Hi Chuck,
Since I was part of the second class to do rotations in Kingman, there weren't exactly written out rules (not sure if that exists now, perhaps some of the current students can elaborate) for what I should do, but I can tell you what I did. The first day and a half I observed, asked a lot of questions on how things were done in the office setting (I asked the MA's, the NP's, the office managers as well as the preceptors). By the end of the second day, I would ask to be allowed to at least start the patients' care: obtaining a history, reviewing their meds and regime since the last visit and any labs, xrays, etc then do a physical. I filled in the chart up to that point (I should comment that I was completely comfortable with documenting since I was a nurse in my former life
😀 ). I would then wait for the preceptor and I would present the case to him. He would go in, and check all that was done, then we would discuss what should go into the assessment and the plan. After a few days, I was seeing them and writing their initial assessments and plans as well. The preceptor and I reviewed these things together and this is where the teaching took place.
For cardiology, I would come in to the hospital at 6:30 or 7 am (depending on the census), round on the inpatients, write notes, review labs, and get an idea how the patients were doing from the nurses. My preceptor would join me somewhere around 7:30 and I would present the patients to him and I would get more teaching here. He would go to the clinic at 8:30 or 9 am as I completed notes and then I would join him in the clinic and work with the out patients. If cardiolyte stress tests were done that day, he would go over them with me (what was infarcted/ischemic tissue, which was healthy etc) and we might do one last set of rounds in the hospital and he would sign the notes. He wrote the orders, as no one will accept orders from a third year med student but part of the teaching included him asking (before he wrote the orders) what would I order for this MI patient, CHF patient, unstable angina patient, etc?
I had the opportunity to observe the interventional cardiologists on his team inserting pacemakers, do catheterizations, etc. Case presentations were expected every Friday on some prearranged cardiology topic.
OB, yes, I definitely delivered my share of babies with the doc in the room, but you are the one guiding the little one out. The day starts earlier on O.R. days when they do gyn surgery (6 am or earlier to round on patients and write notes) then the surgeries start at 7:30. There's at least 30 mins for lunch in the cafeteria then off to the clinic. You will do call (there is a call room that you can use that has a shower, tv, comfortable bed, chair, and clock radio. (Remember there were no residents when I did rotations, hopefully with the renovations they were doing on the hospital they added on call rooms), you have a pager, so if you tell the nurses you are going to rest remember to leave your number with them so you can do your delivery. FP with the doc that did high risk OB gave me even more deliveries the following month.
Surgery as I mentioned before was the only rotation where I didn't get out as much as I should have because of personal circumstances. He did let me do a few procedures but I understand that the other students (particularly the male students) were able to do a bit more (I was only the second student to rotate with this particular preceptor). There are 2 surgeons that precept in Kingman and their styles are very different.
Not sure if all this verbiage helped, I hope so. But remember, things are bound to vary by the time you get to third year but this should give you an idea of what's going on.
P.S. As I mentioned, the hospital was being renovated while I was a third year. They increased the number of beds. Not sure what else they added. Also, you'll be glad to know that AZCOM does have rotations in Bullhead City!
For clarification on anything above that wasn't clear (I was on call with ortho last night and I haven't slept yet) send me a PM and I'll elaborate.
ted, D.O.
Emergency Medicine, PGY-1
somewhere in the city
