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IM rotation

helena

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  1. Medical Student
    I'm a Swedish med student who will probably do an IM rotation in the U.S. in a couple of months. I'm right in the beginning of my clinical eduacation in Sweden but I've understood that things are a bit different in the US when it comes to rotations. What should I expect in terms of work hours and tasks that med students are expected to know/do? Here I sometimes feel that I have to fight (often with other med students over who gets to do the admission or assist in the OR etc) to learn stuff and that doctors willingness to teach vary a lot between different wards. Is that a common problem?
    If someone could just tell me what a normal day in IM looks like that would be great and how you felt your first days that would be great too.
    Do med students often do the nurses tasks (like draw blood, iv needle, catheter etc)? Please tell me everything I might be asked to do so that I can practice this before I go!
    Thanks
     

    neilc

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      on IM your main job will be admitting patients, doing the H&P and write up, and presenting your patients on rounds...that will be the main gist of your day. know all the bread and butter IM stuff, know how to do a good, thourough H&P and know how to present a patient, first off.

      i have done 2 IM rotations in the states, and it was quite different than at my school...first off, you will be on a team, and you will likely be the only med student. even if there is another student, you won't likely be fighting for patients. when i was on a team, we rotated admissions. as a student, i usually had a much smaller patient load then the residents (ie. 3 or 4 at a time), so i had time to read up on my folks and learn the pathophys.

      the day will vary depending on your program...my days typically started with pre-rounds at 6 or 630 am, intake rounds at 7 and teaching rounds sometime after that. intake is where you present you new admissions from the previous day, teaching rounds would cover the other patients that you still had on service. so, after all the rounds, i would do my write ups...also, the afternoon is where you will get to do procedures. on all of my IM rotations, the students did not take call after 5 or so. so, depending on the day, we would leave between 3 and 9. typically, my days were about twelve hours long. i admitted every day, though, which could be a pain.

      coming from my school, we did little in the way of procedures. even so,in my first 2 days i was doing thoracocentesis, paracentesis, LP's on IM. they were happy to show me how and walk me through it, but if you can do some before you come, it wouldn't hurt. i never had to start lines or draw blood, but if you want to learn a nurse can usually show you. basically, as a student, if the intern didn't want the procedure, or was busy, we got to do it. if i hadn't done it before, they either made me watch one, or told me to read up on it, and then do it. the attendings were always there for the crucial parts of the procedure (i think they have to be to bill :thumbup: ), but they sure didn't hesitate to leave while i waited to drain a few liters of ascitic fluid!!! the point is, you won't be asked to do something without being well supervised...at least you shouldn't be! the best way to get to do stuff is to automatically and enthusiastically say "YES!!" to whatever is asked of you, and to say it with a smile. you may get stuck doing some boring crap this way, but it is remembered, and a good attitude and being helpful will ensure that the resident/intern will go out of thier way to help you.

      basically, be up front about what you know, and what you want to learn. every one of my US rotations has been awesome, and while i was super nervous before i started, i usually felt very comfortable pretty quickly. they do expect to teach you things, because you are a student. the key is to always be aggressive about learning, be up front about your knowledge and limitations, and be a positive person on the team. if you have a good attitude and WANT to learn, most of the time they will be happy to teach you.

      hope this helps. if i left something out, or you need more info, post it and i will try to help. good luck!
       

      Cristagali

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        I attend school in Europe with a number of Norwegians. they did rotations in Israel and the States. they were SHOCKED at how hard the students and doctors work. Obviously there are gifted docs on both sides of the Atlantic, but the US system does a much better job integrating the med student into the day to day work in the hospital. You'll work hard, but you'll learn a lot. From what I hear, as long as you don't get a malignant resident or attending, you will enjoy yourself. Good luck. :thumbup:
         
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        neilc

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          Cristagali said:
          I attend school in Europe with a number of Norwegians. they did rotations in Israel and the States. they were SHOCKED at how hard the students and doctors work. Obviously there are gifted docs on both sides of the Atlantic, but the US system does a much better job integrating the med student into the day to day work in the hospital. You'll work hard, but you'll learn a lot. From what I hear, as long as you don't get a malignant resident or attending, you will enjoy yourself. Good luck. :thumbup:

          yeah, don't expect the euro go home after 1pm tradition! lol...

          at my school, you can be as busy (or as lazy) as you are inclined to be. so, coming to the states would be a huge shock for many of them.

          expect to spend a lot of hours at the hospital, and to actually have some (albiet small) level of responsibility. you will be contributing to the care directly, and you will be expected to work hard, and to be learning.

          but, it is a LOT of fun...
           

