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Did your school/rotations allow med students to practice writing orders?

Discussion in 'Clinical Rotations' started by SxRx, Apr 9, 2012.

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Did your school/rotation allow med students to enter/write orders?

  1. Yes. They were edited by residents/attendings later.

    49 vote(s)
  2. Only when residents told me what to write

    15 vote(s)
  3. No.

    20 vote(s)
  1. SxRx

    SxRx 5+ Year Member

    Jan 4, 2009
    Most of my rotations didn't allow medical students (M3 or M4) to enter orders into the computer even before rounding. I feel that this is bit of a concern since I didn't get practice coming up with what to order for some of the most common conditions I will see as an intern. My residents were so busy that most of the times I couldn't sit down to ask them if they'd run through their train of thoughts when deciding what to order for patients we had either.

    I just want to know what percentage of med students actually get to put orders in patients' charts/computer (albeit not effective until an attending/resident signs it).
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  3. sylvanthus

    sylvanthus EM/IM/CC PGY-5 7+ Year Member

    Sep 9, 2008
    Ehhh I write orders in the chart most of the time when on IM and get them cosigned by my attending.
  4. mmmcdowe

    mmmcdowe Duke of minimal vowels Gold Donor SDN Moderator 7+ Year Member

    Sep 12, 2008
    SDN Author
    Rarely, I wouldn't worry about it.
  5. Day man

    Day man 5+ Year Member

    Nov 18, 2008
    it's always sunny
    Some residents make us...we just pend the orders in epic. Definitely makes you think more
  6. MilkmanAl

    MilkmanAl Al the Ass Mod 7+ Year Member

    I did occasionally at the VA. I have absolutely no idea how to do it in Epic, the system I'll be using next year. I wouldn't worry about it.
  7. DrYoda

    DrYoda Space Cowboy 7+ Year Member

    Jun 22, 2008
    Dagobah System
    Rarely. Depends on the location and the residents/attending.
  8. myhandsarecold

    myhandsarecold 2+ Year Member

    Dec 2, 2009
    hope that your hospital has preprinted orders or buy this (there's a 2012 edition that you can buy in some stores, cant find it online for some reason).
    Last edited: Apr 9, 2012
  9. pianoman511

    pianoman511 Member 10+ Year Member

    Jun 8, 2005
    Buffalo, NY
    I have put orders in during rotations both on handwritten order sheets and CPOE. For the handwritten sheets it was often writing them out and the resident signing them and making any changes. For CPOE I would put the orders in and the attending had to cosign them before they were active (Epic).

    One of the big failures of EMR is that many systems were not designed with students in mind or the hospital just doesn't purchase the options necessary to integrate students. The problem is that students then don't get a chance to practice essential skills like writing progress notes or entering orders prior to starting residency. It also removes students even further from providing care from patients. I can't even see the point in prerounding on patients if I couldn't write a progress note.

    Preprinted order sheets are nice, but it definitely makes you lazy because all you do is check boxes. I've seen on rotations where things get inadvertently checked off since it has become so routine that things get ordered when they really shouldn't have been.
  10. ArcGurren

    ArcGurren only one will survive 2+ Year Member

    Aug 6, 2010
    Yes, but only my main teaching hospital actually has written orders. The rest use EMR.
  11. SLUser11

    SLUser11 CRS 10+ Year Member

    Feb 22, 2005
    Writing orders is an essential portion of the learning process. Until you sit there with a pen (or typing on the computer), you won't believe how actually clueless you are about what to write. Not only does it lead to more thought regarding the patient's plan of care, but it is a practical exercise that will prepare you for intern year.

    Many residents won't force you to write orders, and some won't allow it. I recommend that you bring up the topic with your residents, and ask if it's okay to write some orders (especially admit orders and post-op orders). Some will say no, usually because they feel it will take too long, but some good ones will oblige, and it is extremely beneficial.

    However, don't ask until you're ready to do it. Make sure you have ADC VAN DISMAL (or some variant) memorized, and pay close attention to the resident's orders so you know what to write. Know common drugs and dosages....it won't be on your shelf, but you're ultimately going to have to learn these things to be an effective intern, so you might as well start now.
  12. justdoit31

    justdoit31 5+ Year Member

    Jul 13, 2008
    Our hospital has paper charts where orders are written and it depended on attending/residents if you wrote them with them or if you just wrote them and then they co-signed later. Overall I would say it is about half and half. On peds they knew I wanted to go into the field so I wrote almost all my own orders, discharges, scripts, etc and then they just signed off. Other things like surgery I wasn't so ambitious and was more likely to put items in the plan of my daily note and wait til rounds to actually place orders.
  13. 45408

    45408 aw buddy 7+ Year Member

    Jun 13, 2004
    Yes, and it was a huge learning experience. When I did my medicine sub-I at the VA, I entered all of my patients' orders, and the senior resident signed off on them. Near the end of the month, I made a comment on how at least he was reviewing them, and he said "Oh no, about a week into the month, I just started signing all of them without reading them all."

