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I'm a few weeks into third year on a rotation with a resident and one other medical student. There is also an RN student working with the the nurses on our unit. So basically every morning I go in and preround on the patients the resident assigns me, write notes, and prepare for how I will present them to the attending....except that when the attending arrives he wants to hear the RN student present all the patients to him....Apparently on this unit, the nurses usually present to the attending, so now that they have a student there, they encourage her to do the presenting. I've tried to jump in a few times when it's about my patient, but I end up just getting cut off by the attending who says he will "talk to me later" or the nurses. I've tried talking to the resident about it but he seems overwhelmed with his own stuff and the other student seems ambivalent towards it all. I keep preparing each day in case by some miracle I do get a chance to present, but I still have another month left of this rotation and I'm really worried about how weak my presentation skills will be when I start my next rotation due to lack of practice.....and at that point the next attending will probably expect more since it won't be my first rotation anymore. What should I do?!
 

qwerty89

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I'm a few weeks into third year on a rotation with a resident and one other medical student. There is also an RN student working with the the nurses on our unit. So basically every morning I go in and preround on the patients the resident assigns me, write notes, and prepare for how I will present them to the attending....except that when the attending arrives he wants to hear the RN student present all the patients to him....Apparently on this unit, the nurses usually present to the attending, so now that they have a student there, they encourage her to do the presenting. I've tried to jump in a few times when it's about my patient, but I end up just getting cut off by the attending who says he will "talk to me later" or the nurses. I've tried talking to the resident about it but he seems overwhelmed with his own stuff and the other student seems ambivalent towards it all. I keep preparing each day in case by some miracle I do get a chance to present, but I still have another month left of this rotation and I'm really worried about how weak my presentation skills will be when I start my next rotation due to lack of practice.....and at that point the next attending will probably expect more since it won't be my first rotation anymore. What should I do?!
Another story like this? What type of god-awful schools are these? Names please. Post anonymously if you have to. These schools deserve to get called out.
 

GoodWillShunting

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Have you spoken to the other medical student about this? Have other students complained? Can you both go and speak to the course coordinator for this particular rotation?
 

Señor Científico

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I'm a few weeks into third year on a rotation with a resident and one other medical student. There is also an RN student working with the the nurses on our unit. So basically every morning I go in and preround on the patients the resident assigns me, write notes, and prepare for how I will present them to the attending....except that when the attending arrives he wants to hear the RN student present all the patients to him....Apparently on this unit, the nurses usually present to the attending, so now that they have a student there, they encourage her to do the presenting. I've tried to jump in a few times when it's about my patient, but I end up just getting cut off by the attending who says he will "talk to me later" or the nurses. I've tried talking to the resident about it but he seems overwhelmed with his own stuff and the other student seems ambivalent towards it all. I keep preparing each day in case by some miracle I do get a chance to present, but I still have another month left of this rotation and I'm really worried about how weak my presentation skills will be when I start my next rotation due to lack of practice.....and at that point the next attending will probably expect more since it won't be my first rotation anymore. What should I do?!
Talk to your clerkship director.
 

Taddy Mason

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Azete

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I agree this is unfortunate and you have every right to be upset, but the double standard on SDN is pretty insane.

One student will mention a verbally abusive attending degrading their gender/race, or being forced into 90 hour weeks as an M3, and everyone will tell them to shut the **** up and learn their place. As soon as someone mentions an RN or PA student taking some of their training time, there is an uproar necessitating immediate action.
 

cbrons

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You should bitch on an "anonymous" Internet forum.
It's better than doing it to fellow classmates, residents, or attendings. And much better than doing it to your own school's administration, which usually do not tolerate complaints about the quality of the educational experience. Pretty much the reason why this forum exists.
 

mcloaf

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Is the nursing student presenting A&P or just reporting interval events?
 

Donald Juan

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For one thing, I can't imagine that nursing student is there everyday, they have like 10 clinical days a semester. Also, don't worry about not learning your skills at presenting for your next rotation. You will suck at presenting for the next 1-3 years. No one will say, "oh, you're a month into m3?? I expect so much more of you!"
 

