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Archive for the ‘Clinical Rotations’ Category

How to Be a Problem Solver on the Wards

Posted by medliorator on June 10, 2010

take special note of the things the residents and attendings complain about.  What annoys them?  What frustrates them?  Come to think of it, when you are on their service, what annoys/frustrates you?  Make it your goal during 4th year to fix one of these problems.  They will be impressed.

During my fellowship, one of the residents noticed that the ICU attendings complained a lot about the care the Emerency Department (ED) was providing to patients with diabetic ketoacidosis (DKA)…. He did a literature search on diabetic ketoacidosis and created a clinical pathway complete with a standard order sheet (so you really can’t screw up the pathway) that the ED and ICU both agreed to.

Turning Problems into Opportunities to Impress [Medscape]

Corollary: How to Master Humility on the Wards

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How to Honor 3rd Year Rotations

Posted by medliorator on May 26, 2010

A few tips for your 3rd year rotations from Graham Walker, MD …

1. Be enthusiastic. Energy is contagious, and we all need more of it in medicine. Bring it to your rotations! Even if you’re not interested in, say, surgery, look for a particular aspect that you do find interesting. Help out where you can. Volunteer to do more. It goes a long way.

2. Avoid complaining. As hard as you’re working (and I’m sure you are!), your residents are working even harder (or at least have more responsibilities and are balancing more spinning plates). It’s fine to join in when people are venting about how big your team’s census is getting, but you won’t be winning any points by saying how rough your job is. (We all know scut sucks, but if you don’t do it, your resident will be doing it for you.)

3. Anticipate tasks that need to be done. Once you’ve spent a week or two on a service, you can start to see some patterns: calling for a nutrition consult, getting social work involved, collecting a patient’s list of home medications, and requesting the old chart. Surprise your resident by thinking ahead, and you’ll be at the head of the pack.

10. Come up with your own patient assessment and treatment plan. …show your colleagues that you’re thinking and learning. You’ll sometimes be wrong, but you’re supposed to be wrong, right? Otherwise there’d be no reason to go through medical school and residency.

How Can I Distinguish Myself on Clinical Rotations? [Medscape]

CorollaryClinical Years – Acting the Part

CorollaryHow to Master Humility on the Wards

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Clinical Years – Acting the Part

Posted by medliorator on April 12, 2010

Eric Tam @ Medscape…

“Medicine is showbiz”

Terrible as it sounds, there is some truth in it. The point my professor was trying to make was: It is not enough to be nice. It is more important to act nice. It is easy to ignore or act briskly with a patient when ten tasks await you. You have to actually show that you care about the patient and make it obvious to the patient, the patient’s family, nurses and your colleagues. This does not mean that we have to be hypocritical, but that it is important to both be nice and act nice.

Words of Advice for Final Year Students [Medscape Blogs]

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How to Master Humility on the Wards

Posted by medliorator on January 6, 2010

The clinical years of medical school are, in large part, a game of appearances.  Medical students must find there place at the bottom rung, and they must excel in this place.  An air of humility is often interpreted by the rest of the team in a positive light.  Many of your evaluators use humility as a surrogate marker for other personality traits valued in health care (work ethic, cooperation, compassion, intelligence).  Any behaviors that smack of condescension will come back to bite you, even if you are the most productive worker on your team.  Learn humility by avoiding it’s opposite.  Here are a few tips to unlearn condescending behaviors from wikiHow:

3.  Be compassionate, not condescending …see others for all the struggles, triumphs, achievements, doubts, fragility, and strengths that they are really made of.  We are all in positions of unique perspective. Every person you see is a wealth of information and ideas that you haven’t come across. Learn how to approach people looking to find the hidden gem in them. Look for that unique thing in them that makes them special. You will find that you don’t have to fake it.

4. Try something new. Do something you have never done before, something that requires you to rely on somebody else’s knowledge and abilities. Let yourself trust them and keep your mind and ears wide open …Learning is a process of being humble and in being humble, you unlearn condescension.

5.  Be assertive, not biting. make your points using the skills of assertive speaking. If you are afraid that people won’t respect you or listen, think again – people respect the differing views of others when they are put calmly, clearly, and with a view to discussion rather than cutting off further communications

How to Stop Being a Condescending Person [WikiHow]

Posted in Clinical Rotations, Professionalism | 2 Comments »

How to Manage a Negative Clinical Evaluation

Posted by medliorator on November 9, 2009

bad-grades

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]

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

Posted by medliorator on November 5, 2009

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]

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Coping with Difficult Teammates

Posted by medliorator on August 13, 2009

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]

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Common Phrases Medical Students Must Avoid

Posted by medliorator on August 10, 2009

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]

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Down & Dirty Tips for the Wards

Posted by medliorator on August 6, 2009

  • 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]

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How to Read a CXR

Posted by medliorator on August 4, 2009

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]

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