Sei sulla pagina 1di 65

The Unofficial Clinical Clerkship Survival Guide

University of Louisville School of Medicine

Brought to you by the Class of 2016 Track Captains and the Organization of Student Representatives (OSR)

Authors

Eric Kreps - General Information and Track Selection Alexandra Healy - General Surgery Eric Poulos - Internal Medicine John Wehry - Neurology Anne Hayes - Elective Chris Hamann - Obstetrics and Gynecology Evan Rhea - Pediatrics Gerald Cheadle - Family Medicine Catey Harwell - Editor Rudra Pampati - Editor Allison M. Hunter - Editor

Table Of Contents

General Information

.

.

.

.

.

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

1

Parking

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

1

Food and Dining Options

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

2

Scrubs .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

2

Evaluations and Shelf Exams

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

2

Patient Tracking

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

3

Computer Access and Electronic Medical Records

 

4

Prescription Writing

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

5

White Coat Essentials

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

6

Professionalism .

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

. 6

Third Year Track Selection

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

8

8-week Clerkships

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

. 8

6-week Clerkships

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

 

.

.

.

.

.

.

10

General Surgery

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

11

Internal Medicine

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

15

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

19

Elective

.

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

22

Obstetrics and Gynecology

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

24

Pediatrics

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

28

Family Medicine

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

33

Psychiatry

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

37

Values, Calculations, and Commonly Asked Topics

 

41

General Surgery

 

.

.

.

.

.

.

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

41

Internal Medicine

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

41

. Obstetrics and Gynecology

Neurology

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

45

46

Pediatrics

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

46

Psychiatry

.

.

.

.

.

.

.

.

.

.

.

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

. 47

Example Notes and Oral Presentations

 

48

General Surgery

 

.

.

.

.

.

.

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

48

Internal Medicine.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

49

Neurology

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

53

Obstetrics and Gynecology

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

54

Pediatrics .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

56

Family Medicine

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

60

Psychiatry

.

.

.

.

.

.

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

60

2
2

The University of Louisville School of Medicine’s Unofficial

Clinical Clerkship Survival Guide: General Information

By Eric Kreps

General Information

This section is entirely dedicated to the general information that spans all of your third year of medical school and is not necessarily related to an individual clerkship. Topics include parking, on-campus free dining, attire, clerkship evaluations, shelf exam, patient logs, etc. More specific information pertaining to each of the individual clerkships can be found under its own section. Read at length or flip back for reference as questions arise!

Parking

University of Louisville Hospital

University Garage: If you have around $400 burning a hole in your pocket, go for renewing your parking pass to the 620 Garage, but keep in mind you may not be doing all of your rotations at University Hospital. This garage offers 1,711 parking spaces for faculty, staff, and students, and is ID card protected for safe access. HSC Parking Office: 414 East Chestnut Street Hours: 8:00am - 4:00 pm, Monday-Friday, Closed 1:00pm - 2:00pm for lunch Phone: (502) 852-5111

Free Parking: Students often park along Muhammad Ali Blvd, starting at Clay St (in front of the 620 Garage) and ending at Jackson St; there is also free street parking along S. Hancock, Marshall Street, and Clay St. Please be prudent and keep safety in mind as you walk to and from your car during early morning and late night hours. On weekends, there is free parking at the UL hospital garage (on the corner of S. Hancock and E. Madison St, next to the pedestrian crosswalk). Metered parking is also available (most now payable by credit card). Metered spaces are free after 6PM Monday Saturday and all day Sunday.

Norton Hospital and Kosair Children’s Hospital:

Sunday. Norton Hospital and Kosair Children’s Hospital: Students get free parking at a lot adjacent to

Students get free parking at a lot adjacent to the L&N credit union (on the corner of Chestnut St and 2 nd St) while on a rotation at these locations. Students on a rotation at Kosair can obtain a pass for the hospital parking garage by going to the parking office on the first floor of the Medical Towers South (the blue building on the right after you pass Norton Hospital on the corner of Gray and Floyd Street, heading towards Broadway). Go in the double doors that face Gray Street and go to the right, following signs directing you to the Parking Office. Also, parking at Kosairs’s garage (214 Abraham Flexner Way )is free on the weekends!

