UNIVERSITY OF KANSAS
SCHOOL OF MEDICINE
KANSAS CITY
CLINICAL STUDENT
ORIENTATION MANUAL
2005-2006
SPONSORED BY:
THE UNIVERSITY OF KANSAS ALPHA CHAPTER
ALPHA OMEGA ALPHA NATIONAL HONOR SOCIETY
Original Author:
Curtis R. Maslen, M.D., 1985
With contributions from the classes of
1990, 1992, 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006
Alpha Omega Alpha
Kansas Alpha Chapter
Alpha Omega Alpha is the only national honor medical society in the world. National Alpha Omega Alpha was established in 1902 at the College of Physicians and Surgeons in Chicago, with the Kansas Alpha Chapter receiving its charter in 1931. Its raison d’etre can be expressed in a phrase: to recognize and perpetuate excellence in the medical profession. As stated in the society’s constitution, “Alpha Omega Alpha is organized for educational purposes exclusively and not for profit, and its aims shall be the promotion of scholarship and research in medical schools, the encouragement of a high standard of character and conduct among medical students and graduates, and recognition of high attainment in medical science, practice, and related fields.”
To fulfill the role it has set for itself, Alpha Omega Alpha elects outstanding medical students, graduates, alumni, faculty and honorary members to its ranks and offers its membership important national programs such as: Alpha Omega Alpha Visiting Professorships, a quarterly journal - The Pharos, Student Research Fellowships, and two Distinguished Teaching Awards in collaboration with the Association of American Medical Colleges. In addition to national programs, the Kansas Alpha Chapter has several local programs which include: The William Root Lecture Series, the KUMC Clinical Student Orientation Manual, and Residency Information programs.
Election to Alpha Omega Alpha is a distinction that accompanies a physician throughout his or her career. Especially for the younger physician, the society provides a forum for the exchange of ideas as well as a source of valuable contacts. Members can be elected as students, house officers, alumni, or faculty of an affiliated institution, or by virtue of distinguished achievement in any field related to medicine, on an honorary basis.
Elections in the first four categories are carried out by the individual chapters. Chapters elect undergraduate members from students in their last two years of medical school. Scholastic excellence is a key criterion, but not the only one for election; integrity, capacity for leadership, compassion and fairness in dealing with one’s colleagues are also to be considered. Students who are in the top academic quartile of their class are eligible for election, but the number elected may not exceed one-sixth of the graduating class. The Alpha Chapter at the University of Kansas has two separate elections in which undergraduates may be voted into Alpha Omega Alpha. The first opportunity is in the Spring at the end of junior clinical clerkships when the top 12.5% of undergraduates are eligible, and the second opportunity for election is during the Fall of the senior year clerkships when the top quartile is eligible. The students elected to the society are men and women who have compiled the requisite high academic standing and who, in the judgment of the members of the local chapter, have shown promise of becoming leaders in their profession. As noted above, opportunities exist for later election to the society of those not selected as undergraduates.
Respectfully,
Spencer Eagan
Kansas Chapter President, 2005-2006
Welcome to your clinical years! This orientation manual represents an attempt to assist in the transition from basic sciences to the wards and to make that transition as painless as possible. It is full of information that most of us wished we would have had access to BEFORE starting clinics. Since each person’s medical school experience is unique, it does not pretend to foresee everything that will be encountered on the clinical wards. It does, however, present the kind of information that we would have liked to have seen before we suffixed our names with MS3 for the first time, and we believe that it will be useful to most of you. Depending on your previous experiences, some of the material in this manual may be obvious. Nevertheless, since the first several weeks of clinics can, to a greater or lesser extent, be spent “learning the ropes”, we present this material in hopes that it will help you to spend less time “on the ropes” and more time with “the important stuff.”
