THE MED STUDENT SURVIVIAL GUIDE CLERKSHIP’s INs & OUTs A Student to Student Survival Manual Past Student Editors Class of 2011: Lindsay Alston and Eugenia Poon Class of 2012: Shawn Dason and Kan Ma Class of 2013: Matt Foster, Ying Meng and Melanie Zimmermann Class of 2014: Nick Mendis, Alannah Smrke, Matthey Lipinski and Alanna Courtright Class of 2015: Jacquie Filteau, Thiviya Selvanathan, Sam Sigurdson and Adeel Sherazi Student Editors Class of 2016: Yanbo Guo, Allison MacKenzie, Lili Tong Last edited: November 12, 2015 Table of Contents • Introduction . ………… pg. 4 • The Basics . ………… pg. 9 • The Rotations • Anaesthesia . ……… pg. 14 • Hamilton • Waterloo • St. Catharines • Emergency Medicine. ……… pg. 19 • Hamilton Area • Cambridge • Guelph • St. Catharines • Family Medicine . ……… pg. 25 • Hamilton Local • Waterloo Area • Niagara-on-the-Lake • Grimsby • General Surgery ……………… ………. pg. 30 • HHS • St Joe’s • Cambridge • St Catherines • Urology Selective (Hamilton) • Plastic Surgery Selective (Waterloo) • Pediatric Surgery Selective (Hamilton) • Pediatric Urology Selective (Hamilton) • Plastic Surgery Selective (Hamilton) • Cardiac Surgery Selective (Hamilton) • Otolaryngology Selective (Hamilton) • Internal Medicine ……………………….. pg. 68 • Hamilton • St. Catharines • Waterloo • Geriatric Selective (Hamilton) • Infectious Disease Selective (Waterloo) • Intensive Care Selective (Hamilton) • Cardiology Selective (Hamilton) • Nephrology Selective (Hamilton) • Rheumatology Selective (Hamilton) • Obstetrics / Gynecology . ……….. pg. 88 • Hamilton Area • Fergus • St. Catharines • Orthopaedics . ……….. pg. 98 • Hamilton • Waterloo • St. Catharines • Niagara Falls • Pediatrics . …….. pg. 105 • Hamilton Area • Grand River • Niagara Falls/Welland • Psychiatry . …………. … pg.110 • Hamilton • Waterloo • Niagara Falls • Brantford • Forensic Psych (West 5th in Hamilton) • Perspectives . …… ….. pg. 117 • Planning for CaRMS . ………….. pg. 120 • Balance . ………….. pg. 122 Introduction Clerkship is one of the most exciting, challenging, and rewarding times of any future physician’s career. During this session, the 3rd year clerks who are currently finishing up their clerkship rotations will share some of what they now know from having been in clerkship themselves – things learned from their successes, their failures, and from simply being there. Everything about how to get through clerkship cannot be covered in such a short package, but it does provide the bits of information that may not be so easy to find elsewhere as well as the things that clerks wished they had known from the beginning. The hope today is that this session will help you get the most out of this amazing part of your training that you are about to start….so GOOD LUCK!!!! Clerkship Necessities Caitlin Lees, Class of 2013 1. Pager • You will need to pick up your pager prior to starting your first ward rotation (you won’t need it for outpatient rotations like Family Medicine) • Go to the 1st floor of MUMC at the red elevators. Instead of heading for the cafeteria, go the opposite way • Turn left down the long green hallway. Walk down it. • On your right, you’ll see a window in the wall with the heading “Telecommunications.” Say hello and ask to be let into the office to get your pager. • Congratulations - after a few months the sound of your pager will be the stuff of nightmares. For now, enjoy choosing different ringtones. 2. Paging • To page someone within HHS: • Dial 87, then the 4 digit pager number • WAIT for the dial tone • Dial the extension they are to call you back at (handily written on the phone you are calling from) • Dial a priority code (1=NOW, 2=urgent but not life threatening, 3=take your sweet time) • Hang-up and wait. If someone tries to use your phone say, “Sorry, I’m waiting for a page.” Nothing worse than repeatedly paging someone because you don’t know if they called while the line was busy. • To page someone in HHS without knowing their pager number: • Dial 76443 • A friendly person will pick up. Say, “Hi, could you please page [name of person/service resident on call] to [your phone extension]?” • Sit and wait. • To text page within HHS: • Login to corpweb • Click on “Phone book” • Search the persons name • Fill in the blanks and hit send • To page within St. Joe’s • Dial 33311 • A friendly person will pick up. Say, “Hi, could you please page [name of person/service resident on call] to [your phone extension]?” • Sit and wait. • *Note that at St. Joe’s, switchboard will take and leave messages for people. You call switchboard to pick up messages too. 3. Team Pagers • On rotations like medicine, you might carry the team pager • This means that any issues with patients under a given team, the nurse will page that pager and assume you have magic answers • When it goes off, call back and say, “Hi, this is , the clinical clerk on team returning a page.” • Listen to the problem and write it down • Ask for additional pertinent information (vitals!!!) • Explain you are a lowly clerk with no verbal order powers • If it’s a minor over the phone problem, page a resident to call the nurse with a verbal order • If the patient needs assessment, go see the patient, then call the resident • If the patient is in trouble, call the resident to let him/her know, then go see the patient and meet the resident there 4. Parking • Take the Red Elevators in MUMC down to P (P is for Parking!), or drive into the garage and take a regular pay ticket • Walk towards the Main St. W. Exit • To the right of the exit, you will see the door to the office • Go in and say, “Hi, I’m a new clinical clerk. Could I please get my parking pass?” • Transponders are paid for in two week chunks - from the 1st -15th and the 16th-end of the month. Try to wait until the beginning of the period, otherwise you might pay $50 for 2 days of parking (rip off!) • Provide credit card or void cheque, as well as your vehicle license plate, make, model, etc. • Take your transponder - if you have driven in and have a pay ticket, be sure to tell the parking person so that they can let you out for free (only if you’ve activated your transponder right away) • Using your transponder • Drive into patient parking • Look overhead for the grey metal rectangle • Hold up your transponder and wait for the light to turn red • The gate will open! • Parking at St. Joe’s • The parking garage is located near the Fontbonne building • Continue up St. James, past Charlton, and turn into the parking drive • You park in the garage to the right. Your transponder won’t work here until it is activated, so take a ticket. • Take your transponder with you when you leave your car. • Walk through the longest tunnel in history. You are on the third floor. Take the elevator (or the stairs near urology) down to the first floor. • Walk over to the tower (the new part of the hospital, across from Tim Hortons) • Go up the big staircase to the second floor • Wander around/ask for help until you find the parking office. • Show them your ID badge, explain you are a clerk, and ask if your transponder can be activated for St. Joe’s • Give them your transponder, sign their paper, and let them work their magic. If you have parked in the garage, tell them, so that you can be let out with your transponder 5. Swipe Cards • Your regular ID badge will work for HHS locations • For St. Joe’s, make sure you have the extra chip-disc thing on the back. If not, head to the MD office and ask for one. • If at St. Joe’s you don’t have access to things you need (e.g. L&D or the OR), go down to security (down the hall past the information desk) and ask for access. 6. St. Joe’s Computer Logins • You have to get your St. Joe’s username (and dictation number) separately - it’s not given out along with the HHS package at the beginning of clerkship • Go up to the 5th floor • Find room 507 • Knock on the door and say you need a Provider Portal username and password • He’ll check out your ID, have you sign a paper • The next day, you have your username and password 7. Dictating at HHS • Dial 5000 • Follow the instructions - you will get your dictation number at clerkship orientation. I suggest writing it on a piece of tape on the back of your ID badge if you have a poor memory like myself • Remember you have to say the punctuation! This includes periods, new paragraphs, commas, colons, etc. • At first it might be helpful to make yourself a small pocket sized template to follow. • Dictation Template: • “This is [your name - and then spell it], clinical clerk, dictating for [doctors name - and then spell it]. Patient’s name is [name - and spell it] and patient number is [number under the barcode on a St. Joe’s chart, or “U number” at HHS).” • This is a [discharge summary/consultation/admission note] • Copies go to: [other docs this would be relevant to - spell the names] • Start dictation • “ was seen by both myself and the resident on call/attending physician, [name], on [date] for [reason for referral]” • PMHx (numbered list) • PSHx (numbered list) • Meds (numbered list - include doses!!!) • Allergies (numbered list, include reactions) • HPI (summarize into paragraph) • Physical exam (summarize into paragraph) • Investigations (any significant results, summarized in paragraph) • Assessment and Plan (summarize in paragraph - mention admission, future investigations/interventions and treatment) • “Thank you for involving us in this patient’s care.” • “End Dictation” • Write down the dictation number in the chart! 8. Dictating at St. Joe’s • At St. Joe’s, call 32078 to dictate • Your dictation ID is your Provider Portal email - without the P • Unfortunately, this system doesn’t give you instructions as you go like HHS (what code to press for dictation type, etc.) - BUT you can get your instruction card from Health Records (get directions from the information desk) 9.