Differences

This shows you the differences between two versions of the page.

--- medical_student:medical_students [2019/09/19 18:40] – jonathan
+++ medical_student:medical_students [2024/04/05 12:38] (current) – taylor
@@ Line 1: / Line 1: @@
 ==== Expectations for Medical Students ====
-Your first and most important job is to learn. The best way to accomplish this is to see as many patients as possible and learn why everything is being done for each patient. To stay active, present patients on rounds and then to help update the list. This allows you to have a detailed understanding of a few patients and then keep up to date on all the patients on the service. You are expected to help gather numbers and print the list in the morning. Please make sure you are printing the cover sheet with the following custom columns included: Antibiotics, anticoagulation, To Do. Include drain outputs on first cover page. Write the numbers as follows:\\
+{{ :medical_student:ai_orientation_packet.docx |}}
-Temp range / HR range / BP range / RR single value / Desaturation events and times + Oxygen/Vent settings\\
-Ins and Outs\\
-__PO   |   UOP__\\
-IV     |  Other\\
-N: #     A: #\\
-PO - Includes oral intake and any enteric feeds\\
-IV - Anything intravenous\\
-UOP - Urine output. Please also include dialysis\\
-Other - Everything else. Emesis, stools, etc…\\
-*** Make sure you are opening up all the tabs in Ins&Outs (BTW you can save it open with that little green plus)\\
-N = Net 24 hour volume status\\
-A = Net admission volume status\\
-AM Rounds: Medical students should LEAD rounds. You plan the route. Don’t wait for us to finish with a patient. You should be ready and start leaving the room as the we finish with the patient. Get whatever tasks are needed for the next patient done and start figuring out where the next patient’s room is. On a heavy dressing change service (like plastic surgery) please carry the dressing supply bag (in call room). Make sure to leave it outside the room though. Please present 1 patient every day. This presentation should be given to the attending as well. Here is my outline of a presentation:\\
--liner\\
-O/N events\\
-Vitals\\
-Labs\\
-Plan by systems\\
-OR Cases: Scrub every case you can. Divide up the cases fairly. If the attendings ask you pimp questions, please share at the end of the day so we all learn!!\\
-In the OR here are all the tasks you should help with.\\
-write your name and residents name on the board. Write your gloves size too. Get your gloves and hand them to the circulator. \\
-help transfer patient from the stretcher to the OR bed\\
-Get the belt on the patient\\
-Put the SCDs on the patients legs\\
-Be an extra pair of hands to anesthesia to help intubate or put in new IVs\\
-At the end of the case, remove the drapes and put in garbage, help extubate, take off bovie pads, get the stretcher and transfer patient back to stretcher.\\
-Please walk the patient to PACU by opening doors\\
-Clinic: You will likely be assigned to clinic. Please ask how to help prep for clinic. This may be printing out the last note for each patient or helping prepare a list. Wear clinic clothes. Having a spare set of clinic clothes ready in your car can be a lifesaver.\\
-Weekend Rounding: Medical students round 1 weekend day per week and leave once all weekend work is completed if appropriate.\\
-The List:\\
-Pt info:\\
-Path:\\
-PMH:\\
-PSH:\\
-Home Meds:\\
---------\\
-N: \\
-P:\\
-CV:\\
-GI:\\
-GU:\\
-Heme: \\
-Endo:\\
-ID: \\
-FEN:\\
---------------\\
-Operation:\\
-Foley: - nice to write when d/c’d and if patient voiding\\
-Drains:\\
------------\\
-XC -- Primary team if a consult, No labs\\
-Team -- include the plan for the upcoming days here\\
-Discharge -- things for discharge like PT recs or ppx for discharge\\
 Recommended Apps:\\
@@ Line 88: / Line 19: @@
 Great Resources:\\
 In my opinion you need 3 things to be successful studying. Don’t go chasing too many other things to read:\\
-. Question bank: U-world is terrific.\\
+. Question bank: U-world is terrific. I recommend doing at least two NBME exams during your surgery block.\\
 . All inclusive go to resource: medbullets.com. This also has an accompanying premium version with good questions and it’s not too expensive. This website has everything you need for “pimp questions” and the tests. I don’t recommend chasing things further than this.\\
 . Passive learning through onlinemeded.org - these videos are gold. Watch them all for each rotation you are on.\\
@@ Line 96: / Line 27: @@
 {{:medical_student:schedule.png?200|}}
+==== FAQs ====
-Add Michigan Manual\\
+Frequently Asked Questions:\\
-Add Janus\\
-Add Grabbs and Smith\\
-==== Sub-I Guide ====
+**The List**\\
+- What should I be printing out? Both the "current list" and "handoff".\\
+- Where do you prefer us to write the vitals and updates? On the "Handoff."\\
+- Do you prefer the list stapled? yes\\
+- Is it okay to help update the list? Yes, it is your job to add patient's to the list that you are operating on and help update the list with the intern after rounds.\\
-Welcome to the University of Colorado Sub-I! We are really excited to have you. 4th year medical students rotate through Denver Health, UCH and Children's. The sites are a nice strength of the program and you will see a variety of patient populations and cases. Please make sure to coordinate with the different residents on each service. The on site resident can be found on the front page of this wiki. There is also an important section with contact information that can be found on the sidebar. It is recommended that Sub-Is take four "24 hour" call during your month. These calls should be when we are on Hand and/or Face call. You can see this on the front page calendar noted as Name**-H/F**.
