How to organize yourself in rounds

[razorback58]

Has anyone used the cards: Fast Track Cards?
http://www.fasttrackcards.com/index.htm

I was told by a fellow resident who lives in another state that these are really cool.
Has anyone used these?
I seem to be singled out for the creatine level that they had on day 5 of their 24 day admit.........maybe this can help.

Just wondering because I ordered some the other day.

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[Blade28]

Every day I print out a patient list for our service and write important vitals/labs on them. Depending on the font, I can usually fit the entire census on one sheet of paper.

Then I just carry all of these with me, so on any given day during my month-long rotation I can whip out a previous patient list and check old labs, if necessary.

 

[orientedtoself]

also recommend the medfools scutsheet style #2. i had copied it onto card stock, double sided, use them as patient cards. it holds a week's worth of labs, vitals, notes, as well as their h&p essentials. if a patient stays more than a week you can start a second card

 

[anamarylee]

I use the MedFools Heavy Duty Scut Sheet (Pages 1 and 3 back to back) for IM Inpatient rotation. More than enough room, important labs well organized. If I run out of space in the small right grid, I use the "Notes" section in the back/left to write labs.

 

[Pir8DeacDoc]

Every day I print out a patient list for our service and write important vitals/labs on them. Depending on the font, I can usually fit the entire census on one sheet of paper.

Then I just carry all of these with me, so on any given day during my month-long rotation I can whip out a previous patient list and check old labs, if necessary.

Bro that's what the computer is for (look em up on the fly). I can see needed to know a few days but we're in surgery we don't need to keep things for a month

 

[Winged Scapula]

Bro that's what the computer is for (look em up on the fly). I can see needed to know a few days but we're in surgery we don't need to keep things for a month

I dunno...I agree with Blade. I could carry a month worth of lists around with me. Sometimes the info was wanted faster than I could look it up on the computer and sometimes it was info that wasn't readily available on the computer (what was the name of the physician at OSH X that we are transferring patient back to? what is patient's wife's cell phone #? etc.)

Maybe we just had a strange set of attendings that DID want to know what the INR was last week or what day the last CT scan was done on so carrying the lists was helpful and for me, much faster in most cases than the computer.

 

[Blade28]

Maybe we just had a strange set of attendings that DID want to know what the INR was last week or what day the last CT scan was done on so carrying the lists was helpful and for me, much faster in most cases than the computer.

Yeah, that's the way it is here. We don't have time to be running back and forth looking up patient's labs on the computer - much easier to just have it handy in your back pocket.

 

[buckley]

We don't have time to be running back and forth looking up patient's labs on the computer - much easier to just have it handy in your back pocket.

I agree. When attendings want info, they WANT it before you take your next breath. Hahaha. And having some fancy schmancy gadget is just another means for them to give you a grilling, "even with all those gadgets, you still don't know what the patient's ____ is? next time, use your brain."

 

[Blade28]

Yeah, I'd be embarrassed if every time the attending asked for a lab value (e.g. "What was Mr. Smith's creatinine over the weekend?") I had to say "Let me check" and run for the nearest computer.

 

[Pir8DeacDoc]

I don't mean to imply that you shouldn't know pertinent details. My point was that a month's worth seems a bit excessive (to me)..Also, we always have a rolling computer that we make the students push around. They damn sure better have it pulled up to the patient we are rounding on. So the info should be very accessible.

 

[Pir8DeacDoc]

Plus, do you think fumbling through your pockets is really quicker than having someone pull it up on the rolling laptop? Unless you know it off the top of your head then there will be that awkward moment of silence where you try and decide what's what.

 

[buckley]

I guess I'm just not very techie savvy. It really takes me a lot longer to check on the computer than to search the jungle of my own handwriting

 

[Winged Scapula]

Plus, do you think fumbling through your pockets is really quicker than having someone pull it up on the rolling laptop?

Yep, because I rarely fumbled...all lists were in chronological order, so it was quite easy to find the pertinent day.

Perhaps your patient rooms were bigger or your teams smaller and your EMR faster, because ours (COW) would have to be left out in the hallway as they wouldn't fit in the rooms and pulling up individual patients was not nearly as fast as getting the numbers off the lists in my pocket. YMMV.

