Best Advice for Clinicals

[UGoLong]

I thought Maxwell's was a welcome addition to my white coat during the clinical year, especially when someone told me to write a discharge summary or something else that I had not done before. All in all, I carried the following:

 

- Tarascon pcoket pharmacopoeia (even though I had a PDA with epocrates)

- Maxwell's

- Parascon IM and Critical Care Pocketbook

- a card with age-based pediatric vital signs

- ACLS algorithms

- The Practitioner's Pocket Pal

 

The later book was written by Jim Hancock, who is a PA and a paramedic. I made a more detailed 1 page index for it (and the pocket pharmacopoeia) so I could look things up faster.

 

If you have the money, I would buy the full-blown epocrates essentials. I lived in that thing! Besides drugs, you can quickly get information on labs,diseases, drug interactions, and even differentials for symptoms. Most of my preceptors started to count on my having the PDA with me that day.

 

Even with epocrates, the pharmacopoeia has the advantage of quickly showing you all of the drugs in a class. epocrates was better if you had a drug in mind and wanted more info on it. It also only cost $9, so you would not shoot yourself if you forgot to take it out of your scrubs before you pitched them in the laundry bag in the locker room (fortunately I never did).

 

Good luck!

[JenGintheED]

Maxwell's might not be for everybody, but I sure have worn mine out, esp in my hospital-based rotations. It's just a dozen or so pages, so tabs aren't needed in my opinion. Lots of residents on my current rotation still carry theirs.... more worn than mine is :p

[Monica]

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??

 

I agree with UGoLong & LA. Maxwell's is a staple & should be in every clinical year student's pockets IMHO. I used 2 myself during clinical year. The first one got worn about after 4 months. The Practitioner's Pocket Pal is awesome as well.

[tglenn]

So, Maxwells it is!!

 

Just goes to show that you can't take a lot of stock in what some of those book reviews say. Thanks to all for the advice.

[Chronic Student]

Mundane, but get a couple of pairs of really comfortable shoes.

 

They are worth their weight in gold.

 

-Mike

[JenGintheED]

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 ?

 

Sorry it has taken so long to get back to you... my current rotation is whipping my butt :p

 

Here's a few rambling thoughts about presenting:

 

First, think of how an attorney might argue a case. He'd put forth his points. Next is why these points are true. Next is why alternative statements are false. Last is a recap. Now think of the presentation as something similar.

 

When the patient gives you a chief complaint, you need to have a differential in mind. No matter how 'textbook' it seems, you need to consider other alternatives. What other anatomy is nearby, and could it be the source of pathology? Could it be infectious, vascular, hematologic? Could it be refered from another area, nervous?

 

What is the most likely cause - remember horses vs zebras. What is the worst case scenario that you MUST rule out with each complaint (ie, SDH for HA)?

 

When you have your assessment (or at least a narrowed ddx), construct your argument. What in the H&P supports your diagnosis? Why do you think it's not something else from your ddx list? Why is it not the worst case scenario?

 

Now consruct your argument. You will quickly find out how much data your preceptor wants, but be sure to include the data that supports your specific diagnosis, and data that counters the worst possible diagnosis. This support can be from any part of the history, including past medical, social, family, etc. Document everything, but just present the highlights unless your preceptor wants a full, formal presentation. It's not always a bad thing for the preceptor to ask you deeper questions - and it looks good if you can answer them.

 

Pts may come in with a laundry list of complaints. Unless you are in a setting where you can have unlimited time to assess and document, narrow the list down. Specifically ask what is bothering them the most. The list may include chest pain (serious!!) but then they say that urinary burning is bothering them more - this tells you something about the chest pain, although CP is always something to explore. In presentation I say, "The patient presents with multiple complains, the most bothersome of which is (fill in the blank)."

 

Hope this is helpful.. if I think of anything else I'll post it. Anyone else have some pointers??

[doboy]

What you write and what you say should be two different things... With presentations, my doc wants age, sex, pmhx (big ones) then cc and then the soap.

 

Mrs. Smith is a 54 y/o wf with copd, dm, presenting today with abd pain....

 

 

Also repatition helps. It is not about natural talent, it is about how many times you repeat what you do.

[jenniis]

I've been practicing for 3 1/2 years and still carry my maxwells. I often use it for the dermatome map and the mini-mental status exam.

[PAShell]

Thank you all very much for the advice!

 

I start my first Clinical tomorrow. I'm both excited & nervous.