This manual represents an attempt by medical students to help other medical students in the transition from the basic science classrooms to the clinical wards. It is our hope that this manual will prove to be useful, and not only that it will be continued from year to year, but also that it will be improved upon through your experiences. We ask you, therefore, to critically evaluate the information provided in this manual as you progress through the first several months of clinics, make note of important topics which were omitted as well as information which was unnecessarily included, and use that evaluation to modify this orientation manual so that it will be of even greater benefit to the class of 2008.
The following is a discussion of how the clinical student fits into the picture. Since much of the transition from basic science student to clinical student concerns itself with figuring out just exactly what it is that one is supposed to be doing on the wards, this section concerns itself with outlining some of the basic responsibilities and expectations placed on the clinical student. It should be noted first of all that student responsibilities vary tremendously from clerkship to clerkship, service to service, and attending to attending. Therefore, clinical students are well advised to define, as clearly as possible, their responsibilities early on in each rotation by consulting with the residents and attending physician. When new situations arise, “it never hurts to ask”.
More specifically, a list of clinical students’ responsibilities usually includes charting progress notes, doing admission H&P’s, writing orders on the chart, attending rounds, lectures, and conferences, presenting patients to residents and attendings, studying when they have time, and, of course, “scut work”. Order writing is the most variable of these since on some services you will be expected to write virtually all of the patient care orders, while on other services your attempt to do so may result in the loss of life or limb. The specifics of writing orders, charting progress notes, and a few basic items of scut work are discussed later on in this manual. Scut work, as we’re sure you’ve already heard, includes such things as drawing blood, filling out requisitions, consults, and a multitude of other paperwork, inserting foley catheters, starting IV’s, placing NG tubes, and virtually anything else that residents or attendings insist that you do as they wave your clinical evaluation form over your head. For virtually all clerkships, being enthusiastic and helpful is the single most important thing one can do to maximize learning and enjoyment on the service.
Really Important Phone Numbers: KU Pathology x1180
KU Laboratory x1700
* Always dial an 8 KU Radiology reports x 7551, then # 1,1111111,
pt# before all extensions.
5 goes to the previous report filed.
3 rewinds 5-10 seconds
7 fast forwards 5-10 seconds
Note: can look at films on --- KU Radiology online: Pulse, click on pts, then
Vista Imaging System, which is on most computers.
clinical dept, radiology, then pt info, log on: tcao,
password medline
VARadiology reports x7301, then #1, resident pager, 11(or 13 for MRI), pts last four
KU paging system 9-917, then number
VA paging system 86, then number, then function 3
KU operator 0, or x5000
KU medical records x2454
KCVA 816-4700
To put in consult at KU: Fill out request form. Call operator and ask for the number to put in a consult for whatever service you need. Call the number and have available the pt’s name, age, room # and hospital #, attending, resident and pager #, and the reason for consult. This is all done on the computer at the VA.
To find an old chart at KU: Charts are supposed to come to the floors with the pts. Unfortunately, that doesn’t always happen. Your best shot is to go to medical records yourself (ground floor, in the hall between cafeteria and main elevators) and request the chart. Be sure to take the pt’s medical record number! If you are really nice to the med records people, your life will be much easier. By the way, all records are computerized at the VA.
Checking out X-rays at KU: Radiology jackets are available in the film library/reading room on the second floor of the main hospital. Go to the window and fill out the white request form. If you will be taking the jacket with you, you must also fill out a yellow or blue card with the name, number, and your service name. You must fill out a separate card for every jacket checked out. If you need to look at your patient’s daily films, go to Inpatient Radiology and ask to look at inpatient rollo. If patient is coming from ED, check there first.
KU –6:30am to 8:00pm
VA – 8:00am to 2:30pm
As you will find, reading time is valuable during a clinical rotation. You will need to select textbooks which are both accurate and complete yet readable in the relatively short time in which a clerkship lasts.
The following list of books and comments is compiled to help you make a selection as well as to inform you about what is available. Also, see the book section for each rotation for recommendations on specific courses. Before you purchase a textbook, which you feel you may not use after you have finished your rotation, it is recommended that you check with the clerkship’s education coordinator to see if you can get required texts from them on “loan”. Some departments have limited copies available which you can use while you are on their rotation. The counseling center has many review books that can be checked out free. Also check with your big sib or classmates who have taken the rotation already to get other recommendations.