Taddy Mason

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It's better than doing it to fellow classmates, residents, or attendings. And much better than doing it to your own school's administration, which usually do not tolerate complaints about the quality of the educational experience. Pretty much the reason why this forum exists.
Ahh, so SDN exists for dick sucking.
 

Crayola227

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it's fine

it's also fine they came here! I get to offer my awesome advice

they don't expect that much of you even in the second month! so chill out!

sounds like you're doing the right thing preparing, keep doing that. Even if you don't actually get to present, the preparation is part of the process you need to learn

I wouldn't keep bugging the attending though!!!!!!!!

this sounds weird, I don't know why they are shortchanging you for the RN. Do you always have overlapping patients with the RN? Don't you guys have separate patients?

You can, do this though.
To the resident, in the am, if they're on the computer, you can interrupt them, to say, "hey, can I ask you something?" they will probably make a sound and keep doing what they are doing. Try not to look too expectant. Then they will likely pause, and ask you what's up. Just say, "I have a couple of questions about how things work, but it can wait until the end of the day when all the work is done." If they press you like they want to talk now, (they don't), just say you had a few questions about presentation styles. Only do this on a not long call day.

At the end of the day, tell the resident that you're scared because you haven't had a chance to present, and you're worried about the next rotation if you don't get a chance to present. Ask them if they would be willing to listen to your presentation at the end of the day a few times and give you feedback. Tell them you're worried because you're not getting a chance to present to the attending who will be grading you. Ask, "Do I need different patients?"

Then just leave it there. If they are a good resident, they will on rounds perhaps speak up for you, and say "let's let med student present this one." Or they will change the assigning of patients so that you get a chance. Or, all else fails, they will be willing to listen to you present a few times and give you feedback.

Don't suggest that the resident speak up for you or assign different patients. I'm telling you want you can say, and letting you know to leave it there, because I know what the most likely reaction of the resident is. But you don't want to appear like you're telling them what to do.

Also, pay attention to everyone else presenting! You can learn more from seeing what they do, than doing it yourself.
 

Crayola227

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I agree this is unfortunate and you have every right to be upset, but the double standard on SDN is pretty insane.

One student will mention a verbally abusive attending degrading their gender/race, or being forced into 90 hour weeks as an M3, and everyone will tell them to shut the **** up and learn their place. As soon as someone mentions an RN or PA student taking some of their training time, there is an uproar necessitating immediate action.
That's not a double standard. Verbally abusive? Get a thicker skin. 90 hour weeks are tough but nothing to complain about. Usually the student is a sheltered baby that needs to harden up. This is completely different, it's affecting their education. That's what school is for, to learn how to be a doctor. At no time should a nurse or pa take away from a medical student or resident's education ever. Their role is a supportive one. I would definitely take this to the clerkship director. I wouldn't out your school as that could have negative consequences for you but op, that clerkship is an embarrassment.

I don't even understand what an rn student would present, uhh the patient got his metoprolol at 6:29 pm, I "observed him" for effects and his call bell was in reach. Had a urine output that I did not record despite strict I&Os being ordered. Oh by the way I need a prn order for ambien but don't worry, I will call you at 2 am about it even though the patient is comfortably sleeping in his room.
 

Taddy Mason

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Why you mad tho?
Because the answer is really straightforward and I'd be shocked if OP did not genuinely realize that. I worked in 3 different hospital systems in the 6 years prior to med school and its not uncommon to have nursing students practice "presenting" patients while on clinicals. Also, a nurse report/pt. presentation is not the same as how a med student or resident would present a pt. - it genuinely seems as if OP is blurring the lines in that area. If OP is that concerned he/she should either talk directly to the attending or the clerkship coordinator, they're the only ones who can do something if this truly is the issue OP makes it out to be. Whining here will accomplish nothing, hence the snark.
 
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Taddy Mason

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OP
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Thanks (almost) everyone for the helpful advice so far! So to answer some of the questions....

I have tried talking to the my school and the clerkship director about this problem. The problem is that most of the administrative people in charge of setting up these rotations have no background in medicine and don't seem to understand what I am talking about when I bring up "presenting" and "rounds." They seem to be more concerned about whether I have an attending and resident to "work with" everyday and say that the day to day details on how the rotation is run is up to the discretion of my attending.....they have said that they will *try* to place me with a different attending for next month since this is an 8 week rotation, but the problem is that they don't have an open spot for this specialty right now and they can't switch me with another student if they are going to deem this rotation unacceptable, so I'm not holding my breath for that to happen and even they have said that it's unlikely...

