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  1. #1
    BrianB4837 is offline Member 530 points
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    Some Pointers for Clinical Students

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    It's a boring Friday night to be doing night float, so I figured I'd give the clinical students some pointers that I wish I had known when I was in med school. This may be especially useful if you are at a program and trying to impress the people there.

    Being a good resident doesn't necessarily mean you are fluent in reciting papers, guidelines, or texts. The following tips are things to remember that are probably more impressive to your superiors, since they're not really things that are taught in books. In summation, don't be lazy! If you report all of these things in rounds regularly, I guarantee you will get a reputation as a hard worker. I'll try not to be too internal medicine-specific.

    History Items:

    -In your histories, don't just read "CHF, CAD, CKD, COPD etc." from old notes, or get only the diagnoses from the patients. Get the specifics. For example, find out when the last echo was and what it showed, or the last time the patient was cathed and what they found, etc. Find out what the cause of their renal failure is and what their baseline renal function is. Get the most recent pulmonary function test results. Do the leg work, if you have to make phone calls do it, but get specifics to report to your team.

    -Don't forget to find out the patient's baseline functional status. Make sure you know if they normally walk, if they normally talk, if they normally eat solid foods, shop, cook for themselves, etc. Sounds simple, but when you admit 5 patients in 2 hours, you may look past the simple things.

    Physical Exam:

    -Turn bedbound patients over and look for bed sores and skin breakdown on their backs, butts, and heels!! Don't forget to report in rounds if there are none, your attending will be impressed!

    -LINES LINES LINES Remember that lines are sometimes more trouble than theyre worth. Ask yourself regularly "does this patient really need a foley? Are we using this central line anymore?". If you have a drain in place, report not just how much drained today, or the color, or quality of the drainage, but how is the drainage trending?

    Labs and Imaging:

    -individual labs and images are often in and of themselves useless. For labs, it is imperative that you know the trend. Have at least the last 2 values handy and an old baseline value everyday in rounds. Compare images to old images ALWAYS. As a rule of thumb, try to NEVER present a single abnormal lab value or image, ever.

    Management:

    -There are some medications that are simply more important than others to know specific details about. Steroids, antibiotics, fluids, pressors, meds related to the admitting diagnosis. Know the doses, how long theyve been given, any changes, what their baseline dose at home is. If you are following a specific effect of a specific medication, don't forget to check the time that medication was given (or if it was given at all!) in the nurses log.

    -Confirm that your patients are for sure getting rehab as they improve, read the rehab notes, and present in rounds in that the patient is actively participating. Make sure they are getting out of bed. Report this in rounds every day as patients get better.

    -Remember that more important than knowing the pathophysiology of a patient's disease, and the pharmacology of his/her medications, and the evidence supporting his surgical management, is that the patient is better than when he/she came. This means in addition to feeling better, and having benign physical exams, and normal lab values, that their bodily functions are normal. Find out and report in rounds if the patient is eating well, having bowel movements, having good urine output. Remember, sometimes you just have to ask the nurse!



    A lot of these things may seem so obvious to you as you read them. But I promise you if you do them and report them regularly in rounds, you will have a good reputation, and hopefully have a good shot at the residency you want!

  2. #2
    AUCMD2013 is offline Senior Member 527 points
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    Nice! Wish more members like you would post here. Very interesting to read this stuff.
    American University of the Caribbean School of Medicine Graduate

    Basic Sciences [X] Step 1 [X] Step 2 CS [X] Step 2 CK [X] Cores [X] Electives [X] Match [X] M.D. Diploma [X] Step 3 [X] IM Residency [X] Medical license [X] Internal medicine boards ABIM [X] Board certified practicing Hospitalist [Hidden Content ]

  3. #3
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    Slaol is offline Elite Member 7164 points
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    Very helpful advice, thank you for taking the time to post this.
    - Slaol
    http://corbinmd.blogspot.com/

    American University of the Caribbean (AUC) class of 2012

    Chief Resident Family Medicine
    Hennepin County Medical Center

  4. #4
    houmd's Avatar
    houmd is offline Elite Member 7229 points
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    great post! thanks for the useful advice and taking time out of your day to post it.

  5. #5
    RfisherMD is offline Senior Member
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    Thanks! Great Advice.
    AUC c/o 2013
    FM resident

  6. #6
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    ChanceCount is offline Senior Member 510 points
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    I like specificity and formal presentations.

    To restate, if you mention a disease, it's best to characterize it if you can, ie Class III Lupus Nephritis, O2 dependent COPD 2L NC at baseline, Preserved Ejection fraction CHF Acute-on-Chronic Kidney Disease Stage 3 at baseline, etc.

    And if you're presenting and you mention an infection, the antibiotic day and duration of treatment are useful. So, Community Acquired Pneumonia, avelox day 3 of 7.
    "Always carry a flagon of whiskey in case of snakebite, and furthermore always carry a small snake."

  7. #7
    rokshana is offline Member Guru 11644 points
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    look at the poles to see what patients are getting...abx maybe ordered or fluids stopped, but is that really the case?

    and look at the pts trays...it will show if they are really eating...
    Endocrinology, Diabetes and Metabolism Attending
    ABIM certified IM
    ValueMD-the place "where nothing makes sense, but everything is related-fellow vmd'r gabon

  8. #8
    Sreddy1400 is offline Newbie 510 points
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    Really helpful guys thanks alot!

  9. #9
    supremeloc is offline Newbie 510 points
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    I agree that impressing an attending or two by knowing all the facts will definitely help impress, but that's not all that is on the table when trying to land a residency. As most program directors will tell you at an interview, it's not just your medical knowledge but "how you interact and fit with the residents." If you are a machine and can spit out every detail medically and you can't "click" with the residents, getting the spot is unlikely. In most programs the residents will actually vote on who they think will "fit" best and how they get along with the applicant, since they will be with that person for 3-7 years. Recalling medical factoids and memorizing a detailed history is only half the battle.

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