Clinical

Clerkship
Survival Guide

USF Morsani College of

Medicine Class of 2020
Welcome to Third Year!
The third year of medical school is an exciting time in your professional journey. All the knowledge you
have accumulated during your pre-clinical years can finally translate to patient care. This may all seem a
little overwhelming, but don’t panic! The first couple of days of any new clerkship or at any new site will
inevitably be new and confusing, and by the time you get comfortable, it will already be time to switch
to the next one. The purpose of this guide is to minimize the amount of time you spend at the start of
each rotation figuring out what’s going on so you can maximize your learning opportunities and shine
like the great medical student you are!

The purpose of your third year is to begin to learn the clinical skills of a physician and expose you to
many different fields. At times, it may seem overwhelming, intimidating and frustrating, but you will
undoubtedly improve as the year progresses. You will quickly come to realize everything you have
learned and studied so far does not even compare to what you have yet to learn. No one expects you to
know everything, but they do expect you to be interested and try to learn every day.

Always remember that you are an integral part of the team and may be the only team member who is
aware of a key piece of information your patient shared with you! Participate, be engaged, but maintain
respect for your patients, classmates, and superiors. Read, read, and read some more: what you learn
will not just earn you points on an exam, but also can truly help your patients! During your pre-clerkship
years, the effort that you put into your studies directly affected you—a better grade, a higher board
score, a shot at a cool summer opportunity. The difference now is that your effort directly influences
the care your patient receives and the clinical outcome they experience. Be cognizant that your patients
are not simply stepping stones on your journey to becoming an amazing physician. Rather, you are a
part of their medical journey. You are often the person they spend the most time with while in the office
or hospital, and your demeanor can make or break their experience. Patients may be scared, in pain, or
unheard – your job is to listen to them and convey important information to the team!

Enthusiasm, dedication, and flexibility are the keys to performing well and learning in the clerkships.
Throughout your clinical experiences, you’ll interact with an incredibly diverse group of attendings,
residents, and students in a variety of medical environments. The quicker you are able to adjust to these
different situations, maintain enthusiasm, curiosity and integrity, the more successful you will be and
have a much better experience.

There will be times that third year will be very challenging, mentally, physically and even emotionally.
During these stressful times, lean on your friends, family, upperclassmen, and faculty for support. We
all want to see you succeed and are happy to be there for you. Although clerkships may seem
overwhelming or intimidating, generations of physicians have all survived and improved through this
process – you will too! We hope this guide serves as a source of information to quell fears and confusion
about some of the unknown.

Whatever residency you choose to pursue, each of these core clerkships will contribute to a strong
foundation as a future physician. You may not want to be a surgeon, but you will undoubtedly have

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patients that will undergo surgery and therefore, having an appreciation for surgery will make you a
better doctor. Embrace these experiences and make the best out of every rotation.

Good luck!

The Class of 2019

Disclaimer

This guide was written by students. The course syllabus is the official resource for all course
requirements. Every effort has been made to make this guide as comprehensive and up-to-date as
possible – but the USF Morsani College of Medicine is ever-evolving and adapts the curriculum to
provide the best experience possible. Special thanks to contributors of previous editions of this guide,
clerkship directors, and the authors of (1) Feinberg School of Medicine’s “Success on the Wards” and (2)
First Aid for the Wards.

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Table of Contents
Student Perspectives on the 3rd year…………………………………………………………………………………………5
Rules to Live By………………………………………………………………………………………………………………………….6

Ward Basics
The Care Team……………………………………………………………………………………………………………………….….9
Daily Schedule…………………………………………………………………………………………………….………….……..…11
Call……………………………………………………………………………………………………………………………………………11
What to Wear………………………………………………………………………………………………………………………..…12
What to Keep in Your White Coat……………………………………………………………………………….………….…12

Tampa Basics
Clinic Locations, Directions, and Parking………………………………………………….……………………………...14
Where to Eat…………………………………………………………………………………………………………………………….15
Pagers………………………………………………………………………………………………………………………………….…..16
Electronic Medical Records (EMR) ……………………………………………………………………………….………….17

Guide to the Core Clerkships

General Information………………………………………………………………………………………………….…………….18
Primary Care – BCC 7184……………………………………………………………………………….…………………………19
Adult Internal Medicine – BCC 7110…………………………………………………………………………………….…..21
Surgical Care – BCC 7164……………………………………………………………….…………………………………………25
Psychiatry and Neurology – BCC 7154……………………………………………………………………….……….…….28
Maternal, Newborn, and Inpatient Pediatrics – BCC 7185…………………………………………….………....30

Lehigh Valley Health Networks Basics

Making the Transition………………………………………………………………………………………………….…………….32
Clinical Locations, Direction and Parking………………………………………………………….…………………………32
Technology…………………………………………………………………………………………………………………………….…..32

Guide to SELECT Clerkships

General Information…………………………………………………………………………………………………….…………….33
Primary Care……………………………………………………………………………….…………………………..…………………33
Adult Medicine……………………………………………………………………………………………………………..……….…..35
Surgical Care……………………………………………………………….…………………………………..…………………………37
Neurology-Psychology………………………………………………………………………………………………………….…….39
Women’s Health and Pediatrics……………………………………………………………………………..……….…..…....41

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Appendices
Case Presentations………………………………………………………………………………………………….……..……..….44
SOAP Note……………………………………………………………………………………………………………….…………….….46
Topic Presentations……………………………………………………………………………………………………………….….48
Third-Year Pearls………………………………………………………………………………………………….………….….….…49
Commonly Used Hospital Terms……………………………………………………………………………….………..…….50
Commonly Used Abbreviations in OB………………………………………………………………………………..………51
Spanish Crash Course for OB L&D……………………………………………………………………………………………..54
Commonly Used Medical Abbreviations……………………………………………………………………………………56

A Few Final Words……………………………………………………………………………………………………………..….…57

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Student Perspective of the Third Year
I thought that I would be studying less as compared to the first 2 years, but it actually ended up to be as
much reading as the pre-clinical years but with less direction. It takes even more self-discipline to study,
but at the same time, I was more inspired.

Third year will be a challenging year and it is designed to stretch you mentally, physically and maybe
emotionally, but at the end of it you will have grown and matured tremendously. It is a year where you
bring together everything that you have learned in the first two years and then some.

Your social interactions have a lot to do with your clinical evaluations. Knowledge base is only part of it.
You are evaluated on professionalism and rapport with faculty, residents, and patients. Be punctual,
respect colleagues, and above all respect your patients. Start all rotations with an open mind and a
positive attitude. Be willing to try new things and learn from everyone. Study by reading about your
patients and knowing them better than anyone else on the team. Before the first day of each rotation,
find out where you are supposed to be each day. This applies to clinics, grand rounds, and any other
special events that take place every week.

Be polite but also be aggressive towards your workload and responsibility. You should push the
envelope to find the limit of your abilities and the duties that the team will allow you to take on. Try
writing the admission orders, discharge orders, asking nurses to set up kits for procedures that you
know are likely to come later that day.

Some of the residency programs have a hierarchy in place that will not necessarily be apparent or seem
important, but can be very important depending upon with whom you are working and/or who is
present in the room/operating room at the time. Also, sometimes you will find it frustrating when
residents or attendings do not agree with your assessment/plan or each other’s assessment/plan, and
you will be left wondering who to believe. The best approach is to go home, read about it, and come in
the next day with a specific question and supporting data for discussion.

Sometimes residents may forget that you are still at the hospital. It is okay to ask to go home, but make
sure you are polite and ask if there is anything else you can do before you leave.

Finally, there is time in 3rd year to have a life. Keep up with your workouts. Keep up with your social life.
Don’t drown yourself in clerkships; the point of medical school is not to graduate hating medicine!

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Rules to Live By
1. BE A STUDENT. Remember that you are not an intern, a resident or an attending, but a student. Take
full advantage of this unique and privileged opportunity. This may also be your first and last chance to
explore this many fields of medicine, deliver a baby, hold a beating heart, or have the luxury of taking a
two-hour history from a fascinating patient. Relish it. Take advantage of the opportunity with an open
mind and a willingness to learn and you will not regret it.

2. REMEMBER THAT THERE IS A PERSON ON THE OTHER END. Patients deserve our time, help, and
most importantly our respect. Knock before entering a room and then introduce yourself to the patient
and all family members. Always tell them what team you are from (e.g. “General Medicine” or “Plastic
Surgery”) because many of them cannot keep all of the white coats straight! Close the door or curtain
during examinations. Don't promise to do something if you don't think you'll be able to return and do it
later in the day. Check with your resident or attending before revealing any potentially sensitive
information to a patient, as you are often not the appropriate person for this role. Check with the
patient if they would like you presenting their sensitive medical information at bedside if there are other
patients or family in the same room. Most importantly, your job is to treat, not to judge. Be professional
and courteous no matter how rude, smelly, angry or uncooperative a patient is.

3. KNOW YOUR PATIENTS BETTER THAN ANYONE ELSE. Even though it might not always feel like it, you
have the most time. Spending time with patients carries a responsibility to communicate their fears,
questions, and concerns to the team and make sure they are addressed. Your residents will appreciate
it, and it makes you look like you are on top of things.

4. PREPARE/PRACTICE FOR ORAL PRESENTATIONS. Always expect to present your patient, whether you
have admitted them or just picked them up. Your oral presentation is your time to show what you know
and how you have assessed your patient. Be confident when presenting and always include a plan. This
is often the only way for your attending to evaluate you, in addition to what he or she hears about you
secondhand from your resident.

5. ASSERTIVENESS. Patients appreciate when doctors or medical students explain what they‘re doing
and why, with appropriate certainty. Tread the line between assertiveness and cockiness carefully.
During rounds or “pimp sessions”, volunteer answers if you know them (but always give the person to
whom the question is asked a chance to answer first!). However, if you don’t know something when
asked, don’t despair. You're a medical student and innate to being a student is not knowing everything.
There is nothing wrong with saying, "I don't know, but I’ll look it up." There IS something wrong with
not wanting to know.

6. READ. Assertiveness is best when accompanied by knowledge. You will never have enough time to do
all the things you want or think you should do for each rotation. Make a plan at the start of each
rotation and do your best to stick to it. Take advantage of down time while on call, breaks between
lectures, and especially any outpatient months to read, read, and read some more! Accept that you may
never have more than 15 minutes in a row to do productive work. At least everyone is in the same boat!

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Start with reading about your patients. You will remember things better if you have a patient to connect
to the disease, procedure, or treatment.

7. RESPECT YOUR FELLOW CLASSMATES. Learn with, not at the expense of, your colleagues. This is a
great experience for most people and many find themselves making new friends. However, it is likely
that you will have to work with an undesirable classmate at some point during the year. This
unfortunate reality does not change the fact that succeeding in your third year will hinge largely upon
your ability to work well in a team setting as busy residents often seem to perceive students as a group.
Therefore, making others in your group look good, while sometimes painful, will make you look good.
Work together, divide the work evenly, give your classmates a heads-up if you‘re going to present a
topic or article, and never put down or show up another student. Your team will spot "brown-nosing"
and backstabbing easily, even if you think they don’t. This isn’t their first time dealing with it as they
were all in our shoes not too long ago.

8. BE FRIENDLY WITH SUPPORT STAFF, especially the nurses and scrub techs. You are at the bottom of
the medical and hospital totem pole and they all know it! These people may have been taking care of
patients since you were in diapers, so take advantage of their years of experience. Introduce yourself
and learn their names. The nurses know more than you do about how the hospital functions and day-to-
day clinical care—ask them. Also, don't forget the basic niceties, a simple "Please", "Thank you", "Good
morning" or even a smile can go a surprisingly long way in winning a staff member over and thereby
making your life on the wards significantly easier.

9. BE ON TIME. Even if your residents aren‘t. If you’re not 15 minutes early, you’re already late! Never,
ever, arrive after your attending.

10. ASK QUESTIONS. This demonstrates interest and an eagerness to learn. It is better, however, to
focus on clinical decision making skills and questions that can only be answered by someone with
experience. Recognize when it may not be a good time to ask a question and save it for later.

11. SEEK FEEDBACK. It is your responsibility to find out how your team regards you. Ask specific
questions and you will get more helpful answers. It is often helpful to sit down at the halfway mark of
the rotation and ask for formal or informal feedback on what you could improve on with the remaining
time on the rotation.

12. BE ENTHUSIASTIC. This is pretty self-explanatory but hard to remember when you‘re overworked.
Remember anyway, you will pick up on more things and your preceptors will notice.

13. BE ACCOUNTABLE. Provide your residents with your cell phone number and let them know when
you have mandatory lectures that week. Check-in throughout the day, but don‘t annoy your residents.
Update them and offer to help with their work if you have free time.

