Windsor University School of Medicine

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1


Clinical Package

:


Before any student can start rotations


1.

Complete Basic Sciences

2.

Take USMLE review course

3.

Take USMLE
(If you failed the USMLE with a 74 or lower, or attempted it, you are only eligible to start 12 w
eeks.
75 or higher is passing.
You will get your score
sometime in the first 4 weeks. If it is failing, you are not able to
pass the 12 weeks.)

4.

Pay fees for clinical
s



Dear Student:

Please find the following list of

enclosures in
this
clinical package:


1. Clinical

Clerkship Manual


2.
Sample Notes: H&P


3.
List

of Clinical cases


4
. Clinical

Clerkship Evaluation Form
s


5. Clerk Log Sheet





If you have any questions please
fee
l

free to contact us


Sincerely,


Associ
ate Dean of Clinical Clerkships

708
-
235
-
1940

Windsor Information Office














Windsor University School of Medicine



Windsor University Information Office
-

6212 Monee Manhattan Rd, Monee, IL 60449,

Phone: 708
-
235
-
1940
,
Fax: 708
-
235
-
1942

,
www.windsor.edu


2


TABLE OF

CONTENTS



DOWNTIME & WHAT TO DO AFTER NEEDLE STICKS.............................................................. PAGE
3


CLINICAL CLERKSHIP MANUAL
.........................................................................
...
............
.......... PAGE
5


WHAT DO YOU NEED TO KNOW? ABOUT A DISEASE OR SYNDROME ................................ PAGE 7


SYLLABUS FOR EACH ROTATION......................................................................
........................ PAGE 11


PATIENT ENCOUNTER DOCUMENTATION

METHODS ...................................
........................ PAGE 28


SAMPLE NOTES
-

H&P........................................................................................
........................ PAGE 33


CLINICAL ROTATION FEE STRUCTURE
.............................................................
.........................PAGE 37


CORE CLINICAL EXPERIENCES.........................................................................
........................ PAGE 38


PATIENT HISTORY..............
................................................................................
........................ PAGE 40


PHYSICAL EXAMINATION FORM.........................................................................
.........................PAGE 46


STUDENT EV
ALUATION OF CLINICAL ROTATION FORM.................................
.........................PAGE 49


STUDENT EVALUATION OF CLINICAL PRECEPTOR FORM.............................
.........................PAGE 50


ROTATION EVALUATION FORM.......................
...................................................
.........................PAGE 51


CLERK LOG SHEET..............................................................................................................
....
.....PAGE 54


WHAT TO KNOW BEFORE STARTING

A ROTATION.........................................
.........................PAGE
56


THE WARD TEAM................................................................................................................
...
.......PAGE
65


MEDICINE..................
......................................................................................................................P
AGE
66


SURGERY.....................................................................................................................
.....
.............PAGE
70


OB/GYN.......................................................................................................................
...................
.PAGE
73


PEDIATRICS...................................................................................................................
.................PAGE
81


PSYCHIATRY...............................................................................................
...................................PAGE
8
5


LABORATORY/HISTORY CHART..............................................................................................
....PAGE
88


PHYSICAL/FORMULAE CHART..........................................................
...........................................PAG
E
89


ACKNOWLEDGMENT SHEET SIGNED BY STUDENT
........................................
.........................PAGE
90









WHAT CAN WE DO DURING DOWNTIME
?



3




Spend as much time with your patient as possible. Ask them more questions
about their medical history. You may
have some new questions since you admitted them.




Read about all of your patients' medical problems, even the ones that are stable and may not be included in your
current assessment and plans. This may generate more questions for your patient about whether they may have
tried a particular first
-
line medic
al therapy.




Listen carefully to the hearts of all the patients on your team. Write down in the way you would document it in a
note. Now look at the notes and see if you documented them the same way your attending and residents do! If
they have an echo,

now look at the echo result (not until you've listened to all
of
the hearts though!)




Look at your patient's medication list. Are all of the medications treating a current medical problem? Were any
of
the medications prescribed to treat a side effect of
another medication and if so, are both of those medications
necessary? Feel free to ask your patient about this.




Ask your patient permission to do a more complete skin exam than you may have done upon admission. Describe
any lesions using correct dermatol
ogic terminology and check with your team to see if they agree with you.




Find out when any patients on your team are you having any procedures (endoscopy, IR procedure, etc.) and find
out if you can watch. Try to observe the informed consent process as we
ll if possible.




Get the discharge paperwork ready for your patient's discharge, if possible. Arrange any post
-
discharge follow
-
up
appointments if necessary.




If this has not already been done and it is ok with you senior resident or attending, call your
patient's PCP and let
them know about the admission. Think

about any questions you would like to ask them in advance.




Find out when your patient is getting physical and occupational therapy. Ask if you can watch.




For all patients over 65 on your service
, administer
the CAM
(http://www.healthcare.uiowa.edu/igec/tools/cognitive/CAM.pdf
)
, MMSE and Mini
-
cog
(http://www.hospitalmedicine.org/geriresource/toolbox/pdfs/clock_drawing_test.pdf). If these are unexpectedly
abnormal, discuss this with your team.




If
any of your patients are facing an important medical decision (e.g. surgery, a procedure, refusing SNF
placement) read the following review article about bedside assessment of decisional capacity: Appelbaum PS.
Assessment of Patients'

Competence to Consent

to Treatment. N Engl J Med 2007; 357:1834
-
1840. Use table
one to have a conversation with your patient about their decision and think about whether they have decisional
capacity. Discuss this with your team.




As always, you can do your SIMPLE cases. If y
ou have completed the 12 please continue through the list.







WHAT TO DO AFTER A NEEDLESTICK?





APPENDIX E: Procedure Following an Occupational Exposure to Blood/ Body Fluid


Did YOU

just receive a blood/body fluid exposure via a
needle stick

or a spillage on mucous
membrane or non
-
intact skin? Then PROCEED as follows:


PLEASE, DON'T PANIC

.


The vast majority of body substance exposures

do not result in harm to the exposed health care worker, but one
event is an important reminder to be more
alert, aware, and careful while a sharp object is being used and
subsequently disposed of. Learn all that you can from this experience and vow to not have another event happen.
Time matters though, so please proceed swiftly as follows:




REMOVE all soiled c
lothing


4




WASH
-


* Wounds and skin with soap and water

* Flush mucous membrane copiously with water





WRITE down the source patient's name, hospital number, date of birth and location in the hospital or


clinic.




NOTIFY your supervising staff member that
you need to report to Campus or Employee Health.




REPORT TO "CAMPUS" or "EMPLOYEE" HEALTH (after hours report to your facility's EMERGENCY


DEPARTMENT)




At this time, your risks of acquiring a blood
-
borne pathogen vary with the variables of the exposure.
Consider the
type and volume of fluid and type of exposure; also consider the characteristics of the source patient with respect
to infectivity.





It is not appropriate for you to consent the source patient and draw their blood yourself.

Different
facilities
may follow a different protocol, but there is a designated person at each hospital (via employee heath typically)
who will go to the source patient, consent them via appropriate protocol and test their venous blood.




Needed Studies on Source Patient:


*
Hepatitis B surface antigen
(HbsAg)

*
Hepatitis C antibody

(anti
-
HCV)

*
HIV antibody
(with consent)


Note:

in a high risk
source patient whose HIV status is unknown, or if PEP medications will be taken by the
student,

some facilities (including HMC & UWMC
-

via Children's Hospital virology laboratory) have a rapid HIV
test protocol
-

and the rapid test should be ordered.





Special Studies:

in high risk source patients believed or known to be HIV +, and/or known to be a
nti
-
HCV +, viral
"load" studies (i.e. quantitative

viral RNA) should also be sent for each respective virus.