It also may make a difference who's rounding. If I, as the Chief, was rounding with the attending, it was usually a quick dash between cases and the students or junior residents may or may not be around so I'd have to rely on my lists. The only reason for 1 month's worth of lists in my pocket was simply because that's what would fit...and as an intern we were on service for a month at a time, so it became habit to dump the lists at the end of the rotation.

Unless you know it off the top of your head then there will be that awkward moment of silence where you try and decide what's what.

No awkward moment of silence..you simply say I've got it right here...which you would have to say as well if you were pulling it up on the computer (because our screens wouldn't show more than a couple of days at a time anyway).

 

[DarthNeurology]

Making the list is the student's job on my surgery electives, at 4:30 am or so we used a spreadsheet and entered all the labs, cultures, radiology, everything current up to 4:00 am and then print it and make like 25 copies for all the surgery residents, especially the chief surgery residents, and then we'd round on patients around 6:00 am, the am labs aren't back yet so the list is up to date in the a.m. except for STAT labs sent out. We round on the patients and if there is lab we don't have or has not come back yet then the junior residents have to check up on it. Attendings could come get the list too to look at but attendings have never really runned the post-op floor or the siccu where I was at. Throughout the day you just update the list by writing down labs on it. All it takes is a student 2-3 hours in front of a computer to pull up the labs for all the patients. We did not have time to look up labs during rounds, unless on rare occassion we needed a lab value to make a management decision, we did send out a lot of midnight labs which were always on the list. Many institutions have computer programs that "talk" to each other and print out a list with the labs, cultures, almost everything on the list of your patient's census, even vitals ranges too, just click and print, saves everyone time.

 

[Winged Scapula]

Making the list is the student's job on my surgery electives, at 4:30 am or so we used a spreadsheet and entered all the labs, cultures, radiology, everything current up to 4:00 am and then print it and make like 25 copies for all the surgery residents, especially the chief surgery residents,

All it takes is a student 2-3 hours in front of a computer to pull up the labs for all the patients.

No wonder you feel scutted during your rotation!

It was never my student's job to get all the labs and other pertinents for all the patients and residents. Only for the patients the student was carrying (perhaps 2-3 depending on census and acuity) would I expect them to know the data. Seems like you and your colleagues were no more than data collectors rather than learning something about surgery. At least between 0430 and 0600.

Unfortunately, our EMR did not allow for organizing lists by service only by floor and we could not filter out the patients we didn't want. So our list was a program written by a resident many years ago which didn't dovetail with the hospital's EMR. We hand wrote the labs and test results on them.

 

[DarthNeurology]

No wonder you feel scutted during your rotation!

It was never my student's job to get all the labs and other pertinents for all the patients and residents. Only for the patients the student was carrying (perhaps 2-3 depending on census and acuity) would I expect them to know the data. Seems like you and your colleagues were no more than data collectors rather than learning something about surgery. At least between 0430 and 0600.

Considering that we rounded three times a day on say 35-60 patients I felt I learned a lot as usually I would be following 5 of the patients personally (Uh OK post-op day 2 appy I'll do that, SBO ok that's easy I will do that, uh ok post colectomy I can do that, and on and on) and instructing the remaining students on what to go accomplish before rounds. Each of those 30 patients I would assess the diagnosis, post-operative day, blood cultures, review radiology in the computer, what antibiotics they were on, did they have pre-op labs done?, and vitals and had to run and check doppler's on vascular patients. And the ever popular getting a patient up at midnight to walk around the hospital because they won't and they have atlectasis and they are going to get a pneumoniae. Did you ask the radiologist if there any signs of air in the billiary system, is there any signs of necrosis, the residents will want to know. Do you know how to doppler for pulses? Let me go show you, . . . Just go do a blood draw for cbc, ua, the resident will want it anyway . . . By the end of the rotation I was evaluating patients on surgery consults in the ER, and paging the resident for the inevitable appendectomy quickly and efficiently because I had to go do the stupid list.

