SCOOP II: THE DEUCE

L3 Life, Post-Katrina

VVOLUMEOLUME VIII VIII 2010-20112010-2011

A gift to the Class of 2012From the Classes of 2011, 2010, 2009, 2008,

2007, 2006, 2005 & 2004

Table of Contents

Introduction……………….…………………..……………………………………………………….1

General Information…………………….……………………………………………………….……4

Medicine…………………………………………………………………………………………….…9

Surgery……………………………………………………………………………………………….19

Psychiatry…………………………………………………………………………………………....31

OB/Gyn……………………………………………………...……………………………….……….35

Pediatrics……………………………………………………………………………….…………….40

Family Medicine……………………………………………………………………………………..46

Rural Track…………………………………………………………………………………………..48

Mobile Devices…………..………………………………………………………………………….50

Textbook Survey…………………………………………………………………………………….51

Guide to the Hospitals………………………………………………………………………………54

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Introduction

From the editor of the Scoop II, volume I (2003):Welcome to your third year of medical school!! The Class of 2004 wishes you the best of luck during your first clinical year of medicine. This guide is an attempt to help you get through the ups and downs of being an L3. We hope that you will find some answers in here and be prepared to enter the hospital in July.Remember that every person in your class will feel overwhelmed, just like you. Take a deep breath and know that you will become more comfortable every single day; don’t be afraid to ask for help. Your residents and staff are usually willing to assist. Be nice to the nurses or they can make you miserable. Help your fellow classmates – you are all in this together!!Besides the SCOOP II, your own classmates are also a good source of information. Share the helpful hints and study guides from rotations as you change blocks; this exchange of information is a huge help throughout the year. Use the L4’s; we were VERY recently in your shoes and we remember what it is like to be dazed and confused. Our class should be happy to teach you the ropes. This is will be an interesting and informative year for all of you; make the most of it. You should be gaining a ton of clinical information (that you need to keep in your brain for Step 2), and you should also begin formulating your plans for the future. Keep this in mind as you rotate through the blocks. This is the fun part – so work, study, and play hard!!!

Stacey HolmanStudent Body President 03-04Scoop II, Editor

Special Thanks to the Following Authors:Crystal Benjamin - Pediatrics Chris Canlas - OB/GYN Rachal David - Surgery Scott Mayers - Psychiatry Melissa McKay - Medicine Erica Moore - Hospital Guide Seth Roussel - Family Medicine

From the editor of the Scoop II, Volume 2 (2004) :I would like to add a special thank you to the Class of 2004 for all of the hard work they put into making the 1st volume of the Scoop II such a success. The Class of 2005 is honored to continue this by updating the current edition and adding a few helpful hints of our own. I would also like to thank Phil Hoang, Mike Bodin, and Jennifer Melton for helping make the 2nd volume a success. I hope future classes continue the tradition of updating the Scoop II and passing along this “guide to the third year”.Finally, I would like to congratulate all of you in making it this far. Medical school is halfway over, and most people feel 3rd and 4th

year are much more laid back. So, relax and have a great year!Gregory GullungScoop II, Editor

From the editor of the Scoop II , Volume 3 (2005) :Congratulations on getting past MIP and some of the other hidden treasures in second year (consider third year as your reward). To continue the tradition started by the Class of 2004, the Scoop II has been updated to include the latest news and changes in the third year curriculum. This guide to third year is an excellent resource for all of the rotations. Each section will give you a thorough look at the rotation—from what you can expect on the first day to what you should study for the test. Enjoy the year. Although some rotations are busier than others, most of the year is relaxed and easy to enjoy…so enjoy it! If you have any questions along the way, don’t hesitate to ask a fourth year. We look forward to working along side you in the hospiitals.

I would also like to give a special thanks to Christen Cali, Christina Cannizarro, Jason Fuqua and Michelle Salomon for making Volume 3 the best volume of all time.

Barrett JohnstonScoop II, Editor

From the editor of the Scoop II , Volume 4 (2006) :Congratulations on surviving the insanity of second year. Boards will soon be behind you as well, and now you look forward to embarking on what will be a busy, yet fulfilling, year. You will work very hard, sometimes very long hours, but for the most part you will find that your experiences are wonderful as you get out of the lecture hall and into the hustle and bustle of the hospitals and clinics.As you can imagine, in the months following Katrina and Rita the state of the health care system in Louisiana has been constantly evolving. We have attempted to modify and update this resource to reflect the changes that we encountered as we navigated the wards in facilities throughout the state including EKL, Baton Rouge General, UMC, Chabert, Tyler Mental Health, Oschner, and various other sites. Even as I type this blurb, current rotations are being revamped and new rotation sites are being developed by the course directors and faculty. Please take what we say in the Scoop II as an overview of what to expect as you begin this part of your training, but keep your ear to the ground as things will be changing daily.I encourage you to talk with your classmates on other rotations, as they will be your best source for up to date information at each of the sites. Should any other questions pop up, please do not hesitate to ask the L4s. A special thanks to Sarah Jolley, Jamie Hutchinson, Brad Culotta, Tim Haman and Ngozi Onyenekwu for input about the various rotation sites. Thanks to Mike George and lsumedstudents.com for compiling the textbook survey. Best of Luck to you all; we’ll see you on the wards!

Beth ClementScoop II, Editor

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From the editor of Scoop II, Volume 5 (2007)Congratulations Class of 2009, and welcome to third year! You have made it through a huge hurdle with finishing Step 1 and surviving your classroom years. Now welcome to finally getting your hands dirty in your clinical years. These next two years are a completely different approach to learning…you will be working long hours and still studying hard. However, most people find it much more enjoyable working with patients, and there is nothing that beats hands-on learning.

