How to Manage a Negative Clinical Evaluation

Sometimes personalities can clash and an attending may write an overly harsh evaluation that isn’t indicative of your performance. If you feel that this is the case, it’s usually a good idea to speak with the clerkship director and express your concerns. At some institutions, the burden of proof lies with the attending to demonstrate that he or she gave the student constructive feedback and allowed for a chance to improve. If the evaluation is determined to be unjust, it may be removed from your record.

However, if the clerkship director does a thorough investigation and strongly feels that the evaluation is accurate, it’s usually a good idea to stop there

Will a Negative Evaluation Ruin My Residency Options? [Medscape]

Common Mistakes Made by 3rd and 4th Year Medical Students

Kendra Campbell reminds us of some easy-to-avoid clinical mistakes

1. Arguing with a patient.

2. Reporting a physical finding without actually observing it.

3. Pimping your resident or attending. …Thou shalt not pimp up the chain.

6. Documenting an important positive finding without alerting your resident or attending.

9. Forgetting you are in a hospital …We spend so many hours in the hospital that it’s easy to forget that we are surrounded by very ill people.

Top 10 Mistakes Made in Clinical Rotations [Medscape]

Coping with Difficult Teammates

1. Be calm – Someone who is calm is seen as being in control, centered and more respectable. Would you prefer to work with someone who is predominantly calm or someone who is always on edge?

3. Get some perspective from others – In all likelihood, your colleagues, managers and friends must have experienced similar situations in some way or another. They will be able to see things from a different angle and offer a different take on the situation. Seek them out, share your story and listen to what they have to say.

4. Let the person know where you are coming from – Letting them in on the reason behind your actions and the full background of what is happening will enable them to empathize with your situation. This lets them get them on-board much easier.

5. Build a rapport – Re-instill the human touch by connecting with your colleagues on a personal level. Go out with them for lunches or dinners. Get to know them as people, and not colleagues.

7. Focus on what can be actioned upon – Sometimes, you may be put into hot soup by your difficult colleagues, such as not receiving a piece of work they promised to give or being wrongly held responsible for something you didn’t do. Whatever it is, acknowledge that the situation has already occurred… focus on the actionable steps you can take to forward yourself in the situation.

9 Useful Strategies to Dealing with Difficult People at Work [Dumb Little Man]

Common Phrases Medical Students Must Avoid

1. This won’t hurt at all – many procedures do hurt, at least a little, even when performed with skill, and patients would rather know that going in. Pediatricians, in particular, must be careful that patients don’t eventually take such assurances as a prelude to pain. Try, “This could be a little uncomfortable,” or “This will hurt some, but it’ll be over before you know it.”

2. We’re just really busy – uttering these words can disparage the patient, who is probably also quite busy and perhaps missing work for this appointment… apologize and give your patient an estimate for when he will be seen.

3. I understand how you feel – you don’t want to insult your patient or belittle her experiences. Instead, try expressing empathy by saying, “I can only imagine how you feel.”

5. I’m sure it’s nothing serious – false promises are a death blow to patient trust. Instead, provide assurance through thorough exams and attentive listening to patient concerns.

6 Things You Should NEVER Say to a Patient [Physicians Practice]

Down & Dirty Tips for the Wards

• Buy one of those clipboard/organizer deals. Unless your hospital has a full EMR, you will be filling out forms. A clipboard with storage lets you carry around forms so you don’t have to hunt for them
• Find out where the good/clean restrooms are.
• Keep snacks in your pockets. You will need them at some point.
• Don’t stress too much. Things could be worse – at least you’re not the one who is sick in the hospital, right?

10 Tips To Survive Wards [Scrub Notes]

How to Read a CXR

The first thing to always check is that the film is associated with the correct patient. After doing so, to read a PA view, I utilize a mnemonic called RIP ABCDEFGH. Here is how it works:

• Rotation: Check to see that the patient is not rotated. You can look at the clavicles and make sure the vertebral processes line up nicely in between them.

• Inspiration: Check to see that you can see about 9 ribs on each side. Less than 8? It is likely poor inspiration.

• Penetration: You should be able to see lucencies in the middle of the film representing the intervertebral discs. If there are none, the film is over-penetrated; if they are too well-defined, the film is under-penetrated.

• Airway: Trace the lucency from the neck down towards the carina. It should be midline and you should be able to see two bronchi splitting from it.

• Bones: Look at the shoulder joint and trace out each rib contour to check for fractures or other abnormalities.

• Cardiac Silhouette: Check the right and left heart borders.

• Diaphragms: These should be well-defined with no obscuration of their margins.

• Empty Space Fields: Look at the lung fields bilaterally and compare. Don’t forget the apices.

• Gastric Bubble: Check for a lucency in the left upper abdominal quadrant.

• Hardware: Make sure the placement of any lines or other hardware is appropriate.

How To Read A Chest X-Ray [The Radiology Blog]

Medical School Advice – Making the Best of 4th Year

By: Thomas Robey

2. Try to block 5-8 weeks for interviews between October and February. Consult with 4th years in your specialty about when is the best time to keep open.

4. Load the beginning of your year with sub-internships where you can show your stuff and get great letters of recommendation!

6. Do an away rotation or two (depending on your field). You can both get a feel for a residency and use it as a month-long interview.

Top 10 Tips for Fourth Year [The Differential]

Tempered Expectations of Care

By Sarah Averill

How should you handle patients who don’t want to follow your medical advice? How should we deal with the negative emotions that some of them will inevitably bring out in us? What does respect for patients look like? And what should we expect — if anything — from our patients?

One of the most jarring experiences in medical school is hearing doctors denigrate patients… “You are probably too young to have watched the TV show ‘All in the Family’, but this woman is a Meathead, just like Archie’s son-in-law. She’s not going to listen. I don’t know why she’s here.”

… I come from a long line of “meatheads,” people who want to come to their own conclusions about what diagnoses they will accept and what medicine they want to swallow.

labeling your patients and speaking disrespectfully of them can lead to all sorts of bias, set up negative expectations, and lead to suboptimal care. We can easily forget that the patient’s wishes are consummate. It is the patient’s right to refuse treatment — even to refuse being “labeled” with a diagnosis. We too easily forget that disease labels can have devastating consequences for patients. It is our responsibility to respectfully, and patiently, help them understand why we think they may have a particular disease and why what we are offering them — a name for their suffering, and something to relieve it, such as drugs, surgery, physical therapy — may prove beneficial.

Honor Your Mother and Other “Meathead” Patients [The Differential]

2009 Childhood Immunization Schedules

Bookmark this on your mobile device:

http://www.immunizationed.org/ShotsOnline.aspx

2009 Childhood Immunization Schedules [Society of Teachers of Family Medicine]

How to Schedule Clinical Rotations

Daniel Egan, MD:

If you are certain about the specialty you plan to pursue, you should avoid scheduling a rotation in that clinical area first. During your earliest rotations, you will be learning basic medical practices, how to pre-round and round, how to write a note, and how to use the computer system. The best place for you to experience that learning curve is not in the specialty you intend to enter. However, it may make sense to do a so-called “difficult” rotation first, such as surgery, if you are not going to pursue a residency in that clinical area. More difficult rotations can accelerate the process of learning the ways of the hospital as well as decreasing your anxiety level (and requirement for sleep) as the year moves forward.

How Should I Schedule My Clinical Rotations? [Medscape]

Correlate: Electives vs Rotations

Correlate: General Etiquette for 3rd Year