2-3 patients/student is a joke, when I wasn't doing the list it was 11-14 patients, and yes you do everything for them as a student, knowing most recent labs i.e. sitting down at a computer for an hour, from blood cultures to urine cultures to moving them around the hospital, most of us were collapsing from exhaustion when we left after 30 hours . . . 2-3 patients in a whole 24 hours sounds like a "holiday" surgery clerkship, unless you are talking an elective, I was pleased when I only had like 6-7 patients in the sicu that was a vacation and weird watching PGY-2 surgery residents that didn't have the strength to manage even 7 patients, sad, of course they know I did my surgery core at the big university hospital so that garnered instant respect as I was the one who "formerly did the list." Considering that I did 5-6 patients on my own and monitored 35-60 patients frantically and did *very* well on the shelf exam and surgery on step 2, I would say I learned more than your students who may have sleep during their call on surgery clerkship, something I never had the luxury to do.

 

[Winged Scapula]

Considering that we rounded three times a day on say 35-60 patients I felt I learned a lot as usually I would be following 5 of the patients personally and instructing the remaining students on what to go accomplish before rounds. Each of those 30 patients I would assess the diagnosis, post-operative day, blood cultures, review radiology in the computer, what antibiotics they were on, did they have pre-op labs done?, and vitals and had to run and check doppler's on vascular patients. And the ever popular getting a patient up at midnight to walk around the hospital because they won't and they have atlectasis and they are going to get a pneumoniae. Did you ask the radiologist if there any signs of air in the billiary system, is there any signs of necrosis, the residents will want to know. Do you know how to doppler for pulses? Let me go show you, . . . Just go do a blood draw for cbc, ua, the resident will want it anyway . . . By the end of the rotation I was evaluating patients on surgery consults in the ER, and paging the resident for the inevitable appendectomy quickly and efficiently because I had to go do the stupid list.

2-3 patients/student is a joke, when I wasn't doing the list it was 11-14 patients, and yes you do everything for them as a student from blood cultures to urine cultures to moving them around the hospital, most of us were collapsing from exhaustion when we left after 30 hours . . . 2-3 patients in a whole 24 hours sounds like a "holiday" surgery clerkship, unless you are talking an elective, I was pleased when I only had like 6-7 patients in the sicu that was a vacation and weird watching PGY-2 surgery residents that didn't have the strength to manage even 7 patients, sad, of course they know I did my surgery core at the big university hospital so that garnered instant respect as I was the one who "formerly did the list." Considering that I did 5-6 patients on my own and monitored 35-60 patients frantically and did *very* well on the shelf exam and surgery on step 2, I would say I learned more than you students who may have sleep during their call on surgery clerkship, something I never had the luxury to do.

That's a bit presumptuous, IMHO.

While I cannot comment on how much my students learned, please rest assured that if there was work to be done, traumas or consults to be seen, they were not sleeping. Given that they did well on their matches, I'd venture that they must have learned something and if their reports are to be believed, are doing well in residency despite the "vacation surgery rotation" they had with me (and my colleagues as my practice was shared by my fellow residents).

2-3 patients is not a joke when you may have only 10 or fewer patients on service or are dealing with SICU patients. Or if there are more patients, and plenty of residents and other students. It was dependent on a lot of things; students may have seen more patients on larger services such as trauma but it was unusual for us to go over 40 patients per service and it would be much much less for rotations like Transplant, Colorectal, Surg Onc, etc.

I'm sure your former residents would be pleased to know that you thought you managed the patients better than they. For a medical student to manage 6 or 7 SICU patients, seems a bit dangerous to me. Then again, I'm funny that way.

My goal was for students to know everything about their patients, to be in the OR with them (how do you round 3 times a day on 35-60 patients and be in the OR?) and follow them closely. Our attendings wanted the students in the OR and therefore, they were available for am and pm rounds but the rest of the day was in the OR.

If I and they felt they could handle more, then they got them, but most 3rd year students are not capable of rounding on 10 patients, writing 10 notes, and really understanding the concepts behind surgical management. All it takes is to read the A/P and see that it would degenerate into a rote "ambulate TID, advance diet to X, pain control prn and discharge planning" without any real thought as to how to manage THIS patient.

