How to Succeed in Your 3rd Year Rotations

Jim Powers, DO, FACEP

May 12, 2014

Congratulations!

This is the fun stuff and its all good!

Transition to being a self-directed learner

Transition from student to physician Performance: success depends in part on ability to put into practice what

you have learned:

Gather relevant data

Report in clear, organized fashion

Develop differential diagnosis & workup

Interpret data

Develop assessment & plan

Resources for Success

Clinical Affairs Website

http://www.vcom.edu/clinical/3rdyr_clinical.html

Discipline Websites – all curriculum found on these sites*****

Student Handbook

http://www.vcom.edu/catalog/index.html

Clinical Affairs Staff

Director of 3rd Year Rotations (Kelli Bumpus); Kathy Dalton (Immunizations,

CPR, EOR testing information); Dr. P

Clinical Discipline Chairs

DSME

Site Coordinator

Preceptors

Student Responsibilities

Review all material on websites (Clinical Affairs, Discipline Specific)

and in handbook

Follow all policies / procedures

Attendance

Excused absence

Housing

EOR testing / retesting

OMM requirements

Submission of rotation paperwork (Preceptor evaluations, Student evaluation,

Discipline logs, OMM logs)

Immunizations (PPD, influenza)

CPR

Reach out early if you have any questions or concerns

Clinical Rotations: Foundation for 4th Year & Residency

http://www.nrmp.org/data/programresultsbyspecialty2012.pdf

NRMP - 2012

Professionalism “Behaving in a manner that demonstrates high standards”

"Do right. Do your best. Treat others as you want to be treated." Lou Holtz

Professionalism

Consequences of poor performance in areas of professionalism

Failure of rotation; delay in rotations schedule

Call to professional ethics and standards board (PESB)

All comments are included on Dean’s Letter (MSPE)

Noted issues may have significant adverse impacts on residency opportunities

Professionalism “Professionalism aspires altruism, accountability, excellence, duty, service, honor, integrity and respect

for others.”1

Respect

Grooming & dress

How, where & when you discuss patients

No gum chewing

Treatment of ancillary & nursing staff

Your preceptors, site coordinators etc

Showing interest in all learning activities

Confidentiality

HIPAA

Social Media – be careful!!!

Professionalism

Responsibility

For your actions & your education; self-directed learning ***

Meaningful participation in group activities (morning reports, OMM labs etc)

Acknowledge mistakes, apologize & correct them

Complying w/ institutional policies (VCOM & hospital) & procedures****

Addressing problems as they arise

Integrity

Be honest with yourself, colleagues & patients

Timeliness & Attendance

Completion of tasks

Rounds, H+Ps, clinical duties, VCOM responsibilities (immunizations, CPR, presentations, evaluations, checking your

email,)

Being on time (be EARLY!)

Any absences must be made up and must have excused absence form completed*****

"If you stand straight, do not fear a crooked shadow." Chinese Proverb

Professionalism – Why So Important?

During clerkships, students develop & hone attributes of medical professionalism

Altruism, respect, honesty, integrity, dutifulness, honor, excellence and accountability

Professionalism denotes the standard of behavior that individual physicians are

expected to meet as they provide their specific knowledge and skills to those who

seek their counsel, and it is the basis of medicine's contract with society.

Studies indicate that unprofessional behavior in medical school is a predictor of

future disciplinary action by the State Medical Board

Review of MS records of 235 graduates of 3 schools that had been

disciplined by a state medical board over a 13 year period

Disciplined physicians 3x more likely to have negative comments about their

professionalism documented in their medical school record

Types of unprofessional behavior most strongly linked with disciplinary action:

Severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1)

Severely diminished capacity for self-improvement (odds ratio, 3.1)

Identified 3 domains of unprofessional behavior in MS associated

with disciplinary action by a state medical board

Poor reliability and responsibility

Poor initiative and motivation

Lack of self-improvement and adaptability

Some Keys to Success

Before You Go - Prepare!

Prepare for your 3rd year and clinical rotations!

Review all website and handbook material

Check the Portal to verify your rotation assignment / preceptor

Contact your site coordinator & Clinical Affairs if you have any questions

Review specialty basic science & clinical material

Pre-read required assignments

Review objectives, videos, cases

Understand rotation expectations / requirements

Review VCOM clinical website!!

