for those already on rotations, i was curious as to what you guys do--what's a typical schedule liek (not the TIME but duties involved)? what is meant by "work up your patients after rounds"? i figure this would be helpful to know BEFORE i begin my rotations.
rotations
- Thread starter gaba101
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I'll assume you mean Acute care type stuff. Oh and "work up patients" means that you will need to get their past medical history, current hospital history since they were admitted, all pertinent data, and work it all together to come up with a plan of care. Most people just use the SOAP note method.
One of my acute care rotations (I had three) went as such (oh, and you get times, anyway...helps me organize it all):
5:45AM - Attempt to drag self out of bed.
6:15AM - Wife drags me out of bed.
6:45AM - Arrive at school, print out new information that happened overnight on old patients, entire profiles of new patients.
7:00AM - Check-in with team (also called prerounds), review with medical team new patients, split up service with other Rx student.
~7:30AM - Check charts of all of my patients, look at ins/outs, other vitals. Review labs. Remind residents to correct Mg++ before K+ before they are chastised by the attending at rounds. Number of patients I was responsible for could be as little as a handful, at one point was up to 15.
9:00AM - Round w/medical team. You will be asked stuff very randomly, so one should pay the utmost attention. You also get to stand back and watch interns and residents be forced to give rectal exams to 480lbs men while silently chuckling to yourself with the satisfaction that you never have and never will do such a thing. Thank God.
12:00PM or so - End rounds, grab something to eat really quick. Lunch break? Ha. If you want to have zero time to do your ****.
12:05PM - 3:00PM or 3:30PM - Head back to floor and hang around residents, interns. Try to be their Johnny on the spot with the drug info if needed. If they talk about a patient, pay attention. You might catch an error before it even gets off the ground (i.e. One time I happened to be there and chimed in across a counter while writing up a patient after I overheard a brand spankin' new intern tell a nurse he was about to start Macrobid on a pyelonephritis patient.) Gather info about what we were doing to patients/changes throughout the afternoon. Write up all your patients, being sure to do thorough research on guidelines pertinent to their disease state because the preceptor will expect you to know, review med list thoroughly because that's kinda why you are there. Check hospital computer system one last time for new labs, results, whatever.
3:00PM or 3:30PM - 4:00PM or 4:30PM - Meet with Rx preceptor, go over your patients, fill him in on what happened that afternoon, if you had a "side mission" for the day, go over that. He/She will ask you a bunch of questions either directly or tangentially related to your patients that, no matter how well you prepared, you don't know the answer to. You learn humility fast. If not, prepare to feel like a ******.
4:00PM or 4:30PM - Post rounds - Interns, residents go over afternoon changes with teams. Any recos you and the Rx preceptor come up with, you bring up. Overnight plans are discussed, who's discharged, transferred, whatever.
4:45 or so - Go Home.
Oh, and every five days you get "night float" rotating with the other medicine teams. That means you get to come in at 5:45AM AND you have like 12 new patients. Those are the happiest freakin' days of your life right there. Jesus, I get nauseous thinking about it....
One of my acute care rotations (I had three) went as such (oh, and you get times, anyway...helps me organize it all):
5:45AM - Attempt to drag self out of bed.
6:15AM - Wife drags me out of bed.
6:45AM - Arrive at school, print out new information that happened overnight on old patients, entire profiles of new patients.
7:00AM - Check-in with team (also called prerounds), review with medical team new patients, split up service with other Rx student.
~7:30AM - Check charts of all of my patients, look at ins/outs, other vitals. Review labs. Remind residents to correct Mg++ before K+ before they are chastised by the attending at rounds. Number of patients I was responsible for could be as little as a handful, at one point was up to 15.
9:00AM - Round w/medical team. You will be asked stuff very randomly, so one should pay the utmost attention. You also get to stand back and watch interns and residents be forced to give rectal exams to 480lbs men while silently chuckling to yourself with the satisfaction that you never have and never will do such a thing. Thank God.
12:00PM or so - End rounds, grab something to eat really quick. Lunch break? Ha. If you want to have zero time to do your ****.
12:05PM - 3:00PM or 3:30PM - Head back to floor and hang around residents, interns. Try to be their Johnny on the spot with the drug info if needed. If they talk about a patient, pay attention. You might catch an error before it even gets off the ground (i.e. One time I happened to be there and chimed in across a counter while writing up a patient after I overheard a brand spankin' new intern tell a nurse he was about to start Macrobid on a pyelonephritis patient.) Gather info about what we were doing to patients/changes throughout the afternoon. Write up all your patients, being sure to do thorough research on guidelines pertinent to their disease state because the preceptor will expect you to know, review med list thoroughly because that's kinda why you are there. Check hospital computer system one last time for new labs, results, whatever.
3:00PM or 3:30PM - 4:00PM or 4:30PM - Meet with Rx preceptor, go over your patients, fill him in on what happened that afternoon, if you had a "side mission" for the day, go over that. He/She will ask you a bunch of questions either directly or tangentially related to your patients that, no matter how well you prepared, you don't know the answer to. You learn humility fast. If not, prepare to feel like a ******.
4:00PM or 4:30PM - Post rounds - Interns, residents go over afternoon changes with teams. Any recos you and the Rx preceptor come up with, you bring up. Overnight plans are discussed, who's discharged, transferred, whatever.
4:45 or so - Go Home.
Oh, and every five days you get "night float" rotating with the other medicine teams. That means you get to come in at 5:45AM AND you have like 12 new patients. Those are the happiest freakin' days of your life right there. Jesus, I get nauseous thinking about it....
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Each rotation is different, but I will give you my experiences with two sites that interested me. You can also expect to remember almost every guidelines out there, non stop readings on journals and updates, med safety watch, dosing interchanges, impossible questions thrown at you from at least one quirky doctor or pharmacist, and so on.
For my clerkship (which is what I am assuming is most important to you),
8:30 arrive on site; get ready while looking up cultures, daily lab values, etc.
9:00- 9:30 arrive on floor; go through all of the patient's charts to check for new drug orders, current orders and recommendations by residents plus attending comments. Mondays are usually the worst since I am not in on weekends and I do most of the work with the clinical pharmacists double checking everything.
10:00 Rounds begin. It usually consists of 2 medical residents presenting their patients along with their team of medical students to the attending.
12-1 After rounds finish depending on the attending, I go back and write up everything on my patient care spreadsheet.
1-2 I grab an one hour lunch break always. . . around this time.
2-5 The schedule varies but it usually consists of preparing for pharmacy and therapeutics meeting, subcomittee meetings like med safety watch, projects like making patient monographs specific to that hospitals population, making recommendations, double checking medication usage (ie xigris. . making sure the patient fits all the critiera for dispensing), etc.
My rotation at NYC poison control center/ Bellevue ER.
8:00 Morning rounds where emergency residents present case studies. A lot of interesting cases since they deal a lot with drug overdoses, people non compliant with their medications, suicides, etc.
9:00 - 12:00 I interview patients and provide information to them. Patient information can include anywhere from information on their drugs to alternative therapies, the importance of compliance, their disease states (As long as it is within my education), smoking cessation, herbal interactions, etc. I also answer drug questions that attendings, nurses, residents, etc might have.
12:00 -1:00 I report to the pharmacist and present our cases.
1:00- 4:00 The schedule varies but it includes journal club, more interviews, doctor call backs (poison control), presentations by fellows and physcians, scenario run throughs, solving toxicological mysteries, etc.
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