As you well know things are constantly evolving at the School of Medicine as more services become available to residents and students. More student positions will open up in New Orleans as resources become available; however, you will still have some classmates rotating through Lafayette and Baton Rouge. The key thing to remember is that no matter where you are your rotation will be exactly what YOU make of it. There are plenty of learning opportunities to which you will be exposed at each individual place in each of your rotations. Be aggressive, take initiative, be courteous, and don’t be afraid to ask your residents for anything. You will find that as students at LSU we have much more autonomy than most medical students do at other schools. Take advantage of that to expand your knowledge. It will be intimidating at first, but work with your classmates and colleagues. They will be your best source of support, advice, information, and companionship. And remember, the L4s will be around for most of the year, and we are willing and eager to help you all with anything you may need. Best of luck to you all! This is a very fun and exciting year, and I hope you enjoy it immensely!

Special thanks to Lindsey Dietrich and Chad Dugas for their efforts in editing this edition of the Scoop 2.

Melanie MontgomerySGA President, 2007-2008

From the editor of Scoop II, Volume 6 (2008)Congratulations to the Class of 2010 on getting past that little Step 1 quiz and making it this far. Trust me when I say it: 3rd year is so much cooler than the 1st 2 years of medical school. You will all soon have that realization of why you’ve been studying non-stop when the rest of your friends were out having fun. I really wanted to encourage you all to go into each rotation with an open mind. Always work hard, even if you’re not interested in a certain specialty, because there’s always something to learn, and there are real live patients depending on your advice and guidance. You never know if an Ortho surgeon will have to deliver a baby on an airplane, or if a Dermatologist will have to run a code on their grandparents.

A lot of times on your rotations you may feel totally lost, but remember, you’ve got us L4s, residents, nurses, techs, and physicians looking out for you. Don’t ever hesitate to ask questions. Show initiative, be aggressive, and show your patients that you really care. Best of luck and we’ll be waiting for you at the finish line.

Special thanks to Jane Gulick, Victoria Burke, Danny Heine, Natasha Goss, Michelle Troendle, Melissa Rasberry, Brad Cheek, Francois Ancelet, Quynh-Anh Nguyen, Joey Bergeron, Amy Davezac, Eric Hall, Justin Walker, Maria Yates, Lacey Millet, Adam Mellis, Chelsey Tyler, Nikki Gautreaux, Holly Primeaux, Gina Cosentino, Mamina Turegano, Leon Cannizzaro, Kamau Foderingham, and Rohini Singh for their efforts in editing this edition of the Scoop 2.

Hitesh ChhedaL4 President, 2008-2009

From the editor of Scoop II, Volume 7 (2009)Get excited! You’ve finally made it to the most fun part of Medical School! Don’t get me wrong, you will be very busy this year. But, after all of your hard work these last 2 years, there is nothing like the privilege of waking up every morning and going to see patients. Also, studying is not so bad this year because you will have already learned a lot in the hospital or clinics. Always remember to respect your patients and learn as much as you can from them. You will likely remember many of your first patients for the rest of your career. Take advantage of the autonomy we have here at LSU and be confident in the clinical education that you are about to receive!

In the process of editing this document, I would like to thank the following L4s for their assistance: Evan Atkinson, Jessica Butler, Sangeetha Kandan, Casey Battaglia, Ana Paunovic, Rebecca Rings, Matthew Bergstedt, Carrie Goodson, Matt Mutter, Matt Finn. Be warned that things are constantly changing on the third year rotations so be prepared to be flexible! Good luck!

Rachel PastorekSGA President, 2009-2010SCOOP II Editor, 2009

From the editor of Scoop II, Volume 8 (2010)Class of 2012, first let me congratulate you all on finishing your first two years of medical school and on surviving STEP 1! What an accomplishment… Know that you are over the hump, and it is all downhill from here. If you thought the first two years flew by, third year goes even faster. While you have already accomplished and learned so much, third year will afford you the opportunity to build upon that knowledge and actually apply it to a real person and not just some DxR patient. This encompasses much more than just the knowledge of pathophysiology of disease processes, though. Now you are dealing with not only medicine, but feelings, life, and death as well. Cherish the privilege you have to take care of your patients, and although you may not be able to run their entire treatment plan, be sure to also take pride in the little things you can do for them. For instance, make sure they have enough pillows, and that they are getting the flavor Jello they like, because it’s those little

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things that show you care that make such a difference to those who are sick and suffering. Trust me, at times, you will feel so lost that those will be the only things you know how to do! But it will get better, and you will quickly become comfortable with how things work and how you can contribute to the team. If at any point along the way you need anything, just ask those around you and people are usually quick to help out. They know where you are because most of them have been there, too. Good luck, and welcome to your clinical years!

Below we have edited the running document in hopes to brief you on the up and coming year. I’d especially like to thank my fellow classmates who’ve helped me in this editing process: Stephanie Bourque, Brandon Lopez, John Haas, Carrie Spangler, Katie Wolfe, Elliot Hardy, Chris Belfour, Jeff Franklin, McKenzie Mayo, Mike Hulin, John Krieg, Uche Obih, Stephanie Levenson, Chris Burkenstock, Carter Davis, and Catherine Gretchen.