Needed Studies on Exposed Student:



*
Hepatitis B surface antibody
(HBsAb)
-

this should be checked if you have not completed a Hepatitis B
immunization series or if your level of protective antibody from such a series is unknown. If the patient is HBsAg
positive and if your anti
-
Hep B antibody level is < 10 mIU/ml, you will need an in
jection of hepatitis immune
globulin within 96 hours of the

explosure (dose of HBIG: 0.06 mL/kg IM).


*
Hepatitis C antibody

(anti
-
HCV)


*
HIV antibody
(with consent)





Additional Studies: if you elect to take post
-
exposure prophylaxis (PEP), additional baseline blood tests will be
necessary (such as a CBC, renal
function, hepatic and pregnancy test).









CLINICAL CLERKSHIP MANUAL: Description, Objectives, Evaluations, and Competencies


5



LEARNING STRATEGIES AND POINTERS


In order to achieve the objectives and learn as much as possible, it is highly recommended that students should do the follow
ing;


1.

Do histories, physicals and laboratory evaluations of any assigned patients.

2.

Record clinical data of patients including the problem list and assessment of each problem using a

problem
-
oriented medical

record.

3.

Maintain the medical record of each patient including laboratory data and provide appropriate flow sheets.

4.

Present

patients at morning report, during teaching rounds and in patient care settings whenever requested.

5.

Attend conferences, seminars, workshops, x
-
ray and EKG skills sessions and any student lecture series.

6.

Maintain a Patient Experience Logbook, and u
pon request from the faculty, furnish information on assigned patients

in the hospital and selected patients in the clinic or office.

7.

Read textbook sections which pertain to problems of any seen patients and other recommended reading assignments by

y
our preceptor.

8.

Attend all work rounds, teaching rounds and check
-
out rounds. Students should present patients as requested.


GOALS AND EXPECTATIONS

You

are expected to be one of the principal patient providers in any clinic and/or patient wards, with

the focus ranging from a
complete patient evaluation to discrete specific problem identification.


PREPARE

Review a patient's chart and read about the active problems before coming to the clinic; this can be done by checking with th
e staff
attending or scheduling clerks In the clinic on the day(s) prior to your patient's scheduled appointment. If there is no pa
tient
information available, prepare by reading about problems unique to that particular specialty.


FOCUS ON EVALUATION AND MANAGEMENT


Y
ou should play an active role in the patient's care, gathering the relevant data, organizing any oral and written pre
sentation, and
developing a problem list with differential diagnosis. In concert with your preceptor, you will then construct a diagnostic a
nd/or
therapeutic management plan to discuss with the patient. Time with patients in the clinic setting is often lim
ited, so you will need to
focus your attention, with guidan
ce from your preceptor, on the g
oals for a particular visit.
Follow Up

includes retrieval of ordered
labs and consults, and any patient contact to provide further information, education or review o
f a medical problem. It also involves
your own educational follow
-
up, pursuing literature and consultative sources to answer questions raised in your patient evaluation. It
may require finishing an assessment and plan for your preceptor, preparing a small
lecture, or educating another student. You should
understand that "success" as a reasonable "interpreter" and/or "manager" often depends on what you do after your session with

your
preceptor for that day. In order to allow sufficient time for you to indepe
ndently evaluate and then research the problems of the
patients you see, the clinic schedules are deliberately tailored to your needs. Your preceptor will define your level of invo
lvement
prior to the patient encounter and provide follow
-
up confirmation of

your evaluation. She/he should help you set reasonable time
constraints to allow both thorough, but also efficient,
patient evaluation and problem i
dentification. Each clinic will have a slightly
different format and emphasis, but all are centered on stud
ent learning. If you find that you are not actively participating in patient
evaluation and management, please let your clinical rotation director know.
An outline of student g
oals and

expectations in each
rotation s
yllabus is provided in the following cha
pters, and for the purpose of securing a great evaluation, you must share adhere to
them, and share them with your preceptors.


ROTATION CHARACTERISTICS

“O
UT" vs. "IN" PATIENT ROTATIONS
-


There are some distinct differences between the ambulatory and the

ward medicine rotation. What is
not different are the rotation
g
oals and expectations required by Windsor's Clinical Sciences Department; emphasis on knowledge, skills and professional beha
vior
(attitudes) is consistent regardless of the site or setting.
Each of you must begin to make the transition from "reporter" to "interpreter"
during this rotation.


The most obvious differences are evident. The hours for a clinic setting are better and more predictable
-

a typical day is structured
from 0700
-
1700 hou
rs, but as a responsible medical student, you must be willing to conform to your preceptor's schedule 7 days a
week, 24 hours a day.




There are currently several sites and hospitals providing core rotations via both in and outpatient (Ambulatory) opport
unities. All sites
have the same basic rotation structure, but each offers features unique to its own particular patient and
provider practice. Your weekly

6

s
chedule may mimic that of the attending physicia
n, with some time allotted for i
ndependent study, on average, you will be required to
attend 6
-

10 scheduled clinics per week, and may choose to spend some unscheduled time observing and/or participating in a
procedure or specific conference or journal club. Each clinic will designate a

fellow or staff attending to whom you are primarily
responsible; if clinics are busy this may be a shared responsibility.


AMBULATORY ROTATIONS


Your direct supervisor is your preceptor. Working exclusively with senior and skilled staff physicians can be

both intimidating and
exhausting, there is very little "down time" in the clinic, with both patients and staff expecting you to be actively thinkin
g all the time.
Although the hours are better and the clinic schedule seems light at the beginning, most stu
dents are exhausted at the end of the day
and never feel they can gain control of the knowledge they need
-

there is always another patient with a new problem. We have
worked very hard to accommodate the clinic load to your level of learning, and have pick
ed faculty eager to teach and receptive to
mistakes (yours and theirs).


Your weekly schedule may include all general medicine clinics, a mixture of general medicine and subspecialty clinics, or a
concentration of one or two specialty clinics rotating wee
kly with each other. Some sites may include adolescent medicine,
ophthalmology, or dermatology; some have strictly procedural clinics (GI and Cardiology) as part of their clinic experiences.

This is
dependent upon the site and the available faculty, and re
quires a healthy sense of flexibility from both the student and the staff.
Remember
that the process of learning.
Thinking analytically and critically about patient evaluation
-

is not dependent upon what
specialty clinics you have, but rather on the basic

skills inherent to all physicians. There are few mandatory activities but they are
critical
-

attendance at Grand Rounds, Core AM Teaching Rounds and scheduled clinics are the most important, and are not optional.


The ambulatory setting is an exciting p
lace to learn and work. The tools you use to gather and synthesize patient information and plan
management may need to be refined or adapted to concerns such as time, distance and the psychosocial concerns of the patient.

We
hope you will find your rotatio
n settings to be a rewarding, educational and professional experience.


WHAT DO YOU NEED TO KNOW?

Use this format to quickly self
-
assess in practical terms your
knowledge of important, common issues for your own patients as w
ell as
other patients on your

ward team or those discussed during preceptor rounds.



























WHAT DO YOU NEED TO KNOW?
-

ABOUT A DISEASE OR SYNDROME


7


DEFINITION

Can you explain to another what the label means? What it includes/excludes?

Diagnosis: Complete diagnosis, classification (Is there a further classification or "staging"?) How is the diagnosis made? (W
hen can
we be sure the patient has the "label" that is proposed?)

Pathophysiology (NON
-
NEGOTIABLE information, you must know this)
.


CLINICAL PICTURE

Symptoms, Signs, Lab (How does each reflect pathophysiology?)

Who is at risk for this disease? How common is it? Can it be prevented?

How

does age, gender, race, ethnicity, affect prevalence and presentation?

Differential Diagnosis (What else can look like this?)

Natural history (What happens, if you do nothing, in most patients?)

Complications (What's the worst, in how many patients?)


