Best Advice for Clinicals

[orangerusty]

I just thought I would throw out a topic for a thread. If you had one bit of advice....or two that you wish you had known before starting a rotation, what would it be?

 

I have read various posts that tell of great bits of advice, but it would be cool to have them in one place more or less or have people come back to add them after a rough day.

 

Rusty

[EMEDPA]

don't ever miss breakfast.

always arrive early and stay late.

push the med students out of the way so you can see and do procedures.

if you don't know something, don't bs

[tool man]

what a HUGE topic. It's overwhelming

[tool man]

It's good to carry a notebook with you. If you don't know a word, open you notebook and write it down to look up later.

If your preceptor had a teaching point, write it down, so if he/she asks you 2 weeks later, you've had time to look at the point occasionally and will remember. Nothing frustrates preceptors more than when they ask you the same question they asked you two weeks ago...and you still don't remember the answer.

[orangerusty]

Tool Man,

That's the kind of stuff I'd like to know. It seems like such a small thing, but it really helps a lot of us out.

Rusty

[JenGintheED]

A potential preceptor told me that new residents show up at his facility right after July 4th, and they are so eager to get rolling in the first few months of residency that they can be really pushy witha PA student. He said to do summer rotations at sites that don't have residents, if possible.

[NoClinic4Me]

The one thing that I expect from every PA student on my rotation is to be HUMBLE!

I don't care if you discovered ACE inhibitors in your previous life as a researcher, you are still a student and should be HUMBLE. If I ever get a cocky student, the first thing I will do is set them up to look like an ass, so they can get that HUMBLE thing back.

You need to appreciate that people are teaching you during there time, allowing you to slow them down, for FREE! We love doing it, but a cocky student ruins the whole experience.

 

Pat

[Marlene G]

Likewise, there aren't a great many PA students, anymore, over the age of 40. So, when a person over 40 does show up as a student, can you please try to have some mercy and understand that: 1.) It has been awhile since the person has been back in school. My God, some of us cannot even fit into those little seats anymore. LOL! 2.) We cannot move as fast as a 20-something and 3.) Although we may be students, we do have life experience and it is humbling enough to take directons from someone almost half our age who, to us, seems to be the one lacking humility and life saavy.

I am far from cocky and have actually been insulted by people who cannot believe that I can admit that I don't know something or that yes, I really did make a mistake and even had the guts to admit it. That floors most people because they seem to just be waiting with that baseball bat to wack the cocky ones, only to find some humble person took the wind out of their sails.

My suggestion is similar to Laughing Angels. If you can get a rotation at a site where they do not also train residents and med students, you will receive much more personalized training and will come away feeling like you learned rather competed to get a piece of the pie. That is so energy draining and counterproductive.

Pardon me if I sound a bit obnoxious, but I have found some sites really do love to teach and have respect for all people. Other sites love to just play ego and mind games with students. It is most humiliating at my age to have to regress back to early 20-something behaviors. Ho hum. LOL!

Oh, and one more point. Sites that are overworked and understaffed will actually let you do more. You learn a lot at places like this. These have been some of my best experiences.

:D

[Monica]

First I want to recommend this pocket reference book to have in your labcoat during rotations.The Practitioner's Pocket Pal: Ultra Rapid Medical Reference Of course, have your Maxwell's, a Sanford Guide to anti-microbial therapy, & a Tarascon pharm book too..BUT this book is just INCREDIBLE. Why you ask? Well...because the author is a PA of course! :p But seriously, I wish I had discovered this little gem months ago, it's really handy. Rusty remind me to let you look at it the next time I see you on campus.

 

Great advice has been given already, thanks to the wise ones.

 

My two cents is to remember to be the kind of person you want to be around on rotations...helpful, pleasant, knows when it's time to get to work, etc. A sense of humor goes a long way. Sounds silly but the gunner types who will stop at nothing to make sure they get every procedure & who don't know the meaning of being a team player are so annoying. I know I sound like a whiner. :o Do your best & be sure to enjoy it!

 

Great thread Rusty.

 

:) Mon

[tool man]

also, give your preceptor some space. It's annoying to have someone in your backpocket the entire day. Asking 69,000 questions. If you have a question that can be looked up...then look it up yourself.

If your preceptor has to get paper work done, don't bug him/her. Read 5 minute CC or look up some of the things you wrote down in your notebook.

[Monica]

always ask what forms you can write on as a student....

 

think of every rotation as if you have just been hired there, take on as much responsibility as possible..as long as it is appropriate...

 

get to know your ancillary staff, they can be like gold...they can get you the good stuff many times, like equipment for procedures, paperwork, phone numbers, etc....

 

if you are required to wear a pager & the system is set up for alpha paging get one, sometimes it's much easier for your preceptor to send you a quick message than to sit by a phone waiting for you to call back....

 

M ;)

[Monica]

Had some more random thoughts..

 

On every rotation bring several pens with you, the cheaper the better, they will be lost.

 

Surgery rotations: You must buy SURGICAL RECALL!!! Don't start a surgery roation without it. It will save your hide before every case!

 

In the OR--be involved in the entire operative process:

• first and foremost read your patient's H&P & know as much about their case as possible
  
• know your anatomy, the procedure, & why that procedure is being performed
  
• get your patient's xrays (check the name!) & put them up on the xray board in the OR room before the pt. arrives
  
• help with the pre-op process if possible: consent forms, placing patient's IV (anesthesia team is always a huge help with tips, etc), foleys, get patient prepared, etc.
  
• scrub longer than your residents
  
• let your preceptors gown before you
  
• help get patient ready for & transport them to recovery area
  
• if possible, put in orders for your patients after the case is over (meds, diet, etc.)
  
• always protect your eyes please!!!! Wear the mask with the shield...ALWAYS. Even if doing a non-invasive procedure..you never know what can happen...wear eye protection.
  