I have brought up my concerns to the resident a few times and each time I feel like he just brushes me off and just tells me to keep working hard. He doesn't really do any teaching and I'm pretty sure he would get really pissed if I asked him to stay late so he could listen to me present after rounds :( I've even asked the other student if we could practice presenting to each other, but he didn't like that idea. He says he finds the rotation situation very strange too but doesn't seem to care about it as much as I do.

And as far as the RN student's presentations go...she is actually going through the whole HPI, PMH, SH, labs, meds, etc...this is a smaller unit, so there aren't that many patients so I guess it's not that hard for her to stay on top of each one's story especially since she doesn't have to spend time writing notes. She usually comes in the room with me and the other student while we are taking the histories and takes notes and also goes in there later with the RN supervising her to get more information. The only thing she doesn't present about is physical exam because the attending doesn't ask about that and repeats the exam himself.

And as for outing my school...this thankfully doesn't seem to be a widespread issue from what I've heard from other students. I think I may have just gotten stuck with a dud attending (very old, not into teaching). It's just unfortunate that I'm stuck with it for another month. And this was actually a field that I'm very interested in :(
 

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That clerkship makes 0 sense. Why is the rn student going in with you? Why would they present to the attending ever? Why are they concerned with the h&p at all? If they want to be a midlevel, they need to go to midlevel school and learn from midlevels, not steal patients from medical students. And damn my presentations as an M3 sucked hardcore, I can't even imagine how terrible it would be to listen to one from a nonmedical student.
 

Crayola227

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do you have a friend not in this clerkship to present to?

maybe even over the phone?

you should definitely write up that resident for not helping you at all

Even as the slowest ****tiest intern ever going home later than everyone else, I could *always* find 5 minutes at the end of the day to help the med student

bring some delicious pastries and maybe he'll remember you're there and a human
 

OnePunchBiopsy

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Report it to your clerkship director, but remember that administrators always have full plates and sometimes things fall off them.

The bright side is that even if you never get to present to your attending, when you start your next rotation you'll have another attending who wants you to present differently! Even in 4th year I've had to completely rework my oral presentation based on the service I am rotating with. Better to just wait for this to blow over than make too many waves and have it come back to bite you professionally.
 
OP
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do you have a friend not in this clerkship to present to?

maybe even over the phone?

you should definitely write up that resident for not helping you at all

Even as the slowest ****tiest intern ever going home later than everyone else, I could *always* find 5 minutes at the end of the day to help the med student

bring some delicious pastries and maybe he'll remember you're there and a human
Can I call you? ;)

I think the resident is the one who evaluates me so I'm trying to avoid making any waves with him. Thanks for the advice though.
 
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OP
FrenchBreadnButter
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That clerkship makes 0 sense. Why is the rn student going in with you? Why would they present to the attending ever? Why are they concerned with the h&p at all? If they want to be a midlevel, they need to go to midlevel school and learn from midlevels, not steal patients from medical students. And damn my presentations as an M3 sucked hardcore, I can't even imagine how terrible it would be to listen to one from a nonmedical student.
Haha yeah I probably shouldn't be judging since I have yet to present, but the way she presents the patients sounds like how a layperson would talk about medical stuff. She mispronounces medical terms and conditions, so it's kind of obvious she doesn't really understand much of what she is saying and is just reading stuff out. Would be funny if it wasn't so sad.
 
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Instatewaiter

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I agree this is unfortunate and you have every right to be upset, but the double standard on SDN is pretty insane.

One student will mention a verbally abusive attending degrading their gender/race, or being forced into 90 hour weeks as an M3, and everyone will tell them to shut the **** up and learn their place. As soon as someone mentions an RN or PA student taking some of their training time, there is an uproar necessitating immediate action.
No the distinction is that hard work and long hours are part of the education. Also med students tend to be a bit whinny on these forums anyway. Now, having your educational experience taken away by another student- whether another MD student or a nursing student, is not acceptable
 

Azete

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No the distinction is that hard work and long hours are part of the education. Also med students tend to be a bit whinny on these forums anyway. Now, having your educational experience taken away by another student- whether another MD student or a nursing student, is not acceptable
I get what you're saying, and in many ways I agree, but the general hubris on SDN says otherwise. Which is to be expected, I suppose, since we're all current or former medical students looking out for the well being of the profession.

