Davo Posted August 16, 2011 Share Posted August 16, 2011 Monday will be my first day in clinicals, specifically inpatient internal medicine. Since IM is pretty much everything...Im wondering what I should spend my last few hours reviewing. I do have some good pocket books Ive become familiar with, and Ive reviewed basic labs. Any ideas/tips that might help out during my first clinical rotations? Link to comment Share on other sites More sharing options...
MikeyBoy Posted August 16, 2011 Share Posted August 16, 2011 http://www.physicianassistantforum.com/forums/showthread.php/11049-Selected-In-Hospital-Emergencies... http://christem.info/didactics/InternMedGuide/InternMedGuide.asp Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted August 17, 2011 Administrator Share Posted August 17, 2011 Dress right, including making sure your fly is zipped. Sleep well, eat before you have to show up, show up early, drive to the place the day before if you've never been there. Review your history taking skills. Review your horses, not zebras, because you'll see more of the former. Go over DM II, HTN, and Hyperlipidemia, including indications, treatments, and patient education. Link to comment Share on other sites More sharing options...
jmj11 Posted August 17, 2011 Share Posted August 17, 2011 Relax and enjoy and know there are no dumb questions. You can have fun because no one's life is in your hands . . . yet. Link to comment Share on other sites More sharing options...
andersenpa Posted August 17, 2011 Share Posted August 17, 2011 No one expects you to really know anything so don't put too much expectation on yourself. Have fun.... Link to comment Share on other sites More sharing options...
Davo Posted August 17, 2011 Author Share Posted August 17, 2011 Thanks guys this takes the pressure off a bit-I also hope that I get on well with everyone I will be working with. Link to comment Share on other sites More sharing options...
PAdaddy Posted August 17, 2011 Share Posted August 17, 2011 I wish you luck, drop back in and let us know how it went. I'm interested to hear how you feel after the first day. JD Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 17, 2011 Moderator Share Posted August 17, 2011 learn the format for writing a routine admission. washington manual covers this well. read ahead. know everything there is to know about the presentation, workup, tx, etc for the condition being discussed on rounds or resident teaching day. Link to comment Share on other sites More sharing options...
deborah212 Posted August 17, 2011 Share Posted August 17, 2011 Things to have on your first rotation besides your stethoscope, especially on inpatient internal medicine: 1. Small (think 4-5 inches) spiral bound notebook that will fit into your white coat pocket. Essential to record patient medical record numbers, histories, phone numbers, things to remember to read up on 2. Maxwell's 3. Penlight 4. Reflex hammer 5. Multiple black pens. Some hospitals do not allow blue anymore 6. Pocket Medicine or Washington Manual 7. Sanfords Guide to Antimicrobial Therapy Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 17, 2011 Moderator Share Posted August 17, 2011 Things to have on your first rotation besides your stethoscope, especially on inpatient internal medicine:1. Small (think 4-5 inches) spiral bound notebook that will fit into your white coat pocket. Essential to record patient medical record numbers, histories, phone numbers, things to remember to read up on 2. Maxwell's 3. Penlight 4. Reflex hammer 5. Multiple black pens. Some hospitals do not allow blue anymore 6. Pocket Medicine or Washington Manual 7. Sanfords Guide to Antimicrobial Therapy I would add a pocket tarascon pharmacopeia as well. still use mine almost every day. when you come across a med you don't know look it up. at first you will be looking up a lot of stuff but with time it will be only the occasional med that you have not heard of. Link to comment Share on other sites More sharing options...
andersenpa Posted August 17, 2011 Share Posted August 17, 2011 2. Maxwell's 6. Pocket Medicine or Washington Manual 7. Sanfords Guide to Antimicrobial Therapy + pocket tarascon pharmacopeia = Smartphone...if you've got the apps Deborah, EMED...we're old. (plus the smartphone, if it's durable, could function as a reflex hammer as well. But you'll get funny looks.) Link to comment Share on other sites More sharing options...
deborah212 Posted August 17, 2011 Share Posted August 17, 2011 I would add a pocket tarascon pharmacopeia Yep. I forgot this or epocrates. plus the smartphone, if it's durable, could function as a reflex hammer as well. But you'll get funny looks. Haha. That made me laugh. I've yet to master using the bell of my stethoscope to elicit reflexes. I think with my klutziness, I would break my phone but that if successful would truly demonstrate the multitasking of medicine. ;) Link to comment Share on other sites More sharing options...