 

Did any of you use a PDA for clinicals? Pros/Cons of using one?

[medic25]

I lived by my PDA during PA school. With programs like Epocrates, 5 Minute consult and the Merck Manual loaded, you can really cut down on the weight in your pockets by losing the books.

Like some other folks have mentioned, don't be afraid to do the scut. A student who pulls his own IV's and offers to clean up the dirty bedpan when the nurse is busy will have a much better experience on their rotation. If you do the little things for the nurses and techs, they will find you when the interesting case or procedure comes along.

[PAShell]

Thanks so much for the advice! My first clinical is going well. :)

 

I'm trying to take advantage of free PDA software as much as possible, without sacrificing the quality. A few people have mentioned the Merck Manual. I tried to download it, but I can't register for the site because I don't have a medical licence number. Did anyone else have this problem?

 

I searched this site for PDA software and I found a lot of good info.:) Although, I'm always open to more advice.:D

[quarternote]

http://medschool.ucsf.edu/curriculum/clinical/guide/index.asp

 

I found this site helpful. I relied heavily on the section on notes abbreviations when writing daily notes on my IM rotation. It has a quick EKG review and several other really good hints on presenting, etc...Our program gave some good advice...Be nice to the Nurses-Before we went on rotation they told us that the nurses could make or break us. Anything that makes their life eaiser will benefit you. Also don't forget...They are friends with the docs. Some are watching you. Especially if it is a rotation that the Doc's work shifts like ER and the Doctor who will grade you isn't always your physician for the night. On my ER it was like this and he asked the nurses opinion if he felt he hadn't worked with us enough. Also one of the ER Doc's that I had the privilege to work was only there PRN. He was really smart and the nurses loved to work for him. He would always have 2 bags of dove chocolates in his bag and about 1/2 way through the shift he would bring them out. They loved him. I'm not suggesting you buy them with chocolates, but if you're really nice and help them they like you and you end up with a better grade.

tootaloo... :)

[autumn_george]

This hasn't been posted on in a while but I am a surgical tech and it is always helpful for med students, residents and PAs to know how to PROPERLY close glove themselves in surgery. When we are in a hurry preparing the sterile field and the Dr. we don't always have time for you because the Dr. will not wait on us. He/she is ready to drape once they are donned in their gown and gloves.

 

PS closed gloving is the technique used to sterily glove yourself while the gown is on. Any surg tech can teach ya but it takes practice.

 

I hope I remember all things like that when I am on rotations

[egw9457]

Does anyone know some of the best programs to download on your PDA that don't require a monthly subscription? I just don't want to get stuck hauling tons of small books around in my lab coat. :)

[UGoLong]

I suspect you can find other treads on this. My choices:

 

1. epocrates. There is a free version. I absolutely live in epocarates essentials in practice. It has a yearly fee.

 

2. Tabers dictionary. It has a one-time charge and it is useful in clinicals when you hear something you don't understand.

 

3. BDicty, which is an acronym program that gives you medical abbreviations, which you can add to. It was $25 one time charge and I use it frequently.

 

There are others, but that's my 2 cents.

[bradtPA]

Its not free, but Sanford's for the PDA is useful. Hard for me to read the darn book without a magnifying glass; thats what I get for being an AARP PA student:D.

[Melodie]

It is that time of year again and it is nice to see this thread resurrected.

Last week, I gave a speech about education (to the students at my old high school). After I finished, I realized that some of the information might be helpful here (I have not read this entire thread, so much of it may be repetition).

 

Here it is:

 

First, thank you in advance for listening to what I have to share.

 

As I reflected on what I wanted to share with you today, I realized that I end up making the same key points with many of the Physician Assistant Students that I precept. I decided that these points may be helpful to you along the way through your educational journey. I will keep it brief and share my top 10 key points that I have learned along the way.

 

10. Do Unto Others as You Would Have Them Do To You:

Make it a policy to treat others as you wish to be treated yourself.

 

9. Kill ‘Em With Kindness:

When you encounter a difficult person, be as nice and as friendly as possible. It works every time, and it drives the bullies crazy!

 

8. The Customer IS Always Right:

Good Customer Service is a lost art in our society. A friendly “Hello” will get you far. Pay attention to the details, since they get people’s attention. It may seem silly, but knowing how to count change back properly grabs peoples’ attention. They will remember that you did a good job and it is good for return business.