Rounding on more patients, collecting their vitals and labs and spending 2-3 hrs every day in front of the computer doesn't make for a better student or a better understanding of surgery. Perhaps you are better than the average; that may very well be the case but others may learn differently. Since you are not going into a surgical field and have experienced what kinds of students are out there, you shouldn't be suprised that others are not as interested or hard-working. Therefore, why should I ask a student who is only minimally interested in surgery to spend hours collecting data which doesn't teach him or her a significant amount of surgery? I'd rather they:

a) learn a skill which will help them in whatever career they may choose; so that entails learning how to suture, how to evaluate a wound for infection, healing problems, how to dress a wound, remove a drain and of course, how to evaluate a surgical abdomen and other potential surgical problems, when and how to call a consult;

b) have some fun. Most students enjoy the OR, even those who hate surgery.

I'm all for the team concept but when a student rounds on 10 patients, that's 10 patients the resident also has to examine and 10 notes the resident has to read (and we all know how long med student notes are) and co-sign. To paraphrase a famous House of God quote: "Show me a medical student who doesn't triple my work..."

Therefore, I'd much prefer that the student see a reasonable number of patients (which depends on census, student interest and ability), learn some detailed surgical concepts and a few key surgical skills. Using a medical student to lighten the resident's load is not appropriate and if you ask me, that's what the residents were doing to you.

It may not be clear to you, but I and others have recognized that your experience is not the norm for most students. It may have made you an excellent senior student but it is presumptuous that one needs to do what you did to excel on their rotation, Step 2 or to match into the specialty of their choice.

Lastly, I find it odd that you complain about being scutted and when I agree that your experience sounds like you were, you begin to defend it. Classic Stockholm syndrome.

 

[DarthNeurology]

That's a bit presumptuous, IMHO.

Given that they did well on their matches, I'd venture that they must have learned something and if their reports are to be believed, are doing well in residency despite the "vacation surgery rotation" they had with me (and my colleagues as my practice was shared by my fellow residents).

2-3 patients is not a joke when you may have only 10 or fewer patients on service or are dealing with SICU patients.

I'm sure your former residents would be pleased to know that you thought you managed the patients better than they.

If I and they felt they could handle more, then they got them, but most 3rd year students are not capable of rounding on 10 patients, writing 10 notes, and really understanding the concepts behind surgical management.


a) learn a skill which will help them in whatever career they may choose; so that entails learning how to suture, how to evaluate a wound for infection, healing problems, how to dress a wound, remove a drain and of course, how to evaluate a surgical abdomen and other potential surgical problems, when and how to call a consult;

b) have some fun. Most students enjoy the OR, even those who hate surgery.

To paraphrase a famous House of God quote: "Show me a medical student who doesn't triple my work..."


Lastly, I find it odd that you complain about being scutted and when I agree that your experience sounds like you were, you begin to defend it. Classic Stockholm syndrome.

How to evaluate a surgical wound?!? You can tell any old student to look for classic signs like errythema, induration, warmth, obvious pus drainage, but it really does help when you look at 10 surgical wounds in a day . . . we were expected to do this on day #1 and dress the wounds ourselves and do a wound cultures after rounds, any surgical student who can't do this maybe was in a coma during the clerkship.

We enjoyed the OR as it was a short break from the floors. In terms of my SICCU residents they were reprimanded and more . . . , and I was talking in terms of monitoring patients in the siccu, i.e. vitals, how the patient is doing, a lot of time I had to go do a blood gas myself or tell as resident we better consult ID again because if the patient is not getting better they are getting worse, . . .I would usually try to follow the sickest patient most closely which of course the interns/new PGY-2 would neglect. Ii had a patient in respiratory distress, the resident said they were OK without seeing the patient, I saw pulmonary attending in elevator and guess who is intubated within half an hour and guess who gets a talking to? the intensity of a really hard surgery core rotation will prepare you for anything, something even surgical residents understand. I routinely picked up things with patients, manned the list, and did more than the surgery residents. Considering that I prepared the notes and the attending cosigned 'em the next day the surgery residents didn't write any notes AT ALL (sometimes they wrote on/added to our progress note, but it was a worthless generalization), but they needed to be done and we did them. Progress notes are medicolegal, most of communication in medicine and surgery is orally done, there are all a page anyway. These were my glory days as the place couldn't run without students: We do the majority of wound checks/changes, we get the a.m. vitals (in ranges), we update the list for medications, we transported patients, we did many checks on patient's arterial blood flow, we helped out with all the consults, we really helped to run the post-op floors because the hospital is understaff in terms of residents as some left the program for another program. WE monitored patients q hourly in the ICU when needed, we did the midnight blood draws, we harassed radiology to CT our patients, . . .