First a few general comments:
1. Select books you feel you can read cover-to-cover during the one to three months of a rotation. It is important to get an overall view of a particular clinical rotation. Your goal is not to become a world authority on Hematology or Gastroenterology during the two-month medicine rotation. You need to get the whole picture.
2. Once you have selected a book — read it. Don’t attempt to read several different books on specialized areas. Basically, pick one book.
3. Use major textbooks (Harrison’s, etc.) when it is necessary to have more detail. When you want to read about a specific problem on one of your patients - Harrison’s and other references are usually easy to find on the floors. The easiest reference to be used is Uptodate. It has an icon on all desktops in the hospital. It is great to use to look up information prior to rounds.
4. NMS review books as well as other review books are available to check out from the Learning Resources Office, Room 4006 Student Center (588-4688), at no charge. This is an excellent resource to save you $$.
5. Use the library. Many excellent reference books and atlases can be found there. Many of them can be checked out. If a desired book is not there, encourage the department to place one on reserve.
6. Read about your patients — Know their problems.
7. Do Appleton and Lange review questions in addition to book reading.
1. Guides to Antimicrobial Therapy, Sanford. A must. You can usually get a free copy from a professional pharmaceutical representative.
2. Pocket Pharmacopoeia, Tarascon. Updated every year. Essential for writing orders and looking up meds.
3. Quick Medical Reference, Maxwell. Easy place to get common things- everything from note writing and drug levels to dermatomes and mental status exam. Little too.
4. EpocratesRx Clinical Drug Reference – over 2,600 drugs and tables, including adult and peds indications and dosing, contraindictions/cautions, adverse reations, mechanism of action, formularies, black box safety information and pricing. One can run a multi-drug check for up to 30 drugs (www.epocrates.com). FREE
5. EpocratesID Infectious Disease – access comprehensive information on over 300 diagnoses, including more than 350 bugs and over 250 drugs (similar to Sanfords Guide to Antimicrobial Therapy) (www.epocrates.com). FREE
6. MedMath – a free medical calculator designed for rapid calculation of more than 20 common equations and formulas used in adult internal medicine
(http://smi-web.stanford.edu/people/pcheng/medmath ).
Additionally, a website with a large list of PDA resources for the medical student can be found at (www.library.ualberta.ca/subject/index.cfm ).
Title of course: Surgery
Course Director: Chris Haller, MD, x3254
Course Coordinator: Jonya Rakoski, x3173 Office: 5th floor Sudler
On the first day- Meet: 560 Eaton (5th floor Sudler) 8 a.m.
Bring: White Coat, note pad.
Attire: Professional attire is standard, and is required in all clinics and classes.
Entrance to OR locker is accessed by calling on phone at door. Scrubs are checked out using the Auto Valet cards in OR, though students are only allowed ONE pair
at a time. This has become a pain, and it may be easier to get your own. Long hair should be pulled back.
Helpful stuff: At some point during the rotation, fill your pockets with the
following: Trauma scissors, tape, 4 X 4 gauze, note cards. You will spend one month
on a general service and one month in a specialty.
Main OR Desk (core) x2880 PACU x2100 Same Day Surgery x2141
Books:
Loaned by the Surgery department:
Books most of the group used to study:
Helpful Books:
1. Sabiston: The Harrison’s of Surgery. Somewhat more physiologic than Schwartz and a little more difficult to read.
2. Atlas of Surgical Operations: by Zollinger: Excellent for understanding specific surgeries or for making drawings for Dr. Thomas. Expensive; look in the library. (can be found in resident room on Unit 51)
3. Schwartz: A medicine textbook for surgeons; used by many; recommended by the Surgery department; a reference book.
4. Fluids and Electrolytes for the Surgical Patient y Pastana: Excellent book; lots of pictures, easy to interpret diagrams, explains well acid/base disorder; worthwhile purchase.