Jewish Hospital Garage:

Parking pass to the Jewish hospital garage (249 East Muhammad Ali Boulevard) can be obtained from the 5 th floor of the Outpatient Care Center attached to the garage.

VA Hospital:

Parking is available in front of the VA Hospital. Good news: no passes needed! Bad news: many spaces are reserved for just patients and the others fill up very quickly in the morning - it can be difficult to find a spot after 8:30AM! The best advice is to get there early (before 7:50AM). You can park at the Ramada Inn on Zorn Avenue (numbered spots only) or at the Lebanese American Supper Club parking lot off River Road behind the Ramada. A marked VA shuttle will arrive every 15 - 20 minutes to transport you to and from the VA Medical Center between 6:15AM and 6:00PM.

Escort Service: The UofL police department can pick you up from any on-campus location and escort you to your vehicle within 4 blocks of campus if you call 502-852-6111. This is especially useful when it is late and you feel uncomfortable walking to your car.

1

The University of Louisville School of Medicine’s Unofficial

Clinical Clerkship Survival Guide: General Information

By Eric Kreps

Food and Dining Options

Eat for free! Each hospital has its own unique dining options, however this information covers the sustenance that is free of charge only.

Jewish Hospital—Doctor’s lounge in the Rudd Heart and Lung center, 1 st floor. Serves continental breakfast, a full lunch, as well as a soft drink and espresso machine. Don’t miss Taco Wednesdays! Often, your resident will give you their door code or let you in to get to the grub.

Norton HospitalDoctor’s Lounge—2 nd floor Norton Hospital, across from escalators. A full breakfast and lunch are served daily, with snacks available throughout the day. Relive your childhood dreams of chocolate milk with your cereal. Badge access required, so have your resident let you in. Technically this is just for attendings, so opt to sit on the couches and not at the tables if space is tight!

Kosair Hospital Doctor’s Lounge – 1 st floor of Kosairs; have your resident point it out, as it may be hidden. Your badge should give you access to cereal, juice, fruit, peanut butter, crackers and a soda machine.

University HospitalAlthough there are no meals provided, the pre-op doctors lounge does provide bagels and donuts in the morning (they go quick!), as well as access to a soft drink machine (broken about 20% of the time). You can almost always find at least peanut butter and crackers here or in pre-op when you are looking for quick food between cases. While on inpatient wards, most patient floors have access to the nutrition room, stocked with milk, ice cream, soda, peanut butter, and crackers.

Scrubs

In general, wearing scrubs is limited to time in the OR, on-call days for inpatient medicine and pediatrics, and on Labor and Delivery during your OBGYN rotation. During L&D, it is recommended that you come to the hospital in business attire and change into scrubs in the locker rooms (3 rd floor on L&D). It is always best to check with your resident teams about any dress code for rounds. On Surgery, you should never wear scrubs to the Department of Surgery offices (2 nd floor ACB)wear clinic attire with your white coat. The location of scrubs will vary among locations and services, so check with your resident teams or ask a nurse where you can find scrubs. Just a few pearls be conservative with your scrubs; go a size up if you need to and don’t be a hero. Ladies, small tops are hard to come by, so most prefer to wear a t-shirt or tank top underneath these oversized scrub tops.

Evaluations and Shelf Exams

Evaluations:

The seemingly subjective evaluation of your clerkship performance is perhaps one of the most unique and important parts of third year to understand. For the first time your grade depends not only on how well you study and perform on exams, but how well you communicate, interact, and work as a member of a team. The intangibles of professionalism, emotional intelligence, and reading social situations will come in handy. The mainstays of responsibility, hard work, and punctuality will serve you well, so be on your best behavior and prepare to shine as you transition from the classroom to the clinic.