+**Rounding**\\
+- Should I pre-round? Yes, we expect you to see your patient that you will present on rounds. You should be ready to present a 1-liner on your patient, overnight events, vital signs and labs, pain status, diet issues, urine and foley status, anticoagulation plan and antibiotic plan. This should be followed by your plan for the day.\\
+- I feel like I am in the way on rounds. How can I be helpful? I too felt in the way as a medical student. Personally, I stuffed a bunch of gloves in my pocket and had a bottle of hand sanitizer clipped to my jacket. The best way to be helpful is to pay attention to what is in the dressing coming off and then to be ready with the same items to hand to us. Patient's with flaps will always need the doppler ready.\\
+- Where can I get dressing supplies? You will be carrying around the dressing supply bag which is kept in the resident room. It is your job to stock this daily. It is a good idea to go "shopping" on the 6th floor med rooms to stock the bag.\\
+- What are the basic dressing supplies? Kerlix, 4x4 gauze, Medpore tape, ABD pads, ACE wrap, bacitracin, cotton applicators (q-tips), 1/4 inch packing, tegaderm, biopatch, marking pens.\\
+- What does ABD and ACE stand for? ABD is an old acronym for Army Battle Dressing. ACE stands for All Cotton Elastic. These are common pimp questions that you will be asked.\\
+- Should I really lead rounds? Having the medical student help lead rounds is unbelievably helpful. Our patients are all over the hospital and it's easy to miss people. Knowing where we are going next as we are leaving the room will make you very useful. You can help grab the elevator or help get isolation gowns out.\\
-Dr. Mathes is the Chief of Plastic Surgery and Dr. Chong is the Program Director. You should try and scrub as many cases as possible with them at UCH. See the schedule above to see how EPIC works for looking for cases. You should "plan" your week and know what cases you are going to each day. If there is a third year medical student, you are also in charge of splitting up and assigning the cases for the week.
+**OR**\\
+- How do I help get the patient ready for the OR? Make sure you read about the patient and know the PMH/PSH and reason for their operation. Ask the nurse if they would like help transporting the patient to the OR. Almost all cases will have arms out. For breast cases, the arms need to be wrapped. Most people use kerlix, Dr. Mathes uses cast padding, Dr. Livermore uses blankets. First pad the arms with purple foam. Make sure the SCDs are ready on the bed. Help get the bed in and out of the room. Help anesthesia get set up. You can help them set up the extra IVs or a-lines. Makes sure you give the circulator your gloves and gown and write your name on the board under medical student.\\
 ==== Previous Feedback ====
-I would watch youtube videos the night before of each procedure and review the anatomy. For understanding post op care, I thought Pestana’s surgery notes were useful. Touch surgery app was excellent but they didn’t cover many of the cases I saw. I would also note to prepare for multiple of your teams attending’s cases as your day can vary. Overall I think spending a time at night made the OR educational even if I wasn’t actively involved and amazing when I was.
