Preparing for clinical year while still in didactic year

[SERENITY NOW]

Hello everyone,

Clinical year is coming up in about 4 months for my class and I recall some advice from tool man's wonderful stickied thread: "during didactic year, shoot for 85% on exams and spend the rest of your time learning practical knowledge for the clinical year."

 

Some great examples Mr Tool wrote about... "get good at:

taking a quick history, doing a physical exam in your sleep, writing clear professional notes on a chart, presenting patient H&P to preceptor in a clear/direct manner, continually reviewing simplified notes to hammer home the basics of every disease we learn, and listening to lung sounds/heart sounds."

 

I thought this was great advice and was wondering if there might be others who could also contribute to the conversation.  I tried several searches and it doesn't seem like there is too much advice for preparing for clinical year while still in didactic year, so I figured a new topic could be in order.

 

Please share your thoughts and wisdom!  Thanks!

[primadonna22274]

PHARM, PHARM, and PHARM.

I got a great pharm education in PA school. Much better than I got a decade and a half later in med school. That pharmacology knowledge has stood me in good stead throughout my PA-S2 year, in clinical practice and definitely in med school rotations. Choose a source you trust and build on your knowledge daily. Know common interactions and adverse reactions of the most commonly used drugs. Know mechanisms of actions of any drug you use and its target--ESPECIALLY antibiotics--rational matching of bug to drug begins with a solid understanding of where the drug attacks the bug.

Good luck!

[BARONEUS]

Amen to the pharm knowledge. My first two rotations I walked around with my nose in a pharmacopeia because I couldn't remember what went with what.  Also, most of the things you mentioned (H&P, exam writing notes) you'll get plenty of practice doing in clinic; that's exactly why you're there. However, what you are likely going to wish you already had down was how to concisely and effectively present to a physician.  I hate getting that pursed-lip, raised-eyebrow stare that says, "Seriously? That's your presentation?" So what's the best way to practice presenting?

[UGoLong]

The main goals of clinicals are to give you a chance to pull all of your knowledge together and apply it to patients in a controlled environment and to expose you to lots of different clinical settings. I put the following together several years ago for students getting ready for clinicals. I hope it is useful to some of you:

 

 

Rotations for Newbies

 

Attitude

 

1. Decide that you are on the ultimate “field trip” with the goal of learning all you can about what life is like for a PA in whatever rotation you are on.

 

2. Even though you aren’t being paid, consider it a job, and one that you would like to keep! (You might actually get a job offer too).

 

3. These people may play a role in your life later, even if you don’t want to work for them. For example, one day I found my preceptor preparing a recommendation for a student in the class ahead of ours.

 

 

Equipment

 

1. Buy the second white coat so you always have a clean, IRONED coat ready to go. Patients may have more respect for you if you look like you made an effort.

 

2. Consider getting a smartphone with the paid version of Epocrates (Essentials Sx/Dx) on it. Best single piece of personal equipment (next to a pen and a stethoscope).

 

3. Like all disciplines, medicine involves a lot of abbreviations. Consider Beiks Bdicty on your phone  (www.beiks.com) with the “MediAcro” option.  This lets you look up abbreviations (especially in the hospital, which is the home of abbreviations!) without bothering asking even more questions than you need to.  It costs about $25 and lets you know, for example, that your cardiologist’s cryptic remark to his nurse about a “PFO” involves a patent foramen ovale.

 

4. I’d carry the Tarascon Pocket Pharmacopoeia ($10 from www.tarascon.com).  It lets you quickly look up drug doses, fits in your scrubs, and you won’t cry quite so hard if you lose it (like you would for a lost or broken phone).  It will help you when your preceptor says to write a script for him or her. It also has the advantage of showing drugs by family, which is great when you want to see a list of second-generation cephalosporins or anti-emetics to consider.

 

5. Maxwell’s little book of documentation formats the program issues is a great reference.

 

6. Carry a pen and 3x5 cards to write down patient ages etc for tracking, as well as your preceptors pearls of wisdom, or messages you get when you call back doctors that have paged him.

