University of Utah School of Medicine Clerkship Survival Guide - 2021 For students, by students
Founders Rachel Tsolinas (MS 2021) & Sam Wilkinson (MS 2021)
2021 Edition Editors Gina Allyn (MS 2022) & Abigail Luman (MS 2022) Introduction
What is The Clerkship Survival Guide’s Main Purpose?
In an increasingly collaborative era of medicine that is dependent upon rapid advances in technology, navigating these medical systems requires a basic understanding of the predominant values and daily workings of the environment.
This unspoken cultural process with its own rituals and traditions that socializes students to what is valued in medical practice is called the hidden curriculum (HC). It is a concept in medical education that describes the powerful efect of unspoken learning on professional identity formation. Often the HC quickly usurps the formal curriculum as the “true educator” early in clerkships, and maintains this position throughout a physician’s career. Therefore, early awareness of the HC is advantageous. However, in traditional medical education, these tacit processes of values, beliefs, expectations and social practices are not formally taught to students.
The goal of the Clerkship Survival Guide is to tangibly assist students in bridging the divide between the formal curriculum and the HC before clerkships. The document systematically addresses important aspects of clerkships including performance evaluation examples, study resources, targeted advice for core rotations, anonymous reporting of mistreatment and recommendations that range from guidance on rounding etiquette to what constitutes both appropriate and inappropriate behavior. How to Use this Guide
However you want! Most students fnd this guide most helpful at the beginning of MS3 year and then reference it occasionally in later clerkships. Our recommendation, before day 1 of clerkships, is to explore Some Honest Advice, Succeeding as an MS3, and General Inpatient Day Outline. You can reference other sections as needed. We have attempted to answer as many frequently asked questions in this guide as we can. So if you fnd yourself lost in the middle of the hospital, panicking, and asking, “Where is the nearest scrub machine!?” pull out your trusted Clerkship Survival Guide and take a breath. You’ve got this.
Pro Tip: Save this google doc or PDF to your phone and laptop for easy access!!
1 Disclaimer
This guide was created by students and does not necessarily refect the views of the clerkship directors or the University of Utah School of Medicine. It is a superfcial overview of educational purposes only, and is not meant to serve as a comprehensive guide to therapy selection nor prescribing. Please consult current drug references, the resources listed, and your attendings/residents. Importantly, this is not a substitute for the rotation syllabi. You need to read each rotation syllabus to be adequately prepared as the organization of and assignments for clerkships are subject to change.
Special Thanks & Acknowledgements
MS 2019 MS 2020 MS 2021 MS 2022 MS 2023 Andrew Kithas Ali Etman Adelheid Langner Abbie Luman* Amanda Cooper* Angie Schwartz JJ Ward Veronica Urbik Gina Allyn* Jordan Nishimoto* Guinn Dunn Lily Boettcher Samuel Wilkinson* Alyssa Lolofe Hailey Shepherd Rachel Tsolinas* Amanda Truong John Downie Kristen Haapy John Sanchez Julie Weis Troy Teeples
MS 2024
Heather Cummins* Edward Holloway* Jake Winter
*Members of The Core, a UUSOM student group who publish The Clerkship Survival Guide and The Medical School Starter Pack. More information about our group can be found here.
Faculty Project Mentor Dr. Kathryn B. Moore
Faculty & Staff
Dr. Adam Stevenson Ashley Crompton Rachael Smith Dr. Danielle Roussel Carol Stevens Reed Esparza Dr. Jorie Colbert-Getz Dellene Stonehocker Stacey Leventis Dr. Lee Chung Jeanette Church Tammy Llewelyn Dr. Peter Hannon Jessica Bickley Tom Hurtado Dr. Rebecca Lish Julia Price Kylie Christensen Dr. Steven Baumann Kenya Kay Arnett
Other
University of Texas Veritas Mentors in Medicine (MiM) Project
2 Table of Contents
Introduction 1 What is The Clerkship Survival Guide’s Main Purpose? 1 How to Use this Guide 1 Disclaimer 2 Special Thanks & Acknowledgements 2
Clerkship Contact Information 5
Some Honest Advice 6
Structure of Third Year 7
Succeeding as an MS3: Dos & Don’ts 8 The “Do” List 8 The “Don’t” List 13
MD-PhD: The Transition to Rotations 15
Idaho Students 16
Resources 17 Mistreatment 17 Academic Success Program 20 Mobile Apps - Clinical Resources 21
Examples of Clinical Evaluations on the MSPE 22
NBME Shelf Exams and Study Resources 25
Electronic Medical Records (EMRs) 27 Citrix 27 Some Select Epic Tips 27 How to Set Up Dragon Dictation for Epic 29
General Inpatient Day Outline 30 Day 1 30 Pre-Rounding 30 Rounding 32 Ways to Shine 34
Internal Medicine Clinical Clerkship 35
Surgery Clinical Clerkship 42
3 Family Medicine Clinical Clerkship 48
Obstetrics & Gynecology Clinical Clerkship 51
Pediatrics Clinical Clerkship 55
Psychiatry Clinical Clerkship 60
Neurology Clinical Clerkship 63
Electives 66
Rural & Underserved Utah Training Experience (RUUTE) 67
Failed Clerkships 68
Main Clinical Sites 69 University of Utah Hospital 70 Huntsman Mental Health Institute 72 George E. Wahlen Department of Veterans Afairs 72 Intermountain Healthcare 75 Primary Children’s Hospital 75 LDS Hospital 76 Intermountain Medical Center 77 The U’s Emergency Contact Information 81
4 Clerkship Contact Information
Administration
Laurie Leclair, M.D. Assistant Dean, Clinical Curriculum [email protected] 801-585-6125
Rachael Smith Clinical Curriculum Program Manager [email protected] 801-585-6125
Internal Medicine
Katie Lappe, M.D. Director [email protected] 801-581-2401
Carol Stevens Coordinator [email protected] 801-585-7716
Surgery
Luke Buchmann, M.D. Director [email protected] 801-585-7143
Claire Griffin, M.D. Director [email protected]
Dellene Stonehocker Coordinator [email protected] 801-581-8833
Family Medicine
Marlana Li, M.D. Director [email protected] 801-585-5984
Kathryn Hastings, M.D. Director [email protected]
Ashley Crompton Coordinator [email protected] 801-662-5710
Obstetrics & Gynecology
Tiffany Weber, M.D. Director [email protected] 801-213-2995
Ibrahim Hammad, M.D. Director [email protected]
Natalie Moore Coordinator [email protected] 801-581-5501
Pediatrics
Brian Good, M.D. Director [email protected] 801-662-3653
Jonathan Sawicki, M.D. Director [email protected] 801-662-3652
Tiffany Passow Coordinator [email protected] 801-662-5755
Psychiatry
Paula Gibbs, M.D. Director [email protected] 801-585-1575
Lindsay Clark Coordinator [email protected] 801-581-6329
Neurology
Lee Chung, M.D. Co-Director [email protected] 865-850-3589
Peter Hannon, M.D. Co-Director [email protected] 801-587-9935
Jeanette Church Coordinator [email protected] 801-585-6803
5 Some Honest Advice
At some point during third year you will feel overwhelmed. These feelings of discouragement and frustration may leave you thinking that you are a terrible student. This is normal, but not true. You deserve to be here and you have the resilience to make it through this. If you are worried about the state of your mental health at any point, there is help available to you; this includes your classmates, SBOs, admin, the wellness center, mentors, etc. You are not alone.
Third year is a humbling experience for everyone. There is much you don’t know, and you are perpetually the new person on the team. Embrace it. The residents, attendings, nurses, PAs and everyone else know you are there to learn and they were once in your shoes.
Throughout third year you will wonder “what should I be doing right now?” or “do they want me to be doing X, Y, or Z?” We are here to tell you that you are doing exactly what you are supposed to be doing, and that is: learning on the job.
You are not expected to be a seasoned health care provider.
Also, there are going to be many things during clerkships that are outside of your control. Nothing is going to be how you imagined it. Whether it be a global pandemic or a mean scrub tech, 3rd year is the perfect time to start developing resilience. This might involve taking extra time to emphasize your self care or talking to your closest supporters. The coping skills you build during third year will serve you the rest of this journey, and they will be unique to your needs.
Be respectful, take initiative to look things up on your own, stay eager and receptive, and be aware of your surroundings. Keep in mind that you are supposed to be there, asking questions and building the skills to help you take excellent care of people!
Pearl of Wisdom: “The goal of a third year medical student is to learn. That sounds silly and simple, but seriously, just go in with the goal to learn as much as you can! I would often go to my patients' procedures, even if my team wasn't involved, or go check out other therapies ofered by the hospital (PT, OT, speech, etc).”
6 Structure of Third Year
Clinical Clerkships Important Dates
Internal Medicine 8 weeks USMLE 1/Phase 3 Prep/Vacation 04/2021 - 06/06/21 - EPIC/iCentra Training - VA Credentialing - Badging - Phones/Pagers
Surgery 8 weeks Transition to Clerkships 06/07/21 - 06/11/21
Family Medicine 6 weeks Winter Break (Neuro) 12/27/21 - 1/9/22
Obstetrics & Gynecology 6 weeks Winter Break (all others) 12/20/21 - 1/2/22
Pediatrics 6 weeks Class Meeting December TBD
Psychiatry 6 weeks Class Meeting January TBD
Neurology 4 weeks
Other Requirements
Elective Coursework 4 weeks
7 Succeeding as an MS3: Dos & Don’ts
The “Do” List ______
DO Work with the rotation coordinators
Top 5 things the coordinators (and directors) would like you to do:
❖ Read the syllabus before orientation. ❖ Read emails and reply to the individual ones that are sent to you. ❖ Ask questions, no matter how small or large. Coordinator is your frst point of contact. ❖ Let your coordinator/director know in advance of the rotation if you have a conference, presentation, or personal event during the clerkship. Excused time is not permitted in third year, but they will try to modify your clinic schedule. ❖ Let the coordinator, director and your team know if you will not be in the clinic (ex: illness, fat tire, etc.)
DO Study almost* every day
Make a study plan / study goals at the beginning of each clerkship. This looks diferent for everyone, so do what feels right to you. An example can be found here.
❖ Academic Success is an excellent resource, especially the fourth year tutors. ❖ Didactics will help with the highest-yield topics. ❖ Most people select 1-2 content resources (i.e. a book or video resource) and a question bank. See each individual clerkship sections for recommendations. ❖ On average, we estimate students study ~ 0.5 - 2 hours per day depending on the clerkship. This may be during down time during the day or after work.
*some of us choose to have a designated day of every week from all studying/work, this is up to you
Pearl of Wisdom: “I created a study plan for myself, but also made a wellness goal to not study after 7pm which I prioritized over my study plan. If I got home close to or after 7pm, I did not study. I attribute a lot of my sanity to this rule.”
8 DO Be fexible and adapt
Attendings and residents vary greatly in personality, expectations, and teaching styles. Also, team dynamics will be very diferent for each rotation.