• always wear shoe covers, ask for them if you can't find them, the other day I forget to put mine on & it was not a pretty site.... :rolleyes:
  
• always have an extra pair of scrubs with you in your backpack
  
• remember to ask the scrub tech if you need to get your own gown & gloves.

Have fun!

:)

[UGoLong]

I start my rotations in a week and this stuff is great! I'm an "older" student and appreciate all help!

[rcdavis]

here is a copy of my answer to a student going into the hospital for their first time on rotations: inpatient medicine and surgery: i suppose some also applies to the outpatient clinic rotations, too

 

 

For inpatient rotations

start with your medical director.

assuming he set up the rotation for you, ask him specifically what you should be allowed to do...and pin him/her down..do not let him say "whatever they want you to do"

ask: can I examine patients? can I write on the charts? Can i do procedures?

 

and ask - if these issues have been specifically addressed with your contact point in the hospital.

 

if they have, when you get there, seek that person out, and tell him who you are and that you qre there to learn, and that you want to do learn how to (examine, interview, suture, put in lines, whatever the rotation does).

 

If these issues have NOT been addressed, address them yourself with the "in-charge person" on your first day.. find out how they want you to present your patients: probably to the senior resident. NEVER present to the intern or med student.

 

after the first days or two (so that you know the routine) arrive an hour earlier than you need to, familizarize yourself with what happened the night before, and what will be done that day. review the AM labs. help make sure that all the xray/imagiing studies are available. learn a little bit about each patient, but speciafically know (or write down) why they are in the hospital..as the rotation goes by, learn more and be prepared to ask/answwer questions about the patient's diagnoses.

 

For the first 2 days, arrive again 60-90 minutes early to introduce yourself to the nurses. tell them what / who you are. and give them a handle on your comfort level. (do you know howto start IVs, NGTubes, foleys, change dressings, etc? will they help you by teaching you these things? They do it much m,ore often the docs.)

if you are at a teaching institution, you will travel in a herd or " professor/attending followed by chied resident, resident of the floor/ward, junior resident (1-2nd year), 4th yr med student and maybe 3rd year med student.

 

befriend the junior and senior resident...your job will be easier and you'll get more out of it if you can figure a way to make his life easier (run down for things- get data, etc...but tell him up front that you would expect to share those scut duties with the other students, not do them all.

 

If you get asked a question: answer it. you either think you know the answer or not. if you don't say so. if you are totally lost, and they ask you "what else" this (sign/symptom/case) could be, you will alwys be safe in answering, "syphilus, amyloid or sarcoid". And whatHLA system is associated with (that diagnosis) always answer "BW-27" you will be right more often than not.

 

If asked about a sign or symptom that you do not know: do not go to sleep until you do know it, or have written it down and can spout it off when asked about it again.

 

Start chart room conversations simply by asking "why are we doing "x"". and the senior resident will ask the junior resident or the med students...and have a follow up question ready. hopefully, what will happen is that the next conversation will started by one of the other guys and YOU will be asked for the answer...which should be: if you don't know "i don't know" and (hopefully you do know "here is what i thin k the answer is...

 

volunteer to do ALL procedures, once you have 'em on the hook, then tell the truth and say that you have never done one by yourself and can one of them show you?

 

the only objection anyone will have to you is if they perceive that you are hindering their major goal: that is, gettinmg out of work on time.

try to find the guy in the group who understands that physician means teacher and wants to share his knowledge...latch onto him.

 

do not let them tell you "you don't need to know this..only doctors c an do this" . lie and tell them that you are planning on working with doctors in that specialty and you will be expected to be able to do that thing, or understand that thing.

 

For surgery: if you do not know what a "sterile field is" learn it NOW. learn how to move in the OR. Do NOT lean over/pick up anything to give to anyone unless they specifically ask you, and you are sure that you are garbed appropriately (gloved/gowned if needed.) In the OR suite, if you cannot get into the bedside, ask the anaesthesiologist if you can stand and look over the head sheet.

(also ask the the anaesthesiologist if you can start an art line, or central line (IJ, subclavian) and any IVs that need to be started. watch him intubate...ask him to show you the cords.)

 

EAT breakfast!!! e- is absolutely right; you will be better for it.

 

PEE! do not hold it for 'one more patient" you will be less stressed.

 

WORK hard, but ENJOY yourself. If asked: today is a great day, and you are glad to be right where you are.

 

best advice i can give you is to do what i did in my training: spend 15-18 hours a day in the hospital. THAT - not your wife, kids, dog, is your life for the next year/rotation. the system rewards effort, not desires.

 

 

good luck

[JenGintheED]

A classmate shared this... every bit of it has been helpful to me during this clinical year.

 

"SURVIVING CLINICAL ROTATIONS WORKSHOP"

Cynthia Booth Lord, MHS, PA-C

Assistant Professor and PA ProgramDirector

QuinnipiacUniversity

 

 

FOLLOW THE LEADER!

Most, if not all program have "rules and regulations" of clinical rotations. It is most important to observe those guidelines at all times. Many schools have clinical rotation handbooks which students should refer to if questions arise. When in doubt, call the program office/clinical coordinator.

 

BE PREPARED!

Pen/pencil

Pad

Ruler

Penlight

Short white coat

Identification tag

Stethoscope

Medical equipment (as necessary)- I.e., make sure you have your reflex hammer if you are doing a neuro rotation. Many places do not have a tuning fork for neuro or ENT so carry one with you.

 

BE A CARD CARRYING MEMBER!

Carry a wallet-sized copy of your current immunizations with you at all times. Many rotations now require proof of hepatitis titer, varicella titer and rubella titer in addition to immunizations. PPD (tuberculosis) tests may need updating every 6-12 months. Even though programs may forward that information to clinical sites prior to your arrival it doesn't hurt to have it with you, especially if you sustain any kind of injury at the rotation site.

 

HAVE A PLAN!

