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Jefferson Medical College Alpha Omega Alpha
Guide to the 3rd Year:
Example Notes for the MSIII
AOA Recommendations for Rotations
General Recommendations For All Clinical Rotations
- Work hard and be a team player.
- Be Enthusiastic (or at least act interested) and jump right in early on in the rotation.
- Be honest about your career and specialty interests but DO NOT downplay the importance of the specialty that you are working with! Keep an open mind and try to learn as much as you can on each rotation.
- Be Attentive to Detail - Look up labs, studies and consult notes without being told to do so.
- Volunteer to look up information that is unclear to you or the team. Try to do a brief presentation on it the next day or later that afternoon. Carry relevant journal articles that address your patient’s care.
- Be professional in dress AND attitude. Attire is always shirt, tie, and white coat for men and the equivalent for women, unless otherwise specified. (This includes Orientation sessions) Wash your white coat often!
- Ask Questions! Focus on learning by asking questions and asking for a lesson on something when there is down-time. If they don’t have an answer, take the initiative to look it up.
- Ask for feedback early.
- Identify residents and attending physicians you click with and work with them as much as possible. (You can also turn to these people as mentors in the future.)
- Ask to get out of a bad situation by contacting the course administrator or the clerkship liasons. But be aware that there will always be personality conflicts.
- Learn the style and information required in your notes EARLY on in a particular rotation (it will be noticed!).
- Be familiar with your PDA functions, especially Epocrates and Medcalc.
- Be friendly and always introduce yourself to the nursing staff - they are your greatest allies. Utilize 4th year students for advice on presentations and note writing.
- When asked a question that you don’t immediately know the answer to, work through your thought process out loud. You’ll get partial credit!
- www.uptodate.com – Know this website and use it! It is a great resource for updated information in almost every specialty!
- Be proactive about trying to do procedures. The more you ask to do, the more you will be comfortable with (blood draws, suturing, IV, shots, etc.)
- USE THE AOA website. Just go to JEFFLINE & click on “Students” to see the AOA link. http://jeffline.jefferson.edu/Students/AOA/
Things NOT to do
NEVER do anything to make fellow students look bad, for example:
- Rounding on/presenting information on patients that are not yours.
- Never complain of being tired, hungry, or having to use the bathroom.
- Don’t drown out other students answering questions, instead help to create a team environment where even quieter peers feel comfortable. This will be noticed by your attendings!
Internal Medicine
- Write down team pager numbers right away and learn how to tag your pages!!
- Have a system for doing admissions with your residents.
- Be pro-active and make sure you see a variety of patients. If you continue to end up with the same type of patient, bring this up to the resident.
- Focus your studies on your patients, but try to know and read about the other patients on your service as well.
- Try to bring in a good evidence-based review article for some of your topics. Make copies to hand out to the team.
- If you hear about a patient with an interesting finding, go and see the patient.
- Ask your resident up front what your responsibilities are.
- Maxwell’s Pocket Guide is essential and many people also use Sanford Antibiotic guide, and Pocket Internal Medicine (looks like a little three-ring binder).
- You may have spare time in which case it is acceptable to read/learn about something medical. Two rules on spare time: 1) Make sure that you have already checked all labs and studies, read the notes from the consultants on your patient, and you have already decided/ordered the labs and studies necessary for the next day. 2) Make sure everyone knows how to get a-hold of you if you are needed.
- Update the sign-out for your patients if you have access.
Obstetrics/Gynecology
- Write pre-op, op, and post-op notes on all of your patients.
- Practice knot typing/suturing before you go to the OR.
- For OB, know how to read fetal heart tracings and tocometer tracings
- Carry Dr. Wolf’s pocket guide for post-partum notes, ob notes, etc
- Practice presenting post-op patients in a succinct manner.
- Be familiar with the gestational age calculator on your PDA (med calc) or get a wheel.
- Focus on a subspecialty and show interest (Uro-gyn, Gyn-onc, REI, etc)
- Things to definitely know before starting your rotation: Criteria for pre-eclampsia, cardinal movements, indications for colposcopy.
- Use the UWise questions on the APGO.org website - these are very helpful for the shelf exam.
Psychiatry
- Be prepared to discuss DSM-IV criteria to defend your diagnoses
- Don’t carry a stethoscope, it’s dead weight on this rotation. (unless you are on an inpatient service and they routinely do a physical exam on patients)
- Always think about medical conditions that can mimic psychiatric conditions.
- Know psychiatric medications, especially their side effects.
- Carry a few copies of the MMSE in your pocket (use it when needed).
- Try to be in contact with the social workers as much as possible.
- Try to visit the mental health court at Einstein or Belmont.
- Current Clinical Strategies Handbook is a helpful pocket guide.
Surgery
- To do procedures, be persistent about asking (suturing in the OR, etc).
- Have a few intelligent questions prepared for the OR about your case. Review relevant anatomy the night before.
- Try to read the patient’s chart the day before their surgery.
- If you are not planning to do surgery, try to do as many consults as possible, since it will help you to learn how to work-up a surgical patient.
- Keep Surgical Recall in your pocket and read up on cases before going into the OR.
- Eat before going to the OR in the morning; stash granola bars in your pocket.
- Sleep whenever possible.
- Learn to tie with both hands (keep practice suture in your pockets and practice).
- Write pre-op, op, and post-op notes and orders on your patients when possible.
- The NBME surgical shelf exam at the end of the block focuses on the work-up and medical management of surgical diseases. You will have to know VERY LITTLE anatomy and how to perform surgical procedures.
- Take the time to actually watch the NYU surgery modules - they are very helpful for the OR and the shelf.
Pediatrics
- Read about infant formulas.
- Be prepared to get sick early on in this rotation.
- Let kids play with your stethoscope before you examine them (or have another toy), but make sure to clean it often with alcohol.
- Check developmental milestones and growth curves for all visits.
- Know your dermatological diseases for children (most places have a good book or atlas you can use).
- Know your asthma classifications and therapy.
- Develop a routine for each age group. This will help you with developmental milestones later.
- Carry Dr. Lane’s immunization schedule and pocket guides for interviewing.
- Update sign-out/discharge paperwork for your patients when on inpatient.
- Carry your SCO’s (you’ll hear about these at orientation) in your pocket and complete them early.
Family Medicine
- Know the guidelines for treatment of hypertension and hypercholesterolemia (JNC 7 and ATP III, respectively)
- Know the screening recommendations for all age groups and always ask your patients about them (Different cancers, hypertension, high cholesterol, etc.).
- Develop a systematic approach for each type of visit (check up, problem based, etc.) so that you can be quick, but thorough.
- Practice doing quick <1-2 min presentations on your patients, focusing on your plan.
- Ask your attending/resident how they like things done, since you may be working with different people.
- Take advantage of the relatively good hours for research projects, etc.
Interdepartmental Surgical Sub-Specialties (IDEPTS)
- Work on surgery skills (sterile technique, suturing).
- Take advantage of light schedule and free time.
Recommendations last updated March 2010, Guide last updated 2008.
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