❖ Email or text your resident a couple days before the start of the rotation to introduce yourself and ask for meeting time/place. ❖ Ask your resident and attending about their expectations for you and how they like to run the team ❖ Let your resident and attending know what you are hoping to work on! ❖ Read body language and tone for positive and negative feedback. ❖ Ask for feedback early, so you can make appropriate changes to improve. ❖ If the attending or resident are stressed, avoid asking for feedback. It is not the right time. Patient health and safety come frst. ❖ Show that you can accept feedback and improve. ❖ You will get varied feedback rotation to rotation - it gets easier with time to know what is actually important to focus on improving - this idea is often referred to as “chase the attending.” ❖ Be reassured that this improves with time as you move through rotations; it is not easy at frst to adjust to rapidly changing expectations.
Pearl of Wisdom: “Ask about their expectations for you.”
DO Be a team player
Medicine is a team sport that requires many disciplines, including physicians, nurses, PAs, OT, PT, RT, OR techs, admins, medical assistants, maintenance staf, and many more.
❖ Help your classmates and don’t call attention to it when you do. Attendings and residents will notice when you work as a team player. ❖ Work hard during all of your rotations, not just the ones you are interested in. Program directors talk, and all of your evaluations matter. ❖ Take initiative to make sure all of your patients are taken care of.
DO Be respectful
9 Simple, but very important.
DO Be punctual and prepared
Be on time every day. Plan on being early so you are never late. And never walk in late holding a Starbucks cup.
Pearl of Wisdom: “Go home when you’re told to. Ask if there’s anything else to do and then leave.”
DO Dress the part
Always wear either professional dress or scrubs. During the 2020-2021 academic year, residents and students always wore scrubs in the hospital due to COVID precautions. Professional dress was maintained in clinics. If unsure, check with your resident before the rotation starts.
DO Communicate with your team
On day one, write your name and cell phone number on the team whiteboard. Also, let your senior/attending know in advance when you will have didactics or other clerkship requirements.
DO Show interest and ask questions
Ask questions that show your curiosity, even if you know you don’t want to pursue that specialty. You are not bothering your team if you ask questions, but try to have awareness of when is a good time to ask questions. If everyone seems very busy - save the question for later.
DO Manage your time
Allow for more time to pre-round on your patients at the beginning of each rotation. Ask other students or residents on how to improve your efciency. Trust that this improves with time.
DO Tailor your physical exam to the clerkship and the patient
10 You will get a lot of experience doing pertinent physical exams. Consider using Bates or reaching out to your CMC mentor to review relevant physical exams prior to each rotation if needed. Check the specifc rotation syllabi for further details.
Clerkship High-Yield for Physical Exam
Internal Medicine Pulm/CV/ABD on most patients
Surgery ABD is most important for general surgery
Family Medicine Full physical exam. Be sure to review MSK. Pulm/CV/ABD on most patients
Obstetrics & Prenatal exams, fetal heart tones, pelvic exam, breast exam Gynecology
Pediatrics Healthy newborn exam, APGAR, developmental milestones
Psychiatry Mental status exam, neuro exam
Neurology Full neurological exam (Mental status exam, cranial nerves, peripheral nerves, refexes, gait, coordination), ophthalmologic exam
DO Tailor your presentation to the clerkship
This will come with time and observation.
Scutsheets
Having a template that works for you is very important during rounds preparation. Some rotations will provide you with templates to use, however others will not. For the ones that will not here is a resource of premade scutsheets: http://medfools.com/downloads.php
DO Prioritize your well-being
Pearl of Wisdom: “You have very little control over your schedule as a third year, so make your time your own, be purposeful and intentional with how you spend your evenings/day of.”
Third year of medical school is a taxing endeavour for many reasons. You lose control over your schedule and the amount of time spent on rotations makes it more difcult to prioritize self care activities for many of us. Take advantage of every opportunity you have to invest in your happiness and take care of your own health.
11 Pearl of Wisdom: “Take some time for yourself. You're not going to fnd any, but make time.”
Physical & Mental Health Tips
❖ Exercise when you can! Exercise will help clear your mind and improve learning. ❖ Eat real food. Pack your own snacks and meals if you can. ❖ Spend time with friends and family when you can. ❖ It’s okay to take a day of from studying when you need to. ❖ See the doctor when you need to. ❖ The importance of sleep cannot be overstated. ❖ If spirituality is a priority, fnd a plan that works for you. ❖ Most Importantly: If you fnd yourself struggling with depression, anxiety, stress management, time management, career planning, substance use, or anything else, seek help! You are not alone and there is help. Every year, medical students, residents, and young physicians end their life too soon, so please ask for help. Talk to clerkship directors, deans, or the Medical Student Wellness Program. If you don’t take care of yourself, you can’t take care of others.
Pearl of Wisdom: “Continue to exercise and stay close to people you care about. It is easy to become isolated and overwhelmed in 3rd year.”
Medical Student Wellness Program
❖ Phone: 801-213-1102 ❖ Email: [email protected] ❖ Website: https://medicine.utah.edu/students/current-students/wellness/ ❖ FAQs ➢ Who is eligible? Any medical student, spouse, signifcant other, or frst-degree relative living with the medical student. ➢ What does it cost? It is free.
After-Hours Mental Health Emergencies
❖ UNI Crisis Line: 801-587-3000 ❖ Mental health hotline: (800) 273-8255
12 ❖ Suicide hotline: (800) 784-2433
Pearl of Wisdom: “Make time to connect with your med student friends. It’s a tough time and having friends who are going through the same highs and lows is awesome. Plus family don't always think it’s fun to talk about crazy things you’ve seen.”
The “Don’t” List ______
DON’T Act like you know everything
It is seen as inappropriate to argue with an attending when you disagree with them. Open discussion and ofering contributions is good, but it is not okay to imply you know more than they do.
Pearl of Wisdom: “[This year is] going to be difcult but one of the most transformative years of medical school. In the end, you will feel almost competent in at least a few situations.”
DON’T Make other medical students or residents look bad
Making your peers or residents look bad or calling added attention to their mistakes does not help you or your team. Never quiz/test another medical student in front of residents and attendings.
DON’T Make excuses
Own your mistakes and learn from them. This is tough, especially at the start of 3rd year because you will get a large amount of feedback in a short period of time and this can be tiring. Your willingness to grow from feedback will help you improve in the long term!
DON’T Be on your device all the time
Do NOT use your phone to access social media or other personal apps during work hours. You may use your device to look up clinical information, but be aware this may look like you are looking at something else. Make it obvious you are looking up something medical by stating what you are going to look up and laying your phone fat so everyone can see what you are doing.
13 DON’T Lie about the specialty you are interested in
Being honest about your interests will allow for residents to adapt their teaching to your interests. For example, if you are interested in oncology, they may make more of an efort to put you on cases with cancer patients, then ask you to investigate a certain aspect of the case to present to the team. It pays to be honest. Lying about what you want to go into takes away from classmates that need the mentorship from a specialty they are interested in that are on the rotation at the same time as you.
14 MD-PhD: The Transition to Rotations
“Practice Clerkship” - This is an optional 2 week ungraded clinical rotation with the purpose of preparing the MD-PhD student for the clinical environment and of the expectations of a third year medical student. Please contact Dr. Laurie Leclair and Dr. Kim Evason for more information.
Transition to 3rd Year Bootcamp - Held yearly in May for those who will be beginning clinical clerkships. This is a one day session led by current MS4 MD-PhD students.
MD-PhD General Advisors - We recommend meeting at least yearly with your assigned faculty mentor. Individual development plans (IDPs) should also be updated yearly and discussed.
MD-PhD Specialty Advisors - Near the end of the PhD years, a specialty advisor will be assigned based on the student’s clinical interests. This faculty mentor will assist the student in advice for clinical rotations and physician scientist-friendly residency programs.
Monthly Meetings - It is encouraged, but not required, for MD-PhD students in their third year of medical school to continue to attend program monthly meetings and summer research presentations if it does not overlap with clerkship duties.
MD-PhD Program Leadership
❖ Janet Bassett, Program Manager: [email protected] ❖ Michael Kay, MD, PhD, Program Director: [email protected] ❖ Kim Evason, MD, PhD, Associate Program Director: [email protected]
15 Idaho Students Idaho students are required to do their family medicine rotations in Idaho. To set up family medicine rotation contact [email protected] and [email protected].
Does the RUUTE program have diferent requirements for Idaho students? Other rotations may be completed in Utah. Idaho students can participate in both the RUUTE program and the Idaho Family Practice Clinical Clerkship.
Must have prior approval:
❖ The UUSOM pays students mileage for one trip to and from the location in Idaho.
❖ The UUSOM may pay for the mileage for each day the student drives.
❖ The UUSOM may pay up to $125 per week if a student needs to rent a place to stay.
❖ If the student stays with family or friends, the UUSOM may pay up to $75.00 for a host gift. An itemized receipt is required.
❖ The UUSOM may pay up to $75 for a gift for the student’s proctor. An itemized receipt is required.
Students must turn in receipts within one (1) month of the last day of their rotation to Tammy Llewelyn. Unfortunately receipts turned in after this point may not be reimbursed.
Not an Idaho student but want to go to Idaho?
Contact Tammy Llewelyn and Jessica Bickley. They are working to ofer more students the option.
16 Resources
Mistreatment
When raising a mistreatment concern, be as specifc as possible so that the report can be acted upon. If you feel comfortable, give your name and who the other party was, which allows for better follow-up. This can be done in many ways to protect you from retaliation. The University of Utah has a zero tolerance policy in regard to retaliation. Know that you can contact Dr. Stevenson, Dr. Cariello, Tom Hurtado, or other faculty before reporting the mistreatment to unpack whether what occurred was mistreatment. Mistreatment of a Student In person, email or phone: Not anonymous. ❖ Options of people to report your concern directly to: ➢ Course director or course coordinator. ➢ Dr. Stevenson, Dr. Samuelson, Tom Hurtado, Dr. Cariello, Dr. Lamb, etc. (Anyone that is part of of the student afairs or curriculum ofces). ➢ Any faculty mentor of yours, including your LOM preceptor, your CMC preceptor, your specialty mentor, etc. ➢ Generally anyone with whom you feel comfortable.
End of Course Surveys: Anonymous or not. Up to you. UUSOM recommends using this reporting route for specifc mistreatment. ❖ Helpful when you explain everything that happened in specifcs. ❖ If mistreatment has occurred, these get “fagged” for prompt follow up by SOM.
Pearl of Wisdom: “Sometimes attendings and residents are [mean] and it has nothing to do with you. They may be having a bad day, may not like working with students, etc, but it can make your day feel worse too. It's not your fault. You didn't do anything wrong. If it falls into mistreatment, don't be afraid to stick up for yourself and report it. Try to get through it and know the next group will probably be nicer.”
Mistreatment of a Patient File an RL6: Anonymous or not. Up to you.