    Poor guy was working so damn hard that month because the actual interns were leaving a lot of work for him to do.
  14. coldweatherblue

    coldweatherblue 5+ Year Member

    Nov 24, 2007
    Medical students wrote orders on most of our clinical rotations and all of the core rotations.

    On medicine inpt we would write orders on pts we weren't presenting, and the orders would be cosigned by the intern/senior.

    On family my preceptor basically just gave me a script pad, told me how to use lab requisition sheets, and expected me to write all scripts and lab orders for the patients I saw. After I presented he would review the orders, make changes if needed, and sign them.

    On EM we used paper order sheets and I wrote most of the orders for my patients, then chiefed with a senior who cosigned.

    very useful med school experience imo.
  15. C5toC9

    C5toC9 2+ Year Member

    May 30, 2010
    Love the VA because I could actually put in orders that could be easily cosigned
  16. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

    Dec 17, 2008
    As a student I never did it at my school - not bc there is no education in it but because my med school's EMR made it very cumbersome to have orders co-signed by residents and the residents hated when students entered orders (would have to "verify" the entire order set - i.e. double check every order in the order set line by line with no way to know which of the orders specifially were written by the student).

    I think learning to hand-write orders is very important - i got to do this on my away rotation as a sub-I and found it helpful to think through things like postop orders and admit orders. It also came in handy the couple of times during intern year when the EMR was down for maintenance and we actually had to go "old school" and hand-write things.

    As a resident, I don't typically try to get the M3s involved in order writing, but will expect it of sub-Is. I have to say though that at our hospital I think it mostly teaches them how to use our EMR more than it does teach them to think through order writing in general.
  17. Roguelyn

    Roguelyn 2+ Year Member

    Apr 22, 2012
    I never wrote orders as a med student. The hospital's EMR simply wasn't build with us in mind. Not only that, but the physician order entry was rolled out the same time I started my rotations, so everyone was just learning how to use it.
  18. grayscaleart

    grayscaleart 2+ Year Member

    Jul 8, 2011
    yes, i do it all the time but you have to be proactive. our hospital still uses paper charts so whenever we're rounding, I grab the charts and start writing whatever the attending or resident wants ordered. it's not very complicated at all. we have a HUC (health unit coordinator) that enters the orders in the computer. if you write the order wrong, the nurse/lab/radiologist/tech/pharmacist will usually page you to clarify. for the tests, you literally just list them. for the meds, just write it like how you would write it on a prescription pad. there's some orders that are a little tricky like for medications where you need to put parameters as to when they should be withheld. there's also a little book that has templates of admit/discharge/transfer orders in them, you should get that. you'll be fine.
  19. cbrons

    cbrons Ratatoskr! *Roar* 10+ Year Member

    Jul 29, 2007
    Is EPIC (whatever latest version) designed with med students in mind?
  20. Psai

    Psai Account on Hold 2+ Year Member

    Jan 2, 2014
    bro EMRs are designed for insurance companies
    no one cares about physicians, otherwise they wouldn't be so cumbersome and annoying to use
    GUH and notbobtrustme like this.
  21. mcloaf

    mcloaf 5+ Year Member

    Jan 21, 2012
    I wouldn't say that it's designed with students in mind, but the EPIC system at our hospital lets me pend orders and have residents sign them.
  22. NeuroSpeed

    NeuroSpeed Big Schwartz Bronze Donor 2+ Year Member

    Oct 4, 2012
    @ the computer
    I was able to do this on Peds in Epic. However on IM I was specifically told not to write notes or enter orders because they were afraid of what Epic would do with them. I tried to show one of the Attendings on IM how it worked but he didn't really want to hear it. My thought is that the IM preceptors just didn't want to deal with student notes.
  23. justin1390

    justin1390 2+ Year Member

    Mar 15, 2012
    Same here, we use EPIC and are under a user category that allows us to write orders, they are then visible to any user that can sign. It's a neat system, actually. In terms of required to do it, at the main hospital it depends on the rotation, but only 1 or 2 rotations actually WANT you to write orders. At the other hospitals, they usually do want us to write orders. Regardless of whether it's required or not, I do try to write them. I am going to have to do it anyway, and I'd rather be familiar with it.
  24. 22031 Alum

    22031 Alum At the baby factory. 7+ Year Member

    Jul 12, 2008
    I don't recall ever writing orders as an MS3. I was definitely allowed to put in orders as an MS4 on my Medicine and Gyn sub-I's. In residency, students didn't have access to the order system but had assignments where they had to write out orders for various scenarios.
  25. mcloaf

    mcloaf 5+ Year Member

    Jan 21, 2012
    I had an IM preceptor tell me she was taking it easy on me by not having me send her notes to read over and critique, not realizing that I'd written all the notes she'd been signing on my patients already (even though they had my name on the bottom). :shrug:
    NeuroSpeed and cbrons like this.
  26. cbrons

    cbrons Ratatoskr! *Roar* 10+ Year Member

    Jul 29, 2007
    Who did she think was writing those for her? Lol.

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