) Epidemiology Pathophysiology Diagnostic approach Treatment strategies Drug Therapy

How to Learn if … Be the team “expert” on all your patients and participate actively in all aspects of their care –Know all relevant clinical data –Contribute to all diagnostic/treatment planning –Speak for team when patients are discussed –Write orders –Write notes –Perform procedures –Research interesting patient-related topics and present results to team Go to conferences / lectures Read

How to Learn if … Be the team “expert” on all your patients and participate actively in all aspects of their care –Know all relevant clinical data –Contribute to all diagnostic/treatment planning –Speak for team when patients are discussed –Write orders –Write notes –Perform procedures –Research interesting patient-related topics and present results to team Go to conferences / lectures Read

Clinical World Kane 2

Need orientation session What is my role / what are my responsibilities / day - to - day expectations?

Student Responsibilities Be the team “expert” on all your patients and participate actively in all aspects of their care –Know all relevant clinical data –Contribute to all diagnostic/treatment planning –Speak for team when patients are discussed –Write orders –Write notes –Perform procedures –Research interesting patient-related topics and present results to team

Need orientation session What is my role / what are my responsibilities / day - to - day expectations? What about when we are “on call” ?

What is “Call”? Used to be when spent day and night admitting patients (Q 2 – Q 4) 80/30 hour rules Call = admitting patients Could be: –Still Q 2 – Q 4 days –Long/Short call –Everyday

What is “Call”? Orientation questions: –Spend night or when do I go home? –Different dress code? –Who will decide which patients I will see? –Review chart / WebCIS beforehand? –Do H&P entirely alone? –Help write orders? –When write H&P? –Present to resident before rounds? –Weekends?

Need orientation session What is my role / what are my responsibilities / day - to - day expectations? What about when we are “on call” ? When / how will I get feedback ?

Need orientation session What is my role / what are my responsibilities / day - to - day expectations? What about when we are “on call” ? When / how will I get feedback ? How will I be evaluated (on what criteria, what relative importance) ?

Need orientation session What is my role / what are my responsibilities / day - to - day expectations? What about when we are “on call” ? When / how will I get feedback ? How will I be evaluated (on what criteria, what relative importance) ? BE PROACTIVE about getting above info

Grading Preclinical world: –Test score: 100 % Clinical world –Test score: ~ 20 % –Clinical evaluations: ~ 50 % –Other curricular activities: ~ 30% –Grade and comments This course: Pass / Fail –attend and actively participate in all sessions –complete the clerkship evaluation form

Outpatient World

Outpatient Orientation What time does clinic start / when you should arrive / where should you put your stuff ? Will the preceptor pick specific patients for you ? Will you be shadowing or will you see patients on your own ? Will the preceptor prime you with information prior to your seeing a patient ? How do you know when a patient is ready for you to see ?

Outpatient Orientation How much time is allotted for you to see each patient ? How detailed should your history and examination be ? Where will you give your presentation? How detailed should it be ? Where should you write your note? How detailed should it be ?

Outpatient Orientation Should you follow-up on test results ? How ? Should you communicate test results to patients? How ? How and when will you receive feedback on your performance ? Weekend call ? Hospital work ? Is preceptor aware of clerkship requirements ?

Summary

Knowledge –from patients and effective reading/learning ICM skills –practice, get feedback Kindergarten skills –How to behave/basic rules of culture (society) Get orientation/know expectations & role Appreciate culture differences –CQ + PQ > IQ

Summary Knowledge –from patients and effective learning strategies ICM skills –practice, get feedback, more practice Kindergarten skills –How to behave / basic rules of society Get orientation / know expectations & role Appreciate culture differences –CQ + PQ > IQ BE P ROACTIVE