Contact your clinical chair if you have any questions

While You Are There Know your patients better than anyone else

Be the first to know about your patient, - pre-round, check labs, review imaging studies

Develop an assessment & management plan for every patient

Shows ability to integrate didactic knowledge with clinical findings

Transition from student to physician

Present cases

Present patients to residents and/or attending. Practice, practice!

Know where to find the information & how to use it - That's the secret of success” – Einstein

While You Are There

Work hard!

Show that you are a hard worker

Volunteer - extra patient; stay late

Show initiative

Be a self-directed learner!

Contribute ideas to pt care plans

Review articles (VCOM library)

Discuss studies/consults with radiologist / fellow / consultants

Help out with all work that needs to be done

Track down all labs / radiology studies

Set up & clean up

Recheck vitals

Water / food / blankets for your patient

Know what paper work is required & facilitate

While You Are There Be part of the team

Introduce yourself to nurses, techs, scrub techs etc

Clarify your team roles / responsibilities

Follow through on tasks

“How can I help?” – all team members

Be available

Teach the team*

Read & share what you learned

Get involved with procedures

Review common procedures prior to rotation and especially prior to cases etc.

Know the patient

Review surgical schedule for following day

While You Are There

Be enthusiastic & positive

Enjoy your rotation ; show enthusiasm for learning

Be energetic; have a positive attitude – it will be noticed

Show interest in learning

Admit ignorance

“I don’t know but I’ll find out”

Uncomfortable with procedure / plan

Usually residents / attending are happy to supervise / instruct

Ask for constructive criticism / Feedback

At the end of each day

Set up a mid-term appointment

Review your end of rotation evaluation with your preceptor on the last day of the rotation –

leave with the evaluation in hand

Outstanding Medical Students…

Understand that providing patient care is a privilege

Conduct themselves with integrity, maturity, humility & honor

Are professionally attired & respectful of others

Team, patients, staff, consultants

Are honest & trustworthy

Never falsify H+P info to give impression of being thorough

Ask for help or direction when needed

Stay up-to-date on their patients without having to be reminded

Be the “go-to” person on your patients

Know when labs or x-rays are available

Attentive to pt needs

Outstanding Medical Students…

Are interested in learning

Show enthusiasm and an interest in the rotation

Read & apply that knowledge

Attend all conferences & learning sessions

If you don’t know look it up and present findings to the team

Show up early & leave only when they have tied up all loose ends

Don’t leave work for others - Check to see if anyone needs help before your leave

Check with supervisor before leaving – review plans

Always send thank-you notes!

Caution! Never do the following:

Discuss plans with patient until the team agrees on the plan

Gossip

Contradict the residents or attendings

Leave a case in the middle

Complain

Disappear when things are busy

Be afraid to be wrong

Fabricate info

Disregard VCOM or hospital policies or procedures

Post any patient information or details on any social media site (HIPPA violation;

http://www.vcom.edu/facultystaff/policies/#332)

A pelvic, breast, genital or rectal exam on a patient without following pre-established procedures or

having a chaperone

Thanks so much!

Best of Luck on 3rd year rotations!!!!

References

1 American Board of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med.

2002;136: 243–46

The OB-Gyn Clerkship: Your Guide to Success. Authored by the Undergraduate Medical Education Committee (UMEC) of the

Association of Professors of Gynecology and Obstetrics (APGO)

Primer to the Internal Medicine Clerkship (2nd Edition). A Guide Produced by the Clerkship Directors in Internal Medicine.

How to Be a Superstar: EM Externships. EMRA Medical Student Committee. www.emra.org

Mahadevan, S. Garmel, GM. The Outstanding Medical Student in Emergency Medicine. Academic Emergency Medicine. April

2001. Volume 8, Number 4.

Garmel, GM. Getting the Most Out of Your EM Clerkship. SAEM Medical Student Symposium. May 31, 2003.

http://dms.dartmouth.edu/admin/registrar/reg_sub_intern_policy.shtml

http://www.nrmp.org/data/index.html

Aiyer, M. et al. The role of the Internal Medicine Subinternship Director in the 21st Century. The Association of Professors of

Medicine. 2008.

Green, EH. Hershman, W. Sarfaty, S. The Value of the Subinternship: A Survey of Fourth Year Medical Students. Medical

Education Online. 2004;9:7. www.med-ed-online.org

http://journals.lww.com/academicmedicine/Fulltext/2004/03000/Unprofessional_Behavior_in_Medical_School_Is.11.aspx