Exposure control plan. Make sure you are aware of your program's exposure control plan for both bloodborne and airborne pathogens. The Centers for Disease Control (CDC) now recommend starting anti-retroviral therapy as early as one to two hours post exposure. It is important to know the program policy for it may require that you obtain treatment at a site other than the one where the exposure took place. Generally there is a report form that must be filled out and submitted to the clinical site and/or PA program. If your program does not have an exposure control plan in place, you should review the CDC web site (www.cdc.gov) for the latest information on bloodborne and airborne pathogen exposure. You can do a search for blood borne pathogens and find the article:

June 29, 2001

-MMWR-"Updated US Public Health Service Guidelines for the Management of Occupational Exposure to HBV, HCV and HIV and recommendations for post exposure prophylaxis"

OR Go to www.cdc.qov/. Go to contents -A-Z Index (top tab) - Bloodborne Pathogens - Bloodborne Pathogens in Healthcare Settings - Worker Protection - "Exposure to Blood, What Every Healthcare Worker Needs to Know" (http://www.cdc.gov/ncidod/hip/Blood/worker.htm)

 

FLAIR FOR FASHION!

Look presentable. First impressions set the tone for your entire rotation. Minimize jewelry, heavy perfumes/aftershave. Keep nails trimmed short and hair out of your face. Men need to consider a "clean" face (lack of facial hair) during surgical rotations. Women: Dress, skirt, dress pants, blouse. Avoid-shorts, jeans, low-waisted pants, T-shirts, midriff baring tops or sheer tops. Men: Shirt, collared shirt, tie, casual pants. Avoid-shorts, jeans, T-shirts.

 

SCOUT IT OUT!

If at all possible, try to make the drive to your rotation site 1-2 days prior to starting to find the site. Listen to the traffic report for a week or so prior to starting the rotation to get a sense of traffic patterns. Estimate commute time, find parking, locate the office to which you are to report, and scout out the cafeteria!

 

MA BELL

Call your contact person at least 2-3 days prior to starting your rotation to introduce yourself and arrange when and where to meet. Ask your preceptor about housing, "call time," time off (I.e., weekends, nights).

 

TO BE OR NOT TO BE

To Be

Enthusiastic

Assertive

Empathetic

Efficient

Prepared

Open (to change, criticism)

Communicative

Team player

Inquisitive

Confident

Organized

 

Not to Be

Sickening sweet

Aggressive

Sympathetic

Pokey slow

Off the cuff

Defensive

Assuming

Selfish

Know-it-all

Arrogant

Obsessive-Compulsive

 

EQUIVALENT BUT NOT EQUAL!

Remember that each student has a different experience on his/her rotation. The goal of programs is to provide students with equivalent experiences. This means that you will most likely NOT see and do exactly what your classmate did on the same rotation. There are many variables that enter into each rotation and these are ever changing. In large teaching institutions, rotations are many times resident-dependent. Keep this in mind when you return to callback and over hear a classmate raving about a rotation that you did not especially enjoy. To some extent, a rotation is what YOU make of it. Take advantage of any opportunity to attend medical staff meetings at the hospital and any other medical meetings your preceptor may attend (Grand Rounds, Noon conference, evening CME programs etc.)

Medical "politics" are an integral part of modern medicine. As a student you will not be exempted from the difficult patient or the difficult preceptor. You need to develop coping skills so that you do not jeopardize your learning experience.

 

RESCUE 911

If at any time you encounter problems on your rotation, you should contact the program/clinical coordinator. This does NOT mean that every time you have a bad day or get criticized you run to the program. What it does mean is that if there are issues of competency, lack of supervision, or any type of discrimination, you should check in with the program immediately. You don't learn by watching and if that is all you are doing, it will be extremely difficult to manage patients when left on your own. Remember the old saying "See one, Do one, Teach one". You should also remember to call the program and your preceptor if an emergency arises and you need to be excused from your rotation site.

 

HEAR NO EVIL, SEE NO EVIL, DO NO EVIL

Communicate with your preceptor at least twice during a rotation. Get feedback on how you are doing and what you can improve upon (see "X-ray Vision"). Follow up on suggestions made to you. Communicate with your program. Complete site and preceptor evaluation forms. Remember, it is easy to complain, but it takes some thought to give corrective criticism or suggestions on how to improve a rotation site. Communicate with your classmates. As you progress through the clinical phase of your training, you will give and receive helpful "tips" from your classmates. Not all these "tips" will be helpful to you but at least you can get a feel for a rotation.

 

ALPHABET SOUP!

Read. Read. Read. Though you probably will not have time to read major texts of medicine and surgery as you did in the didactic phase of your training, it is critical that you read something. This is a time when "pocket" books and handbooks may be helpful. Do not feel the need to spend a fortune on more books. Any of the texts you currently own will do just fine. You are now reading at a different level and for a different reason. This is (hopefully) not the first time you have read the material and you are just scanning if for the highlights (signs, symptoms, lab tests, differential diagnosis and treatment options). Always attempt to read up on surgical cases the night before and review the appropriate anatomy. It is most helpful for students to review a surgical atlas (i.e., Zollinger or Gliedman) prior to starting the rotation and before scrubbing in on each case (read the night before the case). Most hospitals have libraries and physicians in private offices usually have a bookshelf. Read journal articles. As student members of the AAPA you receive several different PA journals. The major medical journals are available at the hospital. Physicians and physician assistants will frequently refer to journal articles since that information is much more current than texts (which are already outdated at the time of print). The worldwide web is another valuable tool for gathering information. There are hundreds of medical sites that have information including practice guidelines. www.cdc.QOVhas a section called "CDC Recommends" in which you can find practice guidelines for:

- Immunizations

- HIV/AIDS

- Sexually transmitted diseases

- Screening for cervical cancer

- School health programs to promote lifelong healthy eating

WRITERS CRAMP!

Keep a notebook (or PDA) with you at all times. Write down the various illnesses/cases that you see each day. Also, keep a log of clinical "pearls" for each rotation..

 

WEEKLY SPECIALS!