TREATMENT

-

also see "About a Specific: Therapy" below

Options for treatment: Medical/Lifestyle/Surgical/Radiation (Does treatment alter the pathophysiology? Mechanisms)

Treated history
-

is there a standard therapy? And how good is it compared to natural history? What should be followed?

Safety
-

(How "bad"

is therapy, risk, costs and pitfalls?), any alternate therapies?


"WHAT DO YOU NEED TO KNOW?"
-

ABOUT A SPECIFIC THERAPY

How does it work? (Affecting the anatomy or physiology; if a drug, pharmacology; what are the indications?)

How good is it? (Effica
cy
-

short term; long term., are there relapses? how good is the evidence?)

How bad is it? (Risks, side effects, costs; contra
-
indications): alternatives?


"WHAT DO YOU NEED TO KNOW?"
-

ABOUT A TEST

(Again, there are three things)

How does it work? (How
does it address the physiology or anatomy? How will
w
e use the result?)

How good is it? (Sensitivity, specificity, reproducibility; predictive value) ~ How bad is it? (Risk of the procedure, costs,

financial and
otherwise)

What are the alternatives?

Rea
ding for this basic information about diseases, syndromes and tests will have immediate rewards. You will understand better w
hat
is going on with your patients, and will be better "advocates" on their behalf; you will also have done much of the reading f
or

your
written analyses; you will be learning to separate important items from those that can be left out of a presentation on atten
ding rounds.


PROFESSIONAL CONDUCT

As you become an active member of the he
alth care team, your degree of i
nteraction with p
atients will often equal or exceed that of
more senior members of your team. Accordingly, you are required to meet certain minimum standards of professional decorum.


DRESS

You are expected to wear clean white coats with name tags at all times. Men must
wear shirts and ties. Women are expected to be
comparably attired. You may wear a scrub suit when on call (typically obtained from operating room).



PATIENTS

All patients are to be addressed as Mr., Mrs., etc. Any discussion of diagnosis, management or prognosis with the patient or
family
should be first cleared with the house
-
staff or attending physician.


ANCILLARY PERSONNEL

Optimum patient care requires a m
utual attitude of courtesy and respect. You can and should learn a great deal from nurses and other
personnel. Should you have any
i
nterpersonal difficulties with ancillary personnel, notify your resident or attending.


PUNCTUALITY

You are expected to be

present and on time for all rounds, conferences and other scheduled activities.






SELF STUDY


8

Teaching techniques are designed to facilitate more direct patient Interaction and self
-
directed learning. The
emphasis will be on using the "teachable moment
" ~ what is the key point about this patient's history or physical exam or lab work or
therapy that you Should focus on to learn more about on your own time. Structured discussions or presentations will often 'be

scheduled at a time distinct from patient c
linic time; completion of a patient's work
-
up or assessment may involve returning to your
attending the following day or the next clinic.

Read with two objectives: First, to acquaint yourself with the current knowledge or) a
subject and the steps by which

i
t has been
reached, and secondly, and more important, read to understand and analyze your cases
.



The Student Life
-

by Sir William Osler

Suggested Textbooks
-

Relevant to All Rotations

1
.


Current Medical Diagnosis and Treatment, 39th edition, Lange
Medical Books/McGraw
-
Hill

2.

Guide to Clinical clerk student Medicine, 1st Edition. Douglas S. Paauw, Lisanne R. Burk holder and Mary Migeon. Mosby.



3.

Rapid Interpretation of EKG's, 6th Edition: Dale Dubin.

4.

Evidenced Based Medicine recommended re
lated articles



The Medical Student Responsibility


DEDICATION

A student shall be dedicated to providing competent medical service with compassion' and respect for human dignity. The stude
nt
should be thoughtful and professional when interacting, with patients and their families.




NON DISCRIMINATION

It is unethical

for a student to refuse to participate in the care of a person based on race, religion, ethnicity, socioeconomic status,
gender, age, sexual preference, medical risk, or perceived
risk, to the student. It is not

however, unethical for the pregnant student

to
refuse to participate in activities that pose a significant

risk to her fetus.


CONFIDENTIALITY


Student shall abide by HIPPA and JCAHO guidelines.


PROFESSIONALISM


Students should maintain a neat and clean appearance, and dress in attire that is generally accepted as professional by the p
atient
population served. A student should accurately represent herself or himself to patients and others on the medical team. Stud
ents should
never introduce themselves as "Doctor" as this is clearly a misrepresentation of your position, knowledge and authority.


HONESTY


Students are expected to demonstrate honesty and integrity in all aspects of their education and in their intera
ctions with patients, staff,
faculty
, and colleagues. They may not
c
heat, plagiarize, or assist others in the commission of these acts. The student must assure the
accuracy and completeness of his or her part of the medical record and must make a good
-
fait
h effort to provide the best possible
patient care. Students must be willing to admit errors and not knowingly mislead others or promote himself or herself at the
patient's
expense. The students bound to know, understand, and p
reserve professional ethics a
nd

has a duty to report any breach of these ethics
by other students or health care providers through the appropriate channels. The student should understand the protocol of th
ese
channels.




CONSULTATION

Students should seek consultation and supervision

whenever their care of a patient may be inadequate because of lack of knowledge or
experience.


CONFLICTS OF INTEREST

When a conflict of interest arises, the welfare of the patient must at all times be paramount. A student may challenge or ref
use to
comp
ly with a directive if its i
mplementation would be antithetical to his or her own ethical principles, when such action does not
compromise patient welfare. Gifts, hospitality, or subsidies offered by medical equipment, pharmaceutical or other manufactur
ers

or
distributors, shouldn’t be accepted if acceptance would influence the objectivity of clinical judgment. Student

interactions with
commercial i
nterests should conform to the American Medical Association (AM A) & PhRMA guidelines.



SEXUAL MISCONDUCT


9

Th
e student will not engage in romantic, sexual, or other nonprofessional relationships with a patient, even at the apparent re
quest of a
patient, while the student is involved with the patient's care. The student is, not expected to tolerate inappropri
ate s
exual behavior.


IMPAIRMENT


The student will not use alcohol or drugs in a manner that could compromise patient care. It is the responsibility of every s
tudent to
protect the public from an impaired colleague and to assist a colleague whose capab
ility is

impaired because of their

health. The
student is obligated to report persons of the health care team whose behavior exhibits impairment of lack of professional con
duct or
competence, or who engage in fraud or deception. Such reports must conform to establ
ished institutional policies.





CRITICISM OF COLLEAGUES

It is unethical and harmful for a student to disparage without good evidence the professional competence, knowledge, qualific
ations,
or services of a colleague to a review (judicial) body,
s
taff; s
tudents, or a patient. It is also unethical to imply by word, gesture, or deed
that a patient has been poorly managed or mistreated by a colleague without tangible evidence
.

Professional relations among all
members, of the medical community should be marke
d with civility. Thus, scholarly contributions should be acknowledged,
slanderous comments and acts should be avoided, and each person should recognize and facilitate the contributions of other to

the
community. The medical student will deal with professio
nal, staff, and peer members of the health team in a cooperative and
considerate manner.


RESEARCH

The basic principle underlying all research is honesty. Scientists have a responsibility to provide research results of high
quality; to
gather facts meticulously, to keep impeccable records of work done; to interpret results realistically, not forcing the
m into
preconceived molds or models; and to report new knowledge through appropriate channels. Co
-
authors of research reports must be
well
-
enough acquainted with the work of their co
-
workers that they can personally vouch for the integrity of the study and

validity of
the findings, and must have been active in the research itself. Plagiarism is unethical. To consciously incorporate the words

of others,
either verbatim or through paraphrasing, without appropriate acknowledgment is unacceptable in scientific
literature.