Jimmy WhiteL4 President, 2010-2011

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General InformationThe Student Doctor of LSUHSC-NO

You must begin to accept the role of “student-doctor,” but expect various reactions from your patients. Some of them have been coming to the clinics for years and are familiar with the teaching system here. Most will not give you any trouble while you poke and prod on them. But expect to come across the hostile patient occasionally, the one who will be distrusting, argumentative, and difficult to examine at all. For those who may rotate at a private hospital or clinic, do not be offended if an occasional patient refuses to have a student in the room.

We are primarily trained in a charity system but that does not change the way we care for patients, of all types. Adopt an attitude of willingness to treat and understand that people will have very different cultures and practices than you. With this, you will discover the multitude of patients who are very gracious for your help and simply for your time spent taking care of their needs.

As a student-doctor, you will come into contact with the nurses each and every day. There are many who have been here forever and are VERY set in their ways. Do not try to interrupt the system; do your best to help them and they will usually help you. Here are some common sense pieces of advice that not everyone knows about a special topic: How to deal with grouchy nurses?

1. When you walk onto a floor, strip away any preconceived bad images and treat everyone as you would like to be treated. Always show respect and ALWAYS say THANK YOU!!!!!!!!!!!!!!!

2. Always act like you know NOTHING and they know more than you because they DO!!!!!!!!!!!!!! Do not be condescending or arrogant even when they are extremely RUDE to you. Suck it up and SMILE!!!!!!!!!!!!!!!!!

3. Again, SUCK IT UP and SMILE!!!!!!!!!!! I cannot emphasize this enough. It is not worth the time or the effort to get into petty arguments. They have been in the system far longer than you have and they can be VERY helpful at times. Just show them respect, be humble, have manners, and you should have minimal problems. Again, always say thank you and smile no matter what.

4. Many students have had problems with co-workers at certain hospitals. However, most are very nice and are more than willing to help you if you approach them in the right way. Remember you are making first impressions with everyone that you are working with, not just residents and attendings. These little tips will hopefully help you to avoid certain situations and it will make your third year so much more enjoyable. Good luck and enjoy – make the most of your third year.

Writing Notes and Orders

ADMIT ORDERS:L3s are often asked to write orders for patients when they get admitted to your service. The following mnemonic can be used for admit or transfer orders; below is an example. Use it a few times and it comes naturally. All orders should be written on Doctor’s Orders forms.

A D C VAN DISMAL Admit to – specify service and ward locationDiagnosis – why are they in the hospital???Condition(of the patient) – stable (most common), fair, critical, etc.Vitals (how often you want the patient’s vitals checked) – q4, q shift, per routineActivity – ambulate tid, ad lib, bed restNursing (extra instructions for nurses)– accurate I & O’s, daily weights, wound care bidDiet – as tolerated, regular (for age), clear liquids, low sodium, NPOIV Fluids – D5NS @ 125 mL/hrSpecial – includes any special instructions for the patient (respiratory, monitors, etc.)Medications – ABX, antiemetics, pain meds, oxygen (include dosages)Allergies- NKDA (No Known Drug Allergies), etcLabs – CBC and BMP qAM, EKG, X-ray

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Common Abbreviations:

PO – by mouthPRN – as neededq – everyº – hour

q day – once a dayBID – twice a dayTID – three times a day QID – four times a dayQOD – every other dayq4 – every 4 hours

HS – at bedtimeAC – before mealsAC – at meals

** All orders must be cosigned by a resident before they can be carried out. Each facility will have a procedure for indicating to the nurses that there are new orders including color markers on the chart, folding the page so it sticks out of the chart, placing in a special rack, etc. Ask your resident or AI (acting intern) for the proper procedure.

PROGRESS NOTES:L3’s write progress notes on patients each morning on the ward services. This may be a regular progress note, a post-op note, or a postpartum note. All of these follow the SOAP format and must be tailored to the patient’s condition. Refer to the individual sections for specific details.

**must be appropriately titled: L3 Progress Note, Service, Date/Time, Hosp. Day, ABX Day**use only standard abbreviations that everyone will recognize

S: Subjective: patient complaints and comments, nursing comments, how the patient did overnightO: Objective: includes vitals (Tmax, Tc, HR, RR, BP, O2 sat, Ht, Wt, ins and outs), physical exam, lab results

**Different services/attendings may require different formats for the vitals, wanting only 1 set or a range over the last 24 hrs, etc. Try to mirror what other members of the team are doing.

A: Assessment: based on the above (usually A and P are put together – A/P)P: Plan: med changes, lab tests to be ordered or checked, procedures, consults, current monitoring, discharge

HISTORY AND PHYSICAL:L3’s may write up H&P’s when admitting patients from the ER or from clinic. These are done the same way as you learned in ICM. In some cases there will be a pre-printed form to fill out. Other times, you will just write on a blank progress note. It is very important to use standard abbreviations in this note because many people will be reading through it.

PRESCRIPTION WRITING:All prescriptions must contain the following information:

Name and Date Line 1— Inscription: the name of the drug (brand or generic) and the dose of the drug Line 2— Subscription: the directions to the pharmacist (designated by disp.) Line 3— Directions: the directions for taking the medication (designated by sig.) Physician’s Signature Number of Refills

Example Rx:

**It will be helpful for you to pre-write all prescriptions that your patient will require when preparing the discharge orders. That way, your resident can just sign them when he/she co-signs the orders.