14. TAKE CARE OF YOURSELF. Despite the fact that medical students are "lowest on the totem pole,"
you do not have to suffer. Eat when you can, sleep when you can. Always carry around a snack in your
pocket. If you get lightheaded during rounds, surgery, etc. – let someone know! There are juices and

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small snacks on most floors that some kind soul will likely direct you to if you don’t feel well! Most
importantly, ALWAYS take the free food!

15. WORK HARD AND TAKE INITIATIVE. Being a medical student, it is almost a given that you are a hard
worker. But, you need to show it. Volunteer to take on an extra patient. Offer to stay a little longer at
the end of the day to help out. But, remember #6 (and #5).

16. REMEMBER HUMILITY. As a medical student, you should show the appropriate respect to the
residents and attending who were once in your position. Do not try to outsmart, embarrass, or correct
them in the middle of conference (or ever).

17. LOOK PRESENTABLE. You are a member of the team in a professional environment, dress and act
accordingly. Wash your white coat.

18. REMEMBER PATIENT CONFIDENTIALITY. Respect your patients and their trust in you. Hallways,
elevators, stairwells, and any other public locations are inappropriate areas to talk about patients, even
if you leave out their name. There have been incidents in which patients’ families have complained to
the hospital. What would you want for your family?

19. ABOVE ALL ELSE, LEARN! Always remember that this is your main purpose. Even though you might
still feel like it, you’re not just studying for the next exam or grade anymore, everything you learn from
here on out is working towards your career and the lives of your future patients. Unfortunately, there
may be times when your grade does not reflect your ability or the many hours of hard work that you put
in. Don’t be discouraged, your hard work will pay off! Although grades are still important, the knowledge
and experience you gain by applying yourself will ultimately make you better physician.

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 Ward Basics
The Care Team
The members of the patient care team are described below. Students are integral members and may be
the most knowledgeable about the patient.

ATTENDING PHYSICIAN has completed a residency and possibly a fellowship and is a member the USF
faculty. They are ultimately responsible for the patient's care and will thus make or approve all major
decisions. They are also ultimately responsible for educating and evaluating the residents, interns and
medical students. Call them the “supervising physician” to patients because no one knows what “an
attending” is outside of the hospital.

FELLOW has completed a residency program and is now in subspecialty training, e.g. cardiology, vascular
surgery, high-risk obstetrics, etc. Fellows are, in general, exceptionally knowledgeable about their
specialty and slightly less overworked than residents. Thus, they make excellent teachers.

RESIDENT is anyone in their residency training, usually referring to doctors with more than one year of
postgraduate training (PGY-2 and above). Since attendings typically round once a day, the resident is in
charge of the daily work of the team. Besides helping the intern in managing the team's patients, he or
she is also primarily responsible for the education of students. In addition to your attending, you will be
evaluated by residents.

INTERN is in the first year of postgraduate training (PGY-1). The intern is primarily responsible for the
moment-to-moment patient care. You may be paired with an intern who will work with you on the
patients you are assigned. The intern usually has many tasks to be completed through the day, so any
work you can do to help out will be greatly appreciated. In return, they can show you the ropes around
the hospital, teach you about your patients, and offer a good evaluation of your performance to the
resident. Helping the intern with their work can be an excellent learning experience and makes their
lives much easier (therefore, they are much happier and less stressed)...and you will be in their shoes
soon enough!

4th YEAR STUDENT is student who is taking an elective or an acting internship (AI). He or she has the
responsibilities of an intern and is supervised by the resident. The fourth-year student will not be
responsible for your evaluation but they can be a great resource for all of those silly questions that you
have but are afraid to ask the residents. Remember, they were in your shoes a year ago so they can
really help you make the transition.

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YOU: Your first priority is to learn as much as possible.

Every day, write the daily progress notes for the patients you are following. In addition to helping you
integrate your knowledge, these steps will help organize your thoughts about your patients, force you to
think through a clinical plan, and ensure that you are up-to-date on your patients. Read, read, read.
Carry something with you at all times to read because spare time on the wards (or in clinic) is
unpredictable. Aside from learning, your second priority is to make the lives of your team easier. Be a
team player. Taking a detailed history and physical (H&P), following up laboratory results, getting films
from radiology, or drawing blood provides you with opportunities to refine your clinical skills, gain more
patient care responsibilities, and help the whole team to finish their day‘s work earlier so that everyone
can go home or have more time to teach you. Don’t forget, the longer it takes you to finish your notes,
the more delayed your intern, resident, and ultimately attending will be reading/editing/signing them so
always work efficiently. This will be a challenging endeavor, but we promise that your clinical judgment,
problem solving skills, time management, efficiency, and ability to manage patient issues will continue
to develop as the year progresses. Use your residents and attendings as mentors—they are here to
teach you but that‘s their second priority to patient care.

Other Key People on the Floor

Medicine is a team effort. Getting to know the other members can help you stay on top of your patients
and will also make you look like a star.

Unit secretary: One of the most important people on the floor. Can locate a patient's nurse, tell you
where a patient has gone, help find a piece of equipment, and otherwise make life easier in numerous
ways.

Nurses: An invaluable source of information about your patients, the floor, and the hospital in general. If
you make an effort to keep them informed about your team's plans, they will appreciate it. Don't be
afraid to ask them questions!

Charge Nurse: Manage most aspects of the floor. Among other things, they supervise other nurses and
stay on top of all patient arrivals and departures.

Nurse Practitioners: Work with the medical team to manage a subset of patients and help out with
many other miscellaneous tasks.

Social workers: Help with the myriad social aspects of a hospital stay, including coordinating social
support services, obtaining funding, locating housing for visiting families, finding a place for patients to
go after they leave the hospital, and helping them to get a ride there.

Circulating Nurse: Does not scrub in, helps with non-sterile tasks in the operating room like touching the
outside of sterile packages and getting things from other rooms

Scrub Techs: Remain sterile during surgical procedures and are the surgeon’s right hand. They hand
each piece of equipment, and sometimes retract or hold the laparoscope if they are in the best position

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to do so. Be nice to them and introduce yourself! If you are polite and help them, they often advocate
for you to help suture or cut! (But don’t EVER touch their table even to reach for something you or the
surgeon needs!)

Others: You may also encounter medical assistants, respiratory therapists, radiology technicians,
phlebotomists, dietitians, chaplains, hospital volunteers, and many others. As usual, it pays to get to
know them!

Daily Schedule
The daily routine varies with every rotation, and will be elaborated upon in the Core Clerkships section.
The first day of each rotation is orientation, where you will receive your clinical assignments and your
personalized schedule.

On most inpatient rotations, you are responsible for pre-rounding on all of your individual patients and
writing/starting your notes by the scheduled meeting time. After this, the team rounds, typically with
the attending, and makes decisions about the daily tasks. For the rest of the day, you may go finish your
incomplete notes, go into the operating room (if on a surgical rotation), see your patients again
individually, help coordinate their care, contact patients’ private physicians, contact outside hospitals to
obtain records (with approval) or follow-up on test results.

For the outpatient rotations, you may be with the same provider every day or with a different one every
few hours depending on the Clerkship, so pay attention to your schedule. Ask for patient assignments,
look through their charts, and go interview and examine the patient on your own when they are ready.
You will then present the patient to your attending and go back in with them to complete the clinic visit.

Call
For most rotations, you will be “On Call” a specific number of times. During these times, you will be
admitting new patients into the hospital, or helping to care for the current patients after the rest of the
teams have gone home for the night. As a student, your call schedule and corresponding responsibilities
will vary from rotation to rotation. On Adult Medicine and Inpatient Pediatrics, your primary objective
will be to help admit one or two new patients and present them to the attending the next morning
during rounds. While waiting for an interesting admission to come to your service, you should help your
team with the more routine duties of patient management or study. For Labor and Delivery, you are on
night shift, meaning you will spend the night at TGH. For these nights, the team will likely excuse you to
get some sleep when things slow down. Rotation and location specific information is provided in the
Core Clerkships section.

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What to Wear
Clothes: The only two options are professional dress or scrubs, and it varies with each rotation.
Typically, outpatient rotations always require professional attire. Inpatient rotations vary and are
explained in the Core Clerkship section. The general rule of thumb is to dress like your preceptor and
residents.

Access to scrubs varies with each hospital. They are only available to us at TGH and Moffitt. For the TGH
system, you will be allotted 2 pair credits, which you can withdraw from any ScrubEx machine with a
swipe of your TGH badge. You will most likely have to call TGH IT at 813-844-7490 for your card to be
activated. Once both pairs are withdrawn, the machine will only give you a new clean pair after you
deposit a used pair. Word of advice, don’t get caught in your underwear in front of the ScrubEx machine
because you left your other pair at home and are out of credits (if that does ever happen, you can
always use a classmate’s badge to borrow their credit and return the used ones back onto their badge).
At Moffitt, there is a cart filled with scrubs outside the OR locker rooms, use them as you need them.
The remaining clinical sites do not provide scrubs.

Accessories: A watch with a seconds hand is very helpful for measuring a patient’s heart and respiratory
rates

Shoes: You will often be walking &/or standing for very long periods of time throughout the day, so
make sure you have the appropriate footwear for both. Springing for the more comfortable pair might
be a little pricier, but your feet will thank you.

White Coat: An essential part of the medical student uniform. It identifies you as a member of the
medical team, and its short length helps the rest of the medical staff identify you as a medical student. It
provides additional pockets for all your equipment and protects your professional attire from countless
stains. Best of all, it’s your all access pass to wherever you need to go in the hospital or clinic. But you
do not need it at the grocery store or in Starbucks, so please take it off outside of clinical duties. Also,
don’t forget to wash it periodically!

The single most important item you should be wearing at all times is your nametag/ID Badge and you
will need it to access many rooms and areas of the hospital, so don’t leave home without it.

What to Keep in Your White Coat

Label your tools. There’s not that much variety, and people’s equipment can get mixed up. Also,
attendings tend to borrow your stuff, walk off with it, and then not remember which med student they
took it from.

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At a minimum, you should carry:

 Stethoscope
 At least 2 pens  they will inevitably be “borrowed”, misplaced, or lost so don’t get too
attached
 Scratch paper/Blank index cards  always have something available to write down patient
information or teaching points, the fewer times your residents or attendings have to repeat
themselves the better
 Penlight
 Maxwell‘s or some other form of quick reference
 Pair of gloves
 Something to read in case of downtime
Other recommended, but not required items:

 Reference handbook  See Recommended Texts section.

 Alcohol swabs  clean tools in between patients
 Hand sanitizer  usually found every few steps in each hospital, but just in case
 Highlighter
 Smartphone/Tablet
 Snack/Water
Other recommended items in your coat vary slightly with every rotation and are also included later in
their respective sections.

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 USF-Tampa Basics
Clinical Locations, Directions, and Parking
Morsani: 13330 USF Laurel Dr. Tampa, FL 33613

o Park in Laurel Drive Garage – Student parking available Floors 5 and up

o Take bridge across at Level 2
o Elevators to the Left

Moffitt

o Park in MCOM student parking

o Enter through rear entrance

TGH/STC/17 Davis: 2 Columbia Drive, Tampa, FL 33606

o Take I-275 to Ashley St./ Downtown West Exit

o The road forks, stay to the right, which is Ashley St. (to the left is Tampa St.)
o Follow Ashley down to Kennedy St. and make a right onto Kennedy
o Follow Kennedy over the bridge to the signal for Hyde Park Ave (first light, past the church, to
the right will be the University of Tampa)
o Make a left onto Hyde Park Ave
o The offsite parking lot is on the right, the TGH shuttle will take to the hospital
o If you are at TGH between 5am-9pm, Monday-Friday, you must park in the off-site lot.
o If you arrive before 5am or work later than 9pm, you can park in the TGH visitor garage. Show
your student ID to the parking attendant when you leave and the fee will be waived.
o You should receive information from the parking director regarding any changes to these
policies throughout the year.

James A. Haley VA: 13000 Bruce B. Downs Blvd. Tampa, FL 33612

o Park in the student parking lot

o Walk through the building with Student Affairs, and come out the back
o Make your first left (like you are walking to the library)
o To the right will be a stairwell that leads to the footbridge
o You will then be on the second floor of the JAHVA

The doors into the VA from the walkway do not open until 6am and close at 8pm. There is a stairwell
right after you cross Bruce B Downs – sometimes this is locked, so be aware.