+I would watch youtube videos the night before of each procedure and review the anatomy. For understanding post op care, I thought Pestana’s surgery notes were useful. Touch surgery app was excellent but they didn’t cover many of the cases I saw. I would also note to prepare for multiple of your teams attending’s cases as your day can vary. Overall I think spending a time at night made the OR educational even if I wasn’t actively involved and amazing when I was. \\
+--\\
+My only feedback is that the basics of dressing changes were new to me since I haven’t gone through gen surgery yet so I don’t know if you know of a good resource with the basics of dressing changes and materials but that was something that might be helpful. In terms of resources I think it would be great to include Michigan and Janis because they got me through many of the basics of all of the procedures I saw. I think that having high expectations of us is really valuable in preparing us and helping build our knowledge and confidence during third year and moving forward.\\
+--\\
+==== Heslop's intern guide to other interns ====
+{{ :medical_student:how_to_rock_plastic_surgery_-_intern_guide.docx |}}
+==== Advice from Past Medical Students ====
+If you are a medical student who has rotated with PRS, please add something here. It can be something you learned, coffee/food recommendations around the hospital, things to do to impress nurses/residents/attendings, or quotes from residents or attendings that stuck with you.
+//Nicholas R W Cleland, Class of 2023//\\
+Plastics is a surgical field that has an incredible amount of variety. Try and see as many different kinds of surgeries as you can. Since you also need to get evaluations from attendings, it is also a good idea to spend a lot of time working with one or two attendings. This is also a great time to learn general wound care. Sure, being in the OR and learning the steps to a DIEP are cool, but learning how to change a wound vac is more likely to benefit you in the future.\\
+If you haven't already, get compression socks. You will spend a lot of time standing and your feet will be swollen by the end of the day. I also recommend getting 3-5 scrub caps depending on how often you do laundry. I would also recommend getting a qbank on your phone so you can do practice questions in between cases. The Michigan Manual of Plastic Surgery is also nice to have on your phone so you can do some reading on a procedure before a case. A pdf version can be found in the Media Manager of this wiki (upper right corner).\\
+When you are holding a flap for a resident or an attending, the goal is to maximize THEIR view, not yours. Hold it so they can see what they are doing.\\
+"It is not for you to see."\\
+Dr. Kaoutzanis \\
+If you see something that you think is wrong or off, say something. The most important person in the room isn't the attending, it isn't the resident, it isn't you, it's the patient. \\
+"Don't be scared to speak up. The most important person in the room isn't Dr. K, it's the patient."\\
+ Christian the scrub nurse\\
+__Pimp Questions:__\\
+What are the stages of skin graft healing?\\
+Diffusion: skin graft acquires nutrients from nearby areas, but not from extant blood vessels. This keeps the graft alive during days 1-2.\\
+Imbibation: skin graft begins to acquire nutrients from extant capillaries, but the capillaries are not yet lined up. Days 2-3.\\
+Inosculation: capillaries in the graft and the recipient site line up. Days 3-4. \\
+Revascularization: skin graft becomes vascularized. Day 5.\\
+(The answer changes depending on who you ask, but if you get asked this, this is a good answer.)
+What are the layers of the abdominal wall?\\
+Above the arcuate line: Skin, subcutaneous tissue (Camper's fascia then Scarpa's fascia), external oblique aponeurosis, internal oblique aponeurosis, rectus muscle, internal oblique aponeurosis, transversus abdominus aponeurosis, transversalis fascia, extraperitoneal fascia, peritoneum.\\
+Below the arcuate line: aponeuroses of external oblique, internal oblique, transversus abdominus are all shallow to rectus muscle.\\
+What are the anatomical borders of the breast?\\
+Superior: clavicle or 2nd rib\\
+Inferior: IMF (inframammary fold) \\
+Medial: sternum \\
+Lateral: latissimus dorsi\\
+Deep: pectoralis major \\
+What is the blood supply of the breast?\\
+Internal thoracic artery, intercostal arteries, lateral thoracic artery, thoracoacromial artery. \\
+Why do we de-epithelialize a flap for a DIEP or the skin under a nipple for a nipple reconstruction?\\
+The natural life cycle of the epidermis is to slough off. If you leave the epidermis there and then put it underneath more skin, you can end up with a cyst.\\
+What plane do we put a TAb block in?\\
+TAb = transversus abdominus. The block is put in the transversus abdominus fascial plane with ultrasound guidance. \\
+Why do you remove erectile tissue from the penis when making a neo-vagina during a vaginoplasty?\\
+If the patient were to get an erection after the procedure has been completed, you could tear sutures or damage the neo-vagina.\\