17 ❖ RL6 is a U of U hospital form for reporting Unusual Occurrences (ranging from patients having an unexpected outcome, receiving the wrong medication, all the way to unprofessional behavior). ➢ Located on Pulse (Directions for adding RL6 to your homepage on pulse). ➢ Direct link to RL6 report form (Behavioral Event): See bottom of document for images of RL6.
Suspected Patient Abuse
If you encounter a patient you suspect has been a victim of physical or sexual abuse, there are algorithms on the University of Utah PULSE website that can guide appropriate action.
Utah’s state law requires mandatory reporting for the populations outlined below.
Children Vulnerable Adults Competent Adults Qualifers < 17 yrs > 65 yrs OR Not a child > 18 yrs with disability Not a vulnerable adult Who reports? Every adult citizen Every adult citizen Healthcare providers When to report? Suspected Child Abuse OR Witness Suspected violent abuse Assaultive Injury to Domestic violence
(does not have to have an injury to report) (does not have to have an injury to report)
18 Who to contact? Department of Children and Family Adult Protective Services Law Enforcement Services Law Enforcement Law Enforcement
How to access PULSE resources:
19 Academic Success Program
Meet with Academic Success early. There is a library of recommended text books for each rotation that you can check out.
They will automatically provide you with:
❖ 3 NBME Practice Test Vouchers for: ➢ Internal Medicine, Surgery ❖ 2 NBME Practice Test Vouchers for: ➢ Family Medicine, Neurology, Pediatrics, Psychiatry, OB/GYN
If you need more vouchers for NBME’s then email Academic Success to see if they can provide you with some.
See individual clerkship sections for recommendations on content and question bank resources.
Pearl of Wisdom: “Talk with academic success regularly.”
UUSOM Study Rooms
If HSEB is too far to walk, these are dedicated rooms in the UUSOM for us. Code for the doors are provided by Academic Success. ProTip: Save it to your phone when given to you!
❖ 1C047: Academic Success Library ❖ AC133 ❖ AR112
UUSOM Call Rooms
Codes provided by individual clerkships (i.e. Surgery and OBGYN). ProTip: Save it to your phone when given to you!
❖ 2C143 ❖ 2C145 ❖ 2845C ❖ 2849D
20 Mobile Apps - Clinical Resources
If you want an app talk with the library staf … they will probably buy it for you.
App Purpose Cost Most Frequently Key Clerkship Used by Students
Point of Care Medical Resources
UpToDate Evidence based clinical information and guidelines Free* ✓ ALL of them
USPSTF USPSTF preventive care guidelines Free ✓ FM, IM Recommendations
CDC Vaccine Schedule ACIP detailed immunization schedule Free ✓ Peds
DynaMed Medical equations, clinical criteria, decision trees, statistic calculators, units & dose Free* converters, search by specialty
Medline Plus US National Library of Medicine: encyclopedic information on medical conditions, Free medications, medical services.
Medscape Less dense version of UpToDate Free
US MEC US SPR US Medical Eligibility Criteria (US MEC) for Contraceptive Use Free OBGYN
Wiki EM Emergency Medicine specifc Free EM
Medication References
Epocrates Medication dosages, reasons for use, side efects, contraindications Free^ ✓
Good Rx Prescription Drug Prices Free
Diferential Diagnosis Resources
Diagnosaurus Organ system, symptom search for diferential diagnosis $4.99
$39.99/mo VisualDx Symptoms, signs, demographic search for targeted diferential diagnosis $399.99/yr
Other Useful Resources
MDCalc Medical Calculator Free ✓
Doximity Can use the phone feature to make calls from your cell phone and have your number Free appear as the hospital or clinic number
Eye Chart Pro Snellen, Sloan, ETDRS, Near Vision Free
Canopy Speak Multilingual medical translator to explain complex medical concepts in internal medicine, Free emergency medicine, OB/GYN and surgery specialties.
Journal Club Studies/Papers in bulleted format $6.99
Journal Wiki Club Summarizes and reviews landmark studies across medicine and surgical specialties Free
*University of Utah login identifcation: https://library.med.utah.edu/# ^In-App Purchases: Create an account as “medical student” for free access. Call customer service if problems arise
21 Examples of Clinical Evaluations on the MSPE
Process for appealing your MSPE paragraph or course grade (from Student Handbook):
“If a student feels a score or an individual assessment has been decided in an arbitrary or capricious manner s/he may appeal the assessment score to the course director/s up 21 business days (for Phase 3 and 4 courses) after the grade/score is posted. The course director(s) will have three business days to respond to the appeal. If a student wishes to challenge a course director’s decision, s/he may appeal to the Associate Dean of Curriculum [[email protected]]. The student must submit a one page written appeal summary and schedule an appointment to discuss the written appeal with the Associate Dean of Curriculum within three business days of receiving the course director’s decision. The Associate Dean of Curriculum will render a final decision in the matter.”
Pearl of Wisdom: “Forget about trying to honor. Just show up and try to learn. You’ll be less stressed and do better.”
MSPE Paragraph
Below is one example of a MSPE paragraph. Your qualitative preceptor evaluations will be turned into these paragraphs by the clerkship director. Note that the quality most discussed in the written evaluations is work ethic. Keep this in mind as you go through clerkships.
22 Quantitative Evaluations
Below is the rubric your preceptors will use to evaluate your EPAs. These contribute to your numerical clerkship grade. Look at this ahead of time so you know what they are evaluating you on. Consider asking your preceptors halfway through how you can improve on these.
Not EPA Observed 1 2 3 4 5
Patient N/O Lacks rapport Establishes rapport Establishes rapport Interviewing Disorganized Organized with all patients Unprioritized Intuitive Missing key Prioritized Adaptable information Gathers key info Explores additional Inefcient chief complaints
Physical Exam N/O Inattentive to patient Attends to patient Attends to patient comfort comfort comfort Disorganized Intuitive Unprioritized Organized Adaptable Fails to perform key Prioritized Correctly employs maneuvers Correctly performs and interprets Incorrectly performs PE and interprets advanced Unable to distinguish examination normal from abnormal maneuvers
Clinical N/O Fails to integrate info Integrates essential info Integrates info from Reasoning Proposes Proposes rational broad sources inappropriately diferential diagnosis Proposes broad narrow/unprioritized/u Considers standard of rationale and nsupported diferential care in treatment plan prioritized diagnosis diferential diagnosis Does not consider Adapts standard of standard of care in care treatment plan treatment plan recommendations to individual patient
Clinical Testing Recommends Recommends appropriate Appropriately N/O inappropriately tests recommends and broad/narrow/nonstandar Interprets results interprets advanced d testing Recognizes implications for testing Unable to interpret results diagnosis and management Utilizes advanced Fails to recognize resources for test signifcance of results recommendations and interpretation
Documentation N/O Disorganized Organized Highly efcient Unprioritized Prioritized Maintains Inaccurate Accurate organization, clarity, Missing key info Includes key info and accuracy for Poorly articulated Well-articulated clinical more complex Non-compliant reasoning patients Compliant
Presentation N/O Disorganized Adapted to setting Adaptable Unprioritized Organized Highly efcient Inaccurate Prioritized Maintains Missing key info Accurate organization, clarity, Poorly articulated Includes key info and accuracy for Well-articulated clinical more complex reasoning patients
23 Interprofessional N/O Not integrated into Integrates into team Integrates into team Teamwork team function function function Does not accurately Interprets and responds Interprets and interpret verbal and appropriately to verbal responds nonverbal and nonverbal appropriately to communication communication subtle verbal and Disrespectful or Appropriate response to nonverbal dishonest interactions authority communication even Poor communication Shows respect for under stress with team non-physician colleagues Appropriate Poor response to response to authority authority Efectively Dismissive of collaborates with non-physician non-physician colleagues colleagues
Pearl of Wisdom: “The sooner you stop placing value in an evaluation of you by someone you met for 5 minutes the happier you will be. No matter how many people tell you there is a "hack" to honoring - there isn't, be yourself.”
24 NBME Shelf Exams and Study Resources
At the end of each clerkship there will be an NBME shelf exam. Refer to course syllabus for exam score required to pass. Further information regarding scoring will be provided in each clerkship orientation. Shelf exam scores are included in residency applications.
Content & Structure
NBME shelf exams are more clinically oriented than USMLE Step 1 and are best described as short specialty-specifc Step 2 CK exams. Content is similar to NBME Comprehensive Clinical Science exams (practice tests). The shelf exams have questions with a clinical vignette format with one of the following questions:
❖ ...Which of the following is the most ➢ likely diagnosis? ➢ likely explanation for this patient’s symptoms? ➢ likely underlying cause of this clinical/lab/radiographic fnding? ➢ likely causal organism? ➢ likely to improve the underlying condition? ➢ likely to have prevented the patient's condition? ➢ appropriate pharmacotherapy? ➢ appropriate course of action/response? (patient counseling, ethics) ➢ appropriate next step in diagnosis/management? ➢ accurate interpretation of this result?
NBME Study Resources
Most students supplement their clinical experience with a content resource and a question bank. There will not be a study week during clerkships.
25 NBME Sample Subject Exams (Practice Test) Vouchers provided by Academic Success Program www.mynbme.org
Pearl of Wisdom: “Take a practice test every weekend of your clerkship [if you can and if this works for your study style]. Get extra vouchers.”
Clerkship Study Resources
Pick one or two study resources for each clerkship. Some resources are better for certain clerkships than others. You may use diferent resources for each clerkship. See specifc clerkship sections in the following pages for recommendations. Most popular in gold.
❖ Question Banks: ➢ Online MedEd (online subscription needed for QBank) ➢ AMBOSS (online subscription) ➢ UWorld (online subscription) ➢ PreTest book series (free for check out from ASP) ➢ American Academy of Family Practitioners Question Bank (Family Med only; free online at start of clerkship) ➢ Association of Professors of Gynecology and Obstetrics (OBGYN only; free online at start of clerkship) ➢ Surgery by DiVirgilio (Surgery only; free for check out from ASP) ❖ Case-based ➢ Case Files series (free for check out from ASP) ❖ Content Resource ➢ Online MedEd (videos; fashcards/notes/questions available for subscription) ➢ Blueprint series (free for check out from ASP) ➢ Step Up series (free for check out from ASP) ➢ First Aid series (free for check out from ASP) ➢ Dr. Emma Holliday’s review videos on YouTube for IM, Psych, Peds, and Surgery. PDFs of slides can be found here.
26 Electronic Medical Records (EMRs)
EMR training will be provided in Transitions to Clerkships week. This will take some time to learn, but once you can navigate one EMR you will be able to navigate the rest. To submit tickets for Epic, go to Pulse and select the blue button titled “Submit Hospital/Clinics IT Trouble Ticket”.