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All Children’s Hospital: 801 6th St. South, St. Petersburg, FL 33731

o From I-275, take the I-175 E exit (Tropicana Field)

o Stay in the 2nd lane from the left when the North and South exits merge
o For ACH Parking Garage
 Take the 6th Street exit and turn right onto 6TH Street at the first light
 You will travel through one stoplight and pass Bayfront Medical Center on the
right. Follow the road around to the left.
 Park in the garage on the left.

o For USF Student Parking

 Continue until I-175 E becomes Dali Blvd, turn right onto 4th Street at the first
light
 Turn right onto 6th Ave. at the following light
 Parking lot is on the Left

Bay Pines VA: 10000 Bay Pines Blvd. Bay Pines, FL 33744

o Take I-275 in the direction of St. Petersburg to exit 25 (38th Avenue North)
o Travel west, five (5) miles, to Tyrone Boulevard
o Turn right (west) on Tyrone Blvd and travel toward the beaches
o Turn left at the third traffic light to enter the facility
o Parking: Your first day you have to get a parking decal. After that, you will park behind the
credit union.

Genesis/HealthPark: 5802 N. 30th St, Tampa, FL 33610

o Take I-275 to Hillsborough Ave, and take the Hillsborough Ave East exit
o Head east on Hillsborough to 30th St
o Turn left onto 30th St
o Go through one traffic light, and the clinic is on the left. You will see blue signs for Family
Health Care Center and Specialty clinics
o Park in any lot, just don’t park in a “physicians” spot

Where to Eat
MCOM Campus/Morsani:
 Camille’s Sidewalk Café – Morsani 1st floor, open Mon-Fri 7:30 am - 3:00 pm
 Internal Medicine Grand Rounds every Thursday 12:00 – 1:00 pm in MDL 1003 (subject to
change)
 Rising Roll – located in the WELL on USF Health campus

15
Moffitt:
 Cafeteria – located in the basement
o Breakfast: 6:45 - 10:30 am
o Lunch: 11:00 am -2:00 pm
o Dinner: 4:00 - 6:45 pm
o Deli-grill: 11:00 am-1:30 pm

TGH/STC/17 Davis:
 Main Cafeteria – 1st floor West Pavilion, open 06:00am-07:00pm
 Starbucks – 1st flood East Pavilion, open 6am-10pm everyday
 McDonald’s – 1st floor East Pavilion, open 24/7

James A. Haley VA:

 Main Cafeteria – 2nd floor by bridge entrance, open 00:00am-00:00pm
 Salad/Sandwich Bar and Pizza – 2nd floor, open 00:00am-00:00pm
 Rising Roll – located in the WELL on USF Health campus

All Children’s Hospital:

 Cafeteria – located on 1st floor, Open Sunday - Saturday
o Breakfast: 7:00 am - 10:30 am
o Lunch: 10:30 am - 2:00 pm
o Dinner: 2:00 pm to 12:30 am

Genesis/HealthPark
 Nothing, bring your own, many fast food restaurants within driving distance

Pagers
Most of the residents will prefer to use cell phones, but in case you are in an area with no cell reception
or are getting a hold of someone for the first time, here is how to use the pager system:

1. Call the pager  ex. at TGH dial 88 then the Pager number

2. When you get the beep, enter in your call back number (either your cell or the phone you are
calling from, usually found on the screen or written on the phone somewhere) followed by a #.

3. If you are calling someone who has your phone number but you are paging them to a hospital
phone, type in the extension you are at, # or *, and then your phone number – example:
4531#7278675309. That tells the person that 727-867-5309 (you) are calling from x4531.

16
 4. If the pager has an actual phone number, these you can just text it like any other phone and
your message will be displayed, be sure to keep your message short and sweet!

EMR Systems
Each site uses a different one and navigating each takes a little getting used to. Just make sure you
figure out or ask how to see previous patient notes, meds, vitals, labs, imaging, orders, and how to write
a new note. Most systems also have templates so ask your residents or peers to share or show you
where to find them. Also, printing the team’s patient list can be helpful.

 USF (Morsani/STC/17 Davis): EPIC

 TGH & Genesis/HealthPark: EPIC
 VA: CPRS/Vista
 ACH: Cerner Powerchart
 Moffitt: Powerchart

17
 Guide to USF-Tampa Clerkships
General Information
Clerkship Evaluations: At the end of each clerkship, you are REQUIRED to complete both the clerkship
evaluation and the faculty evaluations on E*Value, just like you have been doing for the past 2 years. Be
truthful and honest as these are actually read by the clerkship directors and help determine if students
should be assigned certain faculty members again. Note: These ARE ANONYMOUS. You know who
evaluates you but attendings and residents receive a block of 5 evaluations at a time that are all
unlabeled so some may not see your evaluation of them for weeks after you are done working with
them.

PxDx: For every patient that you see and interact with, you are required to document your Diagnoses
and Procedures on E*Value under the PxDx section. This might be your least favorite part of your
rotations, but it is to make sure you are exposed to all the expected aspects of the rotation. Towards the
end of the rotation, be sure to check your remaining required diagnoses and procedures and ask your
attending or clerkship director for help if there are items you feel you will not have an opportunity to
see or do in order to complete your requirements.

Electives: During both the Neuropsych and Surgery clerkships, you will have the opportunity to select
two 2-week long elective courses. Student Affairs will provide the descriptions of what is available as the
time to select your preferences approaches. The Electives Manual can be found as a link on the left of
the USF Health registrar page.

Organization: While your responsibilities and opportunities as a student will vary a great deal from
month to month depending on the clinical rotation and your team, the basic structure and general
principles that direct your activities are consistent throughout.

At any given point in time, you should be able to provide certain basic information regarding your
patients when asked. This includes, but is not limited to:

 Patient name, medical record number, room number, date of birth and admission date. Also last
4 of SSN# if at the VA
 Chief complaint and brief HPI
 Brief list of active medical problems with corresponding planned management
 Relevant lab results, cultures and diagnostic tests
 Medications: including dosages, start/end dates (especially for antibiotics), if/when last dose
was administered, and use of any PRN medications
 Most recent vitals & 24-hour max values, I/O (intake/output), etc.
 Pertinent findings on exam

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Primary Care – BCC 7184
Structure: 8 weeks. This is the clerkship with the most intricate scheduling, for that reason it is
important to check your schedule on Canvas at least weekly for the most up-to-date information about
where you should report. On some days you may be required to attend two different clinics; one in the
morning, one in the afternoon. Usually they try to keep you at the same location, but you may have to
drive from one to the other. You will mainly be directly working with attendings doing a balance of adult
and pediatric outpatient medicine, so take advantage of the 1:1 time learning. The format of your day
will vary from clinic to clinic. You may shadow your preceptor for the first day or so, but make sure you
express your wish to see patients on your own. Also includes 1 Women’s Health Week involving Gyn
outpatient clinics, Breast clinics and Breast Surgery at Moffitt.

Clinical Duties: Mon-Thurs usually 8 am – 5 pm.

Call: None

Didactics: Friday AM Didactics

Responsibilities: Always ask your preceptor their expectations (including how long you should spend in
each room) and for patient assignments. Primary care clinics are often busy so finding a balance
between doing a thorough history and practicing your exam skills and being efficient (aka focused
histories and physicals) is key to keeping the clinic on schedule. Look through the patient’s chart
beforehand especially reading their last clinic visit note, confirm their current medications, and be aware
of the preventive medicine issues that pertain to the patient (osteoporosis screening, vaccinations up to
date, mammograms, colonoscopy etc.). You can even do this the day before once you get remote access
(you will learn more about remote access during your Intro to Clerkships). Note writing and presentation
specifics vary based on preceptor for ask what they prefer.

Dress: Professional

Additional Tools/Gear: Stickers for Peds clinic, Reflex hammer, disposable microfilaments (used to test
for peripheral neuropathy, found in most clinic rooms)

Suggested Books/Resources (in no particular order):

 AAFP Family Med Boards Qbank (registration free to students)

 Ambulatory Care section in Step Up to Medicine
 UWorld Peds and Medicine Questions
 Case Files Family Medicine
 Pre-test Peds and/or Pre-test Family
 First Aid for Step 2
 Family Med NMS question book
 fmCases/CLIPP Cases

19
Shelf: Family Medicine NBME

 Covers all aspects of medicine including adult outpatient and inpatient medicine and pediatrics.
There is NO Women’s Health on this exam. Large focus on preventative medicine (so be sure to
do UWORLD preventative care section close to the exam).
 Difficult to study for so do as many practice questions as possible.
o Uworld/AMBOSS
o UVM Family Medicine Questions
o NBME Family Medicine shelf practice exams (2)
Grading:

 Clinical Performance (evaluations by faculty)

 NBME Family Medicine Subject Exam
 CPX
 Updated Logbook
 Completed fm and CLIPP cases
 Professionalism

Tips:

 Learn how to write notes in the room, or at least start them, if your preceptor is okay with that.
 On every adult patient, you should be including preventative healthcare/health maintenance (ie
vaccines, cancer screening) at the end your presentation and note.
 Ask all patients in clinic if they need refills.
 Wash your hands over and over and over and over again, outpatient pediatrics is a viral
cesspool, don’t get sick!
 The ambulatory medicine NBME covers adult and pediatric care and includes knowing what
patients need to be admitted for inpatient treatment.
 This is a longer block with weekends off and no call. Use the spare time to study! It will help you
succeed on this rotation and future ones.
 There are A TON of CLIPP/fmCases you have to do, start early and pay attention, they are very
helpful. Don’t wait too long as it becomes impossible to do them all at the end.

20
Adult Internal Medicine – BCC 7110
Structure: 8 weeks (4 weeks at TGH and 4 weeks at JAHVA)

Clinical Duties:

Average Day:
 Morning: Pre-round and write notes on your patients. Most attendings will want these notes
done before morning report/attending rounds.
 Morning report (time depends on site – 8:30am at the VA, 10:30am at TGH)
 Attending rounds (after morning report at the VA, before at TGH)
 Noon conference
 Finish any outstanding tasks for your team
 Daily lectures at clinical site (schedule provided at orientation on 1st day)
 On call if scheduled

Call: Your best chance to do H&Ps on undifferentiated patients and impress your team!
 Your team will be on long call every 5th day
 There is no overnight call, but you may need to stay later to work up your patients
 TGH
o Team on Overflow meets around 7AM in the ED to admit overnight patients. You will
still have to see the patients you’re following beforehand so this is your earliest day.
o 1st short call admits patients to 1PM.
o 2nd short call admits patients from 1PM to 3PM.
o Long call admits patients from 3PM to 8PM.
 JAHVA
o Teams on 1st, 2nd, and 3rd short call will alternate admitting patients until 2PM.
o Team on long call admits patients from 2PM until 7PM.

Didactics: Daily Morning Report, Noon Conference and Lectures/EKG sessions

Team: 1 Attending, 1 Senior Resident (PGY-2 or 3), 1-2 Interns, 4th year Acting Intern, 2-3 MS3s

Responsibilities: Know your patients, finish your notes on time (usually before morning
report/attending rounds), help the interns with anything you can, stay updated on your patients
throughout the day tracking down imaging reports or lab results if needed.

Dress: Professional on all days except long call and post-call. Scrubs for long call and post-call

Tools/Gear: Reflex hammer, Pocket Reference book

21
Suggested Books/Resources (in no particular order):

 UWorld Internal Medicine questions  Internal Medicine Essentials for

 Cecil’s Essentials of Medicine Students (paragraph format)
 First Aid for Step 2  MKSAP for Students 5 Question Book
 Pocket Medicine  Online Med Ed
 Step Up to Medicine  UT Shelf review (online lecture and
 Case Files Medicine PowerPoint)

Assignments:
 Weekly Quizzes – system based, read corresponding chapter and do corresponding practice
questions
 Clinical Skills Exam – comprehensive exam testing ability to read Xrays, Histo slides, evaluate
acid-base disturbances, etc.
 EKG Quiz – Read The Only EKG Book You'll Ever Need by Thaler or Rapid Interpretation of EKG's
by Dubin, and do ALL of Dr. O’Brien’s practice EKGs

Shelf: Internal Medicine NBME

 Very similar to UWorld questions
 Score based on national performance for your specific testing date
 Be careful with time management

Grading:
• Clinical Performance Evaluations (CPX)
• Weekly quiz performance
• Logbook entry
• Attendance/Participation/Overall Professionalism
• Internal Medicine NBME
• EKG Exam, Clinical Skills Exam

Tips:
 This was the rotation where I put in the bulk of my time. Time spent in the hospital
admitting/writing notes/handling problems is time learning, so try to get the most out of the
long hours.
 Learn how to read/interpret EKGs and chest XRAYs early in your rotation and use the rest of the
time to practice. You will get pimped on this.
 You can get to the hospital at whatever time you want, as long as you are done with all your
work on time.
 Read at least 1 hour every day, make sure you utilize down time during the day.
 Use “Pocket Medicine” as a great study tool on your way to the ED to admit patients

22
  Folks who complete the 1200 or so Internal Medicine UWorld questions tend to get Honors
grades for a reason. This is tough but doable. Remember that the bulk of Step 2 is internal
medicine.
 Own your patients. Is your patient better or worse than yesterday... why? Make sure you know
your patients and THEIR MEDS!
 There’s lots of call…just keep your head up because you will get tired.
 Be engaged on rounds.
 Use time efficiently. It shouldn’t take you over 30 minutes to write an H&P. Keep progress notes
simple.
 Being in the hospital is expensive. Do whatever you can to get your patient out of hospital as
fast as possible (ie. talking to social workers for nursing home placement).
 Help your interns with discharge summaries, even though it’s not your job.
 Check out a locker in GME for your month at TGH to keep all your belongings in.
 You can leave your belongings in your work room at the VA, at your own risk.