There have been many instances where a student's education is clearly being infringed by various circumstances, and the standard response on SDN is to quit whining (which, outside of utilizing anonymity to acquire information, is the main purpose of an internet message board). Mention an MD student receiving obvious favoritism on a rotation and you'll still see the finger pointed at the OP.

Mention any other healthcare student receiving an education, or similar autonomy to a med student, and you'll see an instant rebellion. I'm as guilty as anyone in this regard, but at least I'm self aware enough to recognize the innate superiority complex that comes with the territory, rather than living in denial.
 

Psai

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I get what you're saying, and in many ways I agree, but the general hubris on SDN says otherwise. Which is to be expected, I suppose, since we're all current or former medical students looking out for the well being of the profession.

There have been many instances where a student's education is clearly being infringed by various circumstances, and the standard response on SDN is to quit whining (which, outside of utilizing anonymity to acquire information, is the main purpose of an internet message board). Mention an MD student receiving obvious favoritism on a rotation and you'll still see the finger pointed at the OP.

Mention any other healthcare student receiving an education, or similar autonomy to a med student, and you'll see an instant rebellion. I'm as guilty as anyone in this regard, but at least I'm self aware enough to recognize the innate superiority complex that comes with the territory, rather than living in denial.
Yes, you seem very self aware.
 
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Azete

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You don't seem very self aware to me.
I generally appreciate the value you provide SDN, as you call folks out on their bull**** with regularity, but you don't have to personify the internet-tough-guy all the time.
 

Crayola227

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Can I call you? ;)

I think the resident is the one who evaluates me so I'm trying to avoid making any waves with him. Thanks for the advice though.
I would skype you, but good concise (surprise surprise everyone!) presentations were not my strong suit, so you would probably get better feedback from someone else
 
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Promethean

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On this unit, the usual culture is that the nurses present patients. That isn't the way you think it ought to be done, because it isn't how it is going to work elsewhere. But it is how things are done at this site, which isn't going to comprise your entire educational experience. So, when in Rome...

One of the things you are learning is collaborating with others and working in a variety of settings. As others have said, you are getting the experience in doing the preparation.

You can also learn from watching the RN student. Although from your description, it sounds like she really needs the practice, too. But you can learn from bad examples as well as from good ones. Pay attention to her presentation and you can evaluate for yourself what worked about it and what didn't. What would you have done differently or how could it have been improved?

All you are missing is the 2-3 minute experience of rattling off the information that you've gathered in a concise fashion. You can actually practice that, on your own. Just take your notes and run through what you'd want to say if you had the chance.

I'm curious? Would you be as irritated if it were an intern who was always getting to do the presentations? Or would you be more accepting of that, even if it put you in the same position of being concerned about not getting enough experience doing it yourself this rotation?
 
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TBV

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Seems like my presentation changes so much depending on my attending so you may be overstating how much it will help your next rotation provided you generally know how to present. For example my last attending wanted to hear my physical in gory detail. Current attending likes a 1 liner as to why pt is here followed by plan.
 

operaman

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1) $100 says the RN student is not actually presenting the patient, but rather just giving the overnight events and other relevant numbers.
2) this is fairly normal in many places, especially critical care units
3) you can learn a lot by listening to the language the nurses use. Especially notice when there's a disconnect between what you and your team think they mean and what, after some clarifying discussion, they are actually saying. I frequently get pages where I have to read between the lines and figure out my patient may be getting really sick. Getting familiar with these subtle differences is valuable.
4) having the RN present means you get up to date numbers rather than the old charted ones you looked up which havent been updated yet.
5) you'll have plenty of chances to present. How presentations are done varies so wildly between rotations that I can assure you this won't matter. It might even help you. Try taking an honors level student IM presentation into your surgery rotation and see how far that gets you!
 