Clinical Evaluation of the Student:

Your student evaluation will be made up of one ungraded midclerkship evaluation and several graded clinical evaluations.

First, you will be evaluated at the midpoint of each rotation (midclerkship evaluation). This consists of formal, ungraded feedback from an attending using either a paper form or the tool on New Innovations (method is clerkship specific). This is a way to gauge your performance before final graded evaluations, that way if there is significant room for improvement, then you will have time to cover ground before it really counts!

The final evaluations at the end of the clerkship are graded and are the main component of your final clinical evaluation grade. Keep in mind, that no matter how well you perform on your clinical evaluations, you cannot honor a

2

The University of Louisville School of Medicine’s Unofficial

Clinical Clerkship Survival Guide: General Information

By Eric Kreps

clerkship without honoring the shelf exam. Both residents and attendings will evaluate you during each of your rotations. You will be evaluated on the following:

Patient Care - Taking an effective history, physical exam skills, generating a differential diagnoses, creating a problem list, generating a treatment plan

Medical Knowledge - Integration of basic sciences, application of clinical sciences)

Interpersonal and Communication Skills - Spoken and written communication, oral presentation skills

Systems-Based Practice - Teamwork, skills in evidence-based medicine

Professionalism Honor and integrity, responsibility and accountability, caring and compassion, and respect

Finally, your evaluator will have the opportunity to write “Overall Comments.” These comments will be the real meat and potatoes of what appears in your Medical Student Performance Evaluation (MSPE) lettera summary of your overall clinical performance during each of your rotations as a third year. The MSPE letter is a large part of your application for residency, so it is important that it reflects your true performance. These evaluations are completed using New Innovations.

Evaluation pearls: Very rarely will a clinical evaluation keep a student from honoringif you show up, work hard, and are respectful, you should do just fine. If you are consistently not honoring because of your clinical evaluations (i.e. honors on the shelf but not the clerkship), this is something worth talking about. Pediatrics tends to be a little more difficult as their cutoff for clinical performance for honors is higher than most other clerkships.

Student Evaluation of the Rotation, Residents, and Attending:

Be sure to fill out your evaluations of the residents and attendings using New Innovations. You are often assigned residents and attendings to evaluate at the end of your rotation-- constructive feedback (not overly negative) is crucial to improving the experience for others. These evaluations are reviewed and can be used as a means for positive change. Any serious issues or urgent concerns should be addressed sooner rather than later; utilize your Track Captains, residents or anyone else you trust or to hear your concerns. Student mistreatment is taken very seriously, so speak up should you feel uncertain or uncomfortable about an issue. Once the rotation ends, you will receive an evaluation from Paul Klein to provide feedback on the rotation itself. This is a good time to offer up suggestions to improve the way the clerkship operates (and it is anonymous!). Both the Clerkship Directors and the Educational Policy Committee (EPC) review the survey results and comments to monitor the quality of the experience and provide feedback for changes as needed.

Shelf Exams:

Each of the third-year clerkships concludes with a “shelf exam,” typically administered on the last morning of the clerkship. A shelf exam is a clerkship-specific standardized test developed by the NBME that medical schools purchase to gauge how their students perform on a national level. The exam is generally 2.5 hours long and consists of 100 questions. At the University of Louisville, this exam is a generally a hefty portion of the final grade, ranging from 40-50%, depending on the clerkship, and is graded on a curve with respect to percentiles. In order to receive honors for a clerkship you MUST receive a raw score equivalent to the 75 th national percentile (which hovers around a raw score of 80-85/100) or above -- no exceptions. In essence, you must honor the shelf to honor the rotation. A passing grade involves a raw score of greater than the 4 th percentile. If in the course of your third year you fail a single shelf exam, you may retake that shelf exam. However, if you fail more than one shelf exam, then you may have to remediate the entire course. While the school pays for you take the first shelf exam, if you fail a shelf you will pay to retake the exam. Resources for each clerkship are listed under their respective sessions. ONLINEMEDED.ORG has a series of free videos that review clerkship and NBME shelf content.