One of the better ways to learn during your clinical rotations is one on one discussion with your preceptor. These can be in 1 or 2 sessions per week lasting from 10-15 minutes. Some possible "topics of the week" include:

1. Headache

2. Acute abdomen

3. Chronic Obstructive Pulmonary Disease

4. Hypertension

5. Urinary Tract Infection

6. Normal prenatal care and delivery

7. Middle ear disease

8. Diabetes Mellitus

9. Low back pain

10. Syncope

GRAVEYARDS, GHOSTS AND GHOULS!

You must have time to yourself and you need your sleep. We accept that. However, many interesting cases and learning experiences seem to come along at 2:00 a.m. The student who is willing to make the sacrifices will reap the greater benefit (she/he will also dazzle the preceptor with their enthusiasm). Put in "extra" time. Offer to do extra once you finish your daily requirements. Offer to take odd shifts. Most floors and emergency departments are staffed by skeleton crews on nights, weekends and holidays. Fatigued, over worked residents usually cherish the thought of an extra pair of hands on these shifts. If you think about it, most babies are born at night or in the early morning and most motor vehicle accidents take place at night or on weekends.

 

FOOD CHAINS!

It is a fact of life that "students" are low on the predatory food chain. They get the least amount of respect and are often delegated the dirtiest of "scut work". Remember, "scut work" is necessary work and it can be educational if viewed correctly. Also remember that someone else did it before you came and someone will have to do it long after you are gone. To demean the task is often to demean the person who performs it. HOWEVER, there are ways to work around these issues and achieve a level of respect from preceptors and other medical professionals. Hard work and following the guidelines listed throughout this handout can help move you up in the ranks. It is important that you know your position as a student. This may be your most challenging job especially since it can change with each new preceptor. BE RESPECTFUL of ALL medical professionals. The x-ray tech may point out some radiology pearls or the med tech may show you how to draw a blood gas. These

individuals are important members of the health care team that you will soon be part of when you graduate. Remember the following:

1. Smile

2. Give each person the credit and respect due him or her.

3. Help out where and when you can. If a particular task is not beneath their dignity then it should not be beneath yours.

4. Each clinical site has ways of doing things that fit their situation and personnel. Do not be offended if they do not jump at your idea to change a procedure.

WHAT'S UP DOC!

Then there is the physician. He/she will forever be your supervisor but that does not mean you will not have autonomy or responsibility or a collegial relationship. A very important factor in determining the overall success of your clinical rotation/clerkship experience will be the relationship established between you and your preceptor. This relationship should ideally be open, honest and fair from both sides. As a student you should try to earn the respect of your preceptor, whoever it may be. This can be very difficult because of the many different personalities involved. If a preceptor was pimped throughout their training, you can bet they will pimp you. It is once again, a matter of developing coping skills to work around these issues. It is most important to keep your cool and not become disrespectful. As a student you are representing your school as well as the PA profession. Take the middle of the road attitude and try to get along with everyone. No one likes a "cocky" student. Here is some food for thought.

1. You will be a "short term" part of an established medical practice and an established community. What for you is a 4 to 8 week learning experience is a way of life and livelihood for your preceptor. The patients you see are his/her patients.

2. There is a fine line between assertiveness and aggression.

3. Confidence is great. Over confidence can be quite literally fatal.

4. These are old axioms, but worth repeating:

a. "No question is a dumb question if you do not know the answer"

b. "Tis better to ask than to screw up"

THIRD EYE BLIND!

We each have two eyes to see with. Our third "I" is that of insight and many times the "I" that is blind! Demonstrate insight into yourself and your performance. Critically assess your performance during rotations and identify those areas of weakness. Avoid asking preceptors the broad and all encompassing question "How am I doing?" This can scare off your preceptor and result in a very generic, less than honest answer. Identify two or three areas of weakness and bring those to the attention of the preceptor and ask them for advice on how to improve. When asking preceptors for feedback it is important to define the time you are asking for (Le., May I have three to five minutes of your time). There is nothing more frustrating for a preceptor than to have a student ask to sit and discuss their performance (it conjures up visions of a three hour discussion!).

 

PASS THE POPCORN!

Learn to give a good oral presentation. Be succinct, accurate and cut to the chase with oral presentations. If your preceptor has time to get coffee and a bagel or go to the concession stand for popcorn and a soda, you have gone on way too long. Most preceptors will cut you off at the knees when they have had enough. Give a quick HPI, history (pertinent positives), assessment and treatment plan. Remember to make your presentation flow in a logical order or the preceptor will get bored and not listen to what you are saying.

 

LAW AND ORDER

Know your legal limitations. Be informed of what you can and cannot do as a PA student in your state and PA program. For example, if your program does not allow a PA student to administer chemotherapy to a cancer patient, do not do it. If asked, explain that you are not covered to do that procedure and refer the preceptor to the program for clarification. Review your program's policy on students obtaining "consent" forms, especially in surgery. Remember to sign and date all of your chart notes and orders. These are legal documents and part of the patient's permanent record.

 

HIPAA, HIPAA, HOORAY

The Standards for Privacy of Individually Identifiable Health Information ("Privacy Rule") establishes, for the first time, a set of national standards for the protection of certain health information. The U.S. Department of Health and Human Services issued the Privacy Rule to implement the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Privacy Rule standards address the use and disclosure of individuals' health information. A major goal of the Privacy Rule is to assure that individuals' health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being. The "rule" establishes a balance that permits important uses of information, while protecting the privacy of people who seek care and healing. All students should adhere to the following general HIPAA guidelines:

- Patient information should not be discussed where others can overhear the conversation such as hallways, elevators, water coolers, at home or at social events.

- Dictation of patient information should occur in places where others cannot hear the dictation.

- Confidential papers, reports or computer printouts should be kept in a safe and secure place.

- Confidential papers should be picked up ASAP from copiers, mailboxes or faxes.

- Confidential papers should be appropriately disposed of by being shredded or torn up.

- Accessing any information other than what is required to do your job is a violation of confidentiality policies.