EVALUATION


Students should seek fee
dback and actively participate i
n the process of evaluating their teachers (faculty as well as house staff).
Students are expected to respond to constructive criticism by appropriate modification of their b
ehavior. When evaluating faculty
performance, students are obliged to provide prompt, constructive comments. Evaluations may not include disparaging remarks,
offensive language, or personal attacks, and should maintain the same considerate, professional to
ne expected of faculty when they
evaluate student performance.


TEACHING


The very title "Doctor".
--

From the Latin docere, "to teach"
-
Implies a responsibility to share knowledge and information with
colleagues and patients. It is incumbent upon those e
ntering this profession to teach what they know of the science, art, and ethics of
medicine. It includes communicating clearly with and teaching patients so that they are properly prepared to participate in t
heir own
care and in the maintenance of their he
alth.


DISCLOSURE

In general, full disclosure is a fundamental ethical requirement. The patient must be well informed to make health care decis
ion and
work intelligently in partnership with the medical team. Information that the patient needs for decision

making should be presented in
terms the patient can understand. If the patient is unable to comprehend, for some reason, there should be full disclosure to

the
patient's authorized representative.


INFORMED CONSENT

Students are to understand the importan
ce of the obligation to obtain i
nformed consent from patients, but are not responsible for
obtaining such consent. It is the physician’s responsibility to ensure
-
that the patient or his/her surrogate be appropriately informed as
to the nature of the patien
t's medical condition, the objectives of proposed treatment alternatives, and risks Involved. The physician’s
presentation should be understandable and unbiased. The patient's or surrogate's concurrence must be obtained without coercio
n.










10

Syllabus
:

General Surgery


This syllabus has been designed to help the student understand the
g
oals, objectives, and structure of the rotation, the evaluation
process, and administrative requirements

for the rotation. The student s
yllabus guide outlines the attitud
es, skills, and knowledge that
students' need to acquire during the rotation. Students should use this material to help focus their

learning efforts. An

orientation
session for all students will be held on the first day of the surgical rotation. Students w
ill he notified by mail and email of the time and
place. Please
check

the website, email or call the Student Coordinator to find out when and where this will take place. Please review
the following information before you begin the rotation. We are available if you have questions or problem
s. Every department of
Surgery is

c
ommitted to making your rotation a positive educational experience. The Surgery Rotation is typically a 12
-
week rotation
consisting of a combination of General Surgery Service and at a minimum one month on a Subspecialty Surgical Service. The rot
ation
ta
ke
s place in several facilities
throughout TAPION University’s network of affiliated hospitals. The Core Surgical Services include,
but is not limited to GI Surgery, Vascular Surgery and the Surgical Oncology, and Subspecialty Services may include, but are
n
ot
limited to Plastic Surgery, Cardiothoracic Surgery, Ophthalmology, Otolaryngology (ENT), Orthopedics, Pediatric Surgery,
Trauma/Surgical Critical Care and Urology.




Rotation Goals

The g
oal of the surgery rotation is to introduce the student to the p
rinciples of caring
for the surgical patient. This g
oal is accomplished
by allowing the student to participate in the care of patients in various stages (If evaluation) and treatment by surgeons. T
hese stages
i
nclude, but are not limited to the preoperativ
e office or clinic visit, inpatient admission, operative procedure and Inpatient and
outpatient recovery. Through this exposure, the student wil
l begin to understand the general

process of the application of surgical
therapy to patients in a wide variety o
f stages. Furthermore, by participating as a member of the surgical team, the student will observe
the role of the surgeon as a member of the multidisciplinary team that provides care for the patient. The rotation is structu
red upon the
principle that lear
ning is an active process which can be accomplished only by the student. The role of the preceptor and his staff is to
provide guidance, stimulation and example.


Rotation Objectives

It is anticipated that the student will master portions of the overall school objectives during the Surgery rotation. These i
nclude but are
not limited to the following:


Altruism

1.

Knowledge regarding ethical decision making. Students may have the oppo
rtunity to witness and

participate in end of life

discussions with patients and their families. Additionally, there should be ample

opportunity for the student to observe and

participate in
the informed consent process.

2.

Compassionate patient care an
d respect for the privacy and dignity of their patients. Patients who are undergoing surgery face

unique psychological and social stresses; it is Imperative that the students exercise compassionate care and respect for pati
ent

privacy throughout the preo
perative period. It is important not to discuss operative findings in areas of the hospital where the

discussion might be overheard by friends or families of the patient.

3.

Honesty and integrity in all interactions with patients' families; colleagues, a
nd others with whom

physicians must interact

professionally. The student is

expected to wear a dean white c
oat with name tag at all times except in the operative suite. All

patients are to be addressed as Mr., Mrs., etc. Any discussion of diagnosis/ man
agement, or prognosis with the patient or

family should be first cleared with

the house staff or attending physician.

4.

An understanding of, and respect for, the roles of other health care professionals, and of the need to collaborate with other
s in

p
roviding care for individuals and populations. Surgeons typically pride themselves on their ability to manage patients

throughout all of the phases of their Illness. However, medicine has become a very sophisticated science, and collaboration

with other
health care professionals can be expected. Most medical students will not choose a surgical career, but students

should consider that they, will likely consult, with and be consulted by surgeons throughout their professional careers.

5.

The capacity to r
ecognize and accept limitations in one’s knowledge and clinical skills. Surgical therapy typically produces

extreme results. Positive outcomes
-
are extremely rewarding but negative outcomes are Immediate and devastating to the

patient and humbling to the surgeon. The best application of the most current surgical therapy does riot guarantee positive

outcomes. This situation should result in reflection on the part of all members of the team. Sometimes, ideas that arise afte
r

fai
lure result in progress in knowledge.




Knowledge

1.

Knowledge of molecular, biochemical, and cellular mechanisms underlying the pathology of disease. The surgeon must have

a comprehensive knowledg
e of basic science disciplines.
The student will have t
he opportunity to correlate his or her

preclinical
baste science knowledge with the care of the surgical patient.

2.

Knowledge of pathologic changes in the structure and function of organ systems as a result of disease. Surgery is unique in

the degree o
f clinical correlation that can be accomplished. The student can detect findings on a preoperative physical exam,

view radiographs and then be able to see and directly palpate the patient’s pathology. Responsibility for making this possibl
e

is shared amo
ng the students, residents and surgical faculty.


11

3.

Knowledge of mechanisms of drug action, pharmokinetic parameters, pharmacodynamics and
pharmacotherapeutics.

Students will have an opportunity to see a number of medications used in the preoperative per
iod. This should be an excellent

opportunity to review the pharmacology of many antibiotics, analgesics, anesthetics, etc.

4.

Skills for lifelong learning. The hours are long for most surgeons. The call schedule has been modified
in
an attempt to

provid
e students with adequate time for rest and study. Despite these modifications, it is expected you're the surgery rotation

will be one of the most rigorous and demanding experiences of the student's medical school educational experience. One

misconception

that leads to problems is that some students believe that they should only study when away from the hospital.

Instead, the student must develop a strategy that allows them to read and study during any free opportunity during the

working hours. Developin
g this skill will also be useful to the student during residency training, and in future post
-
training

practice.


Skillfulness

1.

The ability to perform both a comprehensive and organ system specific; examination. The surgeon must assess the patient's

entire state of health prior to performing an operative procedure. Therefore, the

student will gain experience with a

comprehensive physical examination during the rotation. Additionally, the student may have an opportunity to learn a very

detailed exam
ination of specific organ systems. This will vary according to the specific nature

of the student's rotations.

2.

The ability to perform routine technical procedures (E.G., nasogastric tube insertion, venipuncture, intravenous

catheterization, arterial p
uncture, urinary catheterization, suturing and skin stapling). Students frequently fail to recognize the

opportunity to
perform procedures on patients i
n the Operating Room. Doing procedures in this environment minimizes

patient discomfort and allows
the

student to learn to do a procedure under supervision.



3.

