abha khandelwal ms, md rush university medical center department of cardiology
TRANSCRIPT
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Through the Looking Glass: Transitioning from Student to Practitioner
Abha Khandelwal MS, MDRush University Medical CenterDepartment of Cardiology
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My Background• CWRU• Weatherhead• OSU• Rush Medical Center
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• Location• Population Density• Hospital Density• Legal Density
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Private vs. Academic• 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.
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Abha’s 5 As
Attitude
Apply Appreciate
Acknowledge
Adapt
Success
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So I start my first day…• Admit patients• Cross cover• Write orders • Communicate with RN• Write notes• Obtain medical records • Perform procedures • Run codes • Talk with families • Follow up on test results • Arrange Dispositions
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Adaptability/Efficiency• At home:
• Schedule: Plan ahead• Outsource: When possible• Hobbies: Continue them
• At work:• Organizing Data
• H&P• Cross cover
• Sleeping• Eating
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Be a Cheshire cat
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Abha’s 5 As
Attitude
Apply Appreciate
Acknowledge
Adapt
Success
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Who are you????
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Patient Care Tech
Nurse
Pharmacy
Doctor
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Primary physicia
n
Volunteers
Pharmacy
Specialists
Nurse
Nutrition
Social Work
PT/OT
Phlebotomy
Radiology
Transport
resident
intern
fellow
fellow
fellow
student
CNA
techs
Wound care
housekeepingRT
NP
Nutrition Delivery
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Intern/Med Student• Accumulate data
• H&P• OSH
• Identify dangerous situations • Learn basic principles • To be a scapegoat
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Life of an Intern
• AMI• SBO• DKA• Sepsis• GI bleed• ACLS/PALS
• BM• BS• Pain• BP• Nausea• Insomnia
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Resident• 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
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Attending• Manage the complex care teams that are involved
in managing a patient• Ensure patient safety• Ensure education for all levels of the team
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Manage expectations• Set expectations at the start of month• Review progress in middle• Summarize at the end
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Abha’s 5 As
Attitude
Apply Appreciate
Acknowledge
Adapt
Success
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How do I fix this?
• 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
1.0400
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Apply
• 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/
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CHF• Seattle heart failure model• Chads2• TIMI Risk calculator in STEMI/NSTEMI• Ekg guide
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SHFM
http://depts.washington.edu/shfm/macosx.php
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MICU• Understand
• Acid/base• PNA hospital score• Score for sepsis for Activated protien C• Ventilator extubation criteria• Electrolytes
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Application• 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
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Application• 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.
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Abha’s 5 As
Attitude
Apply Appreciate
Acknowledge
Adapt
Success
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Patients are MAD
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Attitude
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In Summary
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In Summary• 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
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Questions?