Top 20 Pearls for Pimping1:

Reading a CXR: Deriving a Diff Dx: Causes of ESR >100: Etiologies of AKI:
Airway Metabolic Temporal Arteritis Prerenal (most common): decr
Bones Infectious Chronic Infxn (Osteo, SBE, TB, volume renal vasoconstriction
Cardiac silhouette Neoplastic abscess) Intrinsic: ATN AIN
Diaphragms Traumatic Thyroiditis glomerulonephritis
Effusions Cardiovascular Vasculitis Postrenal: bladder neck
Fields Allergic/Autoimmune Multiple Myeloma obstruction b/l ureteral
Gastric bubble Neurologic obstruction
Hardware Drug Reaction
Youth (Congenital)
“Don’t-miss” Causes of Chest Eosinophilia: Light's criteria: Obstruction, sm bowel:
Pain: Neoplasm TPeff/TPserum >0.5 Adhesions
Myocardial Infarction Allergy LDHeff/LDHserum > 0.6 Bulges
Aortic Dissection Asthma LDHeff > 2/3 upper limit of normal Cancer
Pulmonary Embolism Churg-Strauss of LDHserum Obstruction, lg bowel:
Pneumothorax Parasites Cancer
Esophageal perf. Diverticulitis
Volvulus
Anion Gap Acidosis: Modified Wells criteria for Lupus: Lower GI Bleeds:
Methanol Pulmonary Embolism Serositis Hemorrhoids
Uremia PE as likely or more likely Oral Apthous ulcers Diverticulosis
DKA than alternate dx; clinical s/sx Arthritis IBD
Paraldehyde of DVT 3 each Photosensitivity Ischemic Colitis
INH/ Iatrogenic HR > 100 bpm; prior DVT or Blood (ITP, Hemolytic Anemia) AVM’s
Lactic Acid PE 1.5 each Renal Nephritis Upper GI bleed
Ethylene Glycol Immobilization (bed rest ≥>= ANA (almost always +)
Salicylates 3 d) or surgery w/in 4 wks 1.5 Immunology (dsDNA, anti-Sm, low
Hemoptysis or malignancy 1 C)
each Neurologic (Lupus Psychosis)
Score <= 4: PE unlikely, no Malar Rash
CTA; consider D-dimer. Score Discoid Rash
>4: PE likely, order CTA Dx with ≥4 of these criteria,
sensitivity is ~75%, specificity is ~95%

23
Mortality Benefit in CHF: ECG changes with PE: Common bone mets: Emergent Dialysis:
Beta-blocker Sinus tachycardia Breast Acidosis / hypoAlbumin / Anorexia
ACE inhibitor Specific but not sensitive: Lung Electrolyte imbalance (inc K)
Spironolactone if Class IV CHF S1Q3T3 sign - an S wave in Thyroid Ingested toxins
AICDs lead I, Q wave in lead III, and Kidney Overload (volume)
inverted T wave in lead III Prostate Uremia with Sx (cns changes)
“PT Barnum Loves Kids”
Potassium repletion: Magnesium Repletion: IV Fluids (4:2:1 rule): CHADS2 Score:
Goal > 4.0 Goal > 2.0 4ml/kg/hr for first 10kg Risk stratification for
Every 10 mEq K will raise Each 1 g Mg will raise serum 2ml/kg/hr for second 10kg anticoagulation in A-fib
serum K by 0.1 Mg by 0.1-0.2 1ml/kg/hr for remaining kg CHF = 1 pt
PO: K-Dur, can give 40-60 Give IV in multiples of 2 Shortcut for pts >60kg: HTN = 1 pt
mEq at once grams Weight in kg + 40 = cc/hr Age > 75yo = 1 pt
IV: KCl 10 mEq IV DM = 1 pt
peripherally; need central line Stroke or TIA hx = 2 pts
to give 20 mEq Score ≥ 2 : warfarin (unless poor
candidate)

24
Surgical Care – BCC 7164
Structure:
 General Surgery – Two blocks of 3 weeks each, 6 weeks total. Choose from:
o TGH – Gold/Blue/Green
o Vascular surgery
o Trauma surgery
o Haley VA
o Moffitt
 Subspecialty – 2 weeks (Cardiothoracic, ENT, Urology, Pediatrics, Plastics)
 Gynecology Surgery – 2 weeks
o TGH - Gynecology, Gynecological Oncology, Urogynecology
o Moffitt - Gynecological Oncology

Clinical Duties: Monday-Thursday usually 6am-6pm, rounding on Saturday or Sunday morning

Didactics: Morbidity and Mortality Conference and Grand Rounds (with attendings and residents) on
Monday mornings at 7:30am in the MacInness Auditorium, TGH, 2nd floor above the McDonalds.
Clerkship specific didactics happen immediately after Grand Rounds at the South Tampa Center, 5th floor
conference room (although this may change). Weekly lectures and quiz Friday AM at campus.

Dress: Scrubs for OR, professional for clinics. Never wear scrubs on Monday mornings!

Additional materials: Always carry these in your pocket so you’re prepared to be helpful on rounds (can
get from supply rooms at hospital):
 Scissors
 Gauze
 Saline syringes
 Tape
 Long Q-tips

Suggested Books/Resources:
 Surgical Recall (not for studying, but for the questions you will be asked in the OR- read
pertinent section before every case)
 NMS Surgery
 Pretest Surgery
 Pestano Notes (on Canvas) – know backwards and forwards
 General Surgery by Lawrence, for the on-line questions which are occasionally suspiciously
similar (i.e. verbatim) to many of the quiz questions.
 UT Shelf review (online lecture and PowerPoint)

25
Assignments: One 10 minute presentation on a surgical topic of your choice

Shelf: Majority of questions related to patient management similar to internal medicine shelf

Grading:
 Clinical Performance (evaluations)
 Final Exam (NBME)
 Weekly quizzes
 CPX Clinical Skills
 Professionalism & Logbook

Tips:
 Get the schedule ahead of time. Learn the name of the operation to be performed, the
procedure steps, and relevant anatomy. Also try to look up potential complications.
 Ideally, introduce yourself to the patient in pre-op. Know their general history and the
indications for the operation (even if you have to get it from to chart).
 For presenting your patients on rounds, know: vitals, input/output, diet, type/rate of IV fluids,
every line or tube connected to your patient (nothing is more embarrassing than not noticing
whether your patient has a foley or not!), level of pain, significant events overnight, and– why
are they still in the hospital? When can they leave?
 Introduce yourself to anesthesia personnel, the nurses, and scrub techs.
 Never EVER touch the scrub tech's table without permission. If you need an instrument off the
table, ask them politely for it.
 Ask the scrub tech if you can get your gown and gloves for them before you scrub in.

Pearls for Pimping1:

Post Op Fever: Compartment Syndrome: Anterior Mediastinal Mass (4 T's):

Wind - atelectasis, pneumonia Pain Thymoma
Water - UTI Paresthesia Terrible (T-cell) Lymphoma
Wound - Infection Pallor Teratoma
Womb - endometritis, uterine infxn (if C-Section) Paralysis Thyroid Goiter
Walking - DVT Poikilothermia
Wonder-Drugs - Medications *NOT pulselessness*
Sepsis: Hematuria (ITS): Fistula that fails to close:
Systemic Inflammatory Response Syndrome (SIRS)= I Infection Infarction Iatrogenic (drugs) Foreign Body
Temperature: ↑ or ↓ T Trauma Tumor TB Radiation
Tachycardia S Stone Sickle cell cystitis Infection
Tachypnea Epithelialization
Leukopenia or Leukocytosis Neoplasm
Hypotension Distal obstruction
Sepsis = SIRS + Infxn
Septic Shock = Sepsis unresponsive to fluids (must use
pressors)

Appendicitis: Ascending Cholangitis: Septic (Ascending) Cholangitis:

Rovsing’s Sign Charcot’s Triad: Jaundice Fever (with
Psoas Sign rigors) RUQ Pain

26
Obturator Sign Reynold’s Pentad: Charcot’s Triad
McBurney’s Sign plus Hypotension Altered Mental
Status

Layers of the abdominal wall: Arcuate Line:

1. Skin, then fat Superior to the arcuate line, the internal oblique aponeurosis splits to envelope the
2. Scarpa’s fascia rectus abdominis muscle. Inferior to the arcuate line, the internal oblique and
3. External oblique transversus abdominis aponeuroses merge and pass superficial (i.e. anteriorly) to
4. Internal oblique the rectus muscle
5. Transversus abdominis
6. Transversalis fascia
7. Preperitoneal fat
8. Peritoneum

27
Psychiatry and Neurology – BCC 7154
Structure:
 Inpatient Psychiatry: 3 weeks at JAHVA, Bay Pines VA, or Memorial Hospital of Tampa
 Psychiatry Consults: 3 weeks at JAHVA or TGH
 Neurology: 4 weeks - 1 week each of Inpatient, Consults, Stroke and Outpatient. All are
randomly assigned at either TGH or Haley VA. Outpatient neurology is at Morsani or STC.

Clinical Duties: Monday-Thursday, usually 7am-4pm (very variable depending on the service you are on)

Call:
 2 weekend day calls, at either TGH or Haley VA from 8am-8pm
 3 weekday night calls, from 4-10pm
 Call can be either for Neuro or for Psych – you will get a schedule at the beginning of the
rotation.
 Have to get a Call Ticket signed by your resident to be turned in to the course coordinators
documenting you were present and your performance.

Didactics: Fridays mornings alternating weekly between:

 Psych lectures 8am-12pm at USF Psych building Rm 232 on campus
 Neuro lectures from 7am-12pm at STC Rm. 5051C
 Neurology Morning Report Wednesdays at 8:30am at the VA and 8:15am at TGH, Psych
inpatient students are not required to attend but Psych Consult and all Neuro patients are.
 Neurology Chairman Rounds for Neuro students Thursdays 2-6pm at Morsani Rm 1013

Dress:
 Business professional for most services
 No ties on Psych
 Most neuro inpatient services will allow scrubs; ask your resident

Additional Tools: Tuning forks, Reflex hammer, eye chart, cotton swabs/safety pins on Neuro

Suggested Books/Resources:
 First Aid for Psychiatry
 Lange Psychiatry Question Book
 UWorld Psychiatry and IM Neurology Questions
 On Call Neurology
 UT Shelf review (online lecture and PowerPoint)

28
Assignments: Attend 1 Alcoholics Anonymous meeting, present 1 EBM article and turn in presentation
summary, optional Honors Presentation to be considered for Honors Grade

Grading:
 Clinical Evaluations
 Psychiatry NBME and Neurology Exam
 Logbook
 Professionalism

Tips:
 Go to and pay attention to the review sessions given – they are VERY high yield.
 Know the drugs of abuse.
 Ask Psych patients permission before touching them, safety is very important!
 Review how to do a full neuro exam, including gait assessment, before you begin the neuro part
of your rotation.
 There are only 7 keys available for the Acute Recovery Center (the VA Psych Unit) which you
need for every single door inside, so try not to be the 8th one in line to check one out.
 The Neuro exam is home-grown so read the PowerPoints for your neuro lectures and know
them well.

29
Maternal, Newborn, And Inpatient
Pediatrics – BCC 7185
Structure:
 Maternal-Newborn
o 1 week Labor & Delivery Days (7am-6pm)
o 1 week Labor & Delivery Nights (5:30pm-7:30am)
o 1 week High Risk/Low Risk/Antepartum (Genesis Outpatient Clinic 8am-4pm)
o 1 week Newborn Nursery (7am-4pm)
 4 weeks of Inpatient Pediatrics at ACH or TGH

Clinical Duties: Varies based on your schedule. Typically 1-2 days off per week

Didactics: Wednesday AM/PM for Maternal-Newborn, Daily at noon for Peds

Call: Peds is weekend call 6am-3pm; the schedule is pre-assigned at start of the clerkship. There is no
Maternal-Newborn call.

Dress: Scrubs for L&D days and nights and peds call, professional for everything else.