 

Arrangements

 

1. Try to go to every site some time other than the first day you are due to work. Dress up as if you are on a job interview; I never wore a white coat that day to emphasize that I wasn’t yet working for them. 

 

2. Ask about things you can do to prepare. The preceptors often gave me references to read (sometimes they even gave me the books too). 

 

3. This early trip makes things easier on the first day and also set up a good first impression. It also gives you a chance to meet the staff and SEE HOW THE PHYSICIAN DRESSES.

 

The Rotation

 

1. Look the part and dress at least as well as your physician does (some of them may not exactly be good fashion models!). Depending on the rotation, that might mean scrubs or it might mean a dress shirt and tie.

 

2. The preceptors don’t get paid to have you around, so try to send the message that you are interested in the subject matter and will do anything you can to be helpful. Consider it a success if they actually start depending on you to save them some time.

 

3. If someone says “Would you like to (see a case, see a patient on your own, try a procedure that you have at least seen done once)…”, say “Yes!” If you want someone standing by because you are afraid you might hurt the patient, don’t hesitate to tell your preceptor that as well.

 

4. If you’re trailing your preceptor around, pretend that you are shooting a documentary on what his life is like (talking to patients, doing procedures, talking to family members, interacting with staff, dictating, filling out paperwork, or whatever.). At any moment, he may start telling you to do something that you could have been watching or listening to him do. 

 

5. Ask questions, but be sensitive as to when is the best time to do it.

 

6. Establish relationships with the preceptor and his or her office staff. Get to know each other and try to learn from everyone.

 

7. Be gracious and thank everyone who helps you. This includes the nurse who will invariably save your butt the first time you try to suture a child in the ER or scrub-in in the OR.

 

8. You will often come home too tired to crack a book. Make a list of things you didn’t know or need to know more about. Spend some time on the weekends reading up on them.

 

9. People (including patients) will be interested in who you are and why you are becoming a PA. Have an answer ready!

 

10. Enjoy the patients. They will teach you a lot and they know more about what’s wrong with them than they know. Often you will be the only person who has the time to listen to them.

 

After the Rotation

 

Send a thank-you card to your preceptor. Also to any of the staff who were particularly helpful, and one to the staff as a whole. They did a lot for your education, so show some gratitude.

[SERENITY NOW]

Thank you all so much for the insight!  I really appreciate it.  It is very exciting to think that clinicals are right around the corner, and I want to get as much as I can out of them so I'll definitely work on all of the advice put forth.

 

Thanks again!

[KMD16]

Know your stuff & be humble. You must be engaging. Don't expect to be spoon feed. Study study and study!

[EMEDPA]

UGO- great advice above as always.

Allow me to reiterate-  being on time and available when the preceptor asks you to be there is very important. you could ace everything else but if you are late a few times or no show a shift you may not even pass the rotation. also as mentioned above, dress the part. you are a medical provider in training. that means look like you are serious about being there. nice shoes, good pants, clean lab coat, etc. Think of every day as a job interview. if you are lucky it might be.

[whoRyou]

Excellent advice UGL and EM ... Best to you both ;-)

[rev ronin]

Of the above advice, I disagree with only one thing: I never needed Epocrates, and I was glad I saved the money by not buying it.

 

My added tidbit would be to make sure you talk to the students (your class, or the class ahead of you) who have recently rotated there, and get ideas about what to expect.  Beware the occasional jerk who wants to sabotage you, so try to talk to more than one person and/or make sure if you only talk to one person, it's someone you trust--got burned on this once myself, but it was generally a very good thing to do your research ahead of time.

[cinntsp]

Epocrates is free for students so it's not an issue. I use it almost every day.

 

Sent from my Nexus 5 using Tapatalk

 

 

[BARONEUS]

Agreed. Don't waste your gas money on the full version of Epocrates. Free Epocrates and free Medscape will be all you need. Well, that and Surgical Recall.