UASOM Huntsville Class of 2014
Clinical Hints and Tips
General Information
· Code for HH Main resident’s lounge is 324. This is a good place to hang out/eat lunch when you have free time at the hospital. The code for the resident’s lounge in East is 233*.
· Good apps: Epocrates, Micromedex, Qx Calculate/MedCalc, and LowestMed.
· Be nice and respectful to the nurses. Seriously, they know their patients and can give you great information if you just ask.
· Read about your patients and their problems on UpToDate, form a good plan and don’t be afraid to respectfully voice your opinions. You will be surprised at the insight you can bring to the team. On the other hand, DO NOT ARGUE WITH YOUR ATTENDINGS! EVER!
· When doing rotations in the hospital, you will follow the patients that you admit. This includes writing (or helping your resident write) the admission H&P, seeing the patient every morning to do a physical exam and to write a SOAP note, and helping with discharge paperwork.
o Make copies of all your H&Ps and SOAP notes so you can look at them when the resident/attending needs information (most likely during morning report). Keep each day’s notes for each patient until discharge and then shred them. Keep in mind that if these have patient info on them, HIPAA rules apply. Don’t leave them unattended.
· Try to keep a few blank yellow sheets, discharge sheets, and resident stickers w/ you (anticipate what the team needs- it makes you look great and things go quickly). A clipboard w/ an internal compartment is helpful for toting all of this around!
· Eat and sleep when your residents do, or when they suggest it.
· Case files and Pre-Test are great study books for any rotation.
· A 1-year subscription to USMLE World Qbank is a great resource for all of the shelf exams, but it is not required. There are other Q & A resources as books in the library. This really comes down to how you study best and your financial situation.
· Dean’s Conference is every Monday at noon. You will be excused from your rotations to attend as attendance is required.
· Grand Rounds occurs on most Tuesdays from 12:30-1:30 pm. You will be excused from your clinical duties to attend.
· If you have the opportunity to enroll in a co-enrolled elective, do it! It comes in handy to have an extra 2-weeks of elective credit during your 4th year and you are excused from your other clinical duties to attend it.
Internal Medicine (256-551-4611)
Overview
· Director: Dr. Parekha Yedla
· Attendings: Corman, McConnell, Yedla, Ibrahim, Centor, Fahey, Diaz
· Contact: Juanita Spicer (256-551-4611).
· Teams typically consist of at least one upper level resident, an intern, 1-2 third year med students, and an AI (4th year med student). Your team plus an attending physician will round on patients in the hospital every morning.
· Lecture most afternoons usually starting around 1:30 pm and lasting 1-2 hrs. Attend all lectures.
· Every student does a patient presentation in front of the Medicine attending and the other students on the rotation. These are fairly laid back and interactive (the attendings like to interject!), but make sure you are prepared and organized.
· CLIPP cases- online cases w/ decent review questions. They are only graded for completion, not percent correct. You’re expected to do 8-10 but can do more.
Schedule
Usual Day:
1. Get to the hospital early enough to pre-round on the patients you are following (this may be 5:30 am or 7 am depending on how many patients you have to see, how long it takes you to write the notes, etc)
2. Meet your attending around 7:30 – 8:30 am (depending on the physician)
3. Morning report at 11am on Tuesday, Wednesday and Thursday (The “Centorium” – the room off of the resident’s lounge in HH Main).
4. Finish rounds between 12-1:00 pm
5. If not on day call you are done after lecture! Go home and enjoy yourself (or, you know, do some studying….)
Call: 3rd year students take call with the intern. AIs take call with the upper level.
· Day call - approximately 1-2/weeks per rotation, depending on schedule. Day call starts after rounds and lasts until 7:30 pm. Lecture takes priority over call so just let your resident know if you have lecture that day and they will let you leave. You need to go straight back to the hospital after lecture, find your resident, and ask them to fill you in on any new admissions you missed.
· Weekend day call- 1-2 times/ rotation. You will be on call from 7 am-7:30 pm on Friday, Saturday and Sunday. Starting times for rounds vary on the weekends so find out from your resident what time your team is meeting and then start pre-rounding early enough to see your pts, write your notes, etc
· Night call –
a. Weekday night call- Weekday call rules have changed several times, but usually you should come in at 7:30pm or come in early in the morning to admit one patient. You do not stay overnight.
b. Weekend night call- 1-2 times/ rotation. Your resident will be on call Friday, Saturday, and Sunday night but you only go Friday and Saturday night. On the weekends some physicians start rounding with the night call team very early (like 6 am) so make sure you find out from your resident what time you need to be ready.
· Weekends- you will work 3 weekends and will have the weekend before the shelf off to study.
Duties
· Write H&Ps on patients you admit from the ER. Most residents and students use the H&P template- it’s easy to run out of space on these so if you need more room just write the H&P out on a yellow progress sheet (takes a little bit longer but is better than omitting information or squeezing it all in to the point where you can’t read it).
· Follow these patients from admission to discharge. If all of your patients get discharged before you’re on call again, then just pick a pt that’s already on your team and start following them.
· Pre-round on your patients everyday (including weekend days when you are on call) and write SOAP notes with a good assessment and plan. Also write consultation notes and help with DC summaries. Ask the other members of your team what they need/expect of you. It’s a team effort. If your team looks good, you look good.
Books
· MKSAP’s questions are the best review for the shelf. USE IT!
· Essentials for Medicine Students is also a great reference with very short chapters on lots of commonly encountered topics – great to read as you are forming a differential and A/P on patients you admit from the ER.
· First Aid for the Medicine Clerkship is great.