 

7. Good Manners Should Not be a Thing of the Past:

Calling people by their proper names (like Mr. Smith or Ms. Jones) shows respect. Please, thank you, you’re welcome, and excuse me should be common courtesies. Sending a Thank You Note impresses people, whether it be for a gift received or for extending the courtesy of a job interview. A proper handshake says a lot.

 

6. Know Good Grammar, Spelling, & Punctuation:

You may have done the most perfect report or presentation, but one misuse of their, they’re, or there can blow it completely out of the water. It looks terribly unprofessional. If this does not come easily for you, then invest in a good dictionary, thesaurus, and writing reference book and use them! Don’t always trust spell check!

 

5. Be A Good Listener:

Make good eye contact, nod your head, use open body language. You can find out a lot more information than if you stand there with your arms crossed, looking at the floor.

 

4. Be Confident in What You Know, but Know What You Don’t:

 

• The first part of looking confident is looking the part. Dress properly for the occasion. Plenty of job interviews have been ruined before they even started simply because the candidate looks sloppy. Know how to use an iron.
  
• Looking confident makes people feel reassured, but nothing was ever gained by making up answers or guessing. It is OK to say, “I don’t know.” However, you need to follow up by saying “I will find out and get back to you.” This is one of the first points that I try to make with my students. It shows initiative and it shows that you care. It does not matter if you are discussing diseases or working at the grocery store, this one applies.
  

 

3. See One, Do One, Teach One:

This is a hallmark of medical education. When learning new procedures, you generally attend a lecture and read about the procedure, then observe someone else doing it. After that, it is your turn to try it. Most importantly (and the one part that we often forget about), it is now your turn to share your knowledge with someone else. Be proud that you have it to share!

 

2. Always Have a Back-Up Plan:

 

• Fortunately or unfortunately, the days of working the same job until you reach retirement are gone for most of us. Your work environment can change in the span of a single day. The best job in the world can turn into the worst very quickly.
  
• It’s a good idea to carry that second job that could turn into something more. It is nice to know that you have an out, should you need it.
  
• I am a believer that everyone should do some form of volunteer work. We all have something that we can share with others. Time and Talent are wonderful gifts and our society depends on them. It might surprise you, but that volunteer job could turn into a paying one and save the day for you.
  
• Choose wisely and do not overextend yourself. Make sure that if you are going to do something, you have the time to do it well.
  

 

1. Make Lots of Lists:

This is the only way I can keep track of where I am going and remind myself of where I have been. Whether it is a budget of my home finances, a to-do list for work, a 5-year plan for life, I do this all the time and it keeps me on track.

 

Again, thank you for your attention. It is an honor to be chosen to be here today among such a special and distinguished group.

 

Melodie

[inchfarms]

Don't forget at the end of your rotation, whether good or bad, send a Thank you note. Same with after each and every interview you go on. I always had the note filled out before I went on an interview or on my last day. Then dropped it into the mailbox on the way home after adding a personal touch to it.

[xbeachxlifex]

For surgery rotations -

 

Pick the cases that no one wants i.e.: lumpectomy, cyst removal etc.

 

they might not be the greatest cases but you will get one on one attention with a surgeon who will let you do most of the work since all the other residents/students are "observing" a different case

[xbeachxlifex]

For surgery rotations -

 

Pick the cases that no one wants i.e.: lumpectomy, cyst removal etc.

 

they might not be the greatest cases but you will get one on one attention with a surgeon who will let you do most of the work since all the other residents/students are "observing" a different case

[xbeachxlifex]

For surgery rotations -

 

Pick the cases that no one wants i.e.: lumpectomy, cyst removal etc.

 

they might not be the greatest cases but you will get one on one attention with a surgeon who will let you do most of the work since all the other residents/students are "observing" a different case

[ASteadman07]

I saw that someone a few years ago posted that surgical recall was a good book to read before a surgical rotation. Is this still the case? are there other surgical books you guys rec?

[treejay]

I saw that someone a few years ago posted that surgical recall was a good book to read before a surgical rotation. Is this still the case? are there other surgical books you guys rec?

 

I just finished my Surgery rotation and I can say "Surgery Recall" was an outstanding book. Highly recommended.

[treejay]

actually, the book is "Surgical Recall" by Blackbourne.

[UGoLong]

I posted this in answer to a question on the PA student forum, but thought it might be better here. I wrote it several years ago, but hopefully the advice still helps. You are about to have a magical year; enjoy!

 

Rotations for Newbies

 

Preparing for Rotations

 

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.