Transcript What makes a *Good Third Year Student*
How to be a Good GREAT Student on the Wards…
Debra Bynum, MD
Third Year
Prior third year UNC Medical Student (1992)
Heard in the physician work room this last week….
She is a really good student… One of the best I’ve worked with all year…. (from a third year internal medicine resident….)
WHY?
From the Resident…
She was always available She always had a great attitude She always read about her patients She always did things to help; she did not disappear in the afternoon to study for her tests… She picked up more patients than assigned; even patients she did not pick up, she came to the ED with us to see the patient, learn, and just to help She understands the “big picture” She is great with patients and families
What the resident did NOT say…
She got all honors for second year Her board scores were out the roof… She always out-answered the other student She knew all the answers
Bottom Line: The Good and the Bad
Attitude and energy can make or break you What you know is important, but how you act and demonstrate your knowledge is even more important Excellent first and second year medical students may not always have an easy time during third year (subjective evaluations) Students can shine during clinical years
What makes a good student?
1. Knowledge 2. Good ICM Skills 3. Kindergarten Skills
Bottom Line…
If you energetically try to provide the best care for your patients, you will be a good student and a good doctor
What does this mean?
Know your patient well Read about your patient’s problems and learn how to take care of your patient Make sure your patient gets good care – be their advocate Communicate your patient’s needs to the team
About “Scut”
There is NO scut work related to the care of your patient If your patient needs a lab draw, vital sign, form completed, help getting out of bed – then it is important
The story of Dr. Parker….
DO NOT ASSUME
Do not assume that what your patient needs will actually get done Do not assume your team knows what you do Do not assume to know what your team expects Do not assume your patient knows what is happening
ASK
Ask about call Ask about pre-rounding Ask what patients to pick up on first day Ask about conferences, schedules Ask about notes Ask how you can help
What can I do to make a good impression?
Be positive Be pro-active: Offer to do what is needed before you are asked Offer to do small presentations for the team Look up articles for the team and share Help interns, residents and other students on the team
What can I do….
Go and see and evaluate as many patients as you can – even those patients you will not be “following” Ask about call: If overnight call is not required, offer to stay late or overnight for at least one call night for each rotation
What can I do…
Dress neatly and appropriately
Do not chew gum Do not carry food or beverages on rounds Always be professional, even if others are not
What can I do…
Pay attention on rounds, even to other patients and other presentations If you are bored, do not look bored… Ask the right number of questions Be available Read about your patients Ask to help out with notes, orders, forms
What can I do….
Ask to help out with clinical “scut” work: Pulse oximetry with ambulation Make sure patient gets to their test (go with them) If they need to be NPO, make sure they are Make sure a patient gets up out of bed to a chair Get orthostatics when needed Bring samples down to the lab in acute events Scrub in for surgery and procedures
Follow Up
Make sure the plan for your patient is carried out Do not assume it will happen Ask the nurse Call down to the procedure site Make sure transportation happens Let your resident/intern know if there is a problem
What can I do
Be on time for rounds, lectures, meetings Do not try to make the others look bad Be nice to staff, nurses, HUC’s Be respectful to and of patients, families and visitors
What are my responsibilities as a third year student?
Pre-round on your patients
What is needed will vary by clerkship Anticipate 10-15 minutes per patient (longer initially) Touch base with your intern or resident
Vitals
Each morning….
Overnight events (from nurse and overnight intern/float): TALK TO THE NURSE Subjective issues from the patient Physical exam findings (for the day) Labs and other data Consult reports from prior day/evening Any radiology/tests that came back the day before
Each morning….
Check the MAR for current medications
Pre-rounding
Information to know: “Attachments” IV and Central lines Foley catheters Telemetry box Restraints SCDs
Responsibilities…
Develop your problem list with a plan for the day for each problem Record the above data each day – this can serve as a template for your morning presentation and progress note Meet with the intern/resident before rounds to review plans for your patient
Responsibilities
Prepare your oral presentation (practice) Present to the team on rounds (3 minutes) Keep follow up sheets of data in large, spiral bound notebook so you have easy access to prior days, labs, medications, etc (It is NOT cool to have thousands of cards flying out of your pockets on rounds….) Help write progress notes, orders, discharge notes, prescriptions Be the EXPERT on your patients
Responsibilities
Know your patient Know ABOUT your patient Read about all of the diagnoses for your patient Know the anatomy before going into surgery Anticipate questions (“Pimping”) Don’t freak out about “pimping” – it is an excellent way to learn when done correctly
Responsibilities
Af ter Rounds Keep a “to-do” list Stay organized Follow up on the to-do list!
Be available!! Let the team know if you have a student conference or meeting you have to attend Sign out before leaving, go over list, updates and any other needs
Responsibilities
Your goal is to learn and improve Ask for Feedback interns Residents Attendings Patients/families
Notes and Presentations: SOAP
Subjective Patient complaints, overnight events, pertinent positive and negative ROS Eating, pooping, peeing, walking….
Objective: Vitals (fever, ins and outs, oxygenation) Physical exam (pertinent findings and changes) Labs, xrays, studies
SOAP….
Assessment Summary statement Stick to the Problem List Plan Talk to your resident/intern beforehand Have a plan for the day!!
KNOW MORE THAN YOU WRITE, WRITE MORE THAN YOU SAY…
Other tips for the presentation
Stick to the format Stick to the problem list Run the plan by your intern/resident before rounds Have a plan
The Look
Wear your white coat and badge Things to carry Notebook with patient information, pens Rounds report for patients on your team (even patients that are not “yours”) Clinical “pocket” book for the rotation (ask) Sanford guide/pharmacopeia Scissors (esp on surgery) Reflex hammer Light Stethoscope
What if….
What if my patient looks really sick when I go to pre-round
Use your gut – if someone looks really sick, call your resident Red Flags: Fever Increase pulse rate Shortness of breath Chest pain Increase in respiratory rate Decrease in oxygen saturation Change in mental status Decrease in blood pressure Severe pain
What if…
The nurse is really concerned or worried… Go get your resident or intern; trust the nurse’s instincts as well as your own
What if…
You Have Fun Learn a ton Help a patient