mehc012

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1) $100 says the RN student is not actually presenting the patient, but rather just giving the overnight events and other relevant numbers.
2) this is fairly normal in many places, especially critical care units
3) you can learn a lot by listening to the language the nurses use. Especially notice when there's a disconnect between what you and your team think they mean and what, after some clarifying discussion, they are actually saying. I frequently get pages where I have to read between the lines and figure out my patient may be getting really sick. Getting familiar with these subtle differences is valuable.
4) having the RN present means you get up to date numbers rather than the old charted ones you looked up which havent been updated yet.
5) you'll have plenty of chances to present. How presentations are done varies so wildly between rotations that I can assure you this won't matter. It might even help you. Try taking an honors level student IM presentation into your surgery rotation and see how far that gets you!
You may be right, but it would be wholly inconsistent with the information as presented by OP:
OP's later response said:
And as far as the RN student's presentations go...she is actually going through the whole HPI, PMH, SH, labs, meds, etc...this is a smaller unit, so there aren't that many patients so I guess it's not that hard for her to stay on top of each one's story especially since she doesn't have to spend time writing notes. She usually comes in the room with me and the other student while we are taking the histories and takes notes and also goes in there later with the RN supervising her to get more information.
So it sounds as if she is actually presenting the patient (other than the exam) and that the information is essentially the same as what OP would be using for their presentation. 5) is still good advice for OP, though.
 

Señor S

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Let it go. It's ridiculous of course but as you've found out nobody cares about you and you have no recourse. It's not worth annoying people about. Remember how it felt and don't put others in the same position when your time comes.
 
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Seems like my presentation changes so much depending on my attending so you may be overstating how much it will help your next rotation provided you generally know how to present. For example my last attending wanted to hear my physical in gory detail. Current attending likes a 1 liner as to why pt is here followed by plan.
This. Actually most of my attending use my overnight events as a jumping off point to focus on on issues and ask me questions about labs, I/Os, imaging etc.

Very few attendings have ever let me present straight through. I think that is actually much more efficient and reasonable. Is it like this elsewhere?


Sent from my iPhone using SDN mobile
 

Taddy Mason

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This is your signature sentence in SDN; you must have scored 15 in VR.
I've made that statement 2-3 times out of almost 300 posts...
 
OP
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I am I the only one super confused here? Why on earth would a nurse, let alone a nursing student, be presenting a patient including the A and P? Does the janitor also throw in his two cents?
No, she doesn't present the A and P. I mentioned in another post above that she reports the subjective and objective, minus the physical exam findings.
 

KnuxNole

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I agree this is unfortunate and you have every right to be upset, but the double standard on SDN is pretty insane.

One student will mention a verbally abusive attending degrading their gender/race, or being forced into 90 hour weeks as an M3, and everyone will tell them to shut the **** up and learn their place. As soon as someone mentions an RN or PA student taking some of their training time, there is an uproar necessitating immediate action.
I guess I'm the opposite, I would be more offended at the verbally abusive attending, and would shrug my shoulders at the second scenario...that is until I read that it was a RN student...which makes that scenario weird too...so yeah, that also needs attention. If it was a NP/PA, sure, they need practice and that is legit. RNs do present in certain situations, but if a med student is not being to present at all, that is fishy.
 
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Crayola227

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OP - you'll get the most utility at learning to be efficient in your EHR to put together your presentations.

It's groundwork.

Don't despair.

http://forums.studentdoctor.net/threads/things-to-do-to-shine-in-pgy-1.1188633/#post-17640862
Meant for interns, may have some good advice for rotations in general.

Don't know if you have EPIC, still my system for gathering morning info for pre-rounding could apply to any inpt rotation.

Yeah, I had to do the print my notes thing, the rounding reports were not helpful for basing presentations off of

If you have an official list as your census in EPIC, you can copy that to a new personal list that you can create with your own category headings, this didn't help me so much for presenting but just having some answers at my fingertips when I was prerounding and running around and trying to think

You can search and see what categories you want this list to have.

I had a list that was meant to just help me pre-round, (so it would have like Mg and K on it)
and a list that was my "printing list" that was minimal (meaning it just had like room number and name so and then a bunch of space next to it to write to do's, if they accurately list the nurse for the shift at that point that's nice too depending on your system so I could quickly figure out which nurse I wanted when I called the floor nurse) code status (good to know at a glance when they crump unexpectedly!)