The ability to interpret the results of commonly used diagnostic tests with recognition of their limitations. Frequently, a

surgeon will be requi
red to make decisions based on i
nconclusive tests
. The student should inquire frequently as to why

specific tests have been ordered.

4.

Knowledge of the most frequent clinical laboratory, radiologic and pathologic: manifestations of common maladies. The

surgical pathologists are frequently willing to review the pathologic evaluation

of tissue that has been removed at surgery.

The radiology faculty and house
-
staff are consistently av
ailable to review preoperative i
maging studies.

5.

The ability to reaso
n deductively in solving clinical problems. The residents and faculty will be able to explain to the student

how they have arrived at diagnoses and developed plans.

6.

The ability to construct appropriate diagnostic and management strategies for patients

with common surgical conditions. This

applies to both the conditions that the student actually encounters in patients and those only read about in textbooks.

7.

Knowledge about relieving pain and ameliorating suffering. This will be particularly true in

the post
-
operative period. There

are a variety of ways to relieve post
-
operative pain, and the student should be familiar with these options.

8.

The ability to communicate effectively with patients, their families, and members of the healthcare team. Th
e unique aspect

of surgical care is that often the surgeon must establish a relationship quickly in a stressful situation. Effective

communication is important in guiding a patient, and his or her family,

through these situations. The students will witn
ess

and participate in this process.


Dutiful

1.

The ability to retrieve, manage and utilize biomedical information for solving problems and making decisions relevant

to the care of individuals. The surgeon must synthesize clinical, laboratory, and

ra
diologic i
nformation to solve problems

with or without surgical intervention. The student will be an active participant on the surgical team.




Patient Care Responsibilities: Patients

1.

During your rotation on Surgery, you will have close daily contact with patients and their families. You will be learning

medical facts and developing problem solving skills as well as developing equally
important interpersonal skills i
n terms of

the phy
sician
-
patient and physician
-
family relationship. Although it may sound trite, please remember that patients are sick,

and their families worried. Think about what you're going to say before you say it.

2
.

Always discuss up
-
coming issues regarding diagno
sis, prognosis, or management with hospital/clinic staff and preceptor

before talking with patients and family. It is always acceptable to tell a patient "I do not know, but I will check with Dr.
X
for

you." Never give a patient i
nformation about anythin
g unless you are absolutely certain about it.

3.

Patients have a right to refuse any care or treatment. If a
patient says "don't touch me
"
,

then

don't touch them. Do report this

to your attending physician.

4.

It is recommended that all students on all
rotations document all of their inpatient and outpatient encounters with date,

diagnosis, and a short description of findings. You should ordinarily only list patients whom you actually interview and

examine, but do include trauma and emergency call enco
unter

even if you are only an observer.


For each patient you admit:

1.

Perform a complete history and physical examination on the day of admission.

2.

Formulate a complete problem list.

3.

Review the patient's x
-
rays with house
-
staff and/or a radiologist.

4.

Review the patient’s EKG with house
-
start.


12


Procedure Documentation

Please remember that you must perform procedures on your patients under supervision of someone who knows how to do
the
procedure before you do any procedure without direct supervision. You should ask a house
-
officer, nurse, or appropriate technician to
observe and/or help you with procedures.

Explanations for basic procedures that follow can be found in any pocket war
d manual, such as Tarascon Clinical Clerk Medicine &
Critical Care Pocketbook. You may expect to participate in any of the following procedures, so be well prepared:



Suturing lacerations, knot tying, suture cutting,



Gowning/gloving in sterile fashion



A
rterial line placement





Starting IV'S





Arterial blood gases



Paracentesis



Thoracocentesis



Chest tube placement



Incision and drainage of abscesses



Staple and suture removal



Dressing changes



Foley catheterization



Nasogastric tube insertion



Central nervous cannulation



Drain pulling


Medical Records

1.

Admission H
istory and Physical Examination. For each patient you admit, you must write a complete history and physical,

utilizing standard format, followed by a patient
-
oriented assessment.

2.

Progress notes: Always use SOAP format. You should write daily notes on each patient. The notes must be reviewed,

corrected, and signed by your Clinical clerk student or resident the day they are written.


Presentations (Rounds/Conferences)

3
.

The a
ppropriate length and detail of a presentation vary with circumstances.


New patients are presented in more detail than patients on whom you have already treated.


TEXT

1.

Schwartz’s SURGERY

2.

Evidenced Based Medicine recommended related articles






REMEMBE
R THAT WHAT YOU GET OUT OF YOUR CLINCIAL LEARNING EXPERIENCES WILL BE DIRECTLY
PROPORTIONAL TO WHAT YOU PUT IN
.


Syllabus: Family Practice


Family Practice is a rotation enjoyed by many students. This rotation generally emphasizes patient care in an
outpatient setting. This
rotation offers vast experiences for the student as they learn and explore opportunities in the primary care environment. The

variety of
patients and procedures one sees will vary greatly with the location of the rotation. While so
me family practice offices: offer stress
testing, flex signs, and colposcopies, some will not. In most settings you will spend most of your time seeing patients indiv
idually,
obtaining a focused, problem oriented history, and performing physical exams. Fam
ily medicine is the best time to develop and refine
establishment of patient rapport, communication skills, and interviewing techniques. During this rotation you should also exp
ect to
perform several pelvic exams, breast exams, and rectal exams, all of whi
ch require a chaperon. In addition, you may have an
opportunity to perform small procedures such as wound debridement, removing sutures, removin
g warts, and toe nail removal.
This 4
to 6 week rotation provides supervised exposure to the evaluation and mana
gement of patients at the ambulatory setting of family
medicine with undifferentiated health problems; you will also be introduced to the evaluation and management of health proble
ms
requiring hospitalization which routinely confront the family Physician.
The fundamentals of problem
-
solving in clinical setting are
emphasized in all patient
-
care encounters. Emphasis on concepts of health maintenance and comprehensive and longitudinal health
care in the setting of the family. The student's clinical exposure i
s provided by family practice residency programs and private group
practice sites. The Family Medicine Rotation is designed to provide third
-
year medical students with an introduction to the principles

13

and practice of Family Medicine. The course exposes th
e students to
the concepts, values and skills
that are based

to this discipline.
The rotation provides an understanding and appreciation for Family Medicine through exposure to a system of comprehensive and

continuous medical health care for the entire fam
ily. As a result, students should understand 'an approach to care that has an
orientation toward the he
alth of the person as a whole.
When students complete the rotation, they should have an appreciation of
Family Medicine as a complex; specialty that not
only shares skills and knowledge with other branches of medicine but also has its
own unique body of knowledge, skills and attitudes. The students should become aware of the fact that family physicians provi
de
continuous primary care regardless of age, sex

or type of problem (biological, behavioral or social). The students should also
understand that the family physician serves as the patient's advocate and coordinator in health related matters including tho
se requiring
the utilization of consultative and o
ther community health resources.


Rotation Goals and Objectives

By the end of the course, the student will enhance his/her:


1.

Goal: PERCEPTION OF AND ATTITUDES TOWARD THE ROLE OF A PHYSICIAN.


Objectives:


a.

Assume responsibility and initiative in caring for patients.


b.

Devote appropriate time and energy to all duties.




c.

Exhibit maturing in interpersonal relationships, personal values and medical ethics.


d.

Respect the rights of patients.


2.

Goal:
PERCEPTION OF AND ATTITUDES TOWARD FAMILY MEDICINE.


Objectives:


a.

Understand the necessity for providing continuous, comprehensive health care to the family.


b.

Recognize the importance of life events to the family and the impact of those events on
the health of the



individual.




c.

Provide family and person
-
oriented health care,


d.

Recognize the importance of health maintenance.


e.

Appreciate the necessity for providing care for both the acute and chronically ill patient.


f.

