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--- medical_student:medical_students [2020/06/11 18:36] – old revision restored (2020/03/11 15:33) jonathan
+++ medical_student:medical_students [2024/04/05 12:38] (current) – taylor
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 ==== Expectations for Medical Students ====
-If at any time you there is an issue on the rotation please do not hesitate to contact Erin Oglesby.\\
+{{ :medical_student:ai_orientation_packet.docx |}}
-Course Coordinator: Erin Oglesby. E-mail: erin.oglesby@ucdenver.edu\\
-Office: 303-724-4620 Cell: 443-804-2224\\
-Course Director: Dr. Tae Chong E-mail: tae.chong@ucdenver.edu
-UCH Intern Pager: 303-266-4354\\
-Welcome to Plastic Surgery. MS3s split their time between the University Hospital and Children's. The University Service is separate from the Hand Service, but you are more than welcome to attend those cases as well. The rotation is quite busy and you are expected to round and help prepare the list in the morning with the University Service except when your lecture day starts at 6am. Please round with the team before attending clinic at Children's. Make sure you contact the intern on service before you start so you can coordinate for rounds and preparing the list. The intern can let you know where the dressing bag is currently being kept so you can pick it up before rounds.\\
-You are expected to read and prepare for each case you attend. You are expected to have read and prepared for the case you will attend the night before. The best medical students will pick their assignments for the week before the start of the week.\\
-Reading tips for success -- I highly suggest obtaining the following books. You can search by ISBN number in [[https://libgen.is/|Library Genesis]]. Or you can buy them on [[http://amazon.com|Amazon]].\\
-Operative Steps (Best way to get all the "pimp" question right!): Operative Techniques in Plastic Surgery (Chung). ISBN: 9781496339508\\
-General Reading: Grabb and Smith's (ISBN: 978-1451109559)\\
-Pocket Manual: Michigan Manual (ISBN: 978-1451183672)\\
-Finding the OR Control desk\\
-- University - 2 nd floor on the North side of the OR’s, across the hall from the Cardio-Thoracic ICU
-(please note that this is the AIP OR, not the AOP OR).\\
-- Children’s - 2 nd floor on the North-West side of the hospital\\
-Daily MS3 Assignments:\\
-Monday - Lecture vs Any Attending at University AIP/AOP\\
-Tuesday - University AIP OR with Dr. Chong\\
-Wednesday - Craniofacial Clinic at Children's with Dr. Khechoyan and French. (Please wear your clean white coat and business attire.)\\
-Thursday - Any Attending at University AIP/AOP\\
-Friday - Any Attending at University AIP/AOP\\
-Surgical resident work room - 6th floor across from patient room 661. Take elevator E to the 6th floor.\\
-Plastics call room - near elevator D on the 2nd floor. Turn left coming out of elevator D and find room 2022. Code is master code (84845).\\
-The Plastic Surgery (University) Dressing Bag for morning rounds is the red courier bag on the right wall. Make sure you keep the supply bag well stocked (you can access new supplies in the supply room near the surgical resident's lounge or the ED). Supplies include:\\
-  * Tegaderm of all sizes
-  * 4x4 gauze
-  * Xeroform of various sizes
-  * Bacitracin
-  * Suture removal kit
-  * Staple removal kit
-  * ABD pads (abdominal pads)
-  * Bias (a wrap)
-  * Various tape
-  * Other supplies will depend on specific patient population
-Childrens Multidisciplinary Clinic - 2nd floor from the main entrance. Follow signs to "multidisciplinary clinic". EPIC - use "MDC Craniofacial", go to schedule, drop down MDC Craniofacial. Topics to cover for Craniofacial Clinic: deformational plagiocephaly, craniosynostesis, cleft palate and lip, and sutures of the skull. \\
-==== Sub-I Guide ====
-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**.
-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 and clinic for the week.
-Core topics to cover during your rotation
-  * General: wound healing, infections, flaps and grafts
-  * Peds: cleft lip/palate, craniosynostosis, vascular malformations/skin lesions
-  * Hand: fractures, nerve compressions, tendons, infections
-  * Breast: augmentation, reduction, recon (implant and autologous)
-  * Trunk/Lower Extremity: trunk recon, pressure sores, lower extremity recon
-  * Head/Neck: facial trauma
-  * Aesthetic: body contouring, facial aesthetic procedures, injectables and lasers
-==== Jonathan's (Gen Surg) Med Stud Advice ====
-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:\\
-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 185: / Line 54: @@
 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.\\
 --\\
-How to do well as a M3 on your surgery clerkship
+==== 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\\
- Rule #1:  Know your place on rounds.\\
+__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.)
-Your objective as a third-year on rounds is to help out the efficiency and flow of the team.  You should
+What are the layers of the abdominal wall?\\
-do everything you can to (1) not get in the way of the flow of rounding and (2) speed up the flow.  One particular example of the former is standing near the door so you can leave before your team and direct the team to the next patient’s room; this contributes positively to rounding because you are helping out the team without getting in their way.  You should also carry 4x4 (gauze), a variety of medical tape, saline flushes, and clean gloves (for future rooms) to supply to your team if they choose to change the dressings. Be on time and be prepared to present patients at table rounds.\\
+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.\\
-Rule #2: Know your place in the OR.\\
+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?\\
-Your objective as a third-year in the OR is to help out the efficiency and flow of your OR team (Surprise!
+Internal thoracic artery, intercostal arteries, lateral thoracic artery, thoracoacromial artery. \\
-The goal is not different -- how you implement it is though). You may have learned that anesthesia transfers the patient from their preop bed onto the OR bed and back onto the preop bed for transfer to PACU.  In truth, you should be assisting, if not doing this. You can help a lot by anticipating the flow of the OR, that is, anticipating what you need to do next to get the patient perfectly ready to be operated on.  A brief general outline of this is included below:\\
+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.\\
-      * Transfer patient onto OR bed
+What plane do we put a TAb block in?\\
-      * Attach on arm boards onto OR bed and secure patient’s arms w/ purple foam padding
+TAb = transversus abdominus. The block is put in the transversus abdominus fascial plane with ultrasound guidance. \\
-      * Remove lower segments of OR bed to shorten OR bed (if called for)
-      * Attach stirrups if operation requires lithotomy position
-      * Shave around incision site and tape up hair
-      * Secure the patient with belt or tape (depending on attending preference)
-      *  Know when to scrub in aka when there is a lull in the set up (your resident may already be walking to the door).
-      * When the operation is complete, stay to clean up and be quick about it.  You may have already broken scrub and discarded your scrub material, but grab gloves immediately and help out.
-      * Prior to transfer secure the patient’s arms.  Anesthesia will thank you for this because then they won’t have to worry about the patient trying to claw out the IVs/tubes they took time to insert.
-      *  Follow your patient to pacu and write down your team’s pager number on the patient’s file in the PACU.
+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.\\