Then I had a list that wasn't necessarily my pre-round list but it had a **** ton of data that it helped me to just have on hand while I wasn't in epic, my "data list"

So you can mix and match these categories for what you want
they may or may not exist in your institution's Epic version
(also, you can add any category to your list if the list has patients in it and it will put in the data that it does and you can see if that's what you want)

Keep in mind these categories for the list:

Pt name
Room number
patient location (this can be different than room, let's say know they're in xray, it would show that)
Code Status
Attending
PCP

Mg and K values, that way when I sat down in the am I knew at a glance without going in the chart who needed repletion so I could get that little chore out of my way asap, there was even some heading I had where all I had to do was click on the list in a certain heading to get to where I could throw the orders in, which would work anytime I just wanted to click on patient in the list and go directly to entering orders menu, save me a few clicks
Cr (so made it easier to keep track of my AKI/CKD people so I'd keep that in mind while throwing in orders)
Crit (to watch my bleeders/anemics)
WBC (could watch and write trends, like the list would say today's was 15 and I would write that yesterday's was 12)
Culture or culture results (sometimes it just showed they had a positive culture, then I could write next to that the bug)
antibiotics (and I could write next to that what day # they were on or start/stop dates)
anticoagulation (it would show if they were on heparin or warfarin, good to know)
PLTs (to watch for HITT in my heparin peeps w/o really having to think about that too much but not forgetting it either)
New note (if you use the time mark feature on some of the categories, then just looking at your list you can see if that new imaging report or consultant note or lab value had come in yet without having to go into the chart just to see if it was there)
New consult note
New lab value
New imaging/rads
IV or PO meds (so at a glance I knew who was still getting IV stuff and that would help me to stop and think we I could switch to PO cuz that's always a good thing)
Glucose if you want
EKG maybe (so you can see that pop up or just get right to it by clicking on that box
Resp therapy (it would actually list all the respiratory stuff they were on)
Tele (so I never forgot who was on it and knew just looking at a printed list while I ran around who to ask about when I went to the tele people

The possibilities are endless

There are tabs below your list running horizontally that I had set up that made prerounding a breeze because I would only have to go into the chart itself just to read nursing notes, look at certain details of I/O, or certain labs that didn't come up from the tab
The tabs are never as detailed as when you go in the chart, but man this made my life easier, especially since you can only have so many charts open at a time

All of this without going into the chart unless I needed to investigate further, and a loosely recommended order of importance for pre-rounding:
1) The minute I sat down, I looked at the current vitals only on everyone, that way I would catch any current particularly scary thing, something someone told me that always stuck in my head "vitals are vital". If did all prerounding from start to finish one patient at a time, then I would get to like patient 5 in the census only for the senior to be like "hey, did you see that patient 8 has this ****ty scary vital and you've been sitting here pre-rounding for 10 min and didn't see that, that lesson only happened once and this was how I saw to that) so w/in 4 seconds of being at work I could rest assured at least based on vitals no one was in the process of dying right away while I went about my prerounding
2) the tab that has all the vitals recorded for the last 24 hrs, I would go through that for everyone first too to catch any really scary vitals that happened overnight
3) now I could just start with my first patient to do the whole pre-round bit one patient at a time
4) Comp (comprehensive) this let me see a lot of stuff, like what time the patient spiked their fever, nurse notes that give perspective like why did my patients w/ HR 80s get to 140s, oh I see, they were being helped up to the toilet or whatever, I/Os, a lot of stuff, good luck
5) CBG (tracks at a glance their glucose values and matched with the insulin units they were given)
6) I/O tab (has more detail then the comp view, there was one value there I needed that had to be gleaned from the chart, can't remember but it was useful)
7) Weight tab (where I was didn't always track I/Os well, so this could help me see how my CHF'ers or whoever were doing with diuresis, etc)
8) Cx (let me see what the latest report was, you have to watch those for days sometimes to see how that progresses in detail)
9) Imaging (would show the latest report, you have to go in the chart to look at the image yourself if it hasn't been read already, and obviously you're supposed to look yourself at whatever image they've read, but always good to see what rads had to say)
10) Cards - it had some view that was useful I can't remember what was in it, I think like Qtc from last EKG at a glance, cool huh?
11) Phillips is the name of the tab to look for, I named it "tele" (a link to tele, I don't know, some institutions you can look at tele live from your computer, and some have a link to look at what the tele monitoring people noted, still important to interpret what they say yourself, but it helps you know what time something was noted so you can find an event on the strip, sometimes you can review the whole darn strip at whatever time from your computer, cool! I think it's called Philips the tab for this) Before people bust on me, you have to use judgement, a lot of patients you're going to look at tele before you do some of the stuff above
12) MAR - this tab is useful, but the view is more detailed in the patient's chart under MAR tab, for PRNs like narcs and even the other expected drugs, you don't want to be caught looking stupid that you can't understand their HTN given that you've scheduled a good dose of antiHTN med, only to see that the patient was refusing all the scheduled doses, don't assume because you wrote it the patient is getting it, and PRNs you're not going to know if they needed unless you look
After doing all of the above (obviously skipping like CBG if a patient wasn't diabetic, etc, changing the order depending on what I needed to see first) then I would stop and move to the next patient, this last I leave for last as clean up on each patient as I go through again:
13) Notes (I looked at these last if I was only expecting to see nursing notes, obviously you look sooner if there's a consult you're hoping to see, ideally you should read all nursing notes but if you're short on time that may be the one thing you skip on some patients if their clinical picture makes you think they mostly slept all night)