I don't care about working hard myself, my medical school work is all but done, but obviously there are many students who get taken advantage of or can't work that hard so that is why I advocate for future students, not myself. I don't seem to have identified with most residents who I view as lazy anyhow, so I don't identify with anyone in power over me so I don't have Stockholm syndrome, regardless all the 35-60 patients were mine anyway . . . and I learned from each of them so I don't think it was scut.

And yes, seeing 2-3 patients a day is still a joke to me, Un-acceptable, I always *struggle* to maintain my own census greater than at least 6-7 on all electives and rotations i.e. I have never been assigned any patients cause I take 'em all! Considering that I have read Lawrence about 3 times, FA surgery about 3 times, NMS surgery about once, Surgery case files twice, know surgical recall by heart, can do sub-Q closures with my eyes closed have done a couple first assists one where I clamped big 'old arteries and the burned them with bovie (attending upset intern not there so just started), and did I mentioned that I did Swart'z principles of surgery self-assessment and board review in my spare time and own my own Schwartz for personal reference and because I did something like four presentations in surgery and needed a good book AND sat in on the surgery board review (What is Darth doing here, isn't he post-call!??"--overheard from surgical resident during surgical board review) and did >260 on Step 2 I THINK I CAN GO TOE TO TOE WITH ANY SURGERY INTERN or PGY-2 IN THE SICCU!! You presume too much if you thought they were teaching me . . .there is something wrong in a siccu where a student can look up how an a-line works and most of the PGY-2's can even describe it . . . these residents didn't manage anything that was up to the chief surgical resident they were robots i.e. barely knew all the patients and were told every single they thing to do and never took iniative . . . and they got punished for it . . .they (residents) wanted me (student) to present the M and M patient in surgery grand rounds because I can look up articles and explain them to attendings and not get reamed,(probably more "scut" but at least they knew I could do it) . . . Hmmm must done something right if the residents told me I should do surgery . . .In the end I was doing the job of what is normally given to two students in the rotation so perhaps I was a little overworked . . .but at least I know I can work that hard . . . I should take a break from this board and go read,

 

[johnnywalker]

...

 

[DarthNeurology]

after you are done reading you should go get over yourself, i have to really question the authenticity of your posts. its too bad you can't match directly into fellowship from your med school cos apparently you have nothing to learn from anybody else.

delusions of grandeur possibly????

I learned a lot from senior surgery residents and interns too, just not in that elective (from the PGY-2 and PGY-1 no education, but I did learn a ton from the senior PGY-4 . .) . . . its different from place to place dude, I was motivated to at least make the best attempt to learn what I could, some places give you a lot of autonomy as a student and you are more of a sub-I, I am sure at fancier places surgery residents would kick my booty, I just like to work and see patients nothing wrong there, at some hospitals, at least at the one I was at ALL the students talked about how the place would fall apart without the students, . . .Are you going to say that half a dozen students were delusional? I think not, I am going into the hospital tomorrow, not because I have to, but just to get some cases under my belt, I WILL by laughing tomorrow about the whole 2-3 patients a day, HA HA HA HA! Honestly I wouldn't change my experience in surgery for the world, 2-3 patients a day, would probably have been easier on the feet, but going through a tough surgery clerkship is like surving a war and you have goo d war stories to talk about, and you become really close with other students in your "platoon" as it were.