· High Yield for Internal Medicine is a quick read, and very good.
· Dubin’s for mastering EKG(s).
· Pocket Guide for Medicine (small, green book) is great to keep with you at all times for quick reference.
· You can get Cecil’s if you want, it is expensive and BIG… look at it free on www.mdconsult.com which you should get an account for or look at it in the library.
Hints
· Don’t do the bare minimum. Jump in and get your feet wet as quickly as possible. Ask to write orders, do procedures, and follow as many patients as you can handle (start with 1-2 patients and work your way up to 4).
· If an attending asks you to read about something - DO IT. They will most likely ask you questions about it the next day. Also an attending may ask you a question and then get busy with something else, that gives you a chance to look up the answer! Don't assume they've forgotten about it - they'll remember it sooner or later and ask you.
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· Code for HH Main resident’s lounge is 324.
Pediatrics (256-551-4600)
Overview
· Director: Dr. Steffane Battle
· Attendings: Battle, Knight, Abston, Salazar, Grostick; Horton or Powell for private practice, Peds Hospitalists for Inpatient
· Contact: Ilona Overman (256-551-4600)
· Morning report at 8:00 am Tuesday & Thursday in Woman Children’s Hospital on the ground floor across from the Sleep Center (the code is 345 to get in the door). This is required.
· Lectures 3-4 days a week. Usually at noon, and lunch is not provided so bring food! You are not required to attend lecture if you are pre- or post-night float.
· 23 CLIPP cases are required. Make sure you start early.
Schedule/Duties
· Wards/Inpatient (3 weeks) including 1 week of nights
· UAB Clinic with Well Baby Nursery (3 weeks)
· Private Practice with Hospitalist Well Baby Nursery (2 weeks)
· One day on pediatric oncology (Drs. Cox and Russo)
· Two half days on pediatric neurology (Dr. Limbo)
· One afternoon at United Cerebral Palsy
· One weekend on day shift inpatient wards
Wards Days: Usual day is from 6:30 am (pre-rounding before morning report) until 5:00 pm.
1. Admit patients everyday from the ER, ICU, direct admits, and transfers from other hospitals.
2. Pre-round on all the patients you previously admitted. You will follow assigned patients from admission until discharge during your two weeks of inpatient service, and will write SOAP notes, discharge summaries, and consultation reports.
3. Be prepared to present one patient on Tuesdays and Thursdays at morning report.
4. The inpatient experience has been changing since the Peds Hospitalists began accepting students. If you’re interested and eager to learn, make it a point to ask the Hospitalists questions, follow them on morning rounds, etc. They are wonderful teachers if you make it known you are there to learn/work.
5. When not busy with rounds, paperwork, and admissions, there is a decent amount of down time (especially in the afternoons). This is a good time to do the required online cases (CLIPP).
Wards Nights: Monday to Thursday from 7:30 pm to 9:30 am
1. Admit patients and write H&Ps similar to day call.
2. Pre-round in the morning, help with SOAP notes, and be prepared to present a patient at morning report.
3. You do not have to attend lecture when on nights.
Well Baby Nursery: Arrive around 6:00 am to “pre-round”. Be ready to present when the attending arrives around 7:00 am. Go to morning report on Tuesdays/Thursdays at 8:00 am. Following morning report you will go to peds clinic at UAB or to private practice clinic.
1. Divide the list among the students (usually ~2-3 babies/day).
2. Do daily physical exams on each baby you are following
3. Fill out cards (provided during orientation) for each baby. You will use these to present the patient to the attending. I recommend re-using the same card everyday that you are seeing that particular baby (just make sure to change daily weights and new physical exam findings)- this will save you time from flipping through the chart every morning to find the same info over and over again (birth date/time, birth weight, blood type, etc)
4. Briefly visit the moms to discuss the baby’s health (feeding well? jaundiced?) and d/c planning (breastfeeding, car seats, etc) and give them new baby information sheet (Ilona will give you info about where to find these sheets).
5. All of the above needs to be done before the attending arrives (~7:00 am). Different attendings have different preferences about what students can and can’t fill out in the chart, so ask first! You will only present the babies that you examined, but be attentive throughout rounds because attendings will ask “pimping” type questions. Basically, when the attending is there pay attention to what’s going on even if all of your babies have already been seen.
· UAB Clinic
o When on UAB clinic, you will see all UAB Peds babies. Th
o They do not always have babies, so one student should call around 5AM to confirm how many babies are in the nursery.
· Private Practice Clinic
o When assigned to private practice clinic, you will see all babies assigned to the Hospitalist attendings.
o They almost always have babies in the nursery, but still call to confirm.
UAB Clinic: After newborn nursery and morning report, you will report to clinic (~9:00 am). Clinic ends around 5:00 pm.
1. You will work one-on-one with a different attending everyday and they will tell you which patients to see- go see these patients on your own and do a complete history and physical (take notes- these will just be for your reference).
2. Present your patient to the attending- be sure to come up with an assessment/plan for each patient and be ready to answer any questions the attending may have. If an attending asks a question about the patient’s history and you don’t know the answer because you didn’t ask, that looks bad!! Try to err on the side of caution by asking EVERY question you can think of that might possibly be related to the patient’s problem (that being said, be reasonable and don’t take too long in each room)
3. After discussing the patient, you and the attending will go see the patient together
4. Dr. Abston has outlines of questions you should ask for both well child and sick visits. These handouts can be useful with the other attending as well.
Dr. Horton/Dr. Powell: Start with Well-Baby Nursery and afterwards drive to their office to see patients (Don’t forget morning report on Tuesday/Thursday).