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Archive for the ‘Clinical Rotations’ Category

Medical School Advice – Making the Best of 4th Year

Posted by medliorator on April 13, 2009

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]

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Tempered Expectations of Care

Posted by medliorator on March 18, 2009

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]

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2009 Childhood Immunization Schedules

Posted by medliorator on February 10, 2009

Bookmark this on your mobile device:

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

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How to Schedule Clinical Rotations

Posted by medliorator on January 29, 2009

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

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Forum Filter: How you are Evaluated on Clinical Rotation

Posted by medliorator on January 13, 2009

over at the Differential, Kendra Campbell asks, “have you ever received a grade on a rotation that you thought was not a true reflection of your performance?”

janine – Well, a couple of months after the rotation I get the grade, and I see that I had gotten a C – and to top it off, I had missed a B by one stinking point. I requested a copy of the original evaluation form to see what had been written. Perhaps they had written why I had gotten a C. Well, I happened across more disappointment. The form had no comments on it whatsoever (even though there were specific sections on the form to be filled out with comments) – no comments about what I did right, no comments about what I needed to work on. Just a bunch of numbers carelessly circled, with two of the head attendings’ signatures signed at the bottom of the form – and sadly enough, these were the attendings that I had really not spent a whole lot of time with. I had spent much more time with the other attendings.

So….not only was I annoyed at the grade, but I was also annoyed that the grade wasn’t explained, especially when there was ample opportunity on the form to do so

cardsbound – Your evaluation has little correlation with the amount of work that you put into it. . . welcome to the real world! Realize that the clinical years are much more like a real job, where your performance is evaluated by a lot of factors, with more emphasis on social interactions. My advice is the following:

1. Talk more – you know that annoying gunner that seems to be talking a lot? well he/she’s probably getting A’s. I don’t suggest talking your mouth off, but the students who generally speak up more are noticed.

2. Be personable – sure, your resident probably thinks you’re ok, but do they REALLY like you? that is they should love you. Make them love you. Enough so that they will actually think of writing a good eval at the end.

3. Identify your key evaluators – sure, every single scrub tech, nurse, and resident may think you’re a superstar, but if your preceptor/attending gets a funny feeling from you because you wore scrubs to his meeting, then you’re screwed.

4. Realize this is how real life works and that it’s all arbitrary – in the end, you could have done everything you can, but it’s just arbitrary. But really, who cares? This is your LIFE, and i hope for your sake that good grades isn’t the be all end all. It may be disappointing to get a ‘B’, but it will unlikely prevent you from pursuing and practicing your chosen specialty.

Tell Me What You Want! [The Differential]

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How to Write a Note

Posted by medliorator on January 8, 2009

The basic format for a note is the SOAP note

S – Subjective: any information you receive from the patient (history of present illness, past medical history, etc)
O – Objective: any data, whether in the form of a physical finding during your exam, or lab results
A – Assessment: diagnoses derived from the history and objective data
P – Plan: what you intend to do about the diagnoses from your assessment

The H&P should include the history of present illness, past medical history, past surgical history, allergies to meds, current meds, relevant family history… and social history… For HPI, a helpful mnemonic is OLD CHARTS:

O – Onset: when the problem began
L – Location: what area of the body is affected
D – Duration: how long has it been hurting, is the pain continuous or intermittent
CH – Character: words to describe the problem (dull, sharp, burning, stabbing, throbbing, itching, etc)
A – Aggravating / Alleviating Factors
R – Radiation
T – Temporal: is there any pattern to the pain, such as always after meals
S – Associated Symptoms

How To Write A History/Physical Or SOAP Note On The Wards [Scrub Notes]

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How to Avoid Looking Stupid

Posted by medliorator on November 10, 2008

Every time you start prep for a new rotation, list the 20 conditions that are most common, and therefore most important.

  • Learn them back to front.
  • If you are doing clinical rotations, see at least 5 cases for each.  If you can’t find 5 cases, you have chosen the wrong 20 conditions.
  • Learn all the details of the cases including meds and doses, even though that might not be required at your stage.  For these common conditions, you need to know all algorithms without looking it up.

Once you know those 20 topics back to front, then choose 5 conditions that are uncommon, but life-threatening or catastrophic, or easily misdiagnosed, and therefore important. Learn them back to front as well.

The DrCris “Just don’t look stupid” study plan [AppleQuack]

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Comfort Crying Patients like a Pro

Posted by medliorator on October 30, 2008

Crying can be a completely natural and expected response to information… You also don’t know what else is going on in the patient’s life; sometimes your news is actually the single straw—as unremarkable as it may be—that, according to the proverb, breaks the camel’s back.

You don’t have to do anything if your patient is crying. Sometimes, the best course of action is to just be with the patient. The gives the message that (1) it’s okay to cry, (2) I’m not going to freak out just because you’re crying, and (3) maybe the best response to the situation is to cry.

  1. Acknowledge the situation in a calm manner – Try: “This is understandably upsetting. I’m afraid that I cannot spend the time with you that I’d like to due to the clinic schedule.” Your overt recognition of the situation acknowledges the patient’s experience. Sometimes, that in itself can be healing.
  2. Communicate that you are concerned about the patient and, though there may be nothing you can do to “fix” the situation, you would like to offer what you can – you can offer to visit the patient again later on in the day… you can offer to call the patient in a day or two to check in
  3. Ask the patient what would be most helpful in that moment – This inquiry communicates that you respect the patient’s opinion, that this is a collaborative effort, and that you want to help.

What to Do When a Patient is Crying [intueri]

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What to Expect in Fourth Year

Posted by medliorator on October 17, 2008

the fourth year usually allows you to schedule the individual months and their order. Some schools change the format around a little bit or let you take some electives earlier in the third year, but during the fourth year the ball is generally in your court.

I’ve been told that the true goal of fourth year is “filling in the gaps” in your education

The options include elective months on consult services, research months, months involved in specialties like radiation oncology that you haven’t seen during the third year, etc. Also, this is obviously the time to travel (domestically or internationally) for an away rotation. Of course, applying and interviewing for residencies is busy, and there are a number of requirements that your fourth year has to meet (including subinternships). But the flexibility is there to allow you to fill in the gaps in your own medical education.

Fourth Year: Filling in the Gaps [The Differential]

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How to be an Internist

Posted by medliorator on October 16, 2008

What you have here is how I break down every possible illness known to man.

  • By Organ System. Looking at things by organ system is the first way to conquer disease evaluation and management.
  • By Category of Disease Process. Is it infectious? Is it autoimmune? Is it hormonal? Is it traumatic? Is it genetic? Is it environmental? Is it medication induced? Is it a toxin? Is it allergic? Is it iatrogenic? Is it cancerous?
  • Is It Systemic Or Localized? if it is systemic, how else does it present[?] So much in medicine is lost when you aren’t keeping your eyes open. When you focus so strongly on one part of the body and fail to understand the rest.
  • Is It Acute Or Chronic? As an internist you want to know if the problem is new or old.

The Doctor’s Doctor: How To Be An Internist In Five Minutes [The Happy Hospitalist]

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