hotbovie

Member
7+ Year Member
15+ Year Member
Jun 22, 2002
65
1
USA
Visit site
Status
When I first started my clinical rotations last year, I thought that they were pretty much the same at all schools. Since then, I've learned that isn't necessarily so. For example, I was suprised to learn that some schools don't require students to take overnight call. So I thought it would be interesting to compare basics of rotation experiences here.

We do take overnight call on Medicine, Peds, Surgery, and OB. There is call on Psych and Family, too, but that consists of things like staying til 11pm, or 8-4 on a weekend, or an ER shift.

We write H&P for all patients we see on call, and our H&P goes on the chart. The intern writes a separate H&P, often on a fill-in-the blank type form. We have to write it out fully. (I always thought that was redunant, but when I was on surgery, I learned that the residents often find the student H&P and notes gave them the best information about the patient). There are offical limits on the number of patients a student can carry, but the limits are not always adhered to.

We have to see all our patients and have notes written and on the chart before the intern gets to the patients in the morning. Sometimes we write orders which are later cosigned. Sometimes the residents require us to write discharge summaries.

Overnight call is usually q 4, but can be q5 or q3, often with a full day of clinic, or lectures, or other work following.

Scut isn't too bad. We don't have to draw our own labs, all the hospitals have phlebotomy service. But it's often not done when ordered, so when that happens we have to spend some time on the phone trying to make it happen. Same thing happens with xray. We can start IV's and in fact need to get checked off on that for surgery, but don't have to on a regular basis.

Procedures are pretty good. I know of classmates that did things like central lines, chest tubes and LP during the first weeks of clinical rotations. The services are so busy that the interns get the hang of procedures pretty quickly and pass them on to students. All students get plenty of chances to draw blood gases and get venous blood from the femoral vein during surgery. On OB, average number of delieveries done unassisted, with resident standing by but not touching the baby, is 10-15. It's not at all unusual for students to be allowed to close fascia on c-sections. And I know of a number of my classmates (myself included) who got to do several simple cases during surgery.

Generally, the residents are very student friendly, and welcome even M1 to come observe and participate. M1 and M2 often come to the ER on breaks. One of my classmates got to do a chest tube during M1 year, another drilled a bore hole during a neurosurgery case. I got to do a central line as M1 (all but the stick) and float a swan early in my M2 year.

I'd love to hear how this compares to other student's experiences.
 

univlad

Member
15+ Year Member
Jul 14, 2002
236
28
Status
Attending Physician
. [/B][/QUOTE]What med school do you attend?
Originally posted by hotbovie
[
We do take overnight call on Medicine, Peds, Surgery, and OB. There is call on Psych and Family, too, but that consists of things like staying til 11pm, or 8-4 on a weekend, or an ER shift.

Overnight call on Surgery-- 4 calls total (2 with trauma, 2 with ortho/trauma), IM--q4 call till 11pm, Peds--varies at each hospital, I took 4 weeknight calls till 11 and one weekend call over 3 weeks inpatient and for outpatient peds, it was overnight once a week times three weeks. OB overnight call q3-6 depending on the number of students. No call Psych, Family.



We write H&P for all patients we see on call, and our H&P goes on the chart. The intern writes a separate H&P, often on a fill-in-the blank type form. We have to write it out fully. (I always thought that was redunant, but when I was on surgery, I learned that the residents often find the student H&P and notes gave them the best information about the patient). There are offical limits on the number of patients a student can carry, but the limits are not always adhered to.




We have to see all our patients and have notes written and on the chart before the intern gets to the patients in the morning. Sometimes we write orders which are later cosigned. Sometimes the residents require us to write discharge summaries.

Paper work--write h and p's on our patients, some services like the notes on the chart before rounds, other don't care if we write them after rounds...some services don't let us write notes...No dishcharge summaries are done by students.




Procedures are pretty good. I know of classmates that did things like central lines, chest tubes and LP during the first weeks of clinical rotations. The services are so busy that the interns get the hang of procedures pretty quickly and pass them on to students. All students get plenty of chances to draw blood gases and get venous blood from the femoral vein during surgery. On OB, average number of delieveries done unassisted, with resident standing by but not touching the baby, is 10-15. It's not at all unusual for students to be allowed to close fascia on c-sections. And I know of a number of my classmates (myself included) who got to do several simple cases during surgery.

[/COLOR] Blood draws at VA only. Have IV starting training in Anesthesia and Surgery, but otherwise very little experience. Very few procedures are done by Med students. OB depends on the site. I only delivered one baby hands off.
 

saori

Senior Member
7+ Year Member
15+ Year Member
Jan 28, 2002
345
1
santo domingo, dominican republic
Visit site
Status
As far as my rotations are concerned, my surgical rotation was hard, but rewarding also. I did my rotation at "Luis E. Aybar Hosp." here in Santo Domingo. It was not pretty, it was crowded, hot, no priviledges (not even for parking) and I had to do 3 weeks in urology as part of my rotation. I swear, the 3 longest weeks ever!

A typical day consisted in getting to the hospital, doing rounds, writing up the patient's records, checking that all blood work was done and draw blood when it reports were not complete. Tues. and Thurs. we had "consults" (patients coming in for appointments) and afterwards, academic sessions (Grand Rounds and Class).

The rest of the week (mon., wed. and fri.) OR. That meant the rest of the day in the OR assisting procedures.

It was the other way around during urology rotations.

On call duties: Hourly vital signs on all post-ops, draw blood, X-rays for all patients with chest-tubes. change dressings, measure secretions (from nasogastric tubes, drains, (-) drains, etc.), and so on.

I was kind of surprised to read that someone mentioned that drawing blood from the femoral vein was only done in the OR (or something to that effect), but it was routine for us. Most of the vascular surgery patients can only be drawn from the femoral v. and it had to be done quite frequently.

Also, transfusions were part of our list of chores, inserting Foleys and putting in nasogastric tubes were day to day things. Suturing, handling surgical instruments and assisting (I got a chance to assist the Neurosurgeon for sample harvesting for a possible brain tumor) were also frequent.

I think all in all, it was very difficult, but very interesting. Lots of "hands on" practice and the satisfaction of a job well done at the end of the day.:D
 
About the Ads