Tiger Care Center555 North Street

New Orleans, LA 70505

For: _______________________________________________________ Address: ___________________________________________________

Date: __________________

NOT VALID FOR CONTROLLED DRUGS

Product Selection Permitted Dispense As Written

Refill ___________

Signature ___________________________________________________

Medicaid # _______________________ DEA #____________________

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MISCELLANEOUS PEARLS FOR THE YEAR

Patient ListsOn wards, students are often asked to keep the patient list. Residents will give you a template but usually it looks something like this:

LSU MEDICINE SERVICE, Team 1June 5, 2006

Room NameAge, Race, SexMR #

HD/AD Dx Meds Plan/To Do

602 Blow, Joe82 BM444232

3/ Dehydration 2º Viral Syndrome

None IV Fluids: D5NS @125 ml/hr

312 Doe, John45yo WM555323

4/3 Pneumonia, HTN Ampicillin, Zithromax, Atenolol, Albuterol

CXR, neb treatments

MR: medical record number; you will use it to look up the patient’s information and labs on CLIQ HD: hospital day (how many days the patient has been in the hospital) AD: antibiotic day (how many days the patient has been taking the medication) Top of the page contains the service name and current date Bottom of the page contains a list of everyone on the team’s pager/cellphone numbers as well as important

hospital extensions Email this list to yourself and the other students; put in on your desktop for easy access at the hospital;

some services will keep it on a hospital computer, or the web under a secure password. Guard these lists with your life; DO NOT leave them anywhere in the hospital. Having patient lists visible to

others is a direct violation of HIPAA (patient privacy act). You will get in big trouble…so keep these with you at all times and shred them when they become outdated.

Patient Organization and RoundsSome suggestions for keeping track of your patients:

Use index cards that contain all of the pertinent info – name/age/gender, diagnosis and workup; include the current day’s physical exam, vitals, labs, and the A/P of your note

Formulate a list and carry that list throughout the day. Keep track of pending work by making a checklist for each day on each patient.

For rounds, present the patient in SOAP format. Your staff/residents will tell you exactly what they do and do NOT want to hear every day.

Be prepared to give a differential diagnosis, especially on Surgery and Medicine. Use the following mnemonic to organize your thoughts: VITAMIN C

VascularIdiopathic/IatrogenicTraumaA metabolic disorderMechanical (usually obstruction)InfectiousNeoplasmConnective Tissue Disease/Autoimmune processes.

EvaluationsThe procedure varies for different services. Sometimes the residents will fill them out, other times the staff will.Sometimes you have to collect them to turn in, other times the coordinator will take care of it directly. Sometimes they will carry a lot of weight on your grade, other times, not so much. Ask the individual coordinators for the proper procedure.

In your White Coat Pockets You should always have a stethoscope, penlight, and several black pens.

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Scissors, 4x4s, tape, suture/staple removal kits for surgery/ob, Pregnancy wheel for ob, reflex hammer for

medicine/surgery/peds; etc. Maxwell’s Reference Book is essential for looking up normal lab values, writing orders, and a million other

miscellaneous things you will need on rotations. Get it TODAY!! Pharmacopoeia or Palm Pilot with a drug reference program such as Epocrates Pocket book of questions or information for that block – in case you have time to read Blank notebook to take notes (lots of teaching on rounds or from residents) Snacks if you tend to get hungry often (granola bars, etc) Extra lists, articles, and anything else you think you may need

Your coat will get heavy and begin to hurt your back, so make sure you use everything that you carry; otherwise, leave it at home. Some people carried bags as well larger books and notebooks. While this may be good for lecture, it can be cumbersome on long rounds and there is no safe place to store it- no lockers. So, bags often end up in a conference room or on the ground at the nurse’s station. By the end of the year, you will probably be trying to shove everything in your pockets. Girls, purses are a nightmare! The best piece of advice is to find a change purse to carry money and other essentials that will fit in your coat pocket. You will have it in your possession and have access without having to worry about theft.

What to WearGuys – White coat, slacks, button up shirt and tie. For medicine, this is the dress code for all days unless you are on call – then you can wear scrubs. Some rotations will let you wear scrubs in the hospital, especially OB and surgery. Find out before you show up.

Girls – Dress clothes, unless otherwise told. Some services are particular about closed toe shoes, others are not- the rule is to follow those around you (i.e. match what the residents are wearing). Do NOT wear low cut tops, low riding pants, short skirts or denim. It looks unprofessional and you will be spoken to about your attire; there have been problems in the past. This is also a part of your evaluation.

When in doubt – wear dress clothes. You should never show up for the first day of a rotation in scrubs, not even for surgery. You can bring scrubs to change in to (you might be on call the first night), but it always makes a better impression if you are well groomed. One more piece of advice, try to keep your white coat at least partially clean. They can get really nasty. Some students got a 2nd coat so they can rotate them as on is being washed.

A Word on the Team SystemThis may be obvious, but if it's not, here is a brief explanation about how doctors are organized at LSU. The most important rule is to follow the chain of command at all time.

Inpatient service teams may include students, acting interns, interns, residents, and staff. Residents are designated as HOI, HOII etc. (HO=House Officer). It's usually established how many of each kind of person will be on each team. For example, Pediatric Surgery always has three or four students, two interns and a fourth year resident.

"Chief" means different things in different specialties; sometimes they're residents staying an extra year, sometimes they're in their last year of residency. When you start a rotation, find out what the story is for that service, and learn the rank order of your team.

You may also interact with “fellows” (especially on consults). They are above the residents, and may have even been an attending at some point before starting the fellowship.