- It is the provider's duty and responsibility to keep health information totally confidential.

- Computer "passwords" must not be written down or shared with anyone else.

- You cannot use someone else's "password" to access an institution's or practice's computer system.

PERSON TO PATIENT

Only a few "big" items here.

1. The first law of medicine, "Primum non nocere" (first of all do no harm).

2. Remember that the patient at the other end of the stethoscope is a person too.

3. The patient did not come in to be dazzled with medical terms and scholarly dissertations. They came for help of some sort. Something in their world is not right. It may not be what they complain about. Your job is to find the problem and to help them solve it. If your native intelligence shines through to impress them, consider it a bonus.

4. If you do not know what is wrong with a patient then "I do not know" is an acceptable diagnosis. Send for reinforcements!

PA-ZAAZ

Work hard, but enjoy yourself. This is the time to put it all together. You have worked hard in the didactic phase of your training and now is your chance to apply what you have learned. It is very important to be prepared for rotations, especially the first few. Many times students "waste" their first few rotations getting used to the technical aspects of rotations and miss out on the educational experience. In some instances it may be your only opportunity to attempt a procedure or technique that you may never do again (depending on your area of practice). Do not be afraid to jump in and help. Practicing physician assistants and physicians may have little time to hold you by the hand and it is easy to forget the student in the corner. Know your capabilities and limitations. Most people are willing to teach if you admit what you do not know, but are willing to learn. Above all, keep a smile and remember to never stop learning.

 

[JenGintheED]

OUTLINE FOR ORAL CASE PRESENTATIONS

1. Opening Statement

-Patient profile

- Reason for visit or admission

- Duration of problem or complaint.

2. Body of Report

- Description of present problem(s)

- Use one or more of the following organizational formats for this section:

characterization, chronological report, or problem solving

- Relevant PMH, SH, FH, ROS

- Relevant PE

- Relevant diagnostic tests and procedures (lab, x-ray etc)

- Assessment

- Plan

3. Summary

- Diagnostic

- Treatment

- Patient Education

 

 

GUIDELINES FOR CASE PRESENTATIONS

Follow an outline when presenting your oral report.

The time for your report should be five (5) minutes.

Prepare to present any and all of the cases you see on your rotation.

Be prepared to answer questions about your case.

Be prepared to take suggestions for improvement from preceptors.

 

OUTLINE FOR AN OPERATIVE NOTE

1. Name of operation

2. Indication/reason for procedure

3. Surgeon and assistants

4. Anesthesia (local, general, regional)

5. Preoperative diagnosis (presumptive diagnosis before surgery)

6. Postoperative diagnosis

7. Pathology samples

8. Estimated blood loss

9. Drains (types and placement)

10. Complications

11. Disposition

 

OUTLINE FOR A PROCEDURE NOTE

1. Name of the procedure

2. Indication for the procedure

3. Consent (include risks, benefits, potential complications, name and relationship of person giving consent)

4. Anesthesia

5. Details of the procedure

6. Findings

7. Complications

 

OUTLINE FOR A DELIVERY NOTE

1. Type of delivery (vaginal, c-section)

2. Estimated gestational age of fetus

3. Viability of fetus

4. Gender of fetus

5. APGAR scores at 1 and 5 minutes

6. Weight

7. Delivery of placenta (number of vessels, placenta intact)

8. Lacerations/episiotomies (degree and how repaired)

9. Estimated blood loss

10. Condition of mother immediately postpartum

 

OUTLINE FOR DISCHARGE SUMMARY

1. Date of admission

2. Date of discharge

3. Admitting diagnosis

4. Discharge diagnosis

5. Attending physician

6. Referring and consulting physician (if any

7. Procedures (if any)

8. Brief history, pertinent physical findings and lab values (at time of admission)

9. Hospital course

10. Condition at discharge

11. Disposition

12. Discharge medications

13. Discharge instructions and follow up

14. Problem list

 

GUIDELINES FOR WRITING A DISCHARGE SUMMARY

1. Discharge orders must be written when a patient is ready to leave the hospital.

2. The discharge summary should provide a narrative of the events of the entire hospitalization, especially treatments and the patient's response to treatments.

3. Discharge instructions should be specific, not vague or general.

 

 

GUIDELINES FOR PRESCRIPTION WRITING

1. Date prescription written

2. Prescriber information (name, title, address, telephone number, supervising physician)

3. Patient information (name, address, age/DOB)

4. Inscription-name and strength of medication to be taken in each individual dose

5. Subscription-dosage from and number of units or doses to dispense

6. Signa ("sig")-route, special instructions and how often to take medication

7. Indication-required in some states

8. Refill information-written as the number of times script can be refilled

9. Generic substitution-if generic permitted or write DAW (dispense as written)

10. Warnings-supplied by pharmacist

11. Container information- childproof vs. non-child proof container

12. Prescriber's signature-authenticates prescription; include name and title of prescriber

 

[JenGintheED]

CLINICAL ROTATION BOOK LIST

1. Medical Spanish Made Easy. A.B. Anup, M.D. ISBN 0-9657083-0-6 ($17.99)

2. The Medical Letter (twice a month; now available for Palm OS and Pocket PC) ($38.00/year)

3. Prescriber's Letter (monthly) ($88; student rate available)

4. Physician Assistants Prescribing Reference (Quarterly) ($34.84)

5. Sanford Guide to Antimicrobial Therapy -Palm OS and Pocket PC (Yearly) ($9.00)

6. Guide to Antibiotic Use in the Emergency Dept. (Yearly) J. Bryan. Emergency Medicine Resident Assoc. ($10.99)

7. Tarascon Pocket Pharmacopeia -Palm OS and Pocket PC (Yearly) ($9.95)

- Tarascon Pediatric Emergency Pocketbook ($11.95)

- Tarascon Adult Emergency Pocketbook ($14.95)

- Tarascon Internal Medicine and Critical Care Pocketbook (14.95)