"To be an excellent student, you will have your booty kicked, but you kick their booty too, a mutual booty kicking." --quote from general surgery chief resident describing how he succeeded in medical school . . . or in other words you have to get so involved in patient care that you are indistinguishable from a resident, and constantly question what the residents are doing and don't take what they say as golden, sorta worked for me. My post is accurate in terms of what I observed/did in surgery clerkship, the whole thing, so consider that it is good to be aggressive in surgery clerkship and learn everything you can and don't be intimidated by residents or attendings. I am not loud and arrogant on rotations, I listen very closely to what everybody is saying so I evaluate every little piece of information to see if it is truly a piece of new knowledge or just a generalization or perhaps something that has since changed in the literature so it is not like I am anti learning or anything.

Considering I was read Marino's ICU before I started SICCU I had a head start but I also used for my own info during the elective:

http://www.surgicalcriticalcare.net/

Maybe you should try reading everything I have and then you would be able to judge how much I know compared to a surgical intern . . . being good in the SICCU boils down to re-evaluating your patient regularly, patients and residents get into trouble when it is assumed that their course has stabilized, . . . I could tell what the resident was going to get reamed over, I could offer my advice for this or that patient, especially since I have good ICU experience, obviously I was usually not managing patients care, but unfortunately sit back and watch the train fly off the cliff if residents were too busy/arrogant to listen to me, eventually yes they did assign me to the sickest patients . . . wonder why (sarcasm) . . . and wanted me to tell them when something bad was happening, . . . maybe that little star/asterix on my surgery sub-section bar which ran off the right-side of my Step 2 score reports means something! (more sarcasm)

 

[jetproppilot]

How to evaluate a surgical wound?!? You can tell any old student to look for classic signs like errythema, induration, warmth, obvious pus drainage, but it really does help when you look at 10 surgical wounds in a day . . . we were expected to do this on day #1 and dress the wounds ourselves and do a wound cultures after rounds, any surgical student who can't do this maybe was in a coma during the clerkship.

We enjoyed the OR as it was a short break from the floors. In terms of my SICCU residents they were reprimanded and more . . . , and I was talking in terms of monitoring patients in the siccu, i.e. vitals, how the patient is doing, a lot of time I had to go do a blood gas myself or tell as resident we better consult ID again because if the patient is not getting better they are getting worse, . . .I would usually try to follow the sickest patient most closely which of course the interns/new PGY-2 would neglect. Ii had a patient in respiratory distress, the resident said they were OK without seeing the patient, I saw pulmonary attending in elevator and guess who is intubated within half an hour and guess who gets a talking to? the intensity of a really hard surgery core rotation will prepare you for anything, something even surgical residents understand. I routinely picked up things with patients, manned the list, and did more than the surgery residents. Considering that I prepared the notes and the attending cosigned 'em the next day the surgery residents didn't write any notes AT ALL (sometimes they wrote on/added to our progress note, but it was a worthless generalization), but they needed to be done and we did them. Progress notes are medicolegal, most of communication in medicine and surgery is orally done, there are all a page anyway. These were my glory days as the place couldn't run without students: We do the majority of wound checks/changes, we get the a.m. vitals (in ranges), we update the list for medications, we transported patients, we did many checks on patient's arterial blood flow, we helped out with all the consults, we really helped to run the post-op floors because the hospital is understaff in terms of residents as some left the program for another program. WE monitored patients q hourly in the ICU when needed, we did the midnight blood draws, we harassed radiology to CT our patients, . . .

I don't care about working hard myself, my medical school work is all but done, but obviously there are many students who get taken advantage of or can't work that hard so that is why I advocate for future students, not myself. I don't seem to have identified with most residents who I view as lazy anyhow, so I don't identify with anyone, regardless all the 35-60 patients were mine anyway . . . and I learned from each of them so I don't think it was scut.