All teams have one or more staff doctors for inpatients, clinics, procedures, etc, who officially OK everything that happens, even if they're not actually there. How much you will actually see staff varies with different rotations, but they have the ultimate say. The extent to which staff involves students varies tremendously – sometimes they'll grade you, sometimes the residents will. Sometimes they'll talk to you, sometimes they won't.Interns (or the lowest ranking house officers on a particular team) are generally responsible for making sure everything runs smoothly. They write notes and orders and get called first by the floor if something is going on. Your work will usually overlap with theirs and will be done entirely by them when there are no students. They are often responsible for all the patients, and in most cases will co-sign all your notes. Don't take it personally if it seems like they're repeating things that you already did - it's their job.

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Rules of PagingMost students have a cellphone. In general, keep your cellphone on vibrate, particularly during conferences and lectures. Keep your cellphone nearby if there's even the slightest possibility your residents will be looking for you.

If you can help it, avoid paging people to busy phones, as the line may be tied up when they call back. If your page isn't returned, wait a polite amount of time (around 10-15 min) then page one more time.

Follow the chain of command – page your intern before paging your upper level, etc. Same thing goes if your paging residents for a consult – page the intern before the fellow. Don't page staff unless specifically told to do so.

Wearing your IDObviously you should have your ID on you all the time. Wear it. You can NOT get into the hospitals without it! Wear it to the clinics, to the hospitals, to lectures, to the cafeteria, and to exams. Hospital security, the nurses, and even the patients will expect you to have it on.

The Third Year - How it WorksThe third year of medical school begins with a two-week rotation in Radiology and Ophthalmology. The only other ways to push Rad/Ophth back is with an excused absence like a family wedding or something of a similar magnitude.

These courses are very benign but still take them seriously. You DO need to pass them! Radiology is P/F – go to lecture, review films in small groups, take the test.Ophtho is H/HP/P – go to lecture, attend small groups at the ophtho office, learn how to use the instruments, draw a classmate’s retina, take a test.

Be on time for everything; in fact, be early. Check your email regularly because schedule changes are usually posted here.Do the reading and be prepared for your team. Help out fellow classmates when you can. Do not be the one who tries to make yourself look better by trying to make your classmates look bad – residents will see through the act, so it will only hurt you in the long run.Ask questions – it makes you seem interested.

The rest of the year is broken into four 12-week blocks:Medicine = 12 weeksSurgery = 12 weeksPediatrics = 8 weeks and Family Medicine = 4 weeksPsychiatry = 6 weeks and OB/GYN = 6 weeks

**The following sections highlight the basics of each rotation, including site-specific information. **The final section, an updated Hospital Guide, provides more info on sites developed since Katrina.

Internal Medicine

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The third year medicine rotation is the core block of the year as well as one of the main building blocks of your career in medicine - regardless of the specialty you choose. The block is twelve weeks long, and it is scheduled as three four-week rotations. The rotations include ambulatory clinics (visit different clinics each day, including General Medicine, Cardiology, Rheumatology, Heme/Onc, Endocrine, PM&R, ID, etc.), hospital wards, and consult services (where you will be assigned to two subspecialties, such as Cardiology, Renal, ID, Pulmonary, GI, Endocrinology, and PM&R). Students can be assigned to sites in New Orleans, Baton Rouge, or Lafayette over these three months, with a larger number of students being in New Orleans than at the other sites. The sites that are currently being used include University Hospital, Touro Infirmary, and Kenner Regional Medical Center in New Orleans, UMC in Lafayette, and EKL in Baton Rouge. In addition, you can expect to have a lecture series for about 4 hours per week. In New Orleans in the past, this was done on Tuesday afternoons.

Wards:Wards are typically the most difficult month of the rotation, but this is also the month in which students feel they learn the most. The more diligent and thorough you are about looking up things on your patients and directly participating in their care, the more you will learn! Students will be assigned to a Firm/Wards Team. Each team is overseen by an attending physician, and has an upper level resident(s) and one or two interns. Fourth year students may also be completing their Acting Internship; they will function at a level between you and the intern. If you have questions, they can be a great resource (remember it wasn’t so long ago that we were in your shoes). You will work with the team on a daily basis - writing notes, rounding, attending conferences and taking call. The length of your day and the time your day will begin are based upon your staff, residents and the size of your service. Typically, you will see patients on your own in the morning and then attend morning report at 8 AM (7 AM in Lafayette, 7:30 in BR). Rounds and floor work typically follow this until noon conference (if your site has noon conferences). The afternoons can be comprised of more floor work, lecture, small group sessions, or occasionally free time.

Call nights occur approximately every 4 days during which you will be expected to see a patient(s) in the ER, complete a history and physical, and determine patient care in consultation with your resident(s). Night call typically ends at 11 PM or midnight, but this depends on your site and your residents. Be prepared to present your patient to your attending (or even during Morning Report) the following morning. The presentation consists of a patient’s H&P, the initial treatment plan implemented in the ER, and what progress your patient made overnight on the current treatment plan. Always try to help out your team with any loose ends, such as rounding up pending labs and studies in the mornings or helping with discharge paperwork, as a way to show interest in all of the patients and to be of the greatest assistance to your team. Weekends are typically fair game on the wards, with each student typically getting 4 days off per month over their weekends.

You may also be required to give small presentations on an assigned topic. This usually requires the use of online journal articles, an easy way to find up to date information about the case. Your staff may distribute articles as well – they are often worth saving, so break out a binder and keep them for future reference. Keep in mind that “Up to Date” is a valuable online resource for Medicine (which can be on computers at UH). It is hard work, but definitely a time to learn the basics – you will continue to use what you learn during this month for the remainder of the year. If feedback is not offered, be sure to ask your staff/residents mid-way (if not on a weekly basis) through the rotation how you are doing. Graciously accept any constructive criticism offered and adjust your performance accordingly.