- Tarascon Primary Care Pocketbook (14.95)

- Tarascon Orthopaedia Pocketbook (14.95)

8. Nelson's Pocket Book of Pedi Antimicrobial Therapy.(Yearly) J. Nelson. Lippincott, Wm & Wilkins ($19.95)

9. Pocket Guide to Commonly Prescribed Drugs. G. Levine. Appleton & Lange. ($19.95)

10. Handbook of Commonly Prescribed Drugs. DiGregorio. ($22.50)

- Handbook of Commonly Prescribed Pediatric Drugs. ($18.50)

11. Internal Medicine Clerkship Guide (Clerkship Guides Series). Mosby. ($29.95)

12. Intern Survival Guide. (Surgery, EM etc) ($7.50)

13. Internal Medicine Pearls. (series) Sahn. ($33.99)

14. Surgical Secrets/Medical Secrets.(series) Mosby. ($21.99)

15. Surgical Recall. (series). Williams & Wilkins. ($34.95)

17. House Officer Series-Radiology. (series). Williams & Wilkins. ($29.95)

18. Geriatric PEARLS. (series). FA Davis ($25.95)

19. Internal Medicine On Call. (series). Appleton & Lange. ($34.95)

20. Harriet Lane Pediatric Handbook. Mosby ($44.95)

21. The Washington Manual. A Little, Brown Spiral Manual. ($39.95)

22. Principles of Primary Wound Management. Mike Mortiere, PA.Clifton Publishing ($16)

23. Clinician's Pocket Reference-"Scut Monkey". Appleton & Lange. ($36.95)

24. Clinician's Pocket Drug Reference-The Scut Monkey Drug Manual (yearly). McGraw-Hill. ($9.95)

25. Clinical Survival Guide for PA Students. George Broughton II, MD, PhD. Compass Publishing. www.compasspublishina.ora ($25.00)

26. Saint Frances Guide to Inpatient Medicine. William & Wilkins. ($32.95)

27. Practical Guide to the Care of the Medical Patient. Mosby. ($30.99)

28. The Lane Internal Medicine Clinical Manual. Appleton & Lange. ($29.95) ~ Manual of 29. Common Bedside Surgical Procedures. Williams & Wilkins. ($32.95)

30. Practical Guide to the Care of the Critically III Patient. Mosby. ($27.99)

31. Cope's Early Diagnosis of the Acute Abdomen. William Silen. Oxford Press. ($36.00)

05/03/05

32. Quick Cards Clerkship Series. Bourne Medical Publishing. A pocket reference set for students studying in the field of medicine. The series covers all major areas from surgery to psychiatry. There is also an option to purchase Laboratory Values card and/or Over-the-Counter Drug card. ($23.95) www.medquickcards.com

 

BOARD REVIEW BOOK LIST AND SOFTWARE

 

1. Ferri, Fred: Ferri's Clinical Advisor. 2005 ed. Mosby. ISBN: 0-323-02973-6 $59.95

2. Dambro, Mark: Griffith's 5 Minute Clinical Consult. 2005. Lippincott Williams & Wilkins.

ISBN: 0-7817-5182-9 $69.95

3. Rakel, Robert: Saunders Manual of Medical Practice. 2nd ed. 2000. WB Saunders. ISBN: 0-7216-8002-X $99.00

4. Miller, Anthony and Simon, Albert: Appleton & Lange's Review for the Physician Assistant. 4th ed. 2002. Appleton & Lange. ISBN: 0-0713-7544-9 $39.95

5. Irvine, David: Review Questions for Physician Assistant Certifying Examinations. 1998. Vol. 10. Parthenon Publishing. ISBN: 1-85070-663-8 $39.95

6. Simon, Albert and Miller, Anthony: Appleton & Lanqe's Outline Review for the Physician Assistant Examination. 2nd ed. 2004. Appleton & Lange. ISBN: 0071402896 $44.95

7. Moser, Rodney: Primary Care for Physician Assistants Self-Assessment and Review. 2nd ed. 2001. McGraw-Hill. ISBN: 0-07-137015-3 $34.95

8. Zarbock, Sarah; O'Connell, Claire: A Comprehensive Review for the Certification and

Recertification Examinations for Physician Assistants.2nd ed. 004.Lippincott Williams & Wilkins. ISBN: 0-7817-4462-8 $49.95 .

9. Auth, Patrick and Kerstein, Morris: Physician Assistant Review. 2nd ed. 2005. Lippincott Williams & Wilkins. ISBN: 0-7817-4231-5 $44.95 (2002 ed) ISBN: 0-7817-5026-1 (Available April 2005)

10. Tallia, Alfred: Swanson's Family Practice Review. 5thed. 2005. Mosby. ISBN: 0-323030009 $69.95

11. Habermann, Thomas: Mavo Clinic Internal Medicine Board Review 2004-2005. 2004. Lippincott Williams & Wilkins. ISBN: 0-7817-5773-8 $99.95

12. Ayala, Carlos, Spellberg, B.: Boards and Wards: A Review for USMLE Step 2 & 3. 2003.

Blackwell Publishing. ISBN: 1405103418 $34.95

13. Lewke, G.: Pearls of Wisdom Physician Assistant Review. 2nd ed. BMP-Boston Medical Publishing Group. ISBN: 1-58409-054-5 $32.00

14. Blueprints Q & A Step 1, Step 2 and Step 3 series (Surgery, Medicine, OB/GYN, Pediatrics, and Psychiatry). 2004. Blackwell Publishing. $17.95-29.95