Additional Tools: The usual for pediatrics and stickers; gloves on L&D

Suggested Books/Resources:

OBGYN:
 Ob/Gyn Top 10 (.doc we will share with you)
 Beckmann/Barzansky, Obstretics & Gyneology, Lippincott Williams & Wilkins, 6th ed.
 First Aid for the OB/Gyn Clerkship
 Case Files Obstetrics and Gynecology
Pediatrics:

 CLIPP cases
 PreTest Pediatrics
 UWorld Peds Questions
 Nelsons Essentials for the lectures
 Blueprints Pediatrics
 Harriet Lane Handbook for reference

Grading:
 Clinical Evaluations

30
  Written Exam
 OB Oral Exam
 Homegrown pediatric exam based on CLIPP cases so pay very close attention to ALL of them
 Completing APGO OB Questions

Tips:
Pediatrics
 Take your vitamins. Kids have super germs that seem resistant to all forms of decontamination.
 When talking to younger children, get down on their level. Let them play with your
stethoscope/pretend listen to your heart before examining them. If they seem nervous about
getting on the exam table, do as much of your exam as possible with them in their chair or in
their parent’s lap.
 Examine heart and lungs first, so if they start crying you have already gotten a chance to listen.
On a similar note, exam the back of the throat/ears last because they may not like you much
afterward.
 Explain what you are doing to the kids – nothing is scarier than someone you don’t know coming
at you with scary unknown tools, and doctor = shots to some kids so it is nice to tell them if they
are not getting any shots in advance, then they can relax.
 Be VERY specific and detailed when you do your H&P. The more details the better in peds.
 The exam is based on the CLIPP cases, pay very close attention to them.

OB/GYN
 Introduce yourself to the patient – especially if a vaginal exam will be taking place. It is
inappropriate to be staring at exposed woman parts without telling her who you are.
 Be prepared to hover around the Lounge during your L&D shifts. Watch the body language of
the residents in there though, as sometimes they get really tired of having the students in their
space. If you see them get a little annoyed, bow out for a bit.
 Don’t take it personally. People get cranky when they are awake all night. Nights can be tough –
just get through it.
 Do all the questions from the APGO quiz site that deal with the Big 10 topics.
 Always ask 4 questions to every OB patient: Any contractions? Vaginal bleeding? Leakage of
fluids? Change in movement of the baby?

31
 USF-Lehigh Valley Health Network Basics
Making the Transition
Congratulations! You’ve made it to the clinical years of medical school. We know the
transition to third year alone can be intimidating, and the addition of a physical move can
add its own challenges and stress. First off, we would like to reassure you it is possible and
the hard part is already over. This guide will help ease your mind about the third year
curriculum and the move to the Lehigh Valley.

Clinical Locations, Directions, and Parking

As medical students at LVHN you will be working at the three main hospitals (Cedar Crest,
Muhlenberg, and 17th Street) as well as outside clinics for your clinical rotations. Below are
the addresses for the three main hospitals. The directions for the clerkship specific clinics
will be provided at the respective clerkship orientations. Please note students should park
only in designated staff parking areas. Look for staff parking signs. Maps of the three
hospitals will be provided at orientation.
Cedar Crest Hospital
1200 S. Cedar Crest Blvd.
Allentown, PA 18103
Parking available outside of the Kasych entrance and the 1250 building parking deck (4th
floor and above). Additional parking is available past the Kasych parking, near the water
tower.

Muhlenberg Hospital
2545 Schoenersville Road
Bethlehem, PA 18017
Parking available in lots adjacent to the main entrance as well as near smaller entrances.

17th Street Hospital

400 N 17th Street
Allentown, PA 18102
Parking available across the street outside of the Fair Grounds market building and the Fair
Grounds Theater.

Technology
Technology is an important to healthcare delivery at LVHN. As a medical student at LVHN
you will learn the ins and outs of our medical record system as you work with your medical
teams. You will be provided with a WYSE device and pager. Orientation will include
medical training in the EMR system. The WYSE device is a small laptop device that you can

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use to look up information about your patient, EBM articles and record your patient's
H&Ps. The WYSE device is to be used for profession work only. Each student will also be
given a pager. You may use the paging system to communicate with your colleagues and
your medical team. Please note it is your responsibility to keep up with these items and you
will be responsible for any lost or damaged devices.

Guide to USF-LVHN Clerkships

General Information
Congratulations! You’ve made it to the clinical years of medical school. We know the transition to third
year alone can be intimidating, and the addition of a physical move can add its own challenges and
stress. First off, we would like to reassure you it is possible and the hard part is already over. This guide
will help ease your mind about the third year curriculum and the move to the Lehigh Valley.

Primary Care
This clerkship will cover adult and pediatric care in the ambulatory setting. You will learn how to manage
acute and chronic diseases, learn how to deal with different patient populations and their needs. Your
SELECT knowledge will come into play here and help with your success.

Setup
This clerkship is longitudinal, meaning you will have continuity with clinics throughout the school year.
Each SELECT 3rd year rotation is divided into four 3 week blocks, two blocks are inpatient rotations and
two blocks are outpatient rotation. You will attend your Primary Care longitudinal clinics as part of your
outpatient rotation blocks throughout the entire year. In these outpatient blocks you will have one
whole day of Primary Care at your assigned family medicine clinic. Your day will start at approx. 8am and
end around 5pm. You will also have a half day at your longitudinal clinic during your outpatient blocks,
which will be with a pediatrics clinic for half the year and an internal medicine clinic for the other half of
the year. The half day may be from 8am - 12pm or 1pm - 5pm.

How to succeed
The great part about this clerkship being longitudinal is that you have the opportunity to interact with
patients over the course of the whole year, and your clinical preceptors will see you develop over a full
12 months!

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  Take the time to always write a full note, at least one a day, and get feedback. Your preceptor
will be able to give you really rich and meaningful feedback as they have so much time with you.
 When you see a patient and need to reschedule them, ask them to come back in on a day you
are going to be there again. You will always be coming in on the same day of the week during
your outpatient blocks, so make the most of the longitudinal experience and ask them to come
back and see you. If their schedule allows, this will be great for you AND your patient.
 Make time to study for primary care; you don’t have weeks at a time to go over the medicine
and questions. Be purposeful about how you are preparing for this clerkship. For some that
meant that the night before their Primary Care day they would use that time for Primary Care
prep exclusively. Do what works for you.

Other Requirements
In addition to your days working with your preceptors, Primary Care has assignments and projects that
span the length of the year. The projects and assignments may change year to year, but remember that
these are similar to the work given during other clerkships and require time and effort.
One of the assignments is to complete online Family Medicine CLIPP Cases that are assigned at the
beginning of the year. These are great study tools for your Primary Care midterm exam and for the
NBME at the end of the year. That being said, do what will prepare you best for your exams. You can do
them all at once or space them out. It is important to do these assignments.

Other Advice
If you feel like there is a problem with your primary care experience let your clerkship director know.
The point is not to shadow an attending, you should be interviewing, examining and writing notes as
well as a reasonable assessment and plan, on your own patient. If this isn’t happening let someone
know, this year will go by quickly, make the most of it!

Books/Materials:
Required Books
Beckmann: Obstetrics and Gynecology, 7th Edition.
Nelson Essentials of Pediatrics, 6th Edition
Swanson's Family Medicine Review, 7th Edition
Suggested Books
Case Files Pediatrics
Pediatrics Pre-Test
Case Files Family Medicine
Step-Up to Medicine
Shelf Exam

The shelf exam will take place at the end of the year. The mid-term exam provides good feedback on
areas to work on and prepare further for the shelf exam.

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Adult Medicine
This clerkship is primarily focused on the management of acute and chronic illnesses. There is a lot
material covered in this clerkship and the information you learn on this clerkship will be valuable no
matter what field you end up choosing.

Setup
Inpatient Blocks:
During your inpatient experience, you will be placed on a team with 2-3 interns, a senior resident and an
attending at Cedar Crest. You will be required to follow 2-3 patients, learn about their conditions and
how to manage them appropriately. You should arrive around 6:00 - 6:30 am to see your patients and be
prepared to round on all of your team’s patients by 9:00 am. Some afternoons you will have lectures on
your weekly topic like cardiology, GI, etc. There are also lectures on reading EKGs and radiology films. On
the afternoons that you do not have lectures, you will help your team with tasks, check up on your
patients and admit patients to the hospital in the ER. You are required to do one short call per week
where you are the designated medical student for hospital admissions for your team.

Outpatient Blocks:
During your outpatient experience, you will work with a resident in the 17th St hospital resident-run
clinic. Working with the "LAR" resident is often particularly useful as they usually have only two patients
per half day, giving you more time to see the patient and come up with an assessment and plan. There
will be times where patients do not show up to clinic--during these times, it is best to see if you can
work with another resident or study. Your day will start around 8:00 am and end around 5:00 pm. There
is a small room in the clinic with a few desks where medical students can store bags.

How to succeed
First and foremost read! You have an excellent base knowledge, but now you will learn how to build a
differential. It all starts with taking a great history and physical. The best way to look good on rounds is
to give a thorough but concise H&P. Make sure you know what is important and should be high on your
differential. Always hit your OLDCARTS questions, anything that happened overnight, lab and test
results, and consults. It is also good to know your patients' baseline in order to compare and contrast.
You should consider a broad differential to help guide what tests you will want to order and always have
a supporting reason for why you are ordering that test (help rule in/out items on your differential). If
you do not know about the diagnosis, read about it. UpToDate/Dynamed is a great resource.

Pattern recognition is very important for this rotation and the Shelf exam. The best study material is the
MKSAP question book for students. The same people that wrote this book also write for Shelf. Make
sure you have a textbook/review book that you are reading throughout the rotation - Step Up To

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Medicine is an excellent book and it is used throughout the rotation. Each week of the rotation covers
one system, which should have you prepared for the Shelf. You will be provided with PowerPoints at the
beginning of the rotation and they are good resources as well. Make sure you look over your material as
much as you can before Fridays. The lectures each Friday afternoon vary depending on the
attending/topic. Lectures can be case-based, PowerPoints or Q&A style. The lectures alone will not
completely prepare you for the quiz on Friday; make sure you study throughout the week.

Books/Materials
Required Textbook:
Cecil’s Essentials of Medicine (available online on MD Consult)
The Only EKG Book You’ll Ever Need (very important for the EKG quiz)
MKSAP for Students 5
Suggested Textbooks
Step-Up to Medicine (very useful)
Practical Guide to the Care of the Medical Patient
Tarascon Pocket Pharmacopoeia (excellent pocket reference to have on the ward)
Pocket Medicine (Excellent pocket reference! Most students have one)
NMS Medicine
The Osler Medical Handbook
Internal Medicine Essentials for Clerkship Students

Shelf Exam
The NBME Shelf exam is 110 questions and you will have 165 minutes. It is like Step 1, but includes
diagnosis, management and treatment of different diseases.

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Surgery

This clerkship will go over the general principles of preoperative, intraoperative, and postoperative care.
Within this rotation you will have experiences in general, trauma, vascular, and gynecologic surgery as
well as numerous surgical subspecialties.

Setup
Inpatient
Your typical day begins at 5:00 am for morning sign out. You should arrive 15 minutes early to print the
census of patients for your whole team. Your team will meet at 5:30am in the surgeon’s lounge or the
ECC1 conference room for morning report. This will be your daily quick reference for who your patients
are and their status. Take very shorthand, high yield notes on each patient (especially your own) during
morning sign out and during rounds. You may not need the notes, but if someone asks about the results
of a patient and you have it, you are helping the team and building rapport.
You schedule will vary from day to day. When there is something on the OR schedule, you are expected
to be in the OR.
Schedule
 Mondays, Wednesday, Thursdays - resident lecture from 6-7 a.m. in ECC1. You may wear scrubs
to these lectures. After lecture, go see your patients until completion. You will then round with
the team or go to the OR or both.
 Tuesdays – see your patients from 6-7 a.m. and then go to grand rounds at 7 a.m. in the
auditorium (food and drinks are allowed!). You must dress professionally for grand rounds.
Afterwards, you will round with the team or go to the OR.
 Fridays - see your patients from 6-7 a.m. and then go to Morbidity and Mortality (M&M)
conference. You must dress professionally for M&M. After conference, you will round with the
team or go to the OR.
Rounds vary on time, tempo and location depending on the attending/service. Your residents will help
you figure that out. The day ends whenever your senior resident dismisses you, usually around 5 pm.