5. Manual of Surgical Therapeutics: The surgery version of the Wash manual; good info on fluid and electrolytes.
6. Companion Handbook to Schwartz: Similar to Companion Harrison’s; worth the money if you will use it.
Hours: Expect to arrive at the hospital between 5:00 and 6:00a.m. Surgeries are usually scheduled to begin at 7:30am. Be prepared to leave the hospital between 6:00 and 8:00 pm. Unlike Medicine, you will not be leaving early on your post-call day.
Rounds: Most services round sometime between 6:00 and 7:00a.m., but some will expect you to come see your patient before rounds. Allow 30-60 for this “pre-rounding” time, especially at the beginning of the rotation. Afternoon post-op rounds may be held by trauma on general services (usually not on specialty services). Take the initiative to see your patients prior to post-op rounds.
Weekends: If you are not on call, you will come for morning rounds and usually be done before noon. The on call team will handle emergency surgeries during the weekend. There are no elective surgeries on the weekends. You will have to take call on weekends.
Call schedule: Depends on the # of students, usually every 4-6th night. You will only be on call while on KU’s general surgery rotation (3 times during the rotation). While on call, your team will cover the trauma room. Page the intern on call, and you will follow him for the night. There is no call room, so if it is slow, you will probably be sent home.
Call Room location/ code: At KUMC, KC VA, and Leavenworth VA there are no call rooms. No call is taken at the VA’s.
Grading System; 90/80/70
50% Clinical Evals., 15% presentation and 35% Final USMLE-style exam. Evaluations are done by attending and Chief Residents.
Writing Notes:
Daily Notes:
1. Keep them short, no longer than length of pen
2. Include Post-Operation day number (ie POD#3)
3. Include the number of days on Antibiotics (ciprofloxin #5)
4. Vitals including intake/output (I/O) and drain output
Pre-Op Note:
As a surgery student, it may be your responsibility to write pre-op notes before a patient goes to surgery. The pre-op note provides a brief yet concise description of what is wrong with your patient, what surgical procedure is planned, who plans to do it, and any historical information or findings that are pertinent to the surgical procedure.
1. Notes should be completed the day before a patient is scheduled to go to the OR.
2. Arrive in Same Day Surgery when your patient arrives and page the intern. Stay with your patient until they are taken to the OR.
Pre-Op Note
Hx: This 48yo WF c NIDDM presented 3/24/84 c 2 day Hx of RUQ pain. Outpatient sono revealed nonvisulaized gall bladder, and pippida scan was c/w cholecystitis.
Pre Op Dx: Cholecystitis
Planned Procedure: Cholecystectomy
Surgeons: Dr. Smith/Dr. Jones/Yours Truly MS3
Labs: (List pre-op CBC, Platelet Count, PT/PTT, ASTRA, etc. using the laboratory shorthand mentioned above.)
CXR: Normal chest
EKG: NSR, rate 80, nonspecific ST-T changes
Current Meds: Tavist-1 prn
Blood: 2 U PRBCs typed, crossed, and available
Consent: Signed and on chart
Post-Op Note:
You may also be responsible for writing post op notes on your patients immediately following surgery. Since the post op note is written while the patient is still in the recovery room, you will either have to memorize its format or bring Maxwells along with a pen, and your ID badge, with you in your surgical scrubs. The following sample post op note is self-explanatory. (Most surgeons write the post-op note on the computer and print it out immediately after the case).
Post Op Note
Pre Op Dx: Cholecystitis
Post Op Dx: Same
Procedure: Cholecystectomy
Surgeons: Dr. Smith/Dr. Jones/Yours Truly MS3
Findings: Cholelithiasis, cholecystitis
Anesthesia: GETA(General endotracheal, spinal, local, epidural, etc.)
Fluids: 500cc D5LR (list here the amount and type of fluids given dur-ing the procedure, eg. NS, blood, albumin, etc. You can find this by looking on the anesthesiology record or by asking the anesthesiologist or surgical nurse.)