          helena

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            What exactly is a pre-round? (I excpect the patients are usually asleep at 6 AM.) Are write-ups the admission notes or something else?
            Did you get to perform a lot of arterial punctures?
            I would probably get an introduction in the beginning though since the systems and curriculums are so different.
            It sounds like you really learn a lot but I've heard before that the work hours are crazy...oh well I hope I get used to it:)
             

            neilc

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              helena said:
              What exactly is a pre-round? (I excpect the patients are usually asleep at 6 AM.) Are write-ups the admission notes or something else?
              Did you get to perform a lot of arterial punctures?
              I would probably get an introduction in the beginning though since the systems and curriculums are so different.
              It sounds like you really learn a lot but I've heard before that the work hours are crazy...oh well I hope I get used to it:)

              prerounds are when you visit the patient for the first time that day, before you discuss them on rounds. yes, they are usually sleeping, and yes, you must wake them up. this ain't the Hilton! :sleep: :laugh:

              write ups are admission notes, daily notes, procedure notes, everything. you have to write a note every day and every time you do something the patient. also, you will likely be writing orders, following up on labs and studies, etc...

              respiratory therapy did all of the arterial punctures. in fact, i have never done one. in most of the hospitals (all of the ones i have been to, at least) nurses do blood draws and IV's and RT does the art punctures. most places will teach you if you are interested, but will not even ask you to do these things.

              just ask them on day one what there expectations are, tell them your experience on the wards, and you guys will work it out just fine.
               

              scootad.

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                depending on where in the U.S. you will be, especially New York City you will be the one doing the blood work, arterial punctures, ABGs, EKGs, etc. And lots of the discharge planning and so forth.
                 

                lanziii

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                  Hi, I was wondering if there is a good book to read to learn how to do H&P and write up - the way how we write notes and present cases in our country is quite different. Although the basic principles and concepts are the same, the format and the rules are not. thanks
                   

                  helena

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                    Ok, so I'm going for a nine week rotation to Dayton, OH, in a month and I'm wondering what books I should bring? I have a good swedish IM book that I use and I was thinking of getting this pocketmedicine thing for my PDA (good idea?) Should I also get a a drug program for the PDA (I suppose it's good to know the brand names). What else would be good for a foreginer, first aid for the medicine roation or Step up to medicine? MKSAP? I will attend the lectures and do the tests although I'll kind of come in the middle of the school's rotation and I don't need to pass the tests (or even take them) but I though it'd be nice to try. I've only done clinicals in sweden since december (surgery and IM) so I'm not as experienced as the US third year students either.
                    I have this shoe problem too! I've heard you have to dress up for IM. Does that mean absolutely no birkenstocks/nike sandals? I want comfy shoes but all I have is sneakers, are classy sneakers not OK either? Are white shoes OK (that looks nice)???
                    Any input is appreciated!
                     

                    supratentorial

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                      lanziii said:
                      Hi, I was wondering if there is a good book to read to learn how to do H&P and write up - the way how we write notes and present cases in our country is quite different. Although the basic principles and concepts are the same, the format and the rules are not. thanks


                      There's a little book called Maxwells Quick Medical Reference. It is quite literally the size of an index card and about 15 pages long, but it contains outlines of how to write an H&P, discharge notes, admit notes, pre and post op notes, etc. It also contains lab values and ACLS information. Granted there is some variation between hospitals, but this book does cover the basics.
                       

                      Cristagali

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                        get First Aid for the Wards. It's for 3rd year US students, but pretty helpful for IMG's too. Gives you suggestions on how to document patient data, plus hits high yield topics for each service, ie IM, Surg, peds, etc. As for shoes, I attend school in Europe too. And they all love their sandals here!! BUT....NO SANDALS IN US HOSPITAL!! If you want "compfy" shoes look at Merrels shoes. They're slip on, but professional looking. Anyway. Any PDA IM, drug program will suffice. Don't drag a lot of books around the world, plus I'm sure they have a library if you needed additional stuff. Good luck!
                         

                        BigBadBix

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                          In some (perhaps most?) programs, the residents wear scrubs on their call day. It would be OK to wear sneakers with scrubs, but I don't think it would be appropriate to wear them with dressier clothes. Therefore, most students have some form of comfortable shoe/clog that can be worn with nice clothing as well as scrubs. Dansko clogs are very popular, but there are many other brands out there. These kinds of shoes can get expensive, though. Your shoes can be any color; they don't need to be white. I think if you search around on this site you'll find some threads discussing shoes for rotations.

                          Oh, and as cristagali said, you can never wear open-toed shoes in the hospital, so no sandals.

                          Hope this helps!
                           
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