Plastics

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. 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:
1-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 yo help intubate or put in new IVs
At the end of the case, remove the drapes, help extubate, 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 and leave once all weekend work is done 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:
Touch Surgery - Great overall resource for walking you through the steps of an operation and pertinent anatomy.
Complete Anatomy - A nice Anatomy Atlas for on the go on your phone.
Epocrates - Pharmacy app that is good for looking up medications and dosing.

The Things I Carried:
4 Color Pen: BIC 4-Color Grip Ball Pen
Flashlight: Streamlight 66118 Stylus Pro LED Pen Light with Holster, Black
Trauma Shears: Prestige Medical Fluoride Scissor, Black, 7 1/2 Inch (Amazon)
Stethoscope: Some attendings want this: Schulick, Vogel
Headlight: Useful on ENT
Reflex Hammer: Useful on NSGY

Great Resources:
In my opinion you need 3 things to be successful studying. Don’t go chasing too many other things to read:
1. Question bank: U-world is terrific.
2. 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.
3. Passive learning through onlinemeded.org - these videos are gold. Watch them all for each rotation you are on.

Preparing for cases Section:
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.

To look up the cases for the week, go to EPIC → Schedule and enter then following attendings. Make sure you choose All Departments. You are expected to have read about the patients and each case the night before. In the morning, you will get asked what cases you are doing for the day.

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