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fossildoc
08-13-2009, 11:55 AM
My good friend IMG Reality made a post in this forum warning about "observerships" which may be viewed with suspicion by residency or licensing authorities. He's absolutely right, as usual.

The core rotations I've had so far have been anything but observerships; they've been totally hands-on to the extent that I was, in effect, the doctor, and did everything the docs did except sign prescriptions (but I wrote them).

I'll use my Internal Medicine (IM) and Pediatrics rotations as examples of how it worked, so you can get an idea of what you're in for.

I was in a very busy two-doc group practice, IM and Pediatrics; I did both rotations there, 12 weeks in IM and 6 weeks in Peds. One doc was dual certified in IM and Peds, but did only IM unless the Peds doc was out. These rotations are very popular with students from several schools, and the students have different start dates, so there were times when there were many students and other times when I was the only one.

On a typical day, the Medical Assistants (MAs) take the vitals of a patient and put them in an examining room, writing the Chief Complaint on the chart, which is placed in a chart holder on the door of the room. I (or another student) would grab the chart, read the complaint and vitals, browse through the record of previous visits to get an idea of the health status of the patient, then enter the room. When doing so, you should always announce yourself as a student and that the doc will come in later for a follow-up; this will avoid any misunderstandings later with regard to your status. Also, if you are male and the patient is female, and you are to do a general physical exam or other procedure which may prove embarrassing to the patient, you should always offer to replace yourself with a female doc, med student, or nurse.

Then, you do your thing, just like you learned in PDI. Unfortunately, you can't do everything you've learned because it takes too long and the waiting room is backed up; you will learn from experience what corners to cut without cheating the patient out of the time they need. If the patient is ill, the questioning and exam should be focused on the illness; if the patient has a stubbed toe, don't ask questions about a family history of hypertension.

Formulate a tentative diagnosis and write it on the chart. Then tell the patient that you will return with the doc (or occassionally, a nurse practitioner) to verify your findings. You stay in the room with the doc, who will repeat only a few parts of your examination. As the doc becomes more confident in your abilities, you will be checked less thoroughly. When that's done and the patient leaves, there is usually a short discussion between you and the doc about what you did right and wrong. At my rotations, the interaction with the docs was always very pleasant, never humiliating as you may have heard about other docs.

If you are doing Peds, you absolutely must familiarize yourself with the immunization schedule of the Centers for Disease Control (CDC), which publishes guidelines used by all docs. In Georgia, there is a computerized database, GRITS, which tracks all immunizations of children. If your patient isn't in the system yet, the office manager will fix that. Sometimes kids have just moved into the state and you may have some, and sometimes no, record of what shots they've received. The CDC schedule will tell you what to do in that case. The Peds doc will insist that you carry the shot schedule in your pocket -- in fits on one page -- and he will review the footnotes with you. The footnotes tell you what to do in exceptional cases, like when a kid has missed a shot, or received too many, or the wrong combination, etc. I'd put the web site for the shot schedule here, but the CDC keeps changing it, so you'll have to find it yourself. Just Google "CDC immunization schedule" and you'll find it. It will have several pages; one for infants and young kids, one for older children and teens, and a catch-up schedule. If you memorize the infant schedule before you get to your Peds rotation, it will save you a lot of grief wondering what to do each time you examine a child.

Both the IM and Peds doc will ask you to do a presentation, which need not be on PowerPoint. Don't get carried away; for Peds I did a PowerPoint presentation on panhypopituitarism (you get half credit for pronouncing it correctly), and for IM I did a paper-only presentation on migraine and tension headaches. Each presentation took me about 90 minutes to prepare. For my Family Practice rotation I prepared a presentation on hypernatremia, but the preceptor forgot about it so I never got the chance to present it. For neurology I described some receptor types. I wasn't required to do a presentation for my Urgent Care rotation, but I got grilled daily on various illnesses we encountered during the day.

Occcasionally, an elective rotation is an observership by necessity. There's absolutely no way a neurologist is going to let you do a lumbar puncture or a needle electromyogram. I've observed both, but did not expect to do either. Nor will you be allowed to do a colonoscopy if you do a GI rotation. For the cores, however, you will be hands-on (at least if you get the rotations through MedStars).

Any questions, please PM.

ckp88
08-07-2011, 11:55 PM
Hey I am considering coming to this school and was just wondering where exactly did you do your rotations? Just want to know for when I will have to make a decision on where I will have to do rotations.

RichS
09-30-2011, 10:58 AM
The core IM rotation you describe is an all outpatient rotation for 12 weeks? Does anybody know how residencies would look at an all-outpatient core rotation? Many program directors I have talked to, want inpatient core rotations unless if it's Family Practice.







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