EBL: 50cc (This is the estimated blood loss during the procedure, as shown on the anesthesiologist’s record.)
Tubes/Drains: NG to low intermittent sxn, T-tube in RUQ
Specimens: Gall bladder sent to surgical pathology
Complications: None
Condition: To RR in (good, fair, stable, poor, critical) condition
Post-Op Orders:
Take initiative and offer to write the post-op orders. Ask the resident for their format and follow that format throughout the month long rotation. Although the ADC VAN Dissel (see admit order page) mnemonic can be used to write post op orders, you might find the following format equally useful and match much less cumbersome.
Post-Op Orders
1) Procedure: (eg. S/P cholecystectomy)
2) Allergies: (eg. NKA )
3) Disposition: (eg. Return to 5120 when stable, admit to ICU, etc.)
4) Vital Signs: ( This determines how often vitals will be taken after the patient leaves
the RR, eg. Vitals Q15 minx 8, Q30 min x4, Q4 hrs x 6, then Q shift.)
5) Diet: (eg NPO, advance diet as tolerated, etc.)
6) Activity: (eg. Bedrest, bedrest c BRP, etc.)
7) Tubes/Drains: (eg. NG to low intermitten Gomco, foley to DD, etc)
8) Resp. Care: (eg.TC&DB Q2 hrs x 24 hrs, incentive spirometry, 02, etc.)
9) Meds: (eg. Reorder patient’s pre op meds if appropriate,
Antibiotics, IV fluids, etc.)
10) Call HO if: (eg. Call HO for temp >38.5)
Remarks: Residents and Staff appreciate initiative. This means being an active seeker of knowledge. Things you can do to help the team include: search for path reports and x-ray, print extra copies of rounds reports, gather charts before or after rounds, and recognize that the flow of information is from you to the intern, intern to the chief resident, and Chief to the Attendings. It is recommended to be in surgery or with your residents when not in lecture (don’t say you have lecture when you don’t). Also, it is considerate when scrubbing out of a surgery for lecture to always check back after lecture to make sure the surgery has ended or you are excused to go home.
Title of course: Neuro-Psychiatry
Course Director: Psychiatry: William Gabrielli, MD/PhD, x6401
Neurology: Heather Anderson, MD, x2330
Course Coordinator: Lesley Leive, x6401 Office 1st floor Olathe Pavilion-1006
Paula Mengel, x6996, Landon Center on Aging
On the first day: Meet: Room 1020 Olathe Pavilion (Olathe is down the main corridor past Delp; it’s the section of the hospital across the street from Kirmayer)
Helpful stuff: This is a fun 2 months. You can also learn a lot, but also have some time off to breathe! If you have this rotation early on in 3rd year, then be advised that you will have more time off during these 8 weeks than on other rotations. So either just enjoy the increased time and flexibility or use it wisely! This is a good clerkship to aim for an A! The clerkship is divided into different combinations of clinical experience in Psych and Neurology. This will include:
Sites-
Books:
Books we actually used to study:
1. High Yield Psychiatry by Fadem & Simring- Williams & Wilkins. Quick read and covers most of the material. (all you really need).
2. Blueprints of Psychiatry: also a quick read, but covers most of the material.
3. Psychiatry by Appleton and LANGE – question and answer book that is a good supplement to NMS.
Helpful books: (not usually necessary unless you plan to do psychiatry)
1. NMS Review; Required text; covers personality disorders and child psych in addition to reviewing the field. The shortest of all NMS books- easy to get through.
2. Psychiatry Recall by Fadem & Simring – W & W
1. The DSM IV is a good reference and can be found in most psych depts as well as the library.
2. Psychiatric Diagnosis by Goodwin: Recommended by the psych dept.
3. Psychiatry by Tomb; A good pocket sized review of the field. Can often get free from drug reps.
4. Pocket Handbook of Clinical Psychiatry, Kaplan and Sadock.
5. *Aminoff – borrow if necessary for Neurology, Clinical Neuro
Hours: Rounds- Will vary depending on if you are at the VA or KU. At the VA, the three teams usually round at different times, such as 8:30 a.m., 11 a.m. or even 1p.m. depending on the attending. You usually need to allot 30-45 minutes to see your patients before rounds. KU rounds are usually not before 8:00 a.m.