Clinics:Clinics month is often less time consuming with a more predictable schedule. Your day will be more structured (8am-5pm), and you will typically have more time to study. You will be expected to work five days a week, continue to attend conferences and lecture, and attend morning and afternoon clinics each day. An individualized schedule for each person will be distributed at orientation to the block. The clinic may be within the hospital, or at an off-site location (so carpooling may not be an option). You will be expected to attend your assigned clinic and have your attendance card initialed by staff at every location. These cards are turned in to the course coordinator at the end of the clinic rotation so DON’T LOSE IT!! Some students photocopied it weekly, so just in case it got misplaced, they would have a record. Your responsibilities will vary depending on the clinic and the staff. Some clinics will expect you to see patients and present them yourself, while others will simply allow you to shadow a resident or staff. Just show up on time and try to be relaxed, knowing that each clinic will be a different experience. Clinic students in New Orleans also attend a variety of lectures throughout the week, so be sure to mark these down on your schedule.Consults:The third part of the rotation is consults or subspecialties. You will be assigned to two services, spending two weeks on each. Last year, we did not have a choice in New Orleans on which consult service to rotate.

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Some consults are busier than others, some have longer hours, and some require you to work weekends. Unfortunately, this is a part of medicine that is purely the luck of the draw. The individual subspecialties are site specific, but may include: Renal, PM&R, Endocrine, Cardiology, Pulmonary, Heme/Onc, GI, Rheumatology, or ID.

Responsibilities are somewhat a combination of wards and clinics. You will be seeing patients and writing notes, rounding with your team and attending the clinics that accompany each service. You will also often spend time in various procedure labs depending on what specialty you are assigned (cath lab for cardiology, endoscopy for GI, etc.). There may also be conferences and lectures that are specific to each service, which you will be required to attend if they do not conflict with mandatory medicine activities scheduled. The rule of thumb for consults is simply to follow your residents while on service. Many times, these services are not as busy as the general medicine services, so for teaching purposes you may be expected to give presentations on outside research using journal articles, etc. Each particular service has its own ‘personality’ so be prepared for just about anything. Consults are a more focused look at Internal Medicine; it will provide you with an opportunity to delve more deeply into particular areas and disease processes. Follow the schedule that is given during orientation to the block or by your site coordinator.

Conferences/Lectures:Everyone is required to attend Morning Report, Student Morning Report, Noon Conference, Professor’s Rounds, and Student Core Lectures. Don’t miss – role will be taken. (In past classes, students were caught signing in for other students – they received failing grades and had to repeat the entire 3 month block).

Morning Report – Held at 8am daily at UH (7am at UMC/Touro, 7:30am EKL, 9AM at KRMC). These sessions are led by a staff member at your respective site. A case will be presented by the post-call team, often by the 3 rd or 4th year student. You may also be asked to prepare a short presentation on a relevant topic.

Student Morning Report – This is led by Dr. F. Lopez, Dr. N. Jain, or Dr. M. Ali in New Orleans and is one of the highlights of the course. A student (or Dr. Lopez) will prepare a powerpoint presentation of a case and Dr. Lopez, Dr. N. Jain, or Dr. M. Ali will lead a group, interactive discussion on the learning points. This is some of the most high yield and clinically relevant information that you will get in all of your 3rd year so take advantage of it! The opportunity to interact in a small group setting with the faculty is priceless.

Noon Conferences – Some sites have noon conference and some do not. Sometimes lunch will be provided and sometimes it won’t. You should check with your residents and your site coordinator about what sessions you are required to attend.

Core Lectures – These lectures are given by staff/residents and cover the basic topics of medicine that you need to know both for your test and for daily use. This last semester, the lectures were held in New Orleans from 1:00pm-5pm on Tuesday, and Lafayette students have access to a previous years video of each lecture (Baton Rouge does their own lectures throughout the week at different times). I know that the lectures seem plentiful, but they are designed to cover relevant testable material, and attendance is taken at each of the sites. Handouts have been emailed out the week of the lectures in New Orleans. You should print them and bring them with you to lecture. Be sure to grab a coffee prior to attending these…it might help you stay conscious (note: being post-call is not an excuse to skip lecture).

Didactics – Small group sessions every Thursday afternoon during the clinic rotation. They are given by Dr. Lopez and Dr. Jain and include topics that are very likely to be on the test. Some topics include acid-base disorders, heart murmurs, and antibiotics.

Grand Rounds – This occurs each Friday in the MEB lecture halls during lunch. There will be either a guest speaker or a presentation of current research. These can be a bit beyond your scope as a student at times, but interesting as well. Attendance is mandatory but you get free lunch (so it’s not without its charms).

Professors’ Rounds – Small group learning sessions scheduled in the afternoons with Dr. P. Rigby, Dr. A. Lopez, Dr. Sanders, or other staff physicians, give students a chance to present patient cases to fellow classmates. The lectures that Dr. F. Lopez gives are some of the best around – you will learn to think much more clearly about topics such as acid/base disorders and antibiotics. When you are on clinics, you simply need to attend, pay attention, and participate in the discussion. However, when you are on the wards, you will be expected to present a patient for everyone to discuss. Guidelines will be addressed prior to your turn and vary depending on your staff for these sessions. These tend to be very informal and excellent learning processes, so be sure to relax and enjoy them.

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Site Specific Info

University Hospital in New OrleansWards There are four firms/teams and each team has one L3 student, a potential L4 on an acting internship, a couple of interns, one upper level resident and one attending.