The OR
Get to the OR a little early for the procedure, ideally before the patient is in the room. Introduce
yourself to EVERYONE. Be careful not to break the sterile field (general rule - anything on a table with
blue paper or a metal bin is sterile). Write your name on the dry-erase boards and get your own
gloves/gown. Help move, position and prep the patient. Once scrubbed in, it’s a good idea to do things
only when told. As you get more comfortable and as your team gets more comfortable with you, you
can be a much more useful assistant. Feeling it out is key because like everything else, certain people
want you to do one thing and others will ask you what the heck you’re doing. Typical expected student
tasks: laparoscopic cameraman, retractor extraordinaire, and skin closure guru. After the case, hang
around to help transfer the patient to their bed and fill out the post-op note in the chart.

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Outpatient
You will be visiting different surgical subspecialties each week. This will all depend on when you have
your primary care days. Different subspecialties you may work with include: Surgical Oncology,
Colorectal, Urology, Burn & Wounds, Plastics, Ortho or ENT. If there is a specific surgical subspecialty
that you're interested in, ask the clerkship coordinator if this can be arranged as it is often possible. In
outpatient clinic you will see patients for preoperative and postoperative care. You will obtain focused
H&Ps and give an assessment and plan to your resident/attending. Other days you may join the team in
the OR so be prepared for either.

How to Succeed
The surgery rotation has a completely different culture, environment and personalities. This will require
some time to get used to, but don’t be shocked that it is different or difficult compared to other
rotations. You have to accept it for what it is and you will enjoy your rotation, make the most of it
because for some of you it might be your only and last time doing surgery. Be nice to EVERYONE,
especially your residents because they can make or break you. Make sure you read up on all of your
patients and their conditions to impress your attendings. In addition, use Surgical Recall to look over
questions that might be asked of you while you are in the OR. There are weekly quizzes that consist of
20 questions and are organized by the chapters in Essentials in Surgery. However, your favorite review
book or the PowerPoints provided on Canvas are also helpful.

Books/Materials
Required Textbook
Essentials of General Surgery (pretty dense and brutal to read but the quiz questions
come from this book)
Suggested Textbook
Surgical Recall (not a book to study from, but a must have for the wards)
Case Files (the best resource, quick read, organized)
NMS casebook (great review for the NBME)
Pestana's Surgery Notes (small, easy read, great for shelf studying. Audio files are also
available that go with the book - ask an upperclassman for a copy)
Pretest Surgery

Shelf Exam
There NBME exam consists of 110 questions and you will have 165 minutes. The GYN surgery exam
consists of 20 questions and you will have 30 minutes. There are almost no questions on the shelf about
surgical technique. The whole exam is about the medical management of patients with potential surgical
complications and knowing where to draw the line on when to operate. The NBME practice exams on
their website are very helpful.

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Neurology-Psychology
This clerkship is focused on the diagnosis and therapy of neurologic and psychiatric diseases in the
inpatient and outpatient settings. There are shared approaches to patients with altered mental state.

Setup
Inpatient Psychiatry:
Inpatient psychiatry takes place at Muhlenberg Behavioral Health Unit, in both the adult and adolescent
units. You will rotate through inpatient psychiatry twice during this rotation, it is two weeks out of your
three week inpatient blocks. Your day typically starts around 7:30 a.m. - 8 a.m. depending on your
assigned attending and ends around 3 p.m. - 4 p.m. You will be given a key to enter various rooms while
on the floor, your name badge should give you access to the general area. You will meet with your
attending each morning to receive instructions for that day. There are many other team members
involved in the patient’s care that you will interact with such as PA’s, nurses, social workers and other
students.

Outpatient Psychiatry:
Outpatient psychiatry has numerous locations such as the consultation services at Cedar Crest, child
psychiatry at 1251 Cedar Crest Blvd (across the street from the main hospital) and the Banko building at
Muhlenberg hospital. You often work half days on outpatient psychiatry with the other half of your day
on outpatient neurology so being flexible and ready to switch gears mentally is important. While on
consult service you will page your preceptor by 7-8 a.m. each morning depending on your attending or
meet in the psychiatry consult room in the Anderson Building, 3rd floor by the medical student lounge.
You will be assigned a patient to interview and present. Use this time to expand your differential
diagnosis and suggest treatment options. This is a great opportunity to ask questions and learn. Child
psychiatry can be individual patient interviews or in transitions (outpatient all day therapy). You will get
to practice your interview skills with children in the presence of your preceptor. This is a great way to
received direct feedback.

Inpatient Neurology:
Inpatient neurology takes place at Cedar Crest or Muhlenberg depending on your schedule. Your day will
start around 7:30am. Inpatient Neurology consists of two weeks of your total size weeks of inpatient
time. There are numerous services you could work with including the CC stroke team (H3), the CC
consult service (H2) and the Muhlenberg neuro consult service. Your team may consist of one attending,
1-2 residents and/or PAs/ CRNPs. You will be given a patient(s) to evaluate and present to your team.
You will also round with your team on the other patients on the service and be available for any stroke
alerts that come in.

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Outpatient Neurology:
The outpatient neurology takes place from 8 a.m. to 12 p.m. and/or 1 p.m. to 5 p.m. at Cedar Crest 1250
Building (attached to the main hospital), 1770 Bathgate - the Muhlenberg neurology clinic and 17th
street LVPP clinic on the 1st floor (one floor up from the ground level floor). Use this time to work on
your neurology physical exam and see how abnormal neurological exams can present. These clinics are
usually fast paced.

How to succeed:
The key to this clerkship, like all other clerkships, is to read and actively participate in your clinical
encounters. For psychiatry, learning diagnostic criteria and pharmacology will be the most beneficial.
Learning the material and being able to apply it to your patient H&Ps will take you far. For neurology,
being able to perform a complete neurology physical exam and apply those findings to the differential
diagnosis will be the main objective. Being able to locate stroke lesions based on symptoms is
important. This is also a great clerkship to work on reading radiology scans as CT scans and MRIs are
used daily. Take an active role with each of your patients.

Other requirements:
By the end of the rotation, the student will present and submit a summary of an EBM article relevant to
a patient’s diagnosis, disease state or care. You will do one for Neurology and one for Psychiatry.
Students must attend an Alcoholics Anonymous meeting at some point during the clerkship which needs
to be completed during your free time. Students must turn in an assignment reflecting on their
experience. Logging patient daily on E-value is also a requirement.

Books/Materials
Required Textbooks
Introductory Textbook of Psychiatry
Clinical Neurology
Suggested Textbooks
Concise Textbook of Clinical Psychiatry
First Aid for the Psychiatry Clerkship
Diagnostic and Statistical Manual of Mental Disorders
Neurology, Current Diagnosis and Treatment
Introduction to the Neurological Examination

Shelf Exam
The NBME exam for psychiatry is 110 questions and you will have 165 minutes. The neurology exam is
50 questions and you will have 75 minutes. The psychiatry NBME has very long question stems,
preparation should be adjusted accordingly. Neurology is a home-grown exam from USF that covers
main topics you should see while on the clerkship and from the Friday didactic sessions.

40
Women’s Health and Pediatrics
This clerkship will focus on obstetrics, prenatal care, labor and delivery, newborn nursery, outpatient
gynecology/women’s health and acute and chronic illnesses of the pediatric population.

Setup
Inpatient Pediatrics
You will be assigned to either the Lion or Zebra team for your time on the floor, which consists of an
attending, two residents (from Pediatrics, EM or FM) and other PA/medical students. Each morning
begins promptly at 6 a.m. in the conference room on the 4A wing of the Pool Pavilion with sign out from
the night team. You should try to see and write complete notes on 1-2 patients before 8 a.m. Most
mornings from 8 - 9 a.m. there are morning report meetings, grand rounds or board review prep that
you will attend with the residents. Be prepared to participate in morning report as it is a case
presentation by a resident or 4th year medical student and requires participation from the medical
students in solving the case. At 9 a.m. your team will round on all of the patients on your service – be
prepared to be an expert on your patients. You will present your patients; suggest diagnosis and
management/treatment plans. This is a great opportunity to learn and show your team what you know.
Don’t be afraid to ask questions while rounding! While on the inpatient service you may have the
opportunity to admit new patients coming in from the ED as well as help with patients in the PICU. Sign
out occurs around 4 p.m. each day; take this opportunity to present your patient to the night team. You
are also assigned a short call night each week. Sign out for short call is around 7 - 8 pm.

Outpatient Pediatrics
This portion of the clerkship focuses on sick visits at outpatient pediatrics clinics, most often at the 17th
St clinic. These are more acute visits and the type of illnesses presenting often vary on the season. The
clinic hours are usually 8 a.m. - 12 p.m. and 1 p.m. - 5 p.m. The outpatient team consists of one
attending, one pediatrics resident and possibly other medical students. As the medical student you will
see the patient first, conduct a focus H&P and present to the resident and/or attending. If the patient
load is small take the opportunity to ask questions or go in with the nurses and other health care
providers to experience other parts of the visit, intake and giving vaccinations. There is opportunity for
a lot of autonomy in this part of the clerkship.

Inpatient OB/GYN
OB Days: The labor and delivery unit is located on the third floor of the Jaindl Pavilion. There are locker
rooms on this floor to change into the OB scrubs. You can bring a lock and store your belongings in an
open locker or you can leave your stuff in the resident/attending lounge called the LRC. The key on this
rotation is to introduce yourself, it is crucial on L&D. When you start every shift, go introduce yourself to
the patients in labor as well as the staff and attendings. "Hi my name is ‘X’ and I’m a medical student on

41
the team" will get you far. You get to do a lot on L&D, show enthusiasm and you’ll be surprised how
much they let you do. Your day starts around 5:50 a.m. to change and be ready to round at 6 am on the
recent delivered moms located on the Mother Baby Unit on the 4th floor of the Jaindl Pavilion. Morning
sign out begins at 7 am for the patients currently in labor. You should be assigned 1-2 patients to follow
for the day and are also able to scrub in on scheduled C-section cases. The clerkship provides a little
green book has everything you need to know about OB (Triage, Postpartum, L&D Admit). It is very
helpful! Things to learn/review prior to starting OB: fetal heart tracings (FHT), intrapartum progress
notes and G’s/P’s, these things become second nature quickly. There are also two required 12-
hour weekend shifts during inpatient OB/GYN.

OB Nights: You start Sunday night at 7pm and sign out at 7am Monday morning, every other day starts
at 6pm and signs out at 7am. This week is likely the most time intensive week of 3rd year. Expect to be
in the hospital from 5:45pm-7:45am. This week is really no different from days except there is less time
in the OR as C-sections at night are by emergency only. Have something to read/study in case you have
down time. There is an oral examination at the end of your inpatient OB/GYN block and little free time
during this block due to the long hours on the floor, so make sure you start studying earlier.

Newborn Nursery: The Mother Baby Unit is located on the 4th floor of the Jaindl Pavilion. You usually
start around 6:30 - 7:30 am depending on your attending/resident. These days are usually half days with
the afternoons spend on inpatient OB/GYN floor. It is a great opportunity to learn the newborn physical
exam. It is also important to pick up on the different questions to ask the mother regarding the
newborn. This week is also an excellent opportunity to develop continuity, as you will ideally be able to
participate in a delivery in the afternoon on L&D and then round on mom and baby the following
morning. You will be assigned babies to see on your own and will present to the attending during
rounds. Speak with the peds resident on the first day and see what days they have morning
report/grand rounds. Check with your attending to see if they want you to go with the resident or would
they prefer you stay with them.

Outpatient OB/GYN:
The clinical hours vary depending on location but will usually range 8 a.m. - 12 p.m. and/or 1 p.m. - 5
p.m. You will be assigned to one of two OB/GYN teams: College Heights or OBGYN Associates - both of
which have office locations throughout the Lehigh Valley. The patient visits consist of OB visits, annual
GYN exams, and acute GYN complaints. Take this time to hone your skills, you should feel comfortable
with breast and pelvic exams by the end of this outpatient experience. Always make sure you have
another person present, never perform the PE unsupervised. As the medical student you will see the
patient first, take an H&P, and suggest differential diagnosis and treatment options. Ask questions!

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Other Requirements
During this rotation you will have an oral exam with Dr. Flicker and Dr. Friel, usually scheduled during
your OB inpatient block. There are 4 OB case-based questions, with a series of questions about
management and treatment.
There are online CLIPP cases that need to be completed for the pediatric portion. They are a useful study
tool for the exam and are similar to the FM cases that you need to complete for primary care.

Make sure you stay on top of your patient write-ups. There are several for the women’s health portion
and one formal write up for pediatrics.
Other requirements include attending a childbirth education class, following a lactation consultant, and
attending a new parents discharge class – be sure to stay on top of these requirements as they require
signatures of your attendance.
In addition, you have to do a certain amount of the online uWISE quizzes for OB/GYN. These uWISE
quizzes can be used to supplement what you see and what you don’t see while on the clerkship.
However, they are a great study tool for the exam.