Patient Tracking

You are required to log each of your core clinical clerkships (with the exception of your time on Elective) in a “case log” located on New-innovations. Each of the core clinical clerkships has a list of required clinical diagnoses that you must see or learn about during the course of the rotation. New Innovations will allow you to log your patient with their corresponding diagnosisobviously not every patient fits the exact descriptors, so think big-picture if you do not find the exact diagnoses you are looking

3

The University of Louisville School of Medicine’s Unofficial

Clinical Clerkship Survival Guide: General Information

By Eric Kreps

for. Students are now expected to log patients on a weekly basis. A portion of your grade will be dependent on your completion of patient logs.

Though the process can seem tedious, it serves an important role: the New Innovations system allows the Office of Medical Education and the accrediting body of all medical schools (LCME) to follow the type and number of patients you are seeing to ensure comparability across all clinical sites (this is important for accreditation!). Also, make sure you have fulfilled the required number of clinical diagnoses for each clerkship by running a “requirements summary” in New Innovations.

Computer Access and Electronic Medical Records

Pay close attention to your emails at the end of your second year, as you will be receiving log-in information for up to six different electronic medical record (EMR) systems that you will need access to during your clerkship experience. These systems include: Allscripts (UL outpatient), EPIC (Norton and Kosair), Cerner (Jewish Hospital), NetAccess (UL inpatient), Synapse (UL imaging), and last but not least the infamous VA EMR system.

Both University systems, (Allscripts and NetAccess) can be accessed from your own computer/tablet through installation of the Citrix receiver software on your device. Detailed instructions, including info on installation of Citrix, can be found from the emails sent from the Office of Medical Education.

from the emails sent from the Office of Medical Education. How to access EPIC and Allscripts

How to access EPIC and Allscripts from your home computer.

1. For Allscripts, the link is https://citrix.ulp.org

3. It may ask you to install some software. Let it.

4. Login with your respective ID and you should come to the familiar screen with the

links to "AHS - Live" or "Hyperspace PRD"

How to access EPIC and Allscripts from your iPad.

1. Go to the app store and download the free app called "Citrix Receiver".

2. After the app is installed go to the respective link (Allscripts = https://citrix.ulp.org,

3. Sign in and select your respective EHR ("AHS - Live" or "Hyperspace PRD").

4. This will bring up a screen with a file asking how you want to open it. You should have

a button that reads "Open with Receiver".

5. This should launch the app and bring you to the login screen.

One word of warning: the interface is a bit clunky and takes a few minutes to get adjusted. It is more useful for reading notes and patient data than trying to write notes.

EMR System

Help Contact Number

University: NetAccess, Synapse, Allscripts, Cerner

(502) 588-0411

Norton and Kosair: EPIC

(502)-629-8911

VA EMR

Help Desk Extension 55491

VA fingerprinting and ID services

(502) 287-5983

University Hospital:

Inpatient: NetAccess (health information) and Synapse (Imaging) Login information will be provided to you by email from Tonya Hockenbury (tlhock01@louisville.edu), Administrative Assistant from the Office for Medical Education. Accessed through myapps.ulh.org. IT help number 502-588-0411 for problems with access (i.e. when your username and password expire for the 10 th time). NetAccess will provide you with daily patient information, such as labs and ins/out, and some discharge summaries and operative reports. However, at UL every patient also has a paper chart located on his or her respective hospital floor. Synapse is the system used to access imaging, such as x-rays, CTs, and MRIs.

Outpatient: Allscripts

4

The University of Louisville School of Medicine’s Unofficial

Clinical Clerkship Survival Guide: General Information

By Eric Kreps

Login information will be issued