EMR System Where it is used IT Department
Epic University of Utah 801-587-6000
iCentra - PowerChart Intermountain Healthcare 801-442-5731
CPRS VA Hospital 801-582-1565 x1293
Citrix:
The interface from which Epic and iCentra can be launched. You will need to set this up around Transitions time at access.med.utah.edu. This is where you can always access Epic and iCentra from any computer, including your home laptop or desktop.
If you have a Mac with Catalina:
Catalina is not compatible with Citrix Receiver.
1. Go to receiver.citrix.com 2. Click Download for Mac 3. Install Citrix Workspace 4. Try logging in from access.med.utah.edu
Some Select Epic Tips How to Optimize Epic for Outpatient: https://www.youtube.com/watch?v=3BjSmOLkrh0&feature=youtu.be
27 Epic for Medicine Wards:
Where can I fnd ______? Location
Nursing charting (including CIWA, COWS, Down-facing arrow (top tab level in individual patient descriptions of BMs/urine, etc) chart) -> Rarely Used -> Flowsheets -> Search using box in upper right tab for COWS, CIWA, etc
Charted but unmeasured output (void, Input/Output tab -> will list on left hand side, can BM, emesis) determine time of event by clicking on time period row header to expand the view
Pictures of wounds Chart Review -> Media -> Clinical Photo (staf will document these on admission, sometimes will note progress over time if a long admission)
Pharmacy med reconciliation (“What Notes -> Ancillary (may have to go to sub-tab drop meds does your patient take at home?”) down to see this as an option)
Easy prerounding setup Patient Lists view -> make sure gray arrow below list is pointing down, exposing preview view -> can search tabs like vitals, pain, ins/outs, etc
How to print IM Sign-Out List Patient list view -> New list with Name (MRN), Room/Unit, IM Reason for Admit, IM Anticipated Issues, IM To Do, Code Status -> Print -> Current List
How to print Rounding List Patient list view -> Patient Report -> Select view (BMT has 1 pt per page, Renal or ICU have meds and ins/outs, med and surg are barebones - vitals and outlines)
What tubes/lines/wounds/dressings Summary view -> IP Clinical Overview -> patient currently has Lines/Drains/Wounds/Airways sometimes listed as “LDA”
Outside Hospital Records Click the small “e” next to the patient’s name/picture, then click documents. Media tab for direct photos of records, if not there, can place Communication order to HUC (will need to be co-signed)
28 Orders that should show up but aren’t After typing in order and searching, try changing to appearing in search “Facility List” tab of order pop-up
Patients that I’m cross-covering on an Patient Lists view -> white search box in upper right -> unknown team Search all Admitted
Patient we’re admitting but still in the ED/ Patient Lists view -> white search box in upper right -> not ofcially admitted yet change to Search all Pre-Admits
Clinical scores such as CHADS-VASC MD Calc tab (same level as Summary, etc) – will pre-fll some values based on chart
How To Set Up Dragon Dictation for Epic
You will need to download and confgure the PowerMic Mobile app on your smartphone. This app will be used with Dragon Medical One embedded in EPIC. To install, and confgure, follow the below steps.
1. Download the PowerMic Mobile app from your App store 2. With the Powermic Mobile app open on your phone, tap the link below on your phone. You will then be prompted to choose either IOS or Android confguration. Choose the appropriate auto confguration fle depending on your smartphone.
Username = uNID with capital U. (“U#######”)
http://powermicmobile.nuance.com/PowerMicMobile/23757BA0-CFBE-4A15-B207-9 7AE65113659/index.html
If for some reason the above link does not “auto-confg” your PowerMic mobile app when selected, you can copy the link below, from your phone, tap “Add Profle” from the Powermic mobile app home screen, and paste the fle directly into the “URL” feld, then name the profle, Profle 1.
dmic://confg_?NmsToken=RkEyMzU2Q0UtQTExNC00NkVFLTlFOTctQTVBMDcwMjA4 NjdF
3. In Epic, click EPIC -> Tools -> Dragon to set it up. Select the Mobile App as your location.
Student Afairs should email you a short Dragon Training Document that explains how to use all the features.
Problems setting up Dragon? Email [email protected]
29 General Inpatient Day Outline
Pearl of Wisdom: “Focus on loving everyone and becoming a good doctor.” Note: there are more specifc details regarding each rotation’s day to day within the clerkship sections below!
Day 1
❖ Email (preferred), text, or page the resident at least 1-2 days before to fnd out when and where to meet them, and what time you should be ready to present your patients by. Usually on the frst day you do not pre-round. You can also ask for the dress code (scrubs or business casual). ❖ Remember to ask how notes should be written, and form to use in the EMR. You can copy dot phrases/templates from them. Each service has their own unique note requirements. ➢ Also ask which “Context” your EPIC should be in (if using EPIC) so that the proper tabs and note templates are available. ❖ Set up your patient list in EPIC and arrange with the resident which patients you will begin to follow. ❖ If you are on an operative service (Surgery or OB), set up the OR schedule ahead of time. ❖ Designate attending and/or resident as your co-signer so they can use your notes directly. **Rotation/attending specifc. It is sometimes safer to just “pend” your note and then let the resident/intern know that you are fnished. Check with resident on day 1.
Pre-Rounding
❖ Process by which you gather 24h data on the patient and create your plan for the day which you will present on rounds. ❖ Each service has some unique information they care about that you will gather. I.e. on Psychiatry you may look at CIWA scores (detox score).
30 ➢ Everyone has their own method for jotting down pre-rounding notes. Experiment, observe, and fnd what works for you. EPIC can generate reports that will have vitals and labs already printed. Some services have specifc reports they like to use. Another method is to print yesterday’s note or plan, fold it in half, and write subjective/objective data on either side. ❖ Arrive at whatever time you need to get your pre-rounding done before rounds. ➢ Pro tip: Print everyone on your team a list frst thing in the morning! This is a small action that can go a long way. ❖ General data to obtain: ➢ Subjective ■ Overnight Events (nursing notes, sign out) ■ Consult notes ■ PRN meds given ➢ Objective ■ Overnight vitals (make sure you note when abnormalities occurred and if you know it, what was happening then) ■ Labs ■ Imaging ● Pro tip: look at all of your patient’s imaging yourself! Ask your residents to walk you through what they see when time allows. ■ Specialty specifc daily assessments (ex: In’s and Out’s, daily weights, CIWA score). ❖ Talk to night nurses about medication, concerns, ideas about plan before they sign out to day nurse (usually 7am). ❖ See patients ➢ Wake them up ■ Yes, even at 5 AM! ➢ Ask questions tailored to why the patient is in the hospital ➢ Do a physical exam: Again, tailored to why the patient is there ■ Safe bets for every patient: Pulm, CV, and abdominal exams ■ DO NOT do breast or genital exams without a chaperone present, grab a resident, nurse or aid, make sure to check with your team
31 FIRST if it is pertinent to be doing this exam. You will not ever do a pelvic or rectal exam without a resident or attending present. ➢ Check what meds/fuids are hanging. See how much oxygen they are on if applicable. ■ Pro tip: if you are pre rounding and your patient looks like they are in distress (respiratory, neurologically, etc.) CALL YOUR RESIDENT IMMEDIATELY ■ If they are really really sick (unresponsive, seizing, extremely abnormal vitals) IMMEDIATELY CALL FOR HELP to anyone nearby! Then call your resident. ❖ Return to team room to consolidate notes and formalize a plan. Pro tip: run plan past resident prior to rounds when possible. Start note if you have time. ❖ EPIC Pro Tip: When writing your note, to make sure you’ve written the plan accurately so it matches the Orders, go to Orders -> Order History -> Filter -> Hours to look back -> 12 h (or other) -> Accept. This will show you any changes made to the orders in that time.
Pearl of Wisdom: “You will be overwhelmed but also feel amazing. It’s OK for that to be in the same day. You’re not crazy, that’s just medicine. Treat yourself and those around you including fellow providers with grace. You don’t know why your consultant is grumpy so try to be kind.”
Rounding
❖ Bring your pre-rounding notes to present from. ❖ Presentations: ➢ General order that you can ALWAYS follow no matter the service. Consider writing this down on a note card or sticky note and bringing it with you the frst few times you present. ■ 24 hour events ■ Subjective information (how the patient is feeling that day) ■ Vitals ■ Physical exam ■ Labs ■ Imaging
32 ■ Procedures (example: EGD yesterday showed xyz.. may ft better in 24 hour events) ■ General assessment: ● This is a blankity blank year old blank who is admitted for blank, post op day blank from blank. Overall, the patient is doing blankity blank and our main issues to focus on today are blankity blank. ■ Problems or systems based assessments and plans. ❖ A general rule of thumb for presenting is to try to make every word of your presentation count. Be brief and succinct and limit random elaborations when speaking. ➢ The only way to approve your presentations is through practice. We promise this gets better as you move through 3rd year. No one is a pro at this on their frst rotation. ➢ Listen to the 4th year’s and residents’ presentations on each new service and adapt yours to ft. Every service is slightly diferent. Always start with more information the frst day and trim down as your team asks you to/trusts that you have all the info you need. ➢ Interruptions happen often, fnd a way to cope with this the best you can. It is okay to take a second to regroup before continuing on with your presentation. ❖ Discussing labs is team dependent: ■ Internal Medicine usually goes into more detail. May also say the next most recent value (“WBC 8 from 11.5”). ■ Surgery: “CMP this morning within normal limits, K+ is downtrending from 5.2 to 4.2.” ❖ Rounding Types:
33 Pearl of Wisdom: “This is a choose your own adventure type thing and you can have a lot of freedom. If you want to see a patient again during the day but your team is all doing stuf, go talk to them on your own for a bit and check in on how they are doing. Have a good chat and just enjoy talking to people.”
Ways to Shine
❖ On Day 1, let them know what you are specifcally trying to work on that week and then follow up for feedback. ❖ Pearl of Wisdom: “Make a wellness goal before every new section of rotation. Tell your team your goal too, then they may be able to help you stick to it!” ❖ Clearly state that you want to be included in all discussions regarding your patients. ❖ Cite primary literature/guidelines in your plan on rounds. ❖ Show that you are eager to learn and share what you are learning about. ❖ Send your own pages once comfortable with basics. ❖ Be honest about what you are interested in so that they can tailor their teaching points for you. ❖ Ask intelligent questions: “why did you choose this treatment over x?” ❖ Place yourself in as many uncomfortable conversations as possible (end of life, unsatisfed patient).
Pearl of Wisdom: “Just have fun. Don't get caught up in the complaining with the interns later in the year, maintain your happiness and it will help you look good to attendings and seniors if you maintain a positive, interested attitude no matter the surrounding people.”
34 Internal Medicine Clinical Clerkship
Inpatient Medicine Four weeks of inpatient medicine at either the University of Utah Medical Center, Intermountain Medical Center, or the VA Medical Center. ❖ “long” or “call” days: every 3-4 days where your team will admit patients until later in the day, You will leave around 6-8 pm. ❖ “short” or “golden” days: every 3-4 days, where your team is not admitting new patients. Typically get home between 2-4 pm. ❖ Attire (pre-covid): business casual ❖ Attire (covid): scrubs
Outpatient Medicine ❖ Two weeks of outpatient medicine at a community clinic. This will be Monday - Friday with weekends off. You will typically work 8am - 5 pm. ❖ Most time for studying!
