1. Richard N. Righthand, MD Adjunct Clinical Professor of Medicine Touro College of Osteopathic Medicine UMDNJ New Jersey Medical School

3.  Patient interview skills problem oriented directed examination focused comprehensive  Respectful of patient’s preferences  Identifying additional sources of information  Translation, ethnic, racial, cultural, age specific  Listen!! Let the patient’s try to tell their “story”  Try not to interrupt. Ask open ended questions; such as “How is your sleep?”,“Any problems urinating?”, “Tell me about your pain?”.

4.  Utilizing your understanding of disease, begin to construct possible reasons for the chief complaint as a differential diagnosis checklist one mnemonic is "A VITAMIN C ” Acquired, Vascular, Inflammatory or Infectious, Trauma/Toxins, Autoimmune, Metabolic, Idiopathic, Neoplastic, Congenital  Understanding the relationship between behavior, diet, activities, and disease.

5.  How well do you relate to others: patients, colleagues, attendings, residents, nursing, and administrative personnel?  How well do you communicate verbally presenting the patient and in the written form?  Can you do this in a timely fashion?  SOAP notes, Critical Care, and H&P, Surgical, OBGYN care

6.  Do you show compassion, respect and honesty with your patients, attendings, staff, nurses, and families?  Do you accept responsibility for your actions, errors, omissions?  Do you put the needs of your patients above other concerns?  Does “the buck stop with you?”  Trust and verify

7.  Learning about practicing medicine includes focusing resources to reduce cost without compromising patient care.  Economic resources are decreasing despite increasingly complex medical problems with an aging population.  Can you practice high quality healthcare without sacrificing or over utilizing resources.

8.  Can you include osteopathic principles and philosophy into various disease states?  Can you demonstrate proficiency in utilizing osteopathic manual skills? (or explain them to us allopathic physicians)  Can you demonstrate and explain the neuromuscular basis of homeostasis?

9.  “Proper attire” differs with each rotation: ask?  Punctuality and absences DO MATTER  Your attendance at grand rounds and meetings are mandatory when indicated by your chief medical student.  Being prepared with relevant review and study based upon your clinical encounters is a must. Retrieving information from the medical literature is also a daily occurrence.

10.  Learning various technical skills: physical exam skills, dressings, splinting, casting, suturing, phlebotomy, IV placement, proper hand washing and aseptic technique, etc.

11.  Nothing about your fellow colleagues, nurses, students, technicians, or institution.  Nothing about how the patient feels fine and is ready to go home or was left in hallway for 2 hours awaiting CT scan, etc.  Nothing off color or insulting  Do NOT attempt to alter, white-out, destroy, or modify the record except with a single line and initial, date and time

12.  No matter how tired you are, make sure you study at least one hour every day. Many students learn easiest when they study a chief complaint they encountered that day.  Ask your resident and/or attending what is expected of you and how they like to hear you present. Do this within the first week of the rotation, at the latest. Also ask for feedback on how you are doing and what you need to focus on to improve.

13.  Don't be too hard on yourself. Third year is all about doing something wrong every single day. So just relax, and continue to do stupid things because that means you're learning. It is ok to do things wrong now, because you are not the one making the final decisions. If you don't mess-up now, you're going to mess up later when it matters. So now is your chance.  We want you to achieve great things and turn you into the professionals we will admire.