Typical Day: Usually about 7:30 a.m. (roughly, maybe earlier) until about 4 or 5 p.m. Maybe longer if very busy on inpatient Psych at KU.
Weekends: Probably not, but there is a chance. If you are at the VA you can be almost sure you won’t have any weekends. Students on KU Adult psych. usually had to alternate weekends to be there.
Call schedule: Everyone will be on call twice during the clerkship. All call is taken at KU regardless if you are at the VA at that time. The call is usually with the PLS (psych. liaison service in the ER), and is from 6 p.m. to 10 p.m. Sometimes there will be NO patients at all (you might be sent to read) or could be busy with multiple psych patients in the ER).
Grading System: 90/80/70/60. Based on clinical evals, neuro paper, oral exam (a case presentation), and the shelf test. Opportunity exists for extra credit paper (2% of total grade).
· For Neurology, remember to include all aspects of complete Neuro exam in the objective portion
(cranial nerves, strength, sensation, tone, reflexes, cerebellar function, gait, etc.)
· For Psych, the objective part of your note should include:
*Mood/Affect, Speech/Thought, Insight/Judgment
Attention/Concentration, Hallucinations, Suicidal or Homicidal ideation
*Assessment will include Axis (I, II, III, IV, V) – you will learn all about this part of the
psych assessment
Title of course: Medicine
Course Director: Amy O’Brien-Ladner, M.D., x 6405
Course coordinator: Karen Reeves, x3833 Office: 1012 Wescoe
On the first day: Meet: 4050 Wescoe
Bring: White coat, stethoscope, penlight, ID badge, notepad
Helpful stuff: Blank note cards are a great way to keep track of patient info.
Dress: Professional attire is required.
Books:
Books most of the group used to study:
Other helpful references:
5. Practical Guide to the Care of Medical Patient, by Fred Ferri. A pocket-sized handbook like Wash Manual, but with more procedures. Many residents and students prefer the Wash Manual. Neither is essential.
6. Medical Manual of Therapeutics (also known as the Wash manual): A good book well liked by residents; as a third year student you probably won’t use it much.
7. Companion Handbook to Harrison’s: Contains a lot of information in a short, concise, readable form; nice to have with you at the morning lectures.
8. Book of Lists by Dr. Greenberger: Great for coming up with a differential diagnosis.
9. Rapid Interpretation of EKG’s by Dubin: Great for learning EKG’s; you can read it in one day.
10. Merck Manual of Diagnosis and Therapy: Excellent investment.
11. Medicine, Fishman
Required text (but not really):
1. Cecil’s Essentials of Medicine, fourth edition: This is the required text and the one from which assigned readings are taken. Provides readable discussions of major topics, but includes too much material to read in 2 months. It is also too sparse to serve as a good reference. Reasonable price.
Reference Texts:
1. Harrison’s Principles of Internal Medicine: An excellent reference, the Gold Standard. It is big and expensive, but you will be able to use it during many rotations. Often available in residents’ rooms, and always in the library. A worthwhile purchase if you can afford it.
Hours: Expect hours to be about 6:00 a.m. to 6:00 p.m., with occasional earlier days. Morning report is at 8 a.m. in 4050 Wescoe or Sudler for Grand Rounds. Attendance strongly encouraged.
Rounds: KNOW WHAT IS GOING ON WITH YOUR PATIENTS!
Be sure to read about your patient's diseases because that is where most of the questions during rounds will come from. Rounds usually occur in the morning. They frequently last most of the morning. Most services require that you come in before rounds to see your patients (6:30 or 7:00). Notes may or may not have to be written before rounds - just ask the residents on your team.