Books/Materials
Required Textbooks
Nelson Essentials of Pediatrics
Obstetrics and Gynecology, Beckmann
Suggested Textbooks
Current Pediatric Diagnosis and Treatment
The Harriet Lane Handbook
Lexicomp Pediatric and Neonatal Dosage Handbook
ACOG Compendium
Williams Obstetrics
Obstetrics: Normal and Problem Pregnancy
Creasy and Resnik’s Maternal Fetal Medicine Principles and Practice
Clinical Gynecologic Endocrinology and Infertility

Shelf Exam
The OB/GYN exam is 110 questions and 165 minutes long. It is a standardized NBME exam. The
pediatrics exam is homegrown and is 75 questions and you will have 90 minutes. The didactic lectures
provide a good foundation for the information you will be tested on. The pediatric is tougher and will
require more studying, you should know how to diagnose, manage and treat different diseases. The
CLIPP cases and uWISE quizzes are very helpful and important.

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 Appendices
The Case Presentation 1
This is how your attendings and/or senior residents assess your clinical reasoning skills. Presentation
skills require experience and knowledge, so expect to grow over time. Consider your presentation a
persuasive argument in which you provide evidence for your differential diagnosis.

Important tips:
 Present in order. One of the most common criticisms of student presentations is that they are
disorganized. The SOAP/H&P format is a good standard to follow.
 If Review of Systems is non-contributory, state: “non-contributory” (okay in presentations, not in
notes). If it is relevant to the patient‘s chief complaint, it belongs in the HPI.
 Offer YOUR assessment and plan. Be prepared to justify.
 DO NOT READ OFF YOUR NOTES. You may refer to notes while presenting, but reading from the
page is tedious for everyone. Try highlighting important history/labs beforehand if you do plan to
use notes.
 State only pertinent information. As medical students we often don‘t know what is pertinent and
have been trained to err on the side of thoroughness. Learning pertinent positives and negatives is
an important clinical skill to refine with time.

H&P Presentation Structure

One-liner: Patient‘s name, age, race, sex, chief complaint and any relevant past medical history.
HPI:
 You can abbreviate this for the purposes of presentation
 Plan to include:
o Description of symptoms i.e. OLDCARTS or OPPQRST
o Chronologic development of symptoms in days prior to admission
o Include pertinent positive symptoms, as well as pertinent negatives
PMHx:
 Simply a list of medical conditions which the patient has had
 Elaborate only on those with special relevance
MEDS:
 List ONLY the names unless otherwise directed by an attending or resident
ALLERGIES: drug allergies are most important
SOCIAL Hx:
 Condense to relevant details: lives with husband, employed as secretary, smokes one pack per
day for last 20 years, no alcohol or illicit drug use

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FAM Hx:
 Only include something that might point in the way of one diagnosis or another. It‘s ok to say
here (but not in your note!) that family history is non-contributory.
(Gyn Hx or Maternal Hx included now if applicable – ie: OB/GYN or newborn patients)
PE:
 Begin with vital signs, if they are all within normal limits, it is usually ok to say so without
mentioning specific numbers. Have them on hand just in case.
 List the pertinent positive and negative findings in their respective organ systems. Not every
organ system needs to be presented every time.
LABS/STUDIES:
 Include pertinent (pointing toward or away from a diagnosis) laboratory values and results from
tests or procedures. Have the other labs that were done readily available just in case you
thought one was less important than it actually was.
 Be prepared to look at and thoughtfully discuss any imaging that was done.
ASSESSMENT:
 Finish with a summary statement that includes what you think is going on, and what you want
to do about it. Offer YOUR assessment, plan and justification.
 This is your moment of glory, where you show everything you have learned. DON‘T let your
presentation trail off!

FOR EXAMPLE:
- Mr. Foley is a 53 year old, white male with a history of stage III prostate cancer diagnosed 2 years ago
s/p radical prostatectomy with adjuvant radiation therapy, who presents with intermittent, non-
radiating lower back pain x 2 months. Pain began gradually and has increased to 8/10. Pain is worse at
night but independent of position. He has been taking Advil without relief. He denies history of trauma to
area, change in urination, change in bowel habits, weakness of proximal muscles, fevers, and chills.
- He has chronic urinary retention for which he takes bethanecol. He has no known drug allergies. He
denies ethanol and tobacco usage. Family history is noncontributory.
- On physical exam, the patient is a cachectic male in no acute distress. Vital signs are stable. Lungs clear,
heart regular, abdomen soft and nontender with palpable liver edge at 2 cm below costal margin. Back
exam significant for point tenderness over L4-L5. Neuro exam with 5/5 strength throughout, sensation
intact to light touch bilaterally.
- CMP and CBC were within normal limits except for calcium of 11.5; alk phos of 150. His most recent PSA
one month ago was 10, increased from three months previously which was 5.
- In summary, the patient is a 53 year old male with history of prostate cancer who now presents with
back pain, point tenderness on exam, hypercalcemia and elevated alk phos and PSA. This likely
represents metastasis to the lumbar vertebrae. The enlarged liver may represent liver metastasis. Our
plan is to start Vicodin for the pain, obtain a bone scan to evaluate for bone metastasis, and obtain
abdominal CT to evaluate for liver metastasis.

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The SOAP Note1
The daily progress note documents:
 Significant patient events overnight
 The patient‘s current condition
 The current therapeutic reasoning and plan.
The level of detail expected in a SOAP note is highly dependent on the rotation. See each individual
rotation section for more tips.

S - Subjective:
 Any events overnight? (fever, emesis, bowel mvmt, ambulation, etc.)
 How the patient is feeling today, according to him/her!
 You may document patient care-related discussions, i.e. informed consent, in this section as
appropriate
O - Objective:
 Vitals (Temp, HR, RR, BP, O2 sat)
 Ins and Outs
 Focused Physical Exam (Gen, Heart, Lungs, Abd, etc.)
 Recent lab values and test results
A - Assessment:
 Most important part of your note
 One-liner with YOUR assessment of what is going on: i.e. ―55yo man with hx of … who
presented with …, LIKELY DUE TO … ‖
 It is okay to be wrong, but it helps to go over your assessment with an intern/resident prior to
writing.
 Include a justification of your diagnosis or assessment.
P - Plan:
 Typically organized by problems (ICU and Surgery may use organ systems)
 Start with pt‘s chief complaint or most pressing issue, i.e. ―1) Chest pain.‖
 If not already discussed in Assessment, may include a phrase or two as to likely etiology, i.e.
―likely cardiac in nature, given pt‘s history.‖
 What you are going to do to address the problem, i.e. start/continue meds, check labs, send X-
rays, get Echo.

How to write orders: (medical students typically do not enter orders, but ask your residents if they need
help)

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 Internal Medicine Progress Note Example/Template

Date of admission:
Date: [Current]
Time: [Current]
Current Hospital Day (or Post-Op Day):
Lines Status: [& # of days]
Antibiotic Status:

SUBJECTIVE:
[NAME] is a [AGE] [SEX] admitted *** days ago for ***. Pt stable overnight, no acute events. Pt is calm, communicative and appears to be doing
well. No new complaints.

OBJECTIVE:
Vitals:
Intake/Output:

Physical Examination:
Gen: Well-appearing, in NAD. Non-diaphoretic.
Head: NC/NT.
Eyes: PERRLA, EOMI. Vision grossly intact in all visual fields. No conjunctival injection. Sclera anicteric.
Ears: Symmetric, non-erythematous, non-tender to palpation. Gross auditory acuity intact.
Nose: No nasal drainage. Sinuses non-tender.
Throat: Oral mucosa moist w/o ulcerations. Good dentition. Oropharynx elevation symmetric
Neck: Supple, FROM. Trachea midline. Thyroid w/o obvious enlargement/tenderness/nodules. No LAD. No carotid bruits. No
JVD.
Heart: RRR. +S1/S2, no S3 or S4 detected. No murmurs, rubs or gallops.
Lungs: CTAB. No wheezes, rales or rhonchi. Chest wall elevations symmetric. Respirations unlabored. Posterior lung fields
resonant to percussion.
Abdomen: Soft, non-tender. +BS in all four quadrants, tympanic to percussion. No guarding or rebound tenderness. No CVA
tenderness to fist percussion. No masses or organomegaly present.
Extremities: No muscular atrophy or weakness. No tenderness to palpation. No cyanosis or edema. No joint swelling. No varicose
veins noted.
Pulses: Carotid, Radial, Posterior tibial & Dorsalis pedis pulses 2+ bilaterally.
Skin: No new rashes or lesions. No scars noted. No tattoos visualized. No
forehead tenting, turgor normal.
Neurologic: CNII-XII grossly intact, No focal deficits observed. Achilles, Patellar, Biceps and Brachioradialis reflexes 2+ bilaterally. 5/5
strength throughout. Light touch sensation of Distal extremities intact.
Psych: A&Ox3. Normal MS. Answers all questions appropriately. Mood pleasant, affect appropriate.

Current Meds:
Labs:
Microbio:
Imaging:
[Name of Study] (Date & Time 00/00/00@00:00) – As per Radiology report:
Paste report impression

ASSESSMENT/PLAN:
[Pt. NAME] is a [AGE] [SEX] who presents with:

// Problem #1: Status (Stable, Improving, Mild, Severe, etc.)

- Lab results show […..]
- Consult pending
- etc.

// Code Status:
//FEN:
//DVT PPx:
//PUD PPx:
//Dispo:

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Topic Presentations
In addition to impromptu mini-talks given by senior members of the team on topics relevant to the care
of patients on your service, you may be asked to give at brief prepared topic presentation during the
course of a rotation. Seek advice from your residents about the length and degree of detail expected in
these presentations.

In general, focus on basic principles rather than minutiae, and remember that a concise and complete
discussion is better than an exhaustive dissertation. If your Attending specifies that they want to hear a
5-minute presentation, be sure to keep it to 5 minutes because some Attendings will cut you off if it’s
too long. It helps to practice your talk and time yourself the night before. A one-page handout (one- or
two- sided) is also a nice touch and adds structure to the presentation, but usually not required.

Here is a general outline of how to approach a topic presentation:

1. Try to pick a topic relevant to either a patient you are following or another patient on the
service.

2. Narrow your topic as much as possible. For example, if you choose to do a presentation on
heart failure, narrow it to a specific cause (e.g. amyloid cardiomyopathy) and then narrow it
even further (e.g. heart transplant in amyloid cardiomyopathy).

3. Start with a 2-3 sentence presentation of your patient.

4. Cover the BASIC epidemiology, pathophysiology, clinical presentation, diagnosis and treatment
options.

5. Include a discussion of one or a few relevant papers (you can find papers of interest by doing a
Pubmed search for your key terms).

6. In general, UpToDate is extremely useful for the basic facts of your presentation and the
reference list from UpToDate articles can be very useful. However, it is always good to do a
Pubmed search if possible to find a few original articles of interest or just a great review.

7. Optional: Have your information on a one-page handout (one-sided or two-sided). Feel free to
have almost all of what you are going to say on it or an outline from which you will add
information from memory.