Elective rotations ❖ Two weeks of inpatient electives. You will work six days a week. ❖ Cardiology (UU and VA), Pulmonology (UU), Hematology (Huntsman), and Oncology (Huntsman)
Typical Inpatient Day
05:30 - 05:45 Wake Up 06:30 Arrive at Hospital (Team specifc) 06:30 - 09:00 Preround 09:00 - 12:00 Formal Rounds 12:00 - 13:00 Noon Conference (lunch) 13:00 - 17:30 Place orders, follow-up on patients, admit new patients, teaching
35 Pre-Rounding on Internal Medicine
36 Vitals
Report vitals in 24-hour ranges (7am yesterday to 7am today).
Vitals
Temperature Focus on Tmax over past 24 hours and general trend: ❖ Afebrile ❖ Medicine Fever: > 100.4 F (38C) ❖ Surgery Post-Op Fever: >101.4 F (38.56C) ❖ Hypothermia: <96.8 F (36C)
Heart Rate & Blood Pressure Stable or change? If tachycardic, is it associated with fever/exertion/pain/other?
Respiratory Rate Important if O2 is low and/or hypo/hyper and leading to acid/base disorder
O2 O2 >92% is fne. Note if it is less than this. Report as “XX% on [mode of delivery]”
❖ Room air: FiO2 = 21%
❖ Nasal Cannula: How many liters? For each liter add about 3% O2
Example: Patient is on 3L O2
FiO2 = 21% + (#L O2)(3%) = 30% FiO2
❖ Assisted: mask, BIPAP, CPAP, Vent w/settings
Ins & Outs
There is an EPIC tab that gives you all this information, and it prints out on the rounding forms so there is no need to write it all out. There is also a MedCalc for Urine Output calculations described in the box below.
Ins & Outs
Ins Include oral and IV fuids
Urine Output (UOP) Urine Output (mL)/patient’s weight (kg)/time (mL/kg/hr) UOP should not be less than 0.5 mL/kg/hr in adults
❖ Example: Patient puts out 1000 mL of urine in 24 hours, patient weighs 60 kg
UOP = 1000 mL / 60 kg / 24 hours = 0.69 mL/kg/hr
37 Routine Labs
Fishbone Diagrams
Here are shorthand diagrams for recording routine labs.
38 CBC
WBC Neutropenia: calculate the absolute neutrophil count (ANC) if the patient has a low white count and/or is at risk for neutropenia. ❖ ANC = (%segs + %bands) x WBC ❖ Neutropenic fever tx: ➢ First: Cefepime x 48 hrs ➢ Still fevering: Vancomycin x 5 days ➢ Still fevering: Antifungals Leukocytopenia: Examine which predominates (neutrophils, lymphocytes…), ❖ Remember, steroids increase white count
Hgb/Hct Hgb/Hct should be 1:3 ❖ General Goal >7:21 ❖ ObGyn Goal 10:31 in severe conditions ❖ Transfusing 1 U of pRBCs → increase of 1 in Hgb and 3 in Hct ➢ If patients H/H drops ⅓ then they have lost 1 U blood.
Platelets ❖ Goal >50K so clots can form ❖ Consider transfusing <20K
Chemistry
Na+ If low, think about... If high, they’re dry. ❖ Volume overload ❖ Hyperglycemia Corrected Na+ = measured Na+ + [1.6 (glucose -100) /100]
K+ If low, then replete with… If high “C BIG K, Die” ❖ 10 mEq IV → increase in 0.1 K to goal ❖ Calcium gluconate (stabilize myocytes) (20-40 mEq at a time) ❖ Bicarb ❖ There must be adequate Mg2+ in ❖ IG (insulin/glucose) order to replete K+. ❖ Kayexalate (poop out excess K+)
Cl/Bicarb Refer to “acid/base” status below
BUN/Cr Calculate GFR ❖ Prerenal AKI: BUN/Cr >20, FeNa <1% ❖ Intrinsic AKI: BUN/Cr <15, FeNa >2% ❖ Postrenal AKI: BUN/Cr >15, FeNa <41% If patient is on dialysis, Cr does not matter
Glucose Give the last 3 glucoses
Ca2+ Always correct Ca2+ for low albumin. Ca2+ = [0.8 x (4-Alb)] + Ca2+
39 Acid/Base Status
This is very high yield both clinically and on NBME shelf exams. Make sure you understand this.
❖ pH & Bicarb/CO2: determine acidosis/alkalosis ❖ Anion Gap = Na+ - Cl- - HCO3- (normal 8-12)
3- ❖ Winter’s Formula (metabolic acidosis): PaCO2 = (1.5 x HCO ) + 8 + 2
Emergent Dialysis Indications
AEI(SLIME)OU
❖ Acidosis (metabolic: MUDPILES) ❖ Electrolytes (mainly K+) ❖ Intoxication: Salicylates, Li+, Isopropanol, Mg2+ containing laxatives, Ethylene glycol ❖ “Osis-es” (volume overload): “cardiosis” (CHF), cirrhosis, nephrosis ❖ Uremia: pericarditis, encephalopathy, and/or GI bleed
Risk Scores
The MDCalc app can calculate these for you.
Condition Score Condition Score
STEMI/NSTEMI TIMI Score Liver Disease MELD Score
Pneumonia CURB-65 Liver Disease Child-Pugh
Pleural Efusion Light’s Criteria Stroke NIH Stroke Score
Pulmonary Embolism Wells Score Risk of Stroke s/p TIA ABCD2 Score
Statin Need ASCVD Risk of Stroke w/AFib CHADS2 Score
Pancreatitis Ranson’s Criteria, Apache II
Assessment and Plan
40 For A/P, present by problem. A helpful way to organize it in your mind for presentations and documentation is that for every problem there should be: problem (e.g. AKI), status (e.g. Cr is still 2 from baseline of 1), etiology (diferential diagnosis or confrmed diagnosis), what has been done (e.g fuids were given yesterday), plan (e.g. more fuids today).
Study Resources
Wards
❖ Pocket Medicine (Quick Clinical Reference - very useful for wards) ❖ Maxwell Quick Medical Reference
Shelf
❖ UWorld Medicine Section ❖ Step Up 2 Medicine ❖ NBME Practice Subject Tests ❖ Online MedEd videos
41 Surgery Clinical Clerkship Eight weeks of inpatient, operating room experience, lectures, case presentations, and rounds. Students spend six weeks on general surgery (two of these weeks are with an outside preceptor) and two weeks in specialty areas. Rotations
General Surgery Electives Outside Preceptorship
UTES (Utah Trauma and Cardiothoracic Surgery St. George Emergency Service) Breast Health Provo CRABS (Colorectal/Abdominal Burn Ogden Surgery) Head and Neck Salt Lake City area Foregut/Bariatric Plastic Surgery Surgical Oncology Transplant IMC General Surgery Urology VA General Surgery Vascular at U Primary Children’s Hospital Vascular at VA General Surgery
General Advice for all services
❖ Almost all services do team evals. ❖ Showing interest and having a good attitude goes a long way on this rotation! If surgery is not for you, it is still worth your time to understand what happens to patients when they need surgery because you will see them before or after their surgeries too. Keep this in the back of your mind when it is a tough day! ❖ *Hint: nothing is a fever unless >38.3C ❖ Attire: Scrubs on OR or inpatient days. White coat and business casual for clinic days. Scrubs may be okay in some clinics, make sure you ask your team. Personal scrub caps (ie the sweet looking fabric ones) are okay if you want to have them but are by no means required. ❖ Keep the EMR handof updated for all of the patients that you are following. ❖ Pro tip: you will get the most out of this rotation if you come prepared having practiced the following skills. ➢ 2 hand knot tying
42 ➢ Instrument ties ➢ Simple interrupted sutures ■ Level up: Buried simple interrupted and running subcuticular. ➢ (See below for tutorials! Ask 4th years going into surgery to teach you!)
Typical Inpatient Day
04:45 Wake Up 05:00-05:30 Arrive at Hospital (Team specifc) 05:30 - 06:30 Preround 06:30 - 07:30 Formal Rounds (Team specifc) 07:30 - 12:00 OR case or clinic (varies) 12:00 - **** OR case or clinic (end time difcult to predict)
Surgery Day to Day
Prepping for the OR
❖ Look up the OR schedule ahead of time. You may be able to choose which cases you go to or you may be assigned. Services like UTES, IMC and vascular have urgent or emergent procedures that you cannot prep for. General advice for those cases is to read about common pathology in your down time, some examples are below. ➢ General surgery high yield cases to read about that you may not know are going to happen ahead of time: ■ Cholecystitis ■ Appendicitis ■ Diverticulitis ■ Bowel obstruction ■ Indications to go to the OR immediately for a trauma ■ Bowel ischemia ■ Perineal or other abscesses ➢ Vascular high yield cases: ■ Acute limb ischemia ■ AAA, ruptured or high risk ■ Aortic dissections ■ Vascular trauma
43 ➢ Pediatric surgery: ■ General surgery as above ■ Volvulus ■ Intussusception ❖ For all cases that you go to know the indication for the procedure and the pathophysiology. Focus on understanding the anatomy and physiology of the area to be operated on. As a 3rd year student, you do not need to focus on the technicalities of the operation - i.e. you don’t need to know the steps of an operation (unless you want to). Your priority is to understand why and where the surgery is being done ❖ Come prepared with 1-2 questions to ask during the case. ❖ Bring a notecard, tiny notebook, PHI emailed excel sheet on your phone with your patient’s information with you to the OR. You can include anatomy drawings, surgical recall answers and etc. Find a way that works for you to do this. You can look at it right before you scrub.
In the OR
❖ Before walking in, ensure you have a scrub cap and eye protection. No street clothes past the red line ❖ Get to the OR before the residents and write your name, title, and glove size on the white board. ❖ Introduce yourself to the circulator and scrub tech frst. Ask if you can get your gloves and gown for them. Pull up images on the computer. ❖ Get hands on from the start! Help transfer patient, grab warm blankets, put SCDs on, get razor and tape ready, ask to put in the foley. It is a safe bet to ask nursing staf to show you how to do something. ❖ Don’t grab from scrub tech unless asked and ask frst before playing your hands on the mayo stand. ❖ “May I ask a question?” At appropriate times. If there is bleeding, no one is talking and only moving, or if they are at the critical part of the operation, don’t say anything.
