great questions, here are my dos and don'ts (the don'ts are based on things visiting students have done
) ON C/L the only things you need to know how to do are a
capacity assessment delirium assessment, suicide risk assessment, manage agitation, and
recognize demoralization.
We dont use the MMSE much these days except in more advanced dementia. The
MOCA is the standard cognitive screen. The most useful thing you can get your patients to do is draw a clock. you can also of course ask questions for orientation, attention, registration (repeat 3 objects), short term memory (recall of 3 objects a 5 mins), long term memory (Presidents backwards, who was President assassinated in 1960s?), current events, phonemic verbal fluency (Words beginning with f in 1 min), semantic verbal fluency (animals in 1 min), fund of knowledge (how many camels are there in holland? - answer of 0 or >50 indicates cognitive impairment)
Do
...get there early and stay late
...introduce yourself to everyone (including exactly where you go to medical school)
...look enthusiastic and engaged
...request an appointment to meet with the program director (typically the med student coordinator can arrange)
...bring in a paper once a week relevant to a case you are seeing to present to the team
...offer to call for collateral, make contact with outpatient providers, request records (if applicable)
...ask to meet with someone to discuss expectations (this may be head of service but more likely psychosomatic fellow, chief resident, or senior resident)
...ask for feedback when there is down time or when people aren't busy
...bring in baked treats for the team (ideally made yourself but store bought is okay, i guess...)
...offer to do a brief presentation on a topic for later on in the rotation
...read up on your patients
...ask occasional questions when people aren't busy
...respond to feedback and learn from your mistakes
...read voraciously during the month (the standard CL textbook is MGH handbook of psychosomatic medicine, but Levenson's textbook of psychosomatic medicine is the other choice)
...be ever so polite and kind to everyone
...be friendly with any MS3s or other visiting medical students. It's not a competition. And if it is, chances are the MS3s will look better than you
...request permission if you are doing other activities (such as attending clinic or didactics)
...remember it is better to ask permission than forgiveness as a med student
...be honest about what you can and cannot do. No one expects you to know it all
...remember you are there to learn
...call in if you are sick or running late
...be a team player: ask to do things and offer to do things no matter how scutty
...ask all new patients about suicidal and violent ideation, psychotic symptoms, depressive symptoms, memory/attention/concentration
...write out your notes to help you organize your thoughts
...allow yourself to be part of the team
Don't
...turn up late and leave early
...look disengaged, tired, distracted
...demand to meet with the program director or turn up at their office unannounced
...make the residents look bad! (don't answers questions that were asked of the resident, or interrupt letting the attending know that you've read up on the resident's patients and can't wait to show off)
...continuously ask for feedback when people are busy
...challenge or argue with any negative feedback you receive
...inappropriately touch the residents or other staff members
...allow the patient to split so you are the good object and everyone else is bad
...argue with anyone or express your disagreement with what the resident or attending is doing
...invade people's personal space
...shout at patients
...make sexually inappropriate jokes
...talk about how wasted you got, or that time you did 2 grams of coke
...spend five millions years presenting
...misrepresent yourself or be deliberately vague (for example so that people think you go to a different med school than you do)
...get in people's way
...appear and disappear with no respect for time
...talk or ask questions when people are clearly trying to work
...interject when someone else is interviewing a patient. In fact, don't interview patients that aren't yours
...speak in a family meeting or a multidisciplinary case conference. Chances are you will say the wrong thing
...expect to know everything. It's not what you know, it's who you don't annoy
...think your knowledge of psychopharmacology matters. chances are the service will have their own protocol for how they manage delirium, agitation etc and you will learn this as you go along
...be too eager to start writing notes or take ownership of patients. Spend the first few days trying to observe as much as you can. Look over someone's shoulder and see what their notes look like.
...just turn up to places (for example resident didactics) without being invited, if in doubt, ask
...try too hard to impress, you will probably irritate everyone
...come across as competitive
...cause the whole service to collapse