15. Garfunkel, L, Kaczorowski, J: Mosby's Pediatric Clinical Advisor. 2002. Mosby.

ISBN: 0-323-01049-0 $62.95

16. Lipsky, Martin: Family Medicine Certification Review. 2003. Blackwell Publishing.

ISBN: 1405103249 $48.95

17. Papadakis, Maxine, McPhee: CURRENT Consult Medicine 2005. 2005. Appleton & Lange. ISBN: 0-07-141327-8 $59.95

18. Doherty, Gerard: CURRENT Consult Surgery. 2005. Appleton & Lange. ISBN: 0-07-1423133 $59.95

19. Zaslau, Stanley: Board Buster Step 2. 2004. Blackwell Publishing. ISBN: 1-405-10385-X $34.95

20. Taylor, George: Board Buster Clinical Cases: Steps 2 and 3. 2004. Blackwell Publishing.

ISBN: 1-405-10465-1 $34.95

21. NCCPA Connect. Exams > PANCE > Sample Diseases / Disorders by Organ System.

www.nccpa.net?EXsamplediseases.asp?r=panre

 

Software:

1. Datachem Software, Inc. PAC prep V2.0.

Over 800 questions, answers and explanations. Complete and detailed explanations are provided for each question so you know exactly why something is correct or incorrect. Select questions containing key words or search ALL subjects for a specific topic/question. Mark questions for special review at a later time. www.CertiStep.com 1-800-377-9717. $149.00

 

2. Clinical Rounds: Exam Prep v4.2 Online test simulator for board exams. Clinical RoundsSMExamPrepv.4.2@is an Internet-based test simulator. It is designed to bean

adjunct study tool for providers preparing for their national board exams. The questions, references, and explanations are to be used as a resource. The exam format is to allow one to take computer based testing that is comparable to the tests used in the national board exams. There are three 150- question exams. Two of the exams are clinical and one is pharmacology. www.clinicalrounds.com 1-800-373-5590 $77.00

 

3. Clinical Rounds: Clercship v4.2 Online curriculum guide for board exams. CLERCSHIP is the acronym for Clinical Lessons: Educational Review Curriculum - Self-Help Instructional Program. The program is an internet based study guide curriculum with assigned readings from standard medical textbooks divided into twelve (12) modules by organ system. Each module includes a post test over the subject material. The program is designed to be used as an adjunct study tool for providers preparing for their national board exams. The exam format allows one to take computer based testing that is comparable to the test engines used in the national board exams. There are twelve (12) 50- question exams. Each exam covers the subspecialty area which is studied in the corresponding module readings.

www.clinicalrounds.com 1-800-373-5590 $460.00

 

4. CLER(Certification, licensure, Evaluation and Review) for Physician Assistants: 2003 Online course to prepare for PANCE/PANRE exams from Western University Health Sciences. The Physician Assistant Review Course has been designed to optimize learning through a powerful combination of competency-based assessment, individualized curricular planning, and interactive learning. Based on the results of the Preliminary Assessment, a personalized curriculum is generated for each participant. The curricular plan ensures that the learner focuses his or her study efforts on those areas that need it most. Once the user's individualized study plan has been generated from a "Preliminary Assessment" review begins in earnest. There are a total of 18 distinct Modules, each containing a number of

Review Concepts. A combination of RealAudio-based lectures and professionally-prepared learning materials are used to present the review content in a self-paced format. At the conclusion of each Review Concept, there is a short review quiz to reinforce the material. The results of these review quizzes are added to the Individualized Study Plan above (in the Quiz Score column), so the users can easily track their own progress. www.pareview.ora

$295.00

 

5. Physician Assistant's Board Prep The program cost is $159 and includes over 1000 board related questions with simple and concise answers. A radiology workshop of CXRs, CTs, abdominal series, and broken bones pertaining to the boards which students are held accountable for is also available in the web site. Finally there are over 50 board related handouts that are downloadable in a POF format for your personal use. We made the explanation to be answered concisely and to the point. We are tired of seeing paragraphs of

information for a simple question and by the time you are done reading it you forget what it was that you were suppose to know. This is not a site where we are going to give you test taking techniques. You already have that down from PA school so lets not waste time.

www.paboards.com $159.00

 

6. Kaplan Medical PANCE Qbank Kaplan's Qbank is a resource for students preparing for the Physician Assistant national Certifying Exam (PANCE). PANCE Qbank contains more than 1,200 exam-relevant practice questions and allows you to custom-design your own PANCE practice tests. Provides comprehensive "5-in-1" explanations for all 1,200 questions that discuss not only why the right answer is correct, but also why all of the distracters are incorrect. Students can test themselves in a variety of ways including by timed conditions or tutorial style, with unused, incorrect or all available questions, by organ system and task or a combination of both. Continuously updated onscreen performance feedback. Access is

available 24 hours a day, 7 days a week. Once at the site, got to Allied Health - Our Programs - PANCE Prep http://www.kaptest.com/medhome.ihtml $149-3 month access

$99-1 month access

 

 

Web and PDA Products

1.AAPAPDACenter-PAs receive discounted prices on handhelds and other portable devices,

software and accessories. http://aapa.pdaorder.com

 

2. National Heart, Lung and Blood Institute (NHLBI). A succinct and practical point-of-care

reference to a number of treatment guidelines including:

o Asthma

o Cholesterol

o COPO

o Hypertension

o Obesity

www.nhlbi.nih.Qov/Quidelines

 

3. National Guideline Clearinghouse-National Guideline Clearinghouse 1M(NGC), a public

resource for evidence-based clinical practice guidelines www.Quideline.Qov

 

4. ePocrates Rx-One of the most popular drug reference programs. Includes multiple drug

interactions check, retail pricing, packaging, descriptions, tables and mechanism of action.

www.epocrates.com

 

5. ICD-Notes-Complete 15,000+ IC09 diagnosis code lookup application.

www.med-notes.com/icdnotesdu.htm

 

6. John Hopkins Antibiotic Guide-Serves as a quick-reference tool for accessing the latest

information on diagnoses, pathogens, and antibiotics.

http://hopkins-abxQuide.om

 

7. Medical Eponyms-Whonamedit.com is a biographical dictionary of medical eponyms. It is our ambition to present a complete survey of all medical phenomena named for a person, with a biography of that person. Eventually, this will include more than 15,000 eponyms and more than 6,000 persons.