PROGRESS NOTES: Your team will let you know what time your progress notes should be ready for. Usually, all the notes need to be done by 8:00. Your day will usually start around 6:30, depending on the number of patients you're seeing. At the beginning, give yourself about 45 minutes per patient to get oriented with the ward, charts and CLIQ. This will allow you to put together a complete, organized and legible note. You'll see patients and write progress notes until about 8:00-keep in mind that you may need to be done before then if your intern needs to write behind you. In addition, you will be required to attend student morning report at 7:30 on Mondays-you are still expected to write on your patients. MORNING REPORT: At 8:00, you'll gather with other Medicine students, residents, and staff for morning report in the basement at UH, near the cafeteria. Make sure you have an extra copy of your team’s list for the consensus box which is found in a locked cabinet in the morning report room. Know how many patients are on your service-students are often expected to provide this information for the consensus. Typically, the morning report consists of a patient presentation by a member of the team on call the previous night. You may or may not be asked to present a patient if your team was on-call the night before. On some days, cardiology service will present a patient or there will be a formal lecture. Regardless of the topic, the audience will participate and Staff sometimes will pimp students, so pay attention. Once morning report is over, there is usually a 15 minute session for students only. The purpose of this is to provide additional explanations and to review difficult concepts. This is where students are frequently pimped.  If you don't know something, just admit so and give it your best shot.  ROUNDS: After morning report, you'll meet with your team to round on all of the patients on the service.   Rounds usually last at least a couple hours depending on the number of patients on a service and the teaching opportunities.  Sometimes the team will write orders during rounds to maximize time. Alternatively, residents may choose to wait until rounds are over to do so. LUNCH: Typically, your team will eat lunch together after rounds. On Fridays, everyone is expected to attend noon Grand Rounds at MEB-lunch is provided. There is a cafeteria in UH basement, cash only, or purchase food in the MEB cafeteria. The free food you may hear about is reserved for residents and students on call only. AFTERNOON: After lunch, your residents may be writing/dictating discharge or transfer summaries, updating orders, or going to afternoon continuity clinic. Make yourself useful by offering to help. You are not required to go to continuity clinic with your residents, but if asked to do so, it would be prudent to oblige.CALL: Your team will be on-call every fourth night. You are expected to stay until 11PM and complete at least one full admit. Know the patients you admit and be prepared to present complete H&P, including ED work-up and any overnight changes. You are allowed to help yourself to free dinner found in the resident lounge refrigerator when on call.WEEKENDS: Weekend responsibilities vary with each team. In most cases, you’ll be expected to go in and write notes on your patients and round with the team one weekend day. Most teams give students one weekend day off.

NOTE: There is no convenient, safe place to leave your personal stuff-books, purses, instruments, etc. Make sure you are comfortable carrying stuff you bring with you all day long. Alternatively, since parking is available right across the street, everything stored in your car is easily accessible.

Touro Hospital in New OrleansAfter your orientation at school, you will be directed to attend another orientation at Touro Hospital that day or the following day. There you will meet your residents and staff and will find out where morning report, meetings, conferences are held. Typically, there are 2 third-year students who rotate on the wards at Touro, one on each of the two teams of 4 residents. One team is headed by a staff doctor and the other by a chief resident. Call is every 4th night until 9pm, but typically much earlier than that. Obviously, things will be different for each team so you will figure that out when you get there. A typical day at Touro consists of writing your notes, attending morning report, rounding with your staff and residents, going to see the patients, eating lunch, and then tying up loose ends in the early afternoon.

Student Notes: Speak with your residents when you first start about when you should have your notes completed. More likely than not, you will need to see your patients and have the notes written before morning report at 8am. Your notes should be in the traditional SOAP format, and you should probably give yourself about 45 minutes per patient initially until you get comfortable with the process. So just arrive in the morning as early as you need to have

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these things completed by morning report (and with time to spare to grab some breakfast before heading to morning report).

Morning Report: This starts at 8am sharp on the 4th floor across from the dialysis unit so don’t be late! Your residents will let you know exactly where this is located. One of the students or residents will present an interesting patient, typically one who was admitted overnight, and discussion will be fascilitated by one of the staff doctors. At Touro they like to go over the ECGs and any imaging studies that were done so be sure to discuss these with your residents beforehand, especially if you are responsible for presenting. Depending on the complexity of the cases, either one or two patients will be presented. Most of the time, morning report will be over by 9am.

Rounding with your team: Just after morning report, you will meet with your staff and residents and discuss any pertinent/new issues with your current patients and present any new patients who were not discussed during morning report. Depending on your staff, they may like to look at daily labs and imaging studies at this time so make sure you are aware of these things ahead of time.

Seeing the patients: The entire team will then go see all the patients with the staff. By this time, you should have examined your patients so make sure there are no surprises. Be sure to stay interested and eager when seeing patients other than your own because the staff will normally point out some interesting physical exam findings. Also, be prepared to grab patients’ charts, check pending labs, take the dressing off wounds, etc. For patients who are going to be discharged, make sure that discharge orders are ready and med reconciliation forms are printed out. The more efficient you are, the sooner you will be done. Also, some teams like the elevators and some like the stairs, so be ready.

Lunch: A great thing about Touro is there is always free lunch and you will always eat! If there is no conference that day, lunch will be in the doctor’s lounge. If there is Cardiology conference or Grand Rounds, then lunch will be served at those meetings. You will be with your team regardless so just follow them.

