Transcript Intro to Clinics Night INTRO TO PEDS Get me back to Mod 1!

Intro to Clinics Night
INTRO TO PEDS
Get me back to Mod
1!
Outline
● Rotation overview
● What to get before it starts
● Outpatient tips
● Inpatient tips
● Shelf
● Questions and confidence-instilling
The Setup
● 6 weeks – 3 weeks on inpatient, 3 weeks on
outpatient
○
On inpatient you will do weekend shifts and “call days”
● One shelf
● Lots of didactic (especially on inpatient)
● Assignments
○ 2 Detailed H&P write-ups (see Sample Documents in the AOA
guidebook)
○ Evidenced Based Medicine exercise
○ Case presentations
○ Simulation Sessions
What To Get Before Day 1
● BRS – The best book for peds, by far
● USMLE World Qbank (can split)
● Helpful to have the tables that list normal vitals for
each age group (→Dawn gives you on first day)
● Others: stethoscope, light, an iPhone app for drugs
(Micromedex), antibiotic guide, +/- reflex hammer
● Paper/Multiple pens
● Vaccine schedule, developmental milestones
● VERY OPTIONAL: Great book if considering more peds: The
Philadelphia Guide to Inpatient Pediatrics, Zaoutis et al.
The Peds H&P
● Get all the standard elements: HPI, PM/SH, SH, FM etc.
● Birth history and developmental history (especially for
younger children!)
○
“Ex-full term healthy male” or “Ex 36-weeker w/hx of …”
● Feeding and voiding (pediatricians are more interested in
diet and stooling than the average physician!)
● Know your patient’s weight—everything is weight-based in
peds (more important for inpatients)
● Make sure to keep vaccine schedule/developmental
milestone chart handy so that you can ask about this
● SHADSSS/HEADSS assessment for adolescents
○
School home activities depression/selfesteem substances sex, safety
FYI: The Scoop on Outpatient
● You’ll be at a site somewhere in the community
working the same office hours as the pediatricians
there
○
Some have night schedules
● You’ll get opportunity to do a lot of physical exams
and see many patients, talk to many parents
● Weekends are free and hours can be nicer
How to be Helpful: Outpatient
● Be prepared to be flexible and jump in.
● Review in the chart the patient’s chief complaint and then
look over previous visits
● Use UpToDate (or Diagnosaurus app) to help formulate a
differential diagnosis even before you see the patient, if
time permits. After the encounter refine your DDx and
have supporting reasons for why you think diagnosis
● Assess whether UTD with vaccine schedule and
developmental milestones (copies come in handy)
● Be observant your first few days, try not to mess up flow
of practice
FYI: OUTPATIENT MATTERS
● It is worth the same as the inpatient portion of the
clerkship.
● It is, therefore, important to not blow it off.
● Pediatricians have a rep for being more “nicer” than
most docs BUT this means they may not tell you if
you aren’t meeting their standards.
○
○
So … what do you do? Ask for feedback often (but not so often
as to slow down the efficiency of the practice), be enthusiastic.
Make sure they know it’s your first rotation and if you have any
interest in peds say so…however fleeting it may be ;)
● Mistakes happen to everyone! Jump back in and
take any criticism with grace and use it to improve.
The Scoop on Inpatient
● You will work with the interns primarily as you will carry
their patients.
● The interns can admit patients on all days. However,
because of didactics, you generally will only pick up
patients on your “call day” – which will occur 4x over the
inpatient rotation
● Noon conference, free delicious lunch
● On call days you will stay until you have done 1-2
admissions or until about 10PM. If it is slow, your
resident may send you home and you can instead pick up
a new patient on a non-call day
○
○
When they say go home you say “See you tomorrow” and leave
Unless there’s something you really want to stay for
How to Be Helpful
● Update the family during the day
● Call the PCP for background info
● Update the discharge summaries (just ask on the
first day how to get to these in epic and if the intern
would like your help in updating them)
○
If you do update, make sure to “share” them
● Make a to-do list for EVERY patient that includes
all the tasks discussed on rounds
○
Listen for words like “call” “fax” “grovel”
● After rounds, volunteer to do the tasks. Do not
wait to be asked
General Tips
● Be enthusiastic and proactive
● Start studying early
● Be prepared on rounds with a solid Assessment and
Plan. Always consult your intern when making the
plan
● Ask for feedback early (after week 1). It helps to ask
for specific feedback: “I’m really trying to make my
presentations more concise, but still thorough, do
you have any suggestions on what I should focus on
to do that better next week?”