www.whonameditcom

 

8. Shoots 2004-A quick reference to the 2004 Childhood Immunization Schedule and the 2003-2004 Adult Immunization Schedule. Details on each vaccine are available by clicking on the vaccine names.

www.lmmunizationEd.ora

 

9. Tarascon ePharmacopoeia - AIl-new, expanded-feature, second generation edition of the Palm handheld Tarascon Pocket Pharmacopoeia Deluxe!

www.tarasconpublishinQ.com

 

PDA Website List

10. ABG Pro-completely analyzes arterial blood gas values.

www.stacworks.com

 

11. MedMath 1.21-Medical calculator for things like creatinine clearance, corrected sodium, etc.

http://smi-web.stanford.edu/people/pchenQ/medmath

 

12. Stat Growth Charts-Calculates pediatric growth percentiles based on the June 2000 revision of the COC Growth Charts for the Unites States.

www.statcoder.com/arowthcharts.htm

 

13. First Consult-web and POA-based clinical information system that provides continuously updated, evidence-based point of care guidance on the latest in patient evaluation, diagnosis and management Works alone or with MD Consult. .

www.FIRSTConsultcom

 

14. MD Consult-An electronic information resource set up in a modular format designed to work independently or together. The core edition contains 49 respected medical books, over 71 medical journals and clinics, POFs available for many Elsevier journals and clinics, Medline, over 1,000 clinical practice guidelines. over 5,000 patient education handouts, daily personalized clinical updates and online CME (once you become a PA).

www.MOConsultcom

[Guest obyomeni]

Laughing angel,

 

Thanks a million!!!

[jenniis]

ALWAYS introduce yourself to the patient and make sure that they are aware you are a PA-Student. Also, if you come across patients with a disease that you are not familiar with (that is not particularly common), you might ask the patient about it. (for example, how did you get diagnosed with multiple myeloma, nephrotic syndrome...) Try to be tactful. Taking the opportunity to ask questions about diseases that the patient is not presenting for can be a very good learning experience (something I often do as a practicing PA).

[Guest lisnek]

bring protein bars in your pocket - i swear i'd go 9 or 10 h without food sometimes. my head wouldn't work very well without any glucose left (well, practically, after the glycogen stores began to dwindle)...

 

have fun - i sure did!

 

lk

[Guest pamoon1]

LA or any other takers,

I did a search first on presenting HPI's/cases and such and found the info below - but does anyone have any more tips or advice on how to do this concisely and smoothly when first learning ? We've had a chance to have some patient interaction and have been allowed a shot at eliciting an HPI and presenting - we're all still a bit sloppy though.

Do you recommend having a certain order that you always present in (CC, 7 dimensions, Pert. + and -'s)? Sometimes it seems like the info you gather goes into your brain in a really jumbled manner - and then you need to organize it quickly and spit it out in an orderly way....tips here?

Thanks guys!

LV

OUTLINE FOR ORAL CASE PRESENTATIONS

1. Opening Statement

-Patient profile

- Reason for visit or admission

- Duration of problem or complaint.

2. Body of Report

- Description of present problem(s)

- Use one or more of the following organizational formats for this section:

characterization, chronological report, or problem solving

- Relevant PMH, SH, FH, ROS

- Relevant PE

- Relevant diagnostic tests and procedures (lab, x-ray etc)

- Assessment

- Plan

3. Summary

- Diagnostic

- Treatment

- Patient Education

 

 

GUIDELINES FOR CASE PRESENTATIONS

Follow an outline when presenting your oral report.

The time for your report should be five (5) minutes.

Prepare to present any and all of the cases you see on your rotation.

Be prepared to answer questions about your case.

Be prepared to take suggestions for improvement from preceptors.

 

 

[pahopeful]

I always present with a SOAP note in mind (subjective, objective, assessment and plan)....

 

In the Subjective portion, I always use the OLDCARTS (onset, location, duration, character, aggravators, relievers, treatments tried, symptoms associated).

 

This doesn't work for all presentations, but it gives you a good skeleton to work off of. Usually the PMH, Family Hx, Social hx goes also but usually if there is something from that portion that is important to add, you won't forget it (i.e. if your patient has already had 2 MIs or if their older brother had one at age 35, you'll remember to write this down/tell your preceptor this!)

 

When you get to the Objective portion, you tell pertinent positives and negatives on PE, and give labs/imaging.

 

Then on to your assessment with associated plan.

 

You'll find that brevity is the key with presenting a patient to your preceptor which is why this system worked well for me.

 

If you have a new patient that your preceptor knows nothing about (new consult, new admit etc), then I would stick to a full H&P format which I always kept in my pocket in the form of Maxwell's. Then I jotted notes on a piece of paper so I could remember it all.

 

Good luck...it will all come with PRACTICE!

 

pahopeful

[tglenn]

I searched for Maxwell's on Amazon and found this review:

 

"This reference is not even worthy of the free booklet references that are distributed by pharmacy manufacturers. Those free booklets that you get from drug reps are more informative than this reference except that this reference has no advertisements. There is no index. There are no tabs. If you disassembled the booklet, it would be 12 typed sheets plus some blank pages 5.5 in. X 3.25 inches. It is hard to read because of the dark colored pages and small print. If the price goes down to 2 dollars total cost, I will give it 2 more stars".

Surely, there must be some good reference booklet which is tabbed and user friendly! Any other ideas anyone?

[caldje]

what kind of reference are you looking for? maybe you should start a new thread. I have found quite a few user friendly references mostly from the insight of laughingangel, monika, and emed. If you look through LA's list you will find some great books.

 

chris

[pahopeful]

Maxwell's is not that bad....true, it is not tabbed and is not super easy to read, but it's also usually only about 8 bucks and contains many quick references that you will use many many times. Also, it fits easily into a small coat pocket and the pages are color-coded by section so that you can find what you're looking for.

 

Maybe someone has a better idea though??...Angel, Mon, others??