Weekends: Students are required to see their patients every day. However, most services will provide you one day off a weekend, or allow one student to cover all the patients so the other students can be off. Students are usually allowed to leave the hospital on weekends after rounding and writing note/orders.
Call Schedule: Most teams are on call every 4th or 5th night, but sometimes it is more frequent. Students are usually required to stay. Usually each student picks an intern and takes all call with that intern. It is a good idea to ask about call responsibilities on the first or second day of a clerkship.
Call room location/code: KU: 4th floor Bell, just inside the lobby of the MICU. (ie. Unit 44) Code 243.
VA: 11th floor East Hall. Code 543
Units: Medicine floors are on 4 and 5.
Grading System:
Your grade will be based on the following: Clinical evals 60 pts (30 ea month)
Shelf Test 40 pts
Total 100 pts
88% has been a superior, with grades falling at 70, 60, 50, and 40 thereafter. The medicine department is very clear that they will review point totals and set new cutoffs if necessary, so these numbers are approximate.
Writing Notes: Daily notes on the Medicine services are written in SOAP format. It deserves mention that Medicine notes are usually fairly long, as patients typically have multiple problems. Students are also responsible for writing H&P's on all new patients.
Orders: The student is usually responsible for writing orders on his/her pts both @ KUMC and the VA. A resident must co-sign all student orders. Therefore, students should take the responsibility to make sure that their orders are co-signed in a timely manner so as not to delay patient care.
Remarks: The Basic Medicine clerkship is one which students often consider the most valuable. It is a good place to learn the basics about the presentations and management of human diseases. The amount of material that falls under this heading is vast, so it is important not to get weighed down with obscure facts. The best learning experiences (and the best test scores!) will come to those who learn broad principles of Internal Medicine while on this rotation, and read, read, read.
Title of course: Obstetrics and Gynecology
Course Director: Mary Duff, MD, x3244
Course Coordinator: Valorie Dodd, x6274, Office 3009 Wescoe
On the first day-Meet: OB/GYN Library on 3rd Floor Wescoe
Bring: White coat, note cards, and ID card for labor and delivery access will be provided.
Helpful stuff: At some point you should acquire a gestational wheel. HOWEVER, don’t purchase one – you can usually get one from a drug rep. or on Labor & Delivery.
Books:
Books most of the group used:
Hours: Rounds: Start about 6:45 a.m. at the latest. You will be expected to pre-round and have your notes written before rounds.
Weekends: Yes. Students are expected to round and write notes on weekend days. Most services will allow several students to cover all of the patients so that everyone gets at least a few weekend days off.
Call schedule: Subject to change with each group. Usually there is only one student on call for OB and one for Gyn per night. Therefore, the frequency of your call depends on how many students there are on your particular rotation. Generally, there are plenty of students so call is not as frequent as other rotations. (every 3rd to 6th nights). Students will be involved in all deliveries of babies.
Call room location/code: Call rooms are located in the west hallway on the way to Unit 51. The code is 423. A shower is available in the locker room in Labor & Delivery. There are 2 call rooms.
Grading System: 90/80/70
25% Ob evals, 25% Gyn Evals, 10% Gyn-Onc Evals, 10% Mid-term, 30% USMLE-style exam. Every resident and staff receives an evaluation form regarding each student. If the resident/staff feels that they know you well enough through clinics, surgeries, ward, or on-call they will evaluate you. Occasionally, however, students receive evaluations from resident/staff that they hardly worked with. The point is, be prepared for every interaction.
How to present a patient: Ms.________is a ___year old G__P__LC__(race)____ female with an EDC of ___(date)_____based on (LMP or Sono).
Ms. Jones is a 34 yo G5P4 LC4 white female with an EDC of June 18, 2002 by a 12 week sono.
Questions to Ask Antepartum Patients (about ready to have a child)
Fetal Movement? Vaginal Discharge/Bleeding? Leakage of Fluid?
Cramping or Contraction? Edema? Especially facial edema.
Headaches? Blurring of the vision?