44 ❖ Things you will be asked to do as a med student (and things you can ask to do!): close incisions, cut suture, suction, retract, drive camera, etc. Always okay to ask clarifying questions or to have someone watch you the frst time you do something. ❖ Scrub when your resident scrubs and try to do it for a bit longer than they do. ❖ Suturing and knot tying: Two handed tie, One handed tie (at your own risk and with permission from your attending!), Instrument tie, running baseball stitch, buried interrupted, running subcuticular. ➢ Suture Skills Course (19:45 minutes - Duke Medical School) ➢ Surgical Knot Tie Booklet (Penn Medicine) (pictures) ➢ Behind the Knife Knot Tying ➢ Behind the Knife Instrument Tying ➢ Behind the Knife Simple Interrupted
During rounds
❖ One liner example: ➢ 50 yo M/F with (indication for operation) now POD# from (name of operation). Overall patient is blankity blank. ❖ See the pre-rounding information that is in the general section in the frst part of the survival guide. ❖ Important post operative milestones that you should ask ➢ Pain well controlled? ➢ How is the diet going? Nausea/vomiting? ➢ BM yet? Passing gas? ➢ Walking? ➢ Urinating? ❖ Make note of how the following things look: ➢ Indwelling lines (ex: right peripheral IV, L IJ central line) ➢ Suture site: is the incision dry? Clean? Intact?
24 Hour Shift - Trauma Surgery
❖ Night before: pack toothbrush/toothpaste, snacks, study materials, comfortable shoes, other things you need to be comfortable
45 ❖ Contact the student on UTES beforehand, they will be there all day and will show you the ropes! ❖ EPIC Templates: Important to use the right ones. In the manage smartphrases tab, search "Elisha Haroldsen". You want these: ➢ .iptraumaadmit for trauma admits ➢ .ipgreenconsult for consults ➢ .iptraumaprogress for trauma progress notes ➢ .ipgreenprogwcustomexam for other inpatient progress notes ➢ .iptraumadischarge for discharges ❖ Arrive in scrubs at SICU (2nd foor of main hospital) at 05:45 ❖ Handof is at 06:00 in the big conference room next to PACS. Ask the student or intern there to print you a list for the team you will be with. ❖ Traumas: You will receive a page. Go to trauma bay or the room listed in the page. Pull up a computer (COWS) and drop a trauma admit note (dot phrases above). Write down everything you hear. After trauma, tidy up the note and take a stab at the plan. Don’t sign the note, ALWAYS pend it. Go to CT room after and assist with transportation of patient. ❖ Consults: Do the full H&P with physical exam. Particular emphasis on prior surgeries, family history of bleeding disorders or malignant hyperthermia, allergies to medications, anticoagulation use, etc. Essentially anything that could kill the patient on the OR is important to ask about. Check vitals, interventions in the ED, relevant labs/imaging. Make a plan. Present to chief resident.
Study Resources
SICU/OR
❖ Surgical Recall (the ultimate guide to nailing those questions attendings will ask you).
Shelf
❖ Surgery by Julia DiVergilio ❖ UWorld Section
46 ❖ PESTANA (book + all youtube videos) ❖ NBME practice tests, UWorld, AMBOSS ❖ NBME Practice Subject Tests
47 Family Medicine Clinical Clerkship Six weeks with a community-based family medicine preceptor. The majority of the time is spent with the preceptor in the clinic, hospital, nursing homes, and on house calls. Time is also spent learning about and experiencing other elements of the health care system in the community served by the preceptor. ❖ Attire: Business Casual
Typical Outpatient Day
07:00 - 09:00 Clinic Starts 09:00 - 12:00 Morning Clinic 12:00 - 13:00 Lunch (ask for this!) 13:00 - 17-18:00 Afternoon Clinic
Ways to Shine
❖ Ask all patients a personal question. If there is time then share the information in the subjective portion of your presentation. If clinic is rushed then just present pertinent fndings. ➢ How is work going? ➢ How are their children? ➢ Do they have any pets? ❖ Ask about medication compliance: ➢ Side efects? ➢ Did they fll the prescription? ➢ Taking as prescribed? When symptomatic? When they can remember? If they can aford it? ❖ Diabetes Management: ABCDDEEFGH’s ➢ A1c: When was the last one? What was it? What is the goal? ➢ Blood Pressure: Today? If elevated, was it repeated? What is the goal? ➢ Cholesterol: Lipid panel in last year? On a statin? ➢ Diet: Overweight/obese? What does their diet consist of? Working refrigerator at home?
48 ➢ Diabetic Nephropathy: Urine microalbumin checked in past year? If proteinuria is present and CKD established then do not check urine microalbumin. ➢ Eyes: Diabetic retinopathy screening in last year? ➢ Exercise: Able to? Safe place to do so? Create short and long term goals. ➢ Feet: Diabetic foot exam with monoflament in past year? Ask about and examine the feet each visit. Help patient obtain diabetic shoes if the following exists: foot deformity, prior amputation, pre-ulcerative callus, neuropathy, poor circulation. ➢ Glucose: Do they check? What time of day (am, pre-meal, post-meal, etc.)? When is sugar high/low? Did they bring a log? ➢ Home Meds: Oral? Insulin? Have them detail their regimen for you (what type of insulin, units, when is it administered, etc.) ❖ Live and breath these guidelines: diabetes, hypertension, dyslipidemia ➢ UpToDate ➢ AAFP (American Academy of Family Practitioners) website ❖ Review: vaccine schedule, health maintenance ages (PAP, colonoscopy, etc) ➢ USPSTF Recommendations, especially Grade A and Grade B recommendations. ❖ Assignments: Family Med has a number of assignments in addition to clinic work. Start working on the assignments early so they don’t interfere with Shelf/OSCE study time at the end of the rotation.
Study Resources
Outpatient
❖ Pocket Primary Care
Shelf
❖ USPSTF Recommendations: memorize these. Can fnd short Anki Decks online. ❖ AAFP Questions (American Academy of Family Practitioners) ❖ UWorld Family Medicine
49 ❖ Case Files ❖ StepUp to Medicine (Ambulatory most helpful section; MSK, Rheum,) ❖ Other Resource Options: PreTest, Blueprints, ABFM In Training Exams, NBME Practice Tests ❖ Pay close attention to the practice questions that ask which risk factor makes the biggest diference on the patient’s condition (e.g. weight loss vs. smoking cessation vs. exercise). ❖ Pay attention to which treatment factors actually reduce mortality (e.g. in COPD it’s smoking cessation and oxygen).
50 Obstetrics & Gynecology Clinical Clerkship Six weeks of inpatient and outpatient experiences in addition to lectures, seminars, and review of gynecological pathology. Depending on availability, students will be offered the opportunity to spend two weeks at a rural site. If you want to go rural, watch your email closely in the weeks leading up to the rotation and respond to the coordinator’s email promptly. ❖ Attire: Scrubs inpatient, business casual outpatient.
Typical Inpatient Day - Gyn
05:30 Wake Up 06:00 - 06:30 Arrive at Hospital 06:30 - 07:30 Preround 07:30 - 08:00 Wait for attending to present your patients 08:00 - 16:00 OR case or clinic (varies), study, teaching
Typical Inpatient Day - Labor & Delivery + Antepartum
04:15 Wake Up 05:00 Arrive at Hospital 05:00 - 06:30 Preround 06:30 - 07:30 Postpartum Rounds 07:30 - 17:30 Deliveries, Admits, Teaching, C-sections
G-TPAL
❖ G = gravida = # of pregnancies ❖ P = para “TPAL” ➢ T = term deliveries (twin/triplet delivery counts as one delivery) ➢ P = preterm deliveries (<37 weeks) ➢ A = abortions (spontaneous or elective) ➢ L = living children
Labor & Delivery
51 1. Postpartum Rounding: fever, AM Hct labs, estimated blood loss, breastfeeding, mood, sleep, vaginal discharge, bowel movement, incision site dry/intact/clean, lochia, is pain adequately controlled on medication, PRN’s. 2. Introduce yourself to the laboring patients and ask if they are OK with students. a. You will have to ask nursing staff to ask the patients if they are okay with having you as a part of their care. b. Ask every single patient in labor there so you can maximize the number of deliveries you can go to. 3. Take histories on new patients being admitted to deliver or for pregnancy complications (PPROM, pre-eclampsia). See below for a template. 4. Write the 2-hour Fetal Heart Tracing (FHT) strip notes. You will be taught how to do this on day 1 of L&D.
Gyn ❖ This is a surgery service so all the advice in the Surgery Section applies. ❖ Take histories on new patients: ➢ Annual preventative care: pap smears, mammograms, routine labs (TSH, Hbg, lipid panel, A1c), immunizations (Flu, Tdap, HPV, MMR, VzV) ➢ Menstrual history/ Menstrual History: last menstrual period, duration, cycle, pain, STI screens, number of partners, sexual practicies (oral/ vaginal/ anal/toys). ➢ Obstetric history: GTPALS, age at each pregnancy, date of birth, newborn weights, delivery type, complications during pregnancy/ delivery/ postpartum, transfusions). ➢ Social history: HEADSSS, domestic abuse, psychological stressors, exercise, seat belt, access to food/transportation).
Gyn-Onc ❖ Cheat sheet of potential questions will be sent to you by the coordinator.
52 53 Study Resources
Wards/L&D/Outpatient
❖ Pocket OB/GYN ❖ American Academy of Obstetricians and Gynecologists (ACOG). This is more accurate than up-to-date. ❖ ASCCP Cervical Cancer Guidelines (i.e. what to do with pap/colposcopy results) ❖ Walk through of a C-Section ❖ Bedsiders - Birth Control Methods
Shelf
❖ ACOG UWise Questions: Coordinator will instruct you on how to create an account. ❖ Online MedEd ❖ NBME practice tests ❖ UWorld
54 Pediatrics Clinical Clerkship Six weeks divided into two three-week blocks. Three weeks are spent on the inpatient wards at Primary Children's Hospital (PCH). The other three-week block includes one week on a pediatric subspecialty service, one week in well baby nursery at the University of Utah and one week on Outpatient. ❖ Attire (weekday): check with resident, scrubs on well baby nursery.
Typical Inpatient Day
05:00 Wake Up 05:45 Arrive at Hospital 06:00 - 07:00 Preround 07:00 - 08:00 Morning Report 08:00 - 12:00 Round 12:00 - 13:00 Lunch 13:00 - 17:00 Help others, call PCP, update tracker, hospital course, etc.
Typical WBN Day
06:00 Wake Up 07:00 Arrive at Hospital in blue scrubs 07:00 - 08:30 Preround 08:30 - 09:00 Teaching 09:00 - 12:00 Round 12:00 - 13:00 Noon Conference (Bring food back to WBN for the residents) 13:00 - 17:00 Finish-up work, conferences, teaching, pediatric topic reading
Typical Outpatient Day
07:00 Wake up 08:00 - 12:00 Morning clinic 12:00 - 13:00 Lunch 13:00 - 17:00 Afternoon clinic
55 Ways to Shine
Outpatient
❖ Know immunization history ❖ Know developmental milestones ❖ Utilize the Well Child Curriculum that is on Canvas for the Well Child Checks to know what to ask the patients about.
