What makes a “Good Third Year Student”
Deb Bynum, MD2009
She is a really good student… One of the best I’ve worked with all year…. (from a third year internal medicine resident….)
Heard in the physician work room this last week….
WHY?
She was always available She always had a great attitude She didn’t disappear in the afternoon to
read She always did things to help She looked up stuff about her patients She got really good information from
patients and families that was important for their care
She took feedback on her presentations and really improved
She picked up more patients than assigned; even patients she did not pick up, she came to the ED with us to see the patient, learn, and just to help
She understands the “big picture” She is great with patients and families
From the Resident…
She got all honors for second year Her board scores were out the roof… She always out-answered the other student She knew all the answers
What the resident did NOT say…
Attitude and energy can make or break you◦ What you know is not as important as how you
act
◦ Excellent first and second year medical students may not always have an easy time during third year (subjective evaluations)
◦ So –So students can shine during clinical years
Bottom Line: The Good and the Bad
1. Knowledge 2. Good ICM Skills 3. Kindergarten Skills
What makes a good student?
If you energetically try to provide the best care for your patients, you will be a good student and a good doctor
Bottom Line…
Know your patient well Read about your patient’s problems and
learn how to take care of your patient Make sure your patient gets good care – be
their advocate Communicate your patient’s needs to the
team
What does this mean?
There is NO scut work related to the care of your patient
If your patient needs a lab draw, vital sign, form completed, help getting out of bed – then it is important
The story of Dr. Parker….
About “Scut”
Do not assume that what your patient needs will actually get done
Do not assume that your team knows a piece of data/result that you do
Do not assume that you know what your team expects of you
DO NOT ASSUME
Ask about call Ask about pre-rounding Ask what patients to pick up on day number
1 Ask about conferences, schedules Ask about notes Ask how you can help
ASK
Be positive
Be pro-active: Offer to do what is needed before you are asked
Offer to do small presentations for the team
Look up articles for the team and share
Help interns, residents and other students on the team
What can I do to make a good impression?
Go and see and evaluate as many patients as you can – even those patients you will not be “following”
Ask about call: If overnight call is not required, offer to stay late or overnight for at least one call night for each rotation
What can I do….
Dress neatly and appropriately
Do not chew gum
Do not carry food or beverages on rounds
What can I do…
Pay attention on rounds, even to other patients and other presentations
If you are bored, do not look bored…
Ask the right number of questions
Be available
Read about your patients
Ask to help out with notes, orders, forms
What can I do…
Ask to help out with clinical “scut” work:◦ Pulse oximetry with ambulation◦ Make sure patient gets to their test (go with
them if you can)◦ If they need to be NPO, make sure they are◦ Make sure a patient gets up out of bed to a
chair◦ Get orthostatics when needed◦ Bring samples down to the lab in acute
events
What can I do….
Make sure the plan for your patient is carried out◦ Do not assume it will happen◦ Ask the nurse◦ Call down to the procedure site◦ Make sure transportation happens◦ Let your resident/intern know if there is a
problem
Follow Up
Be on time for rounds, lectures, meetings
Do not try to make the other student look bad
Be nice to staff, nurses, HUC’s
Be respectful to and of patients, families and visitors
What can I do
What are my responsibilities as a third year student?
What is needed will vary by clerkship Anticipate 10-15 minutes per patient (longer
initially) Information needed each morning:
◦ Vitals (include oxygen saturation and amount of oxygen patient is on and T max and T current)
◦ Overnight events (from nurse and overnight intern/float)◦ Subjective issues from the patient◦ Physical exam findings (for the day)◦ Labs and other data◦ Consult reports from prior day/evening◦ Any radiology/tests that came back the day before◦ Check the MAR for current medications
Pre-round on your patients
Develop your problem list with a plan for the day for each problem
Use the Follow up sheet (handout) to record the above data each day – this can serve as a template for your morning presentation and progress note
Meet with the intern/resident before rounds to review plans for your patient
Responsibilities…
Prepare your oral presentation (practice)
Present to the team on rounds (3 minutes)
Keep follow up sheets of data in large, spiral bound notebook so you have easy access to prior days, labs, medications, etc (It is NOT cool to have thousands of cards flying out of your pockets on rounds….)
Responsibilities
KNOW MORE THAN YOU WRITE, WRITE MORE THAN YOU SAY…
Wear your white coat and badge Things to carry
◦ Notebook with patient information◦ Rounds report for patients on your team (even patients
that are not “yours”)◦ Clinical “pocket” book for the rotation (ask)◦ Sanford guide/pharmacopeia◦ Scissors (esp on surgery)◦ Reflex hammer◦ Light◦ Stethoscope◦ Pens◦ Monofilament, tuning fork
The Look
What if….
Use your gut – if someone looks really sick, call your resident
Red Flags:◦ Fever◦ Increase pulse rate◦ Shortness of breath◦ Chest pain◦ Increase in respiratory rate◦ Decrease in oxygen saturation◦ Change in mental status◦ Decrease in blood pressure◦ Severe pain
What if my patient looks really sick when I go to pre-round
The nurse is really concerned or worried…◦ Go get your resident or intern; trust the nurse’s
instincts as well as your own
What if…
What if…