Recognize the

importance of being the physician of first: contact.


g.

Understand the importance of the role of the physician as the coordinator of the health care team




h.

Become the patient's advocate.


i
.

Recognize the importance of socio
-
economic factors in med
ical care.


3.

Goal: ABILITY TO ESTABLISH EFFECTIVE PHYSICIAN
-
PATIENT RELATIONSHIPS.


Objectives:


a.

Establish rapport and communicate with patients in a caring manner.


b.

Gain the confidence of patients by meeting their health needs appropriately,


4.

Goal: SKILLS IN GATHERING AND RECORDING APPROPRIATE PATIENT INFORMATION.



Objectives:


a.

Collect and record historical data recognizing the Impact of the patient's ' hereditary, social, economic,



religious, family and Occupational background on his or her presenting problem.




b.

Understand the characteristics of various lifestyles and life cycles of a family and their effects on



health and disease.




c.

Recognize the importance of

the psychosocial aspects of health and disease.


d.

Perform physical examinations and record resulting data.


e.

Order appropriate laboratory studies for both 'ambulatory and hospitalized patients and record the



data.


f.

Write progress no
tes and' summaries on ambulatory and hospitalized patients for both acute and chronic



care needs.


g.

Perform diagnostic 'procedures and record the data.


h.

Use the problem
-
oriented record system to record data and maintain patient records.



With various presenting problems, participate in the development of diagnoses, assist in the development of health

management plans and follow the provision of comprehensive and continuous health care. These needs are best met by

permitting the studen
ts to participate in the actual provision of this form of health care in clinical settings of Family Medicine

(residency based Family Medicine clinics and private Family Medicine offices). From these experiences, the students observe

the different aspect
s of Family Medicine. For example, the opportunity to observe continuous health care provided by famil
y

14


physicians as they accept the
re
sponsibility for the long
-
term c
are of their patients is available at each of the rotation teaching

sites. If the pati
ents are referred for other specialty care, the students also observe that these family physicians continue to be

involved in the patient's health care. The impact of an illness on the health of the family in disease prevention and

rehabilitation is emph
asized in each of the settings wh
ere patient care is occurring.
The students have opportunities to observe

high
-
quality health care and the development of effective doctor
-
patient relationships. The students also have opportuniti
es to

practice the approp
riate i
nterpersonal skills necessary to establish these relationships.


Student Requirements

In order for the students

to accomplish the performance g
oals, it has been determined that they should be required to complete certain
tasks during their Family Medicine Rotation. The students should evaluate, by appropriate historical and physical assessments
, a
minimum
of 20 patients in the office or

clinic an
d a minimum of one to two patients in the hospital, per week. The students should
also observe and participate in diagnostic and therapeutic procedures. They should subsequently present the patient's clinica
l case
summaries orally to the attending physicia
n and make appropriate written notations in the patient's medical, record and in the Patient
Experi
ence Logbook, when applicable.
During the rotation, the students are expected to develop a knowledge base of diagnostic
problems commonly seen in the practic
e of Family Medicine. To assist the students in the development of this knowledge base,
required reading assignments concernin
g frequent presenting problems i
n Family Medicine have been established.
Throughout

all
patient evaluations, the concepts of compr
ehen
sive; continuous and preventive

health care are emphasized,
as well as the impact

on
the health of the family.


Comprehensive Student Requirements

The student will:

1.

Evaluate assigned ambulatory patients based on presenting problems and hea
lth care requirements determined by age, sex,

and race and family characteristics in the following situations:

2.

Comprehensive health evaluation.

3
.

Health maintenance and disease prevention evaluation.

4
.

Concise evaluation of patients with immediate

care problems.

5
.

Continuous health evaluation.

6.

Control and prevention of health problems.

7.

Factors affecting compliance.

8
.

Support of patient following discharge via provision of continuous and comprehensive care.

9.

Attend Family Medicine conferences and seminars and be prepared to present clinical case summaries on request.

10.

Develop a knowledge base and understanding of problems common to and frequently seen

i
n Family Medicine.

11.

Read the assigned materials on

problems frequently seen in Family Medicine.

12.

Participate in assigned clinical teaching modules.

13.

Complete Patient Experience Logbook as directed.

14.

Take final examination based on reading materials and clinical teaching modules.

15.

Complete
student course evaluation form online.



Key Procedures:

Explanations for basic procedures that follow can be found in any pocket ward manual, such as Tarascon
Clinical Clerk Student
Medicine & Critical Care Pocketbook
.


1.

Phlebotomy

.

2.

Musculoskel
etal Injection IV fine placement

3.

Arterial Line

4.

Arterial blood gas placement

5.

Foley placement


Pocket Stuff

1.

Stethoscope

2.

Eye chart

3.

Tuning fork (512 and/or 1028 Hz)

4.

Penlight

5.

Reflex hammer

6.

Current pharmacopoeia and antibiotic guide

7.

Calipers for ECG reading and an ECG summary card

8.

Index cards and/or patient summary sheets tracking vital signs and test over the hospital stay

9.

Normal
-
lab
-
value reference card




15

Books

1.

Primary Care Secrets

2.

Saint
-
Frances Guide to Outpatient Medicine

3.

Washington Manual of Medical Therapeutics

4.

Pocket Pharmacopoeia

5.

The Sanford Guide to Antimicrobial Therapy

6.

Color Atlas of Dermatology

7.

Evidenced Based Medicine rec
ommended related articles




REMEMBE
R THAT WHAT YOU GET OUT OF YOUR

CLINCIAL LEARNING EXPERIENCES WILL BE DIRECTLY
PROPORTIONAL TO WHAT YOU PUT IN
.




Syllabus: Clinical Clerk Medicine


Welcome to the Medicine Rotation! The next 12 weeks will form the co
rnerstone for much of your medical career, regardless of what
specialty you ultimately choose. The emphasis of this rotation is on acquisition of knowledge, skills, attitudes and behavior
s that form
the core of clinical clerk
student

medicine and
are essential for the education
of all physicians. The overall g
oal is to provide students
with a solid foundation in the comprehensive health care of adults. Prerequisite Objectives: Prior Knowledge, Skills and Atti
tudes




Rotation Objectives

1.

Write
a complete H & P.

2.

Write an in
-
house patient progress note.

3.

Write an out
-
patient progress note.

4.

Interpretation of chest x
-
rays, plain abdominal films, CT of chest and abdomen.

5.

Interpretation of coronary angiogram and peripheral arterial stud
ies, both invasive and noninvasive.

6.

Ability to discuss the diagnosis and management of: Renal Disease, Rheumatoid Arthritis,



Osteoarthritis, Hypertension, Stroke, Diabetes Mellitus I and II, Dyslipidemias, Adult Cardiac



Diseases,

Pulmonary Diseases, GERD, Acid Peptic Disease, Crohns Disease, Ulcerative Colitis

7.

Should be able to discuss the work
-
up of the anemic patient and jaundice patient.

8.

Ability to discuss the classification and diagnosis of hepatic disease.

9
.

Should be able to discuss metabolic diseases of the thyroid, parathyroid, and adrenal glands.

10.

Should be able to discuss common dermatology problems including but not limited to allergic



dermatitis, malignancies and inflammatory diseases

of the skin.


Attitudinal/Professional Skills

1.

To interact in a professional and caring manner with patients and their families.

2.

To increasingly develop professional skills regarding talking with patients and families under the direct



supervision of hospital/clinic staff or preceptor as well as alone.

3.

Enhance your own intellectual curiosity, self
-
stimulated reading and independent study as part of your




daily personal life as a physician.

4.

To work effectively with al
l members of the health care team, i.e., to function as a "team player",


Cognitive Skills

1.

To continue to expand the knowledge of disease processes begun in the basic science years.

2.

To integrate knowledge of pathophysiology of common diseases with

clinical problem solving and



management skills.