Inpatient
❖ Obtain history from parents and kid ➢ Sick contacts? school, daycare, siblings ➢ Has this happened before? Might fnd pattern of illness indicating underlying process ❖ Get phone/fax numbers of child’s primary-care-physician ❖ Conduct a physical exam on sleeping child. Most are heavy sleepers, and there really is not a need to wake them up at 5 am. ❖ Know immunization history ❖ Watch out for fevers: Were they on Tylenol? Need to be afebrile 24 hours before discharge ❖ Calculate kcals/kg/day based on formula ❖ Calculate UOP by mL/kg/hr ➢ Child normal >1 mL/kg/hr ➢ Neonate normal >2 mL/kg/hr ❖ Report & Examine: activity level, breathing (accessory muscles), skin color, rashes ❖ Every time someone shows you a Primary Children’s treatment algorithm (e.g. asthma) take a picture of it.
The Well Baby Nursery
❖ Know these backward and forward: ➢ Newborn VS: HR 12-160, RR 40-60, BP 65/50 ➢ Newborn exam
56 ➢ Breastfeeding benefts ➢ Ortolani and Barlow Maneuvers ➢ Dysmorphic features: Down, Turner, Fragile X ➢ APGAR: you may be asked to calculate this in the delivery room or OR ❖ Pre-Rounding ➢ All the babies are listed on Epic WBN Shared Handof List ➢ Sign up with an intern and remain on the same team. ➢ Coordinate the physical exam with the team so that the mother and baby are not disturbed more than necessary. ➢ Gather the following data for each patient you are presenting ■ Resuscitation method: warm, dry, tactile, OP suction, CPAP, PPV ■ APGAR: at 1 minute, at 5 minutes ■ Daily weight, calculate weight gain/loss, calculate percentage of birth weight, and NEWT score (newborn weight loss trend) for babies with weight loss. ■ Temperature, heart rate ranges ■ Glucose and other labs ■ Number of feedings and which were breast vs. bottle ■ Number of urine and stool diapers ■ Circumcision Plan ■ Health screenings that have been completed ❖ Rounding ➢ For new patients present: delivery history, maternal issues, family and social history as well as overnight events. Always give your plan. ➢ For older patients present a one liner: “This is a 48 hour girl born to a 31 year old ...the vitals, the weight and percent of birth weird and pertinent fndings on exam…” Always give your plan. ➢ Aim to be done presenting your patient in under 3 minutes. ❖ Discharge Planning ➢ Hearing test, newborn metabolic screen sent , Critical congenital heart disease screen, Hep B vaccine (if parents consent). ➢ Follow-up appointments occur within 3 days of discharge ❖ Deliveries
57 ➢ There is a medical student resuscitation pager. Hand it of to the next medical student at each birth. ➢ Stay late one evening until 9 PM to see more deliveries. ❖ Important Conditions: ➢ Jaundice timeline/management ■ Requires evaluation if <24 hours of life or direct/conjugated bilirubin. ■ Transient hyperbili peaks at 2-3 days of life, (60% newborns, 80% preemies) ➢ CN Palsies ■ Duchenne-Erb: C5-C6 (lose axillary nerve, musculocutaneous nerve) ■ Klumpke: C7-T1 (lose ulnar nerve, associated with Horner’s) ➢ Sepsis ■ Early: GBS, E. coli, Listeria ■ Late: coag neg staph, E. coli, GBS ■ Tx: IVF, Cx, Abx (Amp, Gent, Cefotaxime) ➢ Respiratory distress In Newborn ■ More common in premies (lethicin:sphingomyelin ratio) ■ “CTAB with good air movements throughout, subcostal/intercostal retractions, head bobbing, nasal faring, scant scattered coarseness with end-expiratory wheezes throughout” ■ Transient Tachypnea of the newborn (TTN) is more common in Hb S/C babies (benign condition in term infants) ■ Meconium Aspiration
Study Resources
Wards
❖ Pocket Pediatrics
Shelf Resources
❖ OnlineMedEd ❖ UWorld Pediatrics ❖ Pretest
58 ❖ BRS Pediatrics ❖ Other: Blueprints, First Aid Pediatrics, Step Up to Pediatrics, NBME Practice Subject Tests
59 Psychiatry Clinical Clerkship For six weeks students work with teams at either the University Hospital (Med Psych) or at Huntsman Mental Health Institute. Students also attend mental health court, electroconvulsive therapy, and grand rounds. Rotations will either be inpatient or consultations. ❖ Attire: check with the resident.
Typical Inpatient Day
06:30 Wake Up 07:00 - 07:15 Arrive at Hospital 07:15 - 08:30 Pre-chart 08:30 - 12:00 Round 12:00 - 13:30 Documentation (can take longer)
General Advice
❖ Epic Context for all sites = Behavioral Health Service ❖ Sedative in alcoholic patient - don’t use benzo, use Hydroxyzine ❖ Get collateral information on patients by calling family ❖ Pink sheet = Social Work or Police - hold for 24 hrs ❖ Blue sheet = Doctor - hold for 24 hrs ❖ White sheet = Hold after 24 hrs for MH court
Ways to Shine
❖ Know the details of their social histories. ❖ Residents have didactics all day on Wednesday, this is a great opportunity for you to act like the resident and be very helpful to the attending. ❖ We have access to iCentra which the residents don’t. This is helpful to fnd other medical history, especially on the pediatric patients. ❖ Pre-rounding on detoxing patients: in the Summary tab, search for “24 hour detox summary” and it will populate with all the information you need.
60 ❖ When asking orientation questions, if they don’t know the date, ask the month, if they don’t know the month, ask the year; if they don’t know that, ask the season or the weather outside. You lose your orientation in the order of: time, place, person ❖ Ask patients SI/HI, hallucinations every day ❖ Don’t be satisfed when they say 4 drinks a day--of what (beer vs. wine vs. liquor), how much (12 oz, 24 oz, 32 oz, 1 shot, 1 double shot, 1 24 oz bottle of wine vs. 1 L bottle of wine). For drug use, ask how much, how long, and have you ever tried quitting. ❖ Know when they had their last drink. Important for symptoms of detox – you have to worry about seizures for up to 72 hours ❖ Know your medications: frst-line treatments, side efects, contraindications, etc. ❖ Get to know the patients you see as a person; acknowledge that they are people frst, and that they have an illness that does not defne who they are.
Study Resources
Shelf
❖ First Aid for Psychiatry ❖ UWorld ❖ NBME Practice tests, AMBOSS
61 Neurology Clinical Clerkship
The clerkship consists of four weeks divided into two weeks inpatient and two weeks outpatient. Inpatient rotation consists of direct patient care, daily ward rounds, participating in select ‘brain-attack’ stroke-codes, procedures such as lumbar puncture and participation in clinical conferences. The outpatient experience occurs in general and specialty neurology clinics.
This rotation is diferent from the others due to its brevity. You need to have a structured study schedule from day 1 in order to be successful on the shelf exam. The neuro exam and documentation will be reviewed on day 1, and reinforced again during the director-led sessions.
Clinical locations include the U of U Hospital, the Neurology Critical Care Unit (NCCU), the Clinical Neuroscience Center (CNC), the Imaging & Neurosciences Center (INC), Primary Children’s Hospital (PCH) and the VA Hospital. In some cases, community clinics may be available. Epic context for CNC = “CNC Neurology” Epic context for INC = “CAMT Neurology”
Typical Inpatient Day
05:30 Wake Up 06:30 Arrive at Hospital (Team specifc) 06:30 - 08:00 Preround, sign out from night foat 08:00 - 12:00 Formal Rounds 12:00 - 13:00 Noon Conference (lunch) 13:00 - 17:30 Finish Documentation: Follow-up data, procedures,, new admits, teaching
Typical Outpatient Day
0700-0800 Review patients if not done the night prior 0745 First patient commonly roomed 0745-1200 Morning patients 12:00 - 13:00 Noon Conference (lunch) 13:00 - 17:00 Afternoon patients, fnish documentation, teaching
62 Ways to Shine
Be prepared
❖ Know before beginning your rotation: ➢ Review the neurology exam ➢ Review common neurologic conditions and neurologic emergencies from Brain & Behavior ➢ Review the basics of MRI and CT imaging from Brain & Behavior ➢ Review neuroanatomy and pathways ❖ Have all the tools: ➢ Refex hammer ➢ Large tuning fork (128hz) ➢ Pen light ➢ Sensation testing tool: Cotton swab, safety pins, etc, will be available in clinic rooms, but it is helpful to carry safety pins on inpatient. ➢ Pro tip: ask 4th years not going into neurology if they have any tools that they would be okay parting with! ❖ Know neuroanatomy and neuroradiology: ➢ Circle of Willis ➢ Major tracts (corticospinal, spinothalamic, DCML, spinocerebellar, Papez circuit) ➢ Dermatomes & myotomes CT MRI
CT is a series of X-rays used to measure MRI without contrast: look for acute strokes or old lesions, bleeds, stroke, mass , calcifcations dementia patterns, structure ❖ Good for ‘blood, brain and bullets’ With contrast to look for infection, infammation or ❖ HYPERdense: calcifcation, bleeds malignancy ❖ HYPOdense: infarction, edema ❖ T1 ‘anatomy’ (tumors may have surrounding ➢ CSF/water = dark edema) ➢ White matter = white ❖ CT angio: vessel anatomy, ➢ Grey matter = grey occlusions, aneurysms, dissections ❖ T2 ‘lesions’ ❖ CT perfusion: compare ischemic ➢ CSF/water = bright penumbra vs infarct core ➢ White matter = dark
63 ➢ Grey matter = lighter than white matter ➢ Shows old lesions as hyperintense ❖ T2/FLAIR: ‘lesions’ with fuid dark ➢ fuid attenuation inversion recovery uses pulse sequence to null fuids--makes it easier to see hyperintense lesions ➢ CSF/water = dark ➢ White matter = darker than grey ❖ DWI ➢ For acute stroke, will be hyperintense ➢ Age stroke by comparing to ADC (acute = dark) ❖ GRE ➢ Looks for blood (dark)
Study Resources
Shelf
❖ Pretest ❖ Brain & Behavior notes and PPTs ❖ Step Up 2 Medicine (Neurology Section) ❖ UWorld, NBME Practice Tests, AMBOSS ❖ Online MedEd ❖ Other: SAE Practice Questions, Blueprints, Case fles, First Aid for Step 1 neurology section.
64 Electives
Electives are your time to choose what you would like to learn. Two blocks of two week electives are allowed during Phase III.
A more extensive list of electives can be found on Tools in the Course Catalog. Additionally, electives can occasionally be created. Talk to Mike Aldred if you have a particular area of interest that does not currently have an elective.
65 Rural & Underserved Utah Training Experience (RUUTE)
RUUTE Program: [email protected]
Currently, students have the option of doing family medicine, general surgery and OBGYN rotations in rural and underserved areas.
