Medical Student Supervision and Teaching

Updated July, 2008

Medical Student Supervision and Teaching

·  Students should work directly and most closely with the senior resident, but the intern NEEDS to be kept informed of the plan each day.

·  Schedule: Studentswork 6 days a week. They are expected to be available and actively involved every day except when at conference. Except under special circumstances, the student will have the same day off as their senior resident.

·  Patient Load: Student should carry between 2-4 patients at any time (no more, no less). If a discharge is planned, or a student asks, their census may be temporarily increased to 4.

·  Students should be encouraged to be aware of, and learn about, the medical problems of the other patients on their team.

·  Resident Long Day: Students are expected to stay with the resident on their long day. They are expected to be present until their work and the bulk of the work of the team is done. They should sign out to night float WITH their senior.

·  The senior resident should always supervise the medical students sign-out. If the senior is unable to do this personally, they should assign the task to their intern or another senior.

·  Students should ONLY admit patients that they will be following in continuity. They should ideally admit fresh patients from the ED, however, if the census is low and the patient is appropriate they can take ICU or night float transfers with expectation they will write a complete accept note.

·  Resident Short Day: Student’s last admission will occur at the same time as the resident’s last admission. They may leave when their patients are stable, they have signed out appropriately to the intern (in the presence of their resident) and their work is done.

·  Patient Care responsibilities: Students are expected to have ownership of the patients they are following. They should write the patient’s daily note, write all orders, and coordinate care to the extent possible. They should present to the team on Morning Rounds and during Attending Rounds. They should interview their patientand conduct exams on Morning Rounds.

·  The resident should review the patient's care with the student. The resident is responsible for reviewing and co-signing all notes and writing a resident level admit note on all new admissions. The resident is responsible for co-signing all orders in a timely and appropriate manner.

·  If a medical student is not coming to the hospital, the senior residents should write the progress note on those patients.

·  Third year medical students do NOT dictate discharge summaries. It is the seniors responsibility to perform the discharge summary.

·  The resident should encourage the student to write their own admission order set, even if the orders have already been entered into CPOE.

·  The intern should assist the student to get their work done.

·  Students should be encouraged to speak directly with attendings, consultants, residents.

·  Conferences: Students are expected toattend all medical student conferences; the team should cover their patients during these times. Students should attend Medicine Grand Rounds. The students will also have a variety of conferences and will let you know their schedule (these conferences are mandatory). Students are also to be excused for bedside physical diagnosis rounds and meetings with teaching attendings.

·  Teaching: Take advantage of the opportunities to teach your student on Ward and Attending Rounds, when going over student’s written work, and when addressing their questions. Help make students feel like an integral part of the team, involve them in discussion of all team patients, encourage them to review focused topics of patient care and report back to the team, have them speak about and for their patients.

·  Feedback: Provide students with regular feedback; both positive and constructive. Let them know promptly if there are issues or problems with their performance, and coach your students onhow to improve. Also, encourage your students to perform self-assessment and discuss issues with them. At the beginning of the month, make an appointment to give feedback at the midpoint and end of the month. Encourage students to come forward with problems or concerns in clinical, administrative or educational matters. Contact Dr. Albert IMMEDIATELY if there is a problem with a student’s performance.

·  Set a good example: Students are very impressionable. They will view your behavior (both good and bad) as their model for what is right. Bear this in mindwith respect to how you interview or talk about patients, how you write notes, offhand comments, etc.

·  Evaluation: Complete evaluation at the end of your time working together in a prompt, honest, and fair manner, using the standards document attached to the evaluation form.

DO’s and DON’Ts for working with 3rd year medical students:

DO:

·  Allow students to have responsibility for their patients and attend all teaching conferences.

·  New admissions:

o  Let students interview and examine the patient. (fill in the gaps, but let them run the interview)

o  For patients admitted overnight, when feasible have the student repeat and rewrite an H&P for experience and clarity

o  Write admission orders

o  Discuss the case with the attending.

(it’s encouraged for students to use the order sets and pchis notes; for their notes, the content should be similar to if they didn’t use these sheets—the history, exam, A&P should be equally detailed and complete – so they may need to run over to progress note paper for the A&P.)

·  Existing patients

o  Physically round with the student for at least all of the student’s patients. Round as a complete team as often as possible so students can learn from all patients.

o  Have student present, interview and examine patients on bedside rounds

o  Have student present to and discuss the plan with attendings

o  Have student call and discuss cases with consultants

o  Have student write all orders (new admissions and daily orders)

o  Have student write progress notes

o  Assist students to complete discharge instructions

·  Review all student notes and orders

·  Directly observe students in their activities, and

·  Provide students with frequent verbal feedback about how they’re doing at their tasks (and schedule at least one 10 minute meeting for feedback at the middle of the month and at end of month)

·  Assist students to do procedures when appropriate

·  Teach

·  Set a good example, be a good professional role model

·  Complete an honest, thorough and specific evaluation of the student’s performance

·  Notify us early if there are any problems or concerns

·  Encourage or assign brief student presentations on relevant medical topics

DON’T:

·  Uncover students’ patients

·  Ask students to dictate discharge summaries.

·  Try to do everything yourself. It’s only by letting students gain experience that they learn and improve.

·  Underestimate the importance of your role. It may establish the student’s impression of internal medicine and determine your student’s future career path.