Davo Posted August 17, 2011 Author Share Posted August 17, 2011 Thanks for the tips guys, several books I will try to get asap. I dont yet have a smartphone but I am reluctant to trust a tech gadget, especially when I know they can and do fail (and I dont know how cell reception will be). I will report back monday, after day one. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted August 18, 2011 Administrator Share Posted August 18, 2011 You don't need reception to use most of the apps like Epocrates, Mescape, Skyscape, EMPR, etc. Most of them are loaded locally in memory, and only seek Internet stuff for large content (pictures/video) As far as the "it might break" argument... you're using it for quick reference, NOT getting rid of your medical library. An iPod touch, Stethoscope, and items 1, 2, and 5 (Maxwell's, pens, notebook) are the only things I routinely carry. I use the room otoscope in lieu of a penlight, exam rooms all have reflex hammers, and Sanford guide stays with my desk. Link to comment Share on other sites More sharing options...
deborah212 Posted August 18, 2011 Share Posted August 18, 2011 I use the room otoscope in lieu of a penlight, exam rooms all have reflex hammers, and Sanford guide stays with my desk. I think the difference here is the OP is starting an inpatient internal medicine rotation. When you're admitting in the ED, there may be an otoscope/ophthalmoscope mounted on the wall, but these disappear once a patient hits the floor. I would highly recommend getting a cheap set of penlights. Mental status can rapidly change in house. More often than not, the etiology is not an organic neurological process. That being said, in the predominantly elderly population that we care for, I've had multiple patients develop TIAs/hemorrhaic/ischemia CVAs while hospitalized for another primary diagnosis. Epocrates is great. I have a Treo (not an iphone unfortunately), and it's the only medical program that I use. Link to comment Share on other sites More sharing options...
Barmore Posted August 21, 2011 Share Posted August 21, 2011 This information was so helpful for me as well. I start on monday in general surgery oncology and I am soo nervous! I hope it is not too detailed for my general surgery rotation because of it being oncology. Thanks all for the information. Link to comment Share on other sites More sharing options...
Davo Posted August 21, 2011 Author Share Posted August 21, 2011 This information was so helpful for me as well. I start on monday in general surgery oncology and I am soo nervous! I hope it is not too detailed for my general surgery rotation because of it being oncology. Thanks all for the information. Im right there with you, Ive been nervous all week! Maybe anxious is a better word. Today I picked up Tarascons and the Sanford guide, Im gonna spend an hour or so going through them, as well as reviewing the basics. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted August 21, 2011 Administrator Share Posted August 21, 2011 Im right there with you, Ive been nervous all week! Maybe anxious is a better word. Today I picked up Tarascons and the Sanford guide, Im gonna spend an hour or so going through them, as well as reviewing the basics. Wait, what? You went through didactic year without a Sanford guide? What did you use for ID? Link to comment Share on other sites More sharing options...
Davo Posted August 21, 2011 Author Share Posted August 21, 2011 Wait, what? You went through didactic year without a Sanford guide? What did you use for ID? Very little, beyond what was in our texts, and lecture ppt's. Almost NO special attention was given to abx therapy, and why and how they are used clinically. I have little comprehension at this point, Ive simply memorized a few common abx's and dosages. I wish Id known about sanford earlier-last night I actually kissed the book while studying. :) Any tips about navigating through Sanford? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted August 21, 2011 Administrator Share Posted August 21, 2011 Any tips about navigating through Sanford? We did speed exercises, where the entire class had their books out. Our professor would give a scenario (e.g. pediatric patient, 20kg, uncomplicated otitis media, NKDA) and it was a race to find the right drug and write the prescription properly. :-) We also had a set of homework exercises which made us go through the various sections and the index to find particular information. Total effort to get us familiar with the guide was 3-4 hours, with a bit more than half that being in-class lecture or exercises. Link to comment Share on other sites More sharing options...