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Third-Year Pearls
 Being a team player is as important as a strong fund of knowledge.
 Learn everyone on your team’s name and save their phone/pager numbers as soon as possible
 Keep a record of the important hospital phone extensions
 Stay organized.
 Don’t be afraid to ask for help or ask questions.
 Be friendly to nurses and clerks—they can teach you a great deal about your patients and about
how things are done in the hospital.
 Be concise but complete.
 Be assertive but not obnoxious.
 Take some time to learn your way around the different parts of the patient chart early on.
 Always be prepared and on time for rounds. Know your patients well.
 Respect your residents and attendings, but do not kiss up. Insincerity is obvious.
 Learn the many ways to sincerely say, “I don’t know”—tough questions aren’t always intended
to evaluate you, but often to provide a starting point for teaching.
 Ask for feedback midway through the course to help you redirect your efforts if necessary and
avoid surprises at the end of the rotation.
 Do not despair if you receive an unfair evaluation. Almost everyone gets at least one
unexpected grade in the course of their clinical rotations.
 Do not intentionally show up a classmate—news travels fast
 Don’t spend too much time on MedLine/OVID/Pubmed searching for the most recent articles.
Concentrate on the basics.
 Consult your classmates. They are your greatest resource.
 Don’t worry about your grades compulsively. They should not be your primary motivation in the
clinics.
 Relax, smile and laugh naturally. An easy-to-get-along-with, interested, and enthusiastic student
will do well.
 When in doubt, just focus on doing things that will help your patients.
 No one expects you to know everything. That’s why you’re here.
 Stock your pockets with extra supplies your team/attending might need during rounds (extra
gloves, index cards, pens, gauze, tongue blades, cotton tipped swabs, etc), anything to make
rounds more efficient so you don’t have to go hunting for supplies while trying to learn
 Keep an emergency pair of clothes &/or scrubs in your car in case you get puked or pooped on

49
Commonly Used Hospital Terms
Bounceback – after a discharge, the patient is re-admitted back to your service
Crashing – patient condition suddenly deteriorates.
COW – computer on wheels (some attending prefer “WOW” for Workstation on Wheels)
Curbside – getting a specialist’s opinion without a formal consult
To “gas” someone – to draw an ABG on them
Getting burned – any future problems with a patient that you should have been able to prevent
Getting numbers – writing down vitals, I/O’s and labs for overnight patients, usually in the surgery
rotation
Laying some eyes – checking up on your patient without spending much time talking to them
Prerounding – getting vital/labs/test results, then doing a brief overnight history and PE before “rounds”
Run the List – going through the list of patients on your service, updating everyone on new information
Scut work – the work that no one wants to do; usually the work of the interns
Sign out – done at the end of the shift, passing pertinent information to the overnight team
Tuck’em in – checking on your patients before you leave for the day
Update the list – filling in the pertinent info from the day, or adding new patients to the list
Zebras – rare and/or obscure diseases

50
Commonly Used Abbreviation on OB
2VC- 2 vessel cord IUGR- Intrauterine Growth Restriction
3VC- 3 vessel cord IUP- Intrauterine Pregnancy
Ab- Abortion IUPC- Intrauterine Pressure Catheter
AC- Abdominal Circumference L&D- Labor and Delivery
AFI- Amniotic Fluid Index LGA- Large for Gestational Age
AMA- Advanced Maternal Age LMP- Last Menstrual Period
AEDF- Absent End Diastolic Flow LOF- Loss of Fluid
AROM- Artificial Rupture of Membranes LTCS- Low Transverse Cesarean Section
BBOW- Bulging Bag of Water Mec- Meconium
BD- Birth Defects Mono/mono- monochorionic/monoamniotic
BF- Breastfeeding Mono/di- monochorionic/diamniotic
BMZ- Betamethasone MR- Mental Retardation
BPD- Biparietal Diameter MSAFP- Maternal Serum Alfafetoprotein
BPP- Biophysical Profile NST- Nonstress Test
BUFA- Baby Up For Adoption NSVD- Normal Spontaneous Vaginal Delivery
BV- Bacterial Vaginosis NT- Nuchal Translucency
CD- Cesarean Delivery OA, ROA, LOA, OP, LOP, ROP (occiput, right, left, anterior, posterior – fetal
CHTN- Chronic Hypertension head positions)
CNM- Certified Nurse Midwife OCP- Oral Contraceptive Pill
CPD- Cephalopelvic Disproportion ONTD- Open Neural Tube Defect
CS- Cesarean Section P- Parity
CST- Contraction Stress Test PIH- Pregnancy Induced Hypertension
CTX- Contractions Pit- Pitocin/Oxytocin
CVS- Chorionic Villus Sampling PNC- Prenatal Care
D&C- Dilation and Currettage PNV- Prenatal Vitamins
D&E- Dilation and Evacuation POD#- Postop Day#
DFM- Decreased Fetal Movement PP- Postpartum
Di/di- dichorionic/diamniotic PPD#- Postpartum Day#
DR- Delivery Room PPH- Postpartum Hemorrhage
DS- Down Syndrome PPROM - Preterm Premature Rupture of Membranes
EAB- Elective Abortion PreE- Preeclampsia
EDC- Estimated Date of Confinement (“due date”) PROM- Premature Rupture of Membranes
EDD- Estimated Due Date PTL- Preterm Labor
EFM- External Fetal Monitoring PUBS- Pericutaneous Umbilical
EGA- Estimated Gestational Age Blood Sampling
FAVD- Forceps Assisted Vaginal Delivery RBS- Random Blood Sugar
FBS- Fasting Blood Sugar REDF- Reverse End Diastolic Flow
FDIU- Fetal Death In Utero ROM- Rupture of Membranes
FF- Fundus Firm SAB- Spontaneous Abortion
FFN- Fetal Fibronectin SGA- Small for Gestational Age
FH- Fundal Height SROM- Spontaneous Rupture of Membranes
FHR- Fetal Heart Rate SSE- Sterile Speculum Exam
FHT- Fetal Heart Tones SVD- Spontaneous Vaginal Delivery
FL- Femur Length SVE- Sterile Vaginal Exam
FLM- Fetal Lung Maturity TOLAC- Trial of Labor After Cesarean
FM- Fetal Movement VAVD- Vacuum Assisted Vaginal Delivery
FOB- Father of Baby VBAC- Vaginal Birth After Cesarean
FSE- Fetal Scalp Electrode VFI- Viable Female Infant
G- Gravida VMI- Viable Male Infant
GBS- Group B Streptococcus VTOP - Voluntary Termination of Pregnancy
GCT- Glucose Challenge Test VTX- Vertex
GDM- Gestational Diabetes
GHTN- Gestational Hypertension
GTT- Glucose Tolerance Test
HBsAg- Hepatitis B Surface Antigen
HC- Head Circumference
HELLP- Hemolysis, elevated liver enzymes, low platelets
HPV- Human Papilloma Virus
HSV- Herpes Simplex Virus
HTN- Hypertension
ICO- Incompetent Cervical Os
IUFD- Intrauterine Fetal Demise

51
Spanish Crash Course for OB L&D
Admission History and Physical
 My name is ............................................................................................Me llamo
 What is your name?.....................................................................¿Como se llama usted?
 What number pregnancy is this for you? ......... ¿Que numeró embarazó es este para usted?
o First?................................................................................. ¿Primero?
o Second? ............................................................................ ¿Segundo?
o Third? ............................................................................... ¿Tercero?
 What is your due date?...............................................................¿Cual es su fecha de alivio?
 Have you had ultrasounds?........................................................ ¿Ha tenido sonogramas?
o How many?.....................................................................¿Cuantas?

 How frequent are your contractions?.............................¿Que frecuenté son suscontriciones
o When did they start? ............................................................ ¿Cuando comenzaron?
 Has your bag of waters broken?............................¿Se le ha roto la fuente / la bolas de agua?
o What color was the fluid?..............................................¿De que color era el fluido?
 
Are you bleeding? ......................................................................... ¿Se la ha salido sangre?
o How much?..................................................................... ¿Cuanto?
o What color?....................................................................¿De que color?
o Have you passed any mucous?....................................¿Se la ha salido moco o flujo?
 Do you have any serious illnesses?...............................¿Tiene usted una enfermedad seria?
 Have you had any operations? ............................... ¿Ha tenido usted operaciones (cirugía)?
 Are you taking any medicine? .................................¿Usted tome cualquier tipo de medicina?
 Are you allergic to any medications? ................... ¿Tiene usted alergia a cualquier medicina?
o Foods?........................................................................................... ¿Comidas?
 Have you been tested for diabetes this pregnancy? …………..¿Le han hecho examinaciones de la sangre para la
diabetes este embarazo?
 Any spotting/bleeding this pregnancy? .............¿Le ha salido gotas de sangre o hemorragias con este embarazo?
 How much do you weigh now?................................................¿Cuanto pesa usted ahora?
 Do you smoke? .............................................................................. ¿Fuma usted?
o How much?..................................................................... ¿Cuanto?
 Breast or bottle feeding?...............................................¿Le va dar de pecho o de biberón?
Labor
 We need to do a vaginal exam........................Tenemos que hacer una examinación vaginal.
 Your cervix is ___ centimeters dilated......El cuello de la matriz esta abierto ___ centímetros.
 Do you want some pain medication? ..........................¿Quiera usted medicina ara el dolor?
 You need to relax and breathe with the contractions………..Usted necesita relajarse con los dolores.
 We are going to break your bag of waters.........Vamos a romper su fuente, (bolsa de agua).
 We need to make your contractions more frequent ……….Vamos a darle medicina para que le da contracciones mas
frecuenta.
 Do you feel rectal pressure with the contractions?.............¿Cuando le da los dolores, siente presión in el recto?
 Do you feel the urge to push? ............................... ¿Siente usted como que necesita pujar?
 Your cervix is completely dilated. It is time to push.........El cuello de la motriz esta totalmente abierto. Es tiempo
pujar.
 Take deep breaths.......................................................................Respire profundo.
 Hold it (your deep breath). ....................................................... Detenga su aire.
 Put your chin on your chest. ..................................................... Ponga su cabeza en su pecho.

54
  Push downward (on your bottom) like you are having a bowel movement.................. Puje para abajo como si va a
regir.
 Put your hands on your knees and pull them back towards you…. Pone sus manos en sus rodillas y jale hacia usted.
 Push very hard. ............................................................................. Puje muy fuerte.
Delivery
 Don’t push now. ........................................................................... No puje ahora.
 Slow (pant) with your contractions.......................................Sople con sus contracciones
 It’s a boy/girl!.................................................................................¡Es un niño / una niña!
 Push for the placenta................................................................... Puje para la placenta.
 Relax, let your legs fall to the sides…........Relájese y deje que se caen sus piernas a los lados.
 We are sewing up your episiotomy. .............. Vamos a poner puntos donde le cortando.
 We’re going to give you medicine through your IV to stop your contractions........Vamos a darle medicina en la sonde
para que se paren los dolores.
 We need to do an ultrasound. ......................................Necesitamos hacer una sonograma.
 Your baby is coming: head/bottom/feet first........................ Su bebe viene: cabeza/nalga/pies primero.
 Your blood pressure is high.......................................................Su presión esta alta.
 Tell me immediately if you have a headache, blurred vision, or epigastric pain.......Dígame inmediatamente si tiene
dolor de cabeza, la vista doble, o dolor en el estomago.
 This is a consent for a Cesarean section. ........................Esta es un permiso para una cesaría.

55
Commonly Used Medical Abbreviations
A&W-alive and well NAD-no acute distress

Abd-abdomen NCAT-normacephalic, atraumatic

ANA-anti-nuclear antibodies NKDA-no known drug allergies

B/l-bilateral NTND-non-tender, non-distended

BS-bowel sounds N/V/D/C-nausea, vomiting, diarrhea, constipation

CBC-complete blood count OA-Osteoarthritis

Ceseran- c-sections PERRLA-pupils equal round and reactive to light and accommodation

CHF-congestive heart failure Po-orally

CTA-clear to auscultation PPd-packs per day

CXR-chest x-ray PSH-past surgical history

DM-diabetes mellitus QD-daily

DTRs-deep tendon reflexes RA-rheumatoid arthritis

EOMI-extraocular muscles intact ROS-review of systems

ESR-erythrocyte sedimentation rate RRR-regular rate and rhythm

FH-family history S1S2-normal S1S2

F/U-follow up SLE-systemic lupus erythematosus

F/U/D-frequency, urgency, dysuria (pain while urinating) TMI-tympanic membrane intact

GC-gonorrhea U/L-urinalysis

Ggt-being delivered by drip/iv US-ultrasound

HEENT-head, eyes, ears, nose and throat W/r/r-wheals, rales, ronchi

HTN-hypertension

HSM-hepatosplenomegaly

HTN x 5 yrs-hypertension for 5 years

LROM-limited range of motion

MCP-metacarpal

MMM-moist mucus membranes

M/r/g- murmurs, rubs or gallops

56
A Few Final Words
As you start your third year of medical school, keep an open mind and expect the unexpected. You are
about to experience a whirlwind of family medicine, internal medicine, obstetrics, gynecology,
pediatrics, surgery, neurology, and psychiatry…what a year! Allow yourself to fully submerge in these
different fields and begin each rotation as if it were your field of choice. You may be surprised at what
you love and what you can’t stand.

As the year progresses, begin to gather your thoughts on what you see yourself doing ultimately. Do
you like the inpatient or the outpatient setting? Continuity of care or acute care? Surgical management
or medical management? Keep in mind that your experience on a rotation will be influenced by the
people on your team. Embrace this, but try to see past it when deciding which fields you gravitate
toward. Remember, you can always do an elective or externship to test your interest in a new
environment.

Keep in mind the privilege of being someone’s doctor. Your day-in-day-out may be someone’s most
salient life experience—the delivery of their first child, the day they almost lost their life in a car
accident, the day they got the news that it was not cancer. Never take that lightly.

Lastly, have fun and take care of yourself physically and emotionally. Third Year is “the most fun you’ll
never want to have again”! Good luck!

Sincerely,

Class of 2019

Consult Student Handbook and Syllabi or Course Directors regarding:

 Attendance Policy
 Emergencies for Personal Illness, Family Illness, etc.
 Scheduled Time Off for Interviews, Out-of-Town Meetings, etc.
 Medical Student Hours in Clinical Years
 Religious Observations
 Holidays
 Student Mistreatment / Unprofessional Behavior Reporting

57