Other Things to Consider
● Input/Output—you usually describe a child’s I’ s and O’ s
based on their weight (mL/kg/day IN and mL/kg/hour
OUT
● Once or twice during the rotation, bring in an article or
prepare a brief presentation on a pertinent topic.
○
Useful to make a handout with a few points/questions that you’ll
answer in the course of your presentation
● Always inform your fellow students the day before about
what you will be talking about so they can read up on the
subject. Coordinate with them so you both get to do one!
● Keep in mind that sometimes the specialist attendings
do not evaluate you—so you may want to stick to general
peds topics.
Studying for the shelf
● The Peds shelf is a hard shelf and instead of the 12
weeks you have for medicine/surgery, you only have 6
● It’s the one clerkship where it may not be a bad idea to
start studying for during the winter break
○
Definitely not required, but it IS a lot of material to get through
● Read (and outline, if that’s something you’re into) BRS
in the first 3 weeks, if possible
● Do all the USMLE world questions
● Pay attention in didactics -- these are high yield topics
Supplemental stuff
Radiology – Supplemental Stuff
● What if they say “Who wants to read the CXR”
○ Good topic to go over with resident early on
○ Then can wow them with your amazing system on rounds
● What if they pimp you?
○ Peds = benign
○ Treat it as a fun game. Guess within reason, sometimes you’re
right.
● Scutwork
○ My experience is that this isn’t expected of students, just ask
what your intern would find helpful for you to do
Supplemental stuff
● UpToDate from Home
● Access the hospital's Extranet at
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https://extranet.uphs.upenn.edu/
Use your MedView username / password to log in
Create a bookmark on your home page for UpToDate
Click on the "+" that's on the far right side of the "Web
Bookmarks" heading
Name your bookmark and put this URL in the URL spot:
http://uphsxnet.uphs.upenn.edu/uptodate
Click on new bookmark that's now on your home page
Use UpToDate like you would from on campus
Books/Stuff
● Old exams/outlines have been known to float around
dropboxes for different classes
● DynaMed
○
Way better than UTD and includes recent evidence and clear
format: Penn Biomed Library homepage, look under Key
Databases and Tools
● Diagnosaurus
○ iPhone app
● Nelson Textbook of Peds
○ Online under Student→Medical Student tab from biomed
○ http://guides.library.upenn.edu/content.php?pid=375283&si
d=3080034
Don’t let your empathy get
fatigued!!
TAKING AN EXTRA MOMENT TO LISTEN TO
YOUR PATIENT IS A GOOD WAY TO IMPROVE
PATIENT CARE, HELP YOUR TEAM, AND
MAKE THE EXPERIENCE MORE FULFILLING
FOR YOU.
From your upperclassmen-and-women
It all became worth it…
“...When my patient got diagnosed with a very rare (but thankfully treatable)
disease, and I had the time to sit down and walk the family through what it
meant after the busy specialists left. I was able to break it down for them,
walk them through the scans, and make this big scary thing seem a little
more manageable. “
“...When each and every chubby 4-month-old baby smiled and giggled at me
because they were just.that.happy.to.enjoy.all.the.everyday.life.moments
(also just known as normal, happy baby syndrome.)”
Support Systems
Clerkships can be stressful and emotional, but you are never alone.
Suite 100:
- JoMo, Barb, Helene
- Tutors set up through suite 100
Organized counseling:
- CAPS: http://www.vpul.upenn.edu/caps/
- Therapists in the community (Barb from Student Affairs can provide names and contact info)
- Paired mentoring: SNMA, LMSA, Elizabeth Blackwell, House mentors
Other people to turn to:
- Doctoring preceptors
- Advisory deans
- Clerkship directors (it’s really ok to talk to them!)
- Mentors you have connected with in pre-clinical years (through clinics, volunteering, etc)
- Friends and family outside of medicine