acozadd Posted August 21, 2011 Share Posted August 21, 2011 We did speed exercises, where the entire class had their books out. Our professor would give a scenario (e.g. pediatric patient, 20kg, uncomplicated otitis media, NKDA) and it was a race to find the right drug and write the prescription properly. :-) We also had a set of homework exercises which made us go through the various sections and the index to find particular information. Total effort to get us familiar with the guide was 3-4 hours, with a bit more than half that being in-class lecture or exercises. Ive found epocrates to be adequate so far on my rotations, I've never touched a sanford guide. Some people swear by it, others hate it. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted August 21, 2011 Administrator Share Posted August 21, 2011 Ive found epocrates to be adequate so far on my rotations, I've never touched a sanford guide. Some people swear by it, others hate it. How many differing courses of treatment does Epocrates give? The nice thing about the Sanford guide is its depth, and I honestly have no idea if Epocrates mirrors that--I'm so happy with the other FREE alternatives, I've never paid for Epocrates. Link to comment Share on other sites More sharing options...
Davo Posted August 21, 2011 Author Share Posted August 21, 2011 We did speed exercises, where the entire class had their books out. Our professor would give a scenario (e.g. pediatric patient, 20kg, uncomplicated otitis media, NKDA) and it was a race to find the right drug and write the prescription properly. :-) We also had a set of homework exercises which made us go through the various sections and the index to find particular information. Total effort to get us familiar with the guide was 3-4 hours, with a bit more than half that being in-class lecture or exercises. Thats a great idea, I have been doing something similar on my own. Ive really been stressing pocket medicine too, but its got no doses. Link to comment Share on other sites More sharing options...
acozadd Posted August 22, 2011 Share Posted August 22, 2011 How many differing courses of treatment does Epocrates give? The nice thing about the Sanford guide is its depth, and I honestly have no idea if Epocrates mirrors that--I'm so happy with the other FREE alternatives, I've never paid for Epocrates. It gives many options, often 5+. I know that the pharm aspect of epocrates is free and incredibly easy to navigate. It breaks it down into peds and adult dosing, how to change the dosing for liver or renal disease, common side effects, it it's available on the $4 list, cost, everything you could possibly want. What you pay for is if you want access to info on particular diseases. Either way, my school gave us a free subscription for clinicals so I have never paid for Epocrates either Epocates also has other useful tools on it, like a peds dosage calculator, BMI calculator, etc. One of the nicest aspects is that it fits on a smartphone or an itouch (no carrying around extra books) and you can look up drug MOA in about 10 seconds as opposed to thumbing around in a book for 10 minutes. Really nice for that "hmm what does that drug do again?" moment. ;) Link to comment Share on other sites More sharing options...
Davo Posted August 23, 2011 Author Share Posted August 23, 2011 I wish you luck, drop back in and let us know how it went. I'm interested to hear how you feel after the first day. JD Well today was day one. It went pretty well. I joined up with my team a few minutes after they had started rounds (had an orientation thing to go to), and then proceded to round. Im told we were busy-we had 21 patients. Most pts I was able to get an idea of what was wrong, and why tests were being ordered/reacted to on my own. One was pancytopenic and nobody but the attending was able to see the pt. because of strict isolation. The senior resident was not in today, so I interacted mainly with the 2/3rd year docs. I was assigned two pts, both legit medicals, one of which is a transient on a 5150. Im still learning paperwork, and the computers, and a fair amount of time was spent looking for charts, I dont know if this is normal. After lunch, I went to a computer orientation and practiced what appears to be a version of SOAP notes. All in all a good day, though Im both excited and tired right now. Tommorow I will go in early, check on my 2 pts, and get info to the attending on rounds. Link to comment Share on other sites More sharing options...
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