And yes, seeing 2-3 patients a day is still a joke to me, Un-acceptable, I always *struggle* to maintain my own census greater than at least 6-7 on all electives and rotations i.e. I have never been assigned any patients cause I take 'em all! Considering that I have read Lawrence about 3 times, FA surgery about 3 times, NMS surgery about once, Surgery case files twice, know surgical recall by heart, can do sub-Q closures with my eyes closed have done a couple first assists one where I clamped big 'old arteries and the burned them with bovie (attending upset intern not there so just started), and did I mentioned that I did Swart'z principles of surgery self-assessment and board review in my spare time and own my own Schwartz for personal reference and because I did something like four presentations in surgery and needed a good book AND sat in on the surgery board review (What is Darth doing here, isn't he post-call!??"--overheard from surgical resident during surgical board review) and did >260 on Step 2 I THINK I CAN GO HEAD TO TOES WITH ANY SURGERY INTERN or PGY-2 IN THE SICCU!! You presume too much if you thought they were teaching me . . .there is something wrong in a siccu where a student can look up how an a-line works and most of the PGY-2's can even describe it . . . these residents didn't manage anything that was up to the chief surgical resident they were robots i.e. barely knew all the patients and were told every single they thing to do and never took iniative . . . and they got punished for it . . .they (residents) wanted me (student) to present the M and M patient in surgery grand rounds because I can look up articles and explain them to attendings and not get reamed, . . . Hmmm must done something right if the residents told me I should do surgery . . .In the end I was doing the job of what is normally given to two students in the rotation so perhaps I was a little overworked . . .but at least I know I can work that hard . . . I should take a break from this board and go read,

I GET IT!!!

THIS IS REALLY DAVID OTT, THE WORLD FAMOUS HEART SURGEON I DID CASES WITH DURING MY TENURE AT TEXAS HEART!!!

Since nobody, I mean nobody, would post something like this, unless they could do a three vessel CABG AND an AORTIC VALVE with a pump time of less than THIRTY MINUTES!!!!

HEY DOCTOR OTT!!!! BEEN A WHILE!! HOWS IT GOIN?? STILL TAKING A PRIVATE JET ON THOSE HUNTING TRIPS?

YOU DA MAN!!!! hey, no need to impersonate a student. I've done cases with you. I KNOW how good you are.

 

[DarthNeurology]

I GET IT!!!
YOU DA MAN!!!!

Oh why thanks for the nice compliment! Somebody around here finally has some sense . . .

 

[Tired]

Oh why thanks for the nice compliment! Somebody around here finally has some sense . . .

I don't understand how you could feel good about a rotation like the one you describe, while simultaneously crying about having to do scut work in other threads.

 

[DarthNeurology]

I don't understand how you could feel good about a rotation like the one you describe, while simultaneously crying about having to do scut work in other threads.

I don't think my surgery rotation was scut, it was a great adrenaline rush seeing so many patients and surgeries that it was a major let-down when it was over, I returned many months later to the surgery floor and residents still knew my name and slapped me on the back i.e. we really bonded and had a good time. In surgery I was in charge technically of a large number of patients on which me and all the students rounded, so it was like a mega number of cases each day, and tracking vitals and labs helps to know what to look out for in various types of surgeries, so I felt like I did learn some skills, besides surgery is three months so I had the system down in the first month and could easily do a lot of scut without getting too frustrated.

What I don't like is filling out forms I don't understand for PT or stuff like that or being treated rudely by residents, I am not averse to hard work and if anything has earned me high clinical evals . . . I had some medicine residents that were just plain dimissive of medical students, I guess poor resident attitude makes me resent the scut . . . I almost never refuse a task and always offer to do stuff so I am not "anti-scutt" in practice although in theory I guess. I actually like doing scut because I feel like I am sort of earning my keep in the hospital i.e. access to patients and charts. Its a love-hate relationship I guess. It was the best of times, it was the worst of times . . .

 

[johnnywalker]

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[Tired]

I guess poor resident attitude makes me resent the scut . . .

I think this is probably the heart of the issue right here.

 

[jetproppilot]

I don't think my surgery rotation was scut, it was a great adrenaline rush seeing so many patients and surgeries that it was a major let-down when it was over, I returned many months later to the surgery floor and residents still knew my name and slapped me on the back i.e. we really bonded and had a good time. In surgery I was in charge technically of a large number of patients on which me and all the students rounded, so it was like a mega number of cases each day, and tracking vitals and labs helps to know what to look out for in various types of surgeries, so I felt like I did learn some skills, besides surgery is three months so I had the system down in the first month and could easily do a lot of scut without getting too frustrated.