Why you should participate in the RUUTE program The RUUTE program is an enriching experience that allows medical students to fully immerse themselves in rural medicine. Their mission is to increase medical education opportunities in rural and underserved areas of Utah/Idaho by expanding interest and awareness of rural health, maintaining and growing quality educational experiences, and developing and enhancing community partnerships with stakeholders. Past participants have cited how the experience has changed their outlook on their future practice by allowing them to understand the variety of patient issues that rural/underserved providers face, the barriers to providing quality care in rural/underserved areas, and the excitement that comes with preparing for whatever comes in the door.
Students participating in RUUTE will gain: ❖ Firsthand experience working in a rural Utah setting ❖ Assist local providers with diverse and underrepresented patient populations ❖ Exposure to and interaction with the community in order to understand and treat patients and get the most out of the experience ❖ Understand healthcare and community benefts and challenges when working in a rural/underserved area ❖ A relationship with clerkship preceptors and communities that were served ❖ Opportunities for service learning through community integration activities
66 Failed Clerkships
The following information in this section has been taken directly from the UUSOM Student Handbook (January 2019). Please refer to the latest version of the student handbook for further details. This information can, and does, change over time.
Trigger Situation Consequence
One (1) Failed Standardized Exam Any Core Clerkship ❖ Academic Warning ❖ Not reported on MSPE
Two (2) Failed Standardized Exam Same Clerkship ❖ Course Failure ❖ Academic Probation ❖ Referral to Promotions Committee ❖ Course Failure and all Standardized Exam Failures Reported on MSPE
Two Failed Standardized Exam Any Combination ❖ Academic probation ❖ All Standardized Exam Failures Reported on MSPE
Three (3) Failed Standardized Exam Any Combination ❖ Academic probation ❖ All Standardized Exam Failures Reported on MSPE ❖ Referral to Promotions Committee
One (1) Outstanding Failed Past the Winter Break ❖ Academic Probation Standardized Exam OR Past the end of ❖ Reported on MSPE Phase 3 Break ❖ Withdrawn from Current Coursework
Two (2) Outstanding Failed Any Combination ❖ Academic Probation Standardized Exams Any time ❖ All Standardized Exam Failures Reported on MSPE ❖ Withdrawn from Current Coursework
67 Main Clinical Sites
Site IM FM OB/GYN NEURO PEDS PSYCH SURG
University of Utah Hospital X X X X X
Intermountain Medical Center (Murray) X X X
Primary Children's Hospital X X X X
VA Medical Center X X X X
Huntsman Cancer Hospital X X
LDS Hospital X X
University of Utah Neuropsychiatric Institute X
12 Community Based Hospitals & Clinics X X X
Rural X X X
68 University of Utah Hospital
General Information Phone: 801-581-2121 Location: 50 N Medical Dr, Salt Lake City, UT 84112 Safety Escorts: 801-585-2677 Locations:
❖ University Hospital ❖ Huntsman Cancer Institute ❖ University Orthopaedic Center ❖ Huntsman Mental Health Institute (formally “UNI”) ❖ Cardiovascular Center ❖ Clinical Neurosciences Center ❖ Utah Diabetes Center
Map for University of Utah Hospital can be found here. Map for Huntsman Cancer Hospital can be found here.
Parking
❖ University Parking Permit ➢ MS3 and MS4 students are permitted to buy “A” permits over the phone. ❖ Trax
ID Badge & Access
You should already have a University of Utah badge, but if you have lost it go to The University Hospital UCard ofce is located on the A Level by the south entrance to the School of Medicine, Room AC143C. Please look for the “U Card Ofce” sign posted in the main hallway. Ofce Hours: Mon-Fri 7am-7pm.
A word of caution, the badges do not always work so be careful. Many students have gotten locked in the stairwell, especially at the Huntsman Cancer Institute!
IT Departments
University IT: 801-647-7000
Huntsman IT: 801-585-0330
69 Dining Options
Main Hospital
Main Cafeteria Level A by the escalators 6:30 am - 10:00 pm Mon - Fri 8:00 am - 8:00 pm Sat - Sun
Starbucks Cofee First foor main hospital 24 hours 7 days a week Huntsman Cancer Institute
Starbucks Cofee Floor 6 inside The Point Restaurant 7:00 am - 6:00 pm Mon - Fri
Lobby Espresso A Level at the base of elevators 6:30 am - 10:30 am
The Point Restaurant Floor 6 of research (south) building 7:00 am - 10:30 am Mon - Fri 11:00 am - 2:00 pm Mon - Fri
The Point Bistro Floor 6 of main building 6:30 am - 8:30 pm Mon - Fri 11:00 am - 7:00 pm Sat - Sun
The Night Bistro Level A at the base of the elevators 10:00 pm - 3:00 am
Scrub Machine Locations
Main Hospital
Level A Level A, go south of the main elevators down the hall, then turn west down a wide hallway, they are in the hall
Main Hospital OR Level 3, inside the locker rooms
Area E ORs Level 3, outside the locker rooms in the hallway between pre-op and the ORs
Labor and Delivery Level 2, L&D, immediately on your right once you enter L&D Huntsman Cancer Institute
OR Level 3, past the HUC, in the common space outside of the locker rooms
70 Huntsman Mental Health Institute
General Information Formally called “UNI” Phone: 801-583-2500 Location: 501 Chipeta Way, Salt Lake City, UT 84108 Website: Huntsman Mental Health Institute
Parking
❖ The psychiatry coordinator will give you parking access in the parking lot directly east of UNI. ❖ Protip! Make sure your car’s information gets transferred back to your U or A parking permit because if not, you may get a ticket after you leave UNI.
Dining Options
UNI
Dining Room Breakfast: 7am - 10am Lunch: 11:30am - 2pm Dinner: 4:30pm - 6pm
George E. Wahlen Department of Veterans Afairs
General Information
Phone: 801-581-2121 Location: Main Hospital is building 14. 500 Foothill Drive, Salt Lake City, UT, 84148 Visitor’s Guide: Numbers, Maps, Hours
Need help?
Problems with CPRS access, badges, computer access, contact
Danielle Blake, 801-584-1277, [email protected]
It is most helpful to contact her a few days before your rotation starts so that she can give you the access codes ahead of time, but she can also help you on the day of. Your CPRS access codes will become inactive after a couple weeks of leaving the VA, so if you have
71 another rotation there later, you’ll need to do it again. Make a note of what your access codes are before your frst day because this is a giant headache to fgure out the frst day of your rotation. Write these down, or do whatever you need to do to remember this.
National VA IT Department Call them to activate your computer access. Ext 1293 from a VA phone
Parking
❖ Students can park in the large staf parking lot directly west of the main building. ❖ Trax
Dining Options
The VA
Canteen (Cafeteria) Building 8 near the gym 7:30 am - 3:00 pm Mon - Fri (grill closes at 2pm)
TOP Cafe Building 5 5:00 pm - 6:15 pm Mon - Fri 7:00 am - 8:15 am Sat - Sun 11:15 am - 1:00 pm Sat - Sun 5:00 pm - 6:15 pm Sat - Sun
Patriot Store Building 8 across from Cafeteria 7:30 am - 3:30 pm Mon - Fri
Cofee Bar Building 1 7:00 am - 4:00 pm Mon - Fri
72 Campus Map
73 Intermountain Healthcare
Includes LDS Hospital, PCH, and IMC.
Badge Access Pick up Locations:
Primary Children's Safety and Security Desk – must make an appointment, you cannot show up. Do this early. Megan DeBry: [email protected] First Floor Open Monday - Friday, 8am - 4pm
Intermountain Medical Center – prefer you make an appointment; you can just show up HR Ofce: Ciara Burningham 5121 S Cottonwood Street, Murray, UT Building 7 (Women’s building), Lower Level 2 Open Monday - Friday, 7:30am - 4:30pm.
Primary Children’s Hospital
General Information Phone: 801-581-2121 Location: 500 Foothill Drive, Salt Lake City, UT, 84148 Overview map for Primary Children’s Hospital can be downloaded with this link.
Parking
❖ University Parking Permit ➢ MS3 and MS4 students are permitted to buy “A” permits over the phone. ❖ Trax
Dining Options
Primary Children’s Hospital
74 Mountainside Cafe Level 1. Eccles Outpatient 7:00 am - 4:00 pm
Treetop Cafe Lobby. North side of hospital 8:00 am - 3 pm Mon - Fri
Rainbow Cafe Level 1 by north entrance 6:30 am - 2:00 am
Brews on 3rd Level 3 south of main elevators 6:00 am - 7:00 pm
Vending Machines Level 4 south of main elevators and in 24 hours 7 days a week south entrance lobby
Scrub Cabinet Locations
Main Hospital
OR Level 2, in the locker rooms
Team Room There is a scrub cabinet in the team room that is directly across from the resident lounge on Level 3. You will need a key code.
LDS Hospital
General Information
Phone: 801-408-1100 Location: 8th Ave C Street, Salt Lake City, UT, 84143
Parking
Main Hospital
Valet Parking (Free) Main entrance (8th Ave and C street) 7:30 am - 3:30 pm Mon - Fri
Street Parking Fills up quickly
Visitor Parking Structure Across the street from main entrance
Dining Options
Main Hospital
8th and C Café Second foor by central elevator 7:00 am - 8:00 pm Mon - Fri
75 Intermountain Medical Center (IMC)
General Information Website Map Phone: 801-507-7000 Location: 5121 S. Cottonwood St. Murray, UT. 84107
Parking
Covered parking garage to the east of the hospital. Of note, your badge is required to enter this parking garage. If you’re on OB you should be able to park in the parking garage directly west of Bldg 7 (Women’s Center).
Dining Options
Main Hospital (Bldg 5)
Main Cafeteria First foor Bldg 5 24 hours 7 days a week
Physician’s First foor Bldg 5, 24 hours 7 days a week with badge Lounge near the access cafeteria
Scrub Cabinet Locations
Main Hospital (Bldg 5)
OR – Men’s Locker Room First foor, in the locker rooms
OR – Women’s Locker Second foor, in the locker Room rooms
Women’s Center (Bldg 7)
Men’s Locker Room LL1, in the locker rooms
76 Women’s Locker LL1, in the Labor and Delivery locker Room rooms
Other things to think about: ❖ Gen Surg will have an orientation with the coordinator before you start, she’ll give a tour that’s helpful! ❖ The OR is on the second foor of the employee elevators, or there are stairs just past the elevators almost to the pre-op doors that require badge access. ❖ There’s no surgery team room, so the physician’s lounge is their main hang out / meeting space. There is a med student call room, that’s the best place to keep your backpack etc. as the lockers are small and then you’ll have a quiet place to study if you need. ❖ If you’re rotating there, you’ll get meal vouchers (called “Cami Bills”) from Cami Bills; email her if you haven’t heard from your coordinator about getting some.
77 Campus Map
78 79 The U’s Emergency Contact Information
80