General Rotation Requirements

1.

The minimum standard for passing Medicine Is 70% or better on each clinical evaluation.

2.

Students are required to turn in 3 H&P new patient work
-
ups repres
enting his or her work for each



four weeks to the attending physician.

3.

Students are required to turn in" his or her patient log for each four
-
week rotation to Windsor medical



school, when required.


Rotation Activities Genera
l Weekly Schedule

1.

You should see your patients (and their charts) when applicable each morning before work rounds




during the in
-
patient component of your Medicine rotation.


16

2.

In most hospital/clinics Work Rounds: Usually begin at 7:00 am, (time set by individual preceptor).



Staff and students review current status of each patient, and formulate plans for the day. You



should present patients you are fo
llowing, know all lab and X
-
ray data on your patients, and be



prepared to Interpret the available information. Your preceptor may or may not be present on work



rounds.

3.

Attending Rounds: You should do initial and follow
-
up pres
entations on all patients you are following.



You should read in a standard medical text about



Presentations (Rounds / Conferences)

1.

Use minimal notes. (It is permissible to have a 3 X 5 card with pertinent Lab data.)

2.

Give concise, succinct; well
-
organized presentations. (Less than 5 minutes.)

3.

The following is a standard acceptable form to use for patient presentations:


a.

Pertinent history. (Always begin with patient's age; & chief complaint, followed by HPI, and






PMH,

ROS only as pertinent.



b.

Pertinent physical findings.


c.

Lab data. (Blood work, EKG, X
-
rays, etc.)


d.

Assessment, Including differential diagnosis; concise statement of your assessment of the





patient’s

problem(s).


e.

Pla
n for care, including diagnostic and therapeutic interventions.

4.

Prepare in advance for your presentation for rounds (consider practicing the presentation to your



Clinical clerk student or fellow student).

5.

Keep up with your pat
ients (symptoms, lab data, and physical findings) and be ready to give a brief



summary at any time.

6.

READ in standard textbook of medicine about your patient's diseases before rounds.




Medical Student Inpatient Ward Responsibilities


At
tendance

1.

Attend your scheduled conferences, teaching and grand rounds; with designated faculty at designated




times.

2.

Days off: Any weekend day or holiday when the attending is not on call or post call is an appropriate



day
for you to be off. You should arrange coverage for your patients
.
It is recommended that all students should take one day

off in 7.


Clinical Responsibilities

1.

Students are to be assigned two patients on the first day of each four
-
week block, during in
-
patient



rotations.

2.

You should not take more than 2 to 3 new patients while on call or carry more than 5 patients at any



given time. You should strive to keep your service in the 3
-
5 patient range, not the 1
-
2 patient range.

3
.

Complete 2 to 3 History and Physicals weekly. These should include an expanded discussion of an



assessmen
t and a differential diagnosis.

4.

Pre
-
round on all your patients before work rounds.

5.

Give 2
-
3 minute presentation (follow
-
up) in old

patients. Please include hospital day, antibiotic day (if



applicable), subjective and overnight nurse notes (flip over the chart prior to evaluating your patient).



Focused Physical Exam and pertinent labs, today's plan for each
problem, long
-
term planning and



disposition.

6.

Formally present new patients to your team the post
-
call morning (try not to take more than 5



minutes per new patient).

7.

Work closely with the Clinical clerk student and resident, when applicable.



8.

Prepare assigned topics related to your patients. These are to be discussed weekly with your



preceptor.

9.

Be honest and act in a professional manner to other h
ospital staff.

10.

Timeliness is crucial for teaching to run smoothly.

11

Write your notes using the SOAP format. Timely notes are a plus. Remember to time and date all



notes.



12.

Call your attending and/or Clinical
clerk student to report any abnormality
-
offer suggestions and/or explanation.



13.

Know everything about your patients
-
read about their problems and bring in review articles relevant



to their problems.

14.

Remember that you are the patient's d
octor. The rest of the team is here to help you.

15.

Check out your patients with your attending prior to leaving the hospital every afternoon.

16.

Student may be asked to present a patient at morning report.


17

17.

Attend workshops
.



Key Procedures:

Explanations for basic procedures that follow can be found in any pocket ward manual, such as Tarascon
Clinical Clerk Student
Medicine & Critical Care Pocketbook
.

1.

Phlebotomy

2.

Musculoskeletal injection

3.

IV line placement

4.

Arterial line

5.

Arte
rial blood gas placement

6.

Foley placement


Pocket Stuff

1.

Stethoscope

2.

Eye chart

3.

Tuning fork (512 and/or 1028 Hz)

4.

Penlight

5.

Reflex hammer

6.

Current pharmacopoeia and antibiotic guide

7.

Calipers for ECG reading and an ECG summary car
d

8.

Index cards and/or patient summary sheets tracking vital signs and tests over hospital stay

9.

Normal
-
lab
-
value reference card


Books

1.

Primary Care Secrets

2.

Saint
-
Frances Guide to Outpatient Medicine

3.

Washington Manual of Medical Therapeut
ics

4.

Pocket Pharmacopoeia

5.

The Sanford Guide to Antimicrobial Therapy

6.

Evidenced Based Medicine recommended related articles




REMEMBER THAT WHAT YOU GET OUT OF YOUR CLINCIAL LEARNING EXPERIENCES WILL BE DIRECTLY
PROPORTIONAL TO WHAT YOU
PUT IN
.





Syllabus: Obstetrics/Gynecology



Welcome to the Obstetrics and Gynecology rotation. Our affiliate faculty and staff look forward to working with you and to sh
aring
with you the emerging knowledge in the field of Obstetrics and Gynecology and
its various subspecialties. We hope that during the
next six weeks your time with us will be fruitful and enjoyable.

The purpose of this rotation is to impart the necessary knowledge, skills, and experience in OB/GYN to enable the student to
incorporate t
his in to his/her practice of medicine. No matter what field of medicine you decide to pursue as a career, issues in
wo
men's health will be important.
All students may rotate on the OB service for three weeks and the

other three weeks will be spent

on Beni
gn Gynecology
,

Gynecologic Oncology, or Reproductive Endocrinology.

Your rotation may also be a

combination of all the
above.
Most students find their third year Obstetrics and Gynecology rotation to be a pleasant and rewarding experience. We hope tha
t
you

will find the attending and house
-
staff's enthusiasm for this area
of health care to be contagious. The goal i
s to present you with a
concentrated introduction to this specialty, focusing on cognitive know
ledge and clinical experience.
The material you wi
ll be
presented with and responsible for will include

didactic lectures, textbooks, j
ournal articles, clinic, ward, and operating room
exposure. This broad experience should prepare you for addressing issues of women's health care as it relates to your med
ical career.


Rotation Objectives:

The major g
oals which we hope our students will achieve during this rotation service are as follows:

1.

To become skillful in obstetrics and gynecology history taking and in the physical examination of

women.



2.

To

learn the principles and practice of antenatal care, including the maternal changes in pregnancy, the management of

normal labor, delivery and the puerperium.

3.

To know common obstetrical complications, and understand the Interaction between pregnancy
and common medical

disorders.


18

4.

To comprehend common gynecological disorders.

5.

Ability to discuss the management of Pregnancy and Labor including but not limited to: Stages of Labor and Delivery, Fetal

monitoring during labor, premature labor, ante
parturn bleeding.

6.

Ability to discuss the identification of high risk pregnancy.

7.

Ability to discuss diagnosis and management of maternal hypertension, diabetes, heart disease, thyroid disease and anemia.

8.

To become familiar with all aspects of co
ntraception, sterilization and abortion.

9.

To know in depth about all medical and surgical problems that affect patients assigned to the student.

10.