What I don't like is filling out forms I don't understand for PT or stuff like that or being treated rudely by residents, I am not averse to hard work and if anything has earned me high clinical evals . . . I had some medicine residents that were just plain dimissive of medical students, I guess poor resident attitude makes me resent the scut . . . I almost never refuse a task and always offer to do stuff so I am not "anti-scutt" in practice although in theory I guess. I actually like doing scut because I feel like I am sort of earning my keep in the hospital i.e. access to patients and charts. Its a love-hate relationship I guess. It was the best of times, it was the worst of times . . .

I think those coconuts you've eaten in the last few days are laced with CONBUD.

 

[Finding Chi]

Bringing it back to the original point...
My general philosophy is that you should keep a running list of labs/vitals/important radiology etc. on all patients you are following, regardless of your level. So as the resident, I have cards on each pt on the service with this info. When we round on that pt, I have their card out for quick reference, so no fumbling. I encourage the interns to have similar cards for the pts they follow (typically half the service). The same goes for the students (anywhere from 1 - 6 pts depending on our census, total # of med students, and the student's motivation/ability). That way, lots of redundancy. If an attending wants a value, he/she can ask anyone covering that pt, and everyone looks like rock stars.

Also, I can keep the cards the whole month. That way, if we get a bounce-back, I already have a card with all the info from their earlier admit.

 

[Strength&Speed]

Considering that we rounded three times a day on say 35-60 patients I felt I learned a lot as usually I would be following 5 of the patients personally (Uh OK post-op day 2 appy I'll do that, SBO ok that's easy I will do that, uh ok post colectomy I can do that, and on and on) and instructing the remaining students on what to go accomplish before rounds. Each of those 30 patients I would assess the diagnosis, post-operative day, blood cultures, review radiology in the computer, what antibiotics they were on, did they have pre-op labs done?, and vitals and had to run and check doppler's on vascular patients. And the ever popular getting a patient up at midnight to walk around the hospital because they won't and they have atlectasis and they are going to get a pneumoniae. Did you ask the radiologist if there any signs of air in the billiary system, is there any signs of necrosis, the residents will want to know. Do you know how to doppler for pulses? Let me go show you, . . . Just go do a blood draw for cbc, ua, the resident will want it anyway . . . By the end of the rotation I was evaluating patients on surgery consults in the ER, and paging the resident for the inevitable appendectomy quickly and efficiently because I had to go do the stupid list.

2-3 patients/student is a joke, when I wasn't doing the list it was 11-14 patients, and yes you do everything for them as a student, knowing most recent labs i.e. sitting down at a computer for an hour, from blood cultures to urine cultures to moving them around the hospital, most of us were collapsing from exhaustion when we left after 30 hours . . . 2-3 patients in a whole 24 hours sounds like a "holiday" surgery clerkship, unless you are talking an elective, I was pleased when I only had like 6-7 patients in the sicu that was a vacation and weird watching PGY-2 surgery residents that didn't have the strength to manage even 7 patients, sad, of course they know I did my surgery core at the big university hospital so that garnered instant respect as I was the one who "formerly did the list." Considering that I did 5-6 patients on my own and monitored 35-60 patients frantically and did *very* well on the shelf exam and surgery on step 2, I would say I learned more than your students who may have sleep during their call on surgery clerkship, something I never had the luxury to do.

Darth-are you crazy? Seriously, im starting to think you're a little nuts. Are you trying to tell me you were taking care of 11-14 patients as a student? I find that EXTREMELY hard to believe. No, not extremely. Impossible. 6-7 ICU patients? Where the hell did you train? Or are you smoking extremely hard stuff. And from what you are telling me...you were volunteering for things...like oh...post op appy? I'll do that. No, you don't volunteer for that stuff if you are already seeing 6 ICU patients. Something stinks about your story.

Edit::: i read a few more posts, and you are certifiably crazy. If you aren't in 4 point restraints by the end of your residency, then I owe you $5.

 

[johnnywalker]

...

 

[Finding Chi]

It's pretty amazing that with all those patients and surgical responsibilities, our good friend Darth can find the time for such extensively eloquent posts!