Location Population Density Hospital Density Legal Density
Established relationship amongst practioners More variability in management strategies More ancillary services Established relationship between patient and pracitioner Less direct access of patients to Attendings. More standard management strategies More access to physicians with sub-specialized interests Conferences where complicated cases can be discussed in a multidiscplinary fashion. Allowance in time devoted to research and academic pursuits.
Primary physician Volunteers Pharmacy Specialists Nurse Nutrition Social Work PT/OT Phlebotomy Radiology Transport resident intern fellow student CNA techs Wound care housekeeping RT NP Nutrition Delivery
Accumulate data H&P OSH Identify dangerous situations Learn basic principles To be a scapegoat
AMI SBO DKA Sepsis GI bleed ACLS/PALS BM BS Pain BP Nausea Insomnia
Comprehend the clinical situation of the patient being managed Master procedural/Exam/diagnostic skills Manage dispo and social issues for the patient Teach the intern/medical students Keep charge nurses informed
Manage the complex care teams that are involved in managing a patient Ensure patient safety Ensure education for all levels of the team
Set expectations at the start of month Review progress in middle Summarize at the end
A Give 80 meq of potassium B Give insulin C Do nothing this is normal D Give hypertonic saline E None of the above 124 100 2.6 13 29 1.0 400
Talk to colleagues who have done the rotation. Use evidence based medicine to guide you management decisions. Websites: www.uptodate.com, www.asco.org, www.shfm.org, www.scutwork.com, www.nejm.org www.idsociety.org www.cardiologysite.com, www.acponline.org, http://www.medicalstudent.com/#Handheld, www.medscape.com/ www.uptodate.comwww.asco.orgwww.shfm.orgwww.scutwork.com www.nejm.orgwww.idsociety.orgwww.cardiologysite.com www.acponline.orghttp://www.medicalstudent.com/#Handheld www.medscape.com/
Seattle heart failure model Chads2 TIMI Risk calculator in STEMI/NSTEMI Ekg guide
Understand Acid/base PNA hospital score Score for sepsis for Activated protien C Ventilator extubation criteria Electrolytes
Rounds: Identify pertinent information Learn to group things together (meds, labs, sx) Synthesize a cohesive management plan based on guidelines Procedures: Know the indications and potential complications Research: Case Reports PubMed: gastric massage
Heme/Onc: Neutropenic fever, transfusion thresholds, oncologic emergencies ID Sanford, travel hx, antibiotic hx, immunizations Surgery Ileus, nutrition, anatomy, bm, pain control Pediatrics Milestones, congenital syndromes, embryology Renal Electrolytes, urine sediment, nephrotic, vs nephritic.
Adapt: and be efficient Acknowledge: and learn your role in the team Appreciate: and be respectful to all members of the team, understand their perspective Apply: book knowledge into practical/clinical knowledge Attitude: Stay positive