Writing Notes:
Vaginal Delivery
Postpartum Day #1 *Pt may go home if>24 hours post delivery if she is afebrile. Check cbc Hb
Postpartum Day #2 Pt goes home if afebrile
*Check and report: birth control plan
breast or bottle feeding
Postpartum Hgb/Hct
Rubella immune status: if non-immune, pt needs Rubella injection prior to discharge
VDRO
Blood Type: if Rh-, Aby scree-, and infant Rh+ pt needs Rhogam injection prior to discharge
Any culture results or pending
Discharge orders *Follow up: in _____ clinic in 6 weeks
*Activity: no tampons, douching or intercourse x 4 weeks
*Diet: regular
RTC: if temp>101, foul smelling discharge, severe abdominal pain, bleeding more than a pad an hour
Discharge Meds *Motrin 800 mg 1 po q 8 hrs prn pain, #30; no refills
*Colace 100 mg 1 po BID #60; no refills
*if Hgb<10.0, FeSO4 6 weeks worth; no refills
Hgb9.0-10.0, FeSO4 325mg 1po q day with meals
Hgb<9.0, FeSO4 325mg 1 po BID with meals
*if breast feeding, PNV 1 po q day #100; 5 refills
C-Section
Post-op Day #1 *remove surgical bandage before rounds (if on > 2 hrs)
*Orders Ambulate QID
D/C Foley
Heplock IV
Clear liquids
Check cbc
*Meds D/C IM pain meds
Motrin 600 mg1po q 6 hrs prn pain, do not exceed 4 in 24 hrs
Tyl #3 1-2 po q 4-6 hrs prn pain
Colace 100 mg po BIC
Post op Day #2 *advanced diet if tolerated clear liquids well
Post op Day #3 *remove staples and steri-strip just prior to discharge
*ask about plans for birth control, breast or bottle feeding
*Pt to go home
Discharge Orders *follow-up in _______ clinic in 4 weeks
*activity: no tampons, douching, or intercourse x 4 weeks
*diet: regular
*RTC: if temp > 101, foul smelling discharge, severe abdominal pain, or bleeding > 1 pad per hour
Discharge Meds *Tylenol #3 1-2 po q 4-6 hrs prn pain #30, no refills
*Motrin 600 mg 2 po q 4-6 hrs prn pain #30, no refills
*Colace 100 mg 1 po BIC #60, no refills
*if Hgb <10.0, ReSO4 6 weeks worth; no refills
Hgb 9.0-10.0, FeSO4 325 mg 1 po BID with meals
Hgb <9.0, FeSO4 325 mg 1 po BID with meals
*if breast feeding, PNV 1 po q day #100; 5 refills
Title of Course: Pediatrics
Course Director: Stephen Smith, M.D., x6340, 3032 Delp
Course Coordinator: Benito Berardo, x6310, 2010 Miller Building
On the first day: Meet: 2001 Miller at 8 a.m.
Bring: Pen light
Helpful stuff: 1. - The CDU has copies of note cards with developmental milestones.
2. - Take copies of the clinic sheets for each age group. Read…
Locations: Peds floor - Unit 55 Bell Hospital.
Clinics - Miller building, 1st floor. Tunnel between main elevators and cafeteria.
Peds ICU - 1st floor, main hospital. Take escalator to one. Turn right to end of hall.
NICU - Unit 56. Main elevators to 5th floor. Past mother baby on Unit 56.
Lockers - Bottom floor of Miller building. Assigned at orientation
Full-Term Nursery - Unit 56
Books:
Books provided by the clerkship:
1. Rudolph’s Fundamentals of Pediatrics, 3rd edition, 2002, Appleton & Lange – Too long to get through during a 6 week clerkship. Use this textbook as a reference.
2. Blackwell’s Underground Clinical Vignettes, 2002, Blackwell Publishing – Excellent, concise set of vignettes. Not comprehensive, but good to read when you have a few minutes of downtime.
3. Blueprint Q&A Step 2