To acquire certain clinical skills, such as aseptic techniques in the operating and delivery room, taki
ng cervical cytology,

smears and cultures, diagnosing and treating vaginitis, diagnosing pregnancy,
i
nterpreting selected sonograms and x
-
rays

and interpreting fetal heart rate patterns in labor.


Student Objectives/Expectations in OB/GYN

Please note that the following are guidelines and established minimums of conduct. A student's rotation grade is based on the

ability to
meet these expectations and objectives. The OB/GYN rotation is a comprehensive set of exposures to gynecology that inco
rporates
facets of Clinical clerk
student

medicine, general surgery, and even some oncology. The rotational block consists of three areas; (l)
Inpatient care, (2) Operating room, (3) Ambulatory Care, or Clinic.


Specific Expectations on OBI GYN

By the co
mpletion of the rotation, the student should:

1.

Be competent in performing a history and physical with reasonable differential diagnosis and plan in



patients with gynecology problems.



2.

The student should be able to perform an adequate a
bdominal and pelvic exam, which is of prime



importance for all students on the OB/GYN rotation. This may include bimanual exam for nodularity,




masses and uterine size.

3.

The student will also assess other systems of the body par
ticularly important in reproductive medicine,



including the breast and thyroid gland.

4.

The student should have a good basic understanding of pelvic anatomy and physiology.




ONCE DURING THE ROTATION, STUDENTS MAY BE ASKED TO GIVE A 5 MINU
TE

PRESENTATION DURING ATTENDING ROUNDS ON A GYNECOLOGY TOPIC OF THEIR CHOICE. IT IS THE
STUDENT'S RESPONSIBILITY TO REMIND THE PRECEPTOR ABOUT THIS PRESENTATION.


Deliveries

Students are expected to directly be involved in the pre, intra and post care
of at least one vaginal delivery, and one Cesarean section.
Competency levels include;

1.

Steps of a vaginal delivery

2.

Normal and abnormal labor patterns (duration, cervical dilation)

3.

Indications for cesarean section

4.

O
utlines of frequently written notes: preop, op, postop, delivery note

5.

Diagnosis & management of preeclampsia / eclampsia and other common maternal or obstetrical



complications:


a.

Abruption placentae


b.

Placenta previa


c.

Preterm labo
r


Inpatient Care

The student is expected to cover all round on all patients on the service, including any patients admitted overnight, as

well as
scheduled admissions. The admission history and p
hysical will be done by the hospital resident. The student

is expected to see the
patient and place a day of admissi
on note on the chart. They are

also expected to perform the p
elvic exam with the attending.
Students
are expected to be familiar with all the orders on their patient charts. They should have an unde
rstanding of admission orders, pre
-
op
orders, post
-
op orde
rs, and daily progress orders, s
tudents are expected to write the dairy orders discussed during rounds and
occasionally may be asked to write
the pre
-
op or post
-
tip orders.
Students should write an
Operative note and a Night of Surgery note
(
NOS) on all surgical patients, s
tudents are also

expected to help formulate the

discharge plan which may include writing the
discharge prescriptions and filling out the discharge paperwork.




Outpatient Care

M
any surgical cases done on the

OB/GYN service are
-
outpatient s
tudents should assist in writing prescriptions and discharge
instructions on these patients.


Consults


19

The OB/GYN service is responsible for a number of consults from other services throughout

the day. Students should assist the
attending and residents with all consults, including obtaining past medical and surgical histories, documenting recent labora
tory or
radiology reports, and reporting medications. Students should follow their consult pat
ients until the OB/GYN service had signed off
on them.


Clinics
-

Preop / Postop

Students should see any patients that have been placed in a room, after patient consent has been obtained. The majority of th
ese
patients will be postoperative. The student
should review th
e patient's hi
story, operative report, hospital course (if any), and pathology
(if applicable) prior to seeing the patient. They should then obtain a good overall history, Inquire about health since surge
ry, perform a
general physical exam,

document their findings on the patient’s clinic chart, and then present the patient to the resident. The pelvic
exam is to be done with the resident. Staple and suture removal may be done, but
sterile
-
strips should not be placed prior to the
resident exam
ining the wound.




Clinics
-

Ambulatory

Students will rotate with attending. All attending assigned patients are to be seen by the student. The initial presentation
to the
attending for new patients should include:



Chief co
mplaint, past medical histo
ry, s
ocial history
, family h
istory


The initial presentation to the attending for return patients should include:



Chief complain
t, history of present illness, u
pdate since last visit

Students need to be sure the patients are up to date on routine stud
ies such as Pap smears, mammograms, etc. A breast exam should be
in

the chart within the past year

and may need to be repeated if the patient is a new one. This should all be discussed with the
attending. The pelvic examination is performed with the attend
ing. After the exa
mination, the impression and p
lan will be formulated.


Operating Room

The students are expected to be in the OR for all attending assigned cases. Students should assist with patient
placement; prepping and
draping
.

Students should absol
utely scrub in on cases involving their p
atients. Occasionally, students

will have better visibility i
f they
do not scrub in (as i
n the case of laparoscopy). The final determination of whether the student should scrub in or not will be made by
the precepto
r. All students in the OR should perform an examination under anesthesia, as this is an excellent opportunity to learn.
Students should introduce themselves to the patients in the Holding Area. Students should also assi
st in writing Operative notes.
Studen
ts are expected to know their patients, read about the pro
cedures before coming to the OR

and to review basic pelvic anatomy
to better understand the procedure being performed. Lack of preparedness may adversely affect a student's rotation evaluation
.


Ke
y Procedures

Explanations for basic procedures that follow can be found in any pocket ward manual, such as Tabor’s Clinical Clerk OB
/
GYN
Pocketbook.

1.

Delivering babies

2.

Cervical checks.

3.

Pap smears

4.

Cervical/vaginal cultures

5.


External fetal monitoring

6.

IV lines

7.

Basic suturing

8.

Knot tying

9.

Retracting for visualization during procedures.


Pocket Stuff

1.

Pregnancy wheel

2.

OB/GYN handbook of your choice

3.

Penlight

4.

Stethoscope


5.

Index cards to keep track of your patients

6.

Pocket tape measure

7.

Contraception guide




Books

1.

Obstetrics and Gynecology for Medical Students (3rd edition) by Beckman, Ling, et aI, 1998.

2.

"Survival Guide" to Gynecology

3.

Pocket

Pharmacopoeia

4.

Current Obstetric & Gynecologic Diagnosis & Treatment


20

5.

Fundamentals of Surgery

6.

Atlas of Human Anatomy

7.

Washington Manual of OBGYN Therapeutics

8.

Evidenced Based Medicine recommended related articles




REMEMBER THAT
WHAT YOU GET OUT OF YOUR CLINCIAL LEARNING EXPERIENCES WILL BE DIRECTLY
PROPORTIONAL TO WHAT YOU PUT IN
.




Syllabus: Pediatrics


No field of specialized medicine has a broader scope or greater responsibilities than has pediatrics, which is distinguished
by its major
concern for the growth and development of its subjects. Every physician must understand how the medical, surgical and behavio
ral
problems of infants and child
ren differ from those of adults

and how to manage them so as to permit the child to a
chieve an optimal
state of mental and physical health. Therefore,
the fundamental purpose of the P
ediatric rotation is to provide a structured environment
in which each medical student

acquires a basic knowledge of p
ediatric medicine as well as human growt
h and development which will
serve as a foundation for providing quality child health care in whatever field of

medicine he or she may enter.
This syllabus has been
designed to h
elp the student understand the g
oals, objectives, and structure of the rotatio
n, the eval
uation process

and administrative
requirements

for the rotation. The student s
yllabus guide

outlines the attitudes, skills

and knowledge that students need to learn during
the rotation. Students should use this material to help focus their learn
ing efforts. The rotation is structured upon the principle that
learning is an active process

which can be accomplished only

by the student. The role of the faculty is t
o provide guidance, stimulation