While in a patient's chart a lot of the following tabs you can put in on your toolbox
Learn dot phrases
Make templates with helpful dot phrases
Your started note if it has the right dot phrases pulling in what you need can be printed and while you do the above stuff you can write that in

Using that system above I could do all my prerounding completely, systematically, and jot what I needed down like wicked crazy fast, and I write slow
Using my above list categories and horizontal tabs and corresponding tabs in each chart, I could see everything I needed to see on all 10 patients in like 15 minutes, it would take me longer starting notes and on particular things and writing it all down

I was like the slowest little intern that could, so spending my off time learning epic like the back of my hand and customizing my lists and tabs and dot phrases was like giving myself all the help I can get. From any view or in any chart I could put my hands quickly on anything I needed to know within seconds
There's probably some Epic support team you can call for help at times and they can be your friends

I know this response isn't totally on point, but I hope it helps interns pre-round and get data faster for their presentations and notes
 
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ChiDO

10+ Year Member
Apr 16, 2008
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Didn't read the entire thread. Who cares if you don't get to present the patient...its a third year rotation, not a sub-i or audition rotation. If this were me, I'd chalk this up as a "win" for me..less pressure..breeze through rounds.

As for your next rotation, who knows what you'll have to do, if you'll have any presenting to do, or what previous knowledge/experience you have.

Do I expect students who come audition for us to have the same base knowledge? No; I expect you to show me what you know and grow in knowledge through 4 weeks.
 

TBV

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Jun 5, 2014
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No, she doesn't present the A and P. I mentioned in another post above that she reports the subjective and objective, minus the physical exam findings.
Damn where can I get a nurse to say all that dumb ****? I want to say this is the same person that we have seen the last 15 days and today we will discontinue "drug"... moving on with rounding.
 

Crayola227

The Oncoming Storm
5+ Year Member
Oct 22, 2013
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You could see if you could have a chance to *nicely* say to the attending that you'd like to present one of the patients one of the days on service to prepare for your next rotation.

It all depends on delivery.

Could get you noticed for interest and initiative.
Could be annoying.
Could present, and it lowers his opinion of you.

No way to know.

FWIW, I think it's worth a shot if you're sure that you won't come off badly. I a girl and Queen at playing Mouse, so I can usually pull these things off.

this is how you should come across as a med student at first:

 

Cipher9422

5+ Year Member
Sep 8, 2012
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If he follows this advice, we'll be seeing a post in a month "Failed my rotation, don't know why"
If he goes behind the attending's back and complains there is a slight chance that he/she may find out. Then the attending is left wondering why OP didn't come to him/her first. I'm not saying that OP should walk in and act confrontational, he should just address his concerns in a polite and respectable fashion. I don't believe any adult, let alone professional, would take this as an insult and fail him just because he is confused or worried. At the end of the day I would hope the attending would want OP to further his education and his concerns are legitimate.