I need more practice

[LuckyCharms83]

So far I am 5 months into my rotations and I haven't had a whole lot of inpatient experience. I have had mostly preceptorships and these have mostly involved working in the clinic or shadowing in the hospital (except for 2 weeks inpatient peds and 1 day a week doing neurology consults). I am getting worried that I am not going to get very good at working up patients in the hospital. Worse, my internal medicine clerkship is my very last one in June and I hear its more like a Sub-I. So, I would imagine they will expect me to know my stuff by then since supposedly I would have had a year of experience. I might get some more practice in surgery, EM, and on the psych wards in the next few months, but I am still pretty nervous.

I was wondering if anyone has any suggestions on ways I can practice working up cases on my own time? I think this might help me feel more comfortable. If anyone is familiar with The peds CLIPP cases, I think something like this would be helpful. Anything interactive that requires me to think on how to work patients up, what tests to order, etc. would be awesome.

Anyone find themselves in a similar situation now or in the past and possible remedies??

 

[Scaredshizzles]

So far I am 5 months into my rotations and I haven't had a whole lot of inpatient experience. I have had mostly preceptorships and these have mostly involved working in the clinic or shadowing in the hospital (except for 2 weeks inpatient peds and 1 day a week doing neurology consults). I am getting worried that I am not going to get very good at working up patients in the hospital. Worse, my internal medicine clerkship is my very last one in June and I hear its more like a Sub-I. So, I would imagine they will expect me to know my stuff by then since supposedly I would have had a year of experience. I might get some more practice in surgery, EM, and on the psych wards in the next few months, but I am still pretty nervous.

I was wondering if anyone has any suggestions on ways I can practice working up cases on my own time? I think this might help me feel more comfortable. If anyone is familiar with The peds CLIPP cases, I think something like this would be helpful. Anything interactive that requires me to think on how to work patients up, what tests to order, etc. would be awesome.

Anyone find themselves in a similar situation now or in the past and possible remedies??

Something that helps me (and this might be person dependent), everytime I read something, I scribble some notes and try to think out exactly what the ramifications of what I'm reading would be to patient care. I try to think of what in the physical exam/history can actually be realistically and reliably obtained from patients given your own time constraints and the relative health awareness of your patient base. I try to think what lab tests or imaging studies can rapidly narrow down a differential diagnosis, in particular weeding out or ruling in the most common causes on the differential list. I try to think of the side effects of the proposed treatment and try to imagine what threshold the severity of the patient's problem would have to be in order for me to consider using those treatments. But nothing really replaces actual clinical experience, being on a team managing several patients. If you don't really get that experience until your medicine rotation, well then you'll just have to aim to learn quickly then and work hard. Your surgery rotation will deal with several management issues, but your surgery team most likely won't spend the time in discussing their rationale behind those management decisions.