Tying up the loose ends: Unless you have a lot of patients on your team, you will be done rounding before lunch so there is not much left to do. You need to make sure that certain orders were written and appropriate tests are done. Also, there may be a procedure like a lumbar puncture that needs to be performed in the afternoon. If you are not on call, your day typically ends around 1-2pm.

Call nights: Two residents from each team are on call each night. On your first day, you will be assigned to two residents and will therefore take call whenever they take call. On these days, they will let you know when there are patients to be seen in the ER. You will then see the patient first by yourself and write up the admit H&P. You will then discuss the patient with the residents and see the patient with them. If the patient is to be admitted, the residents will help you write admit orders until you get comfortable doing so yourself. When on call, you will stay no later than about 9pm but usually leave much earlier than that. And yes, you have to work the weekends whenever your team is on call.

Final Tips:-do not be late for morning report.-the doctor’s lounge is open 24/7 and loaded with goodies: cereal and bagels in the morning, food for lunch, coffee, drinks, and ice cream all the time, computers/printers, TV, and massage chairs. There is also a residents’ lounge so there may be a push for residents/students to use this more than the doctor’s lounge. You will find this out when you get there.-parking: you can always park on the street/in the neighborhood but you are doing so at your own risk. If your residents are nice, they will give you their code that you write on the back of the parking ticket so you can park in the garage for free. If not, you have to pay to park in the garage. Just be sure to park on or above the 4th floor (I think that’s right).-attire: on call nights, you can wear scrubs. Otherwise, dress professionally.-you are part of a team: be sure to stay connected with your team (exchange phone numbers, etc), especially in the morning, to ensure that all patients are seen before morning report and to assist them in whatever else needs to be done during the day, like discharge orders and doctors’ orders. It is also recommended that you speak with your residents throughout your 4 weeks so there are no surprises on your evaluation.-be sure to read up on your patients and know everything you possibly can about their diseases, pathologies, treatment, management, etc.-stay eager and interested: Don’t be afraid to ask questions and jump on any opportunity to perform bedside procedures.

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Oschner Kenner Regional Hospital in KennerStudents can be placed at Oschner-Kenner for wards, consults, and clinics during their medicine rotation. The wards service is divided into two teams and a student is placed on each team. Each team takes call every other night but the teams are divided in half and rotates taking call, so you will take call every fourth night. You will see your patients in the morning and write notes/check labs/check imaging studies before 9 am morning report. The number of patients you see will depend on the size of your service and how many residents/interns are on your team. The computer system for labs is different than at UH so students do not have a username or password. Just ask your residents to show you how to use the program and ask them if you can borrow their username and password.

Morning report will consist of the previous night’s call team presenting a case they admitted. Morning report is more laid back here then at UH but staff may still ask the students questions. It usually runs from about 9:20-10 because teams meet with the hospital social workers at 9 (You still need to be there at 9). Morning report is located right across from the cafeteria on the first floor in the Bayou Room. Everybody eats breakfast during morning report, so feel free to go get some food from the cafeteria. After morning report, you will round with staff. Make a copy of your note from the morning so you are prepared to present your patient in case the chart is not readily available to you. Make sure to be attentive during rounds so you will know what labs/procedures to follow up on later. Pay attention to all patients on rounds, even if you are not seeing them. It will make you look good if you know what is going on with everyone. Staff doesn’t know who you are assigned to see in the morning, so they may ask you a question on any patient. Following rounds, you will assist the residents in any orders, discharges, or other floor business that needs to be taken care of. You are required to go to Grand Rounds on Fridays. They are typically at noon. You will be required to attend the student lectures.

The consult services at Kenner consist of ID and GI. The GI Consult Service is staffed by Dr. Danny Raines. He normally has one or two fellows working with him and a resident. You should see your patients in the morning before 9 am morning report. Also, you may see any consults that came in the afternoon before with the resident or on your own. Following morning report, you will go to the endoscopy lab on the second floor (Take the elevators that are to your left on your way to the cafeteria. On the second floor, take a right, go through a set of double doors, and take an immediate right. You will know you are in endoscopy if you see some GI charts/posters on the wall). The procedures usually last until 11 or 12 and you just watch. (You may get consults during this time as well) You will then have a chance to go get lunch and then round on the patients and see any of the new consults. He is really laid back and rounds fairly quickly. Remember to update the patient list based on what occurred during morning report. On Mon, Wed, and Thurs afternoons, you will have clinic in the medical administration building next to the hospital. Be pro-active and see the patients before they ask you. You will see patients there for a referral for lower GI bleeding needing a colonoscopy, hepatitis treatment, inflammatory bowel disease, etc. Write your SOAP note in the folder and then present your patient. Tuesdays are his light days so if you are lucky, you may get out early. Fridays are GI lectures at LSUHSC. Lastly, Dr. Raines requires the students to choose an article to present during the rotation.

ID Consult Service at Kenner is different than the GI service. First, there is no clinic you are required to attend. Secondly, different staff rotate through the service, so you may have one staff for a week, then another one the next week. Rounding times will depend on when the staff can be at Kenner. It was usually around 2 or 3 in the afternoon though. The only advantage to this is that you do not have to write your notes on your patients until after morning report. This will all depend on your resident or fellow though. Some of the doctors require you to take turns with the residents presenting a different journal article every day on topics such as STDs, antibiotics, endocarditis, sepsis, etc. You will also be responsible for seeing any consults that come in through the day. Depending on your fellow/resident, this may be with them or by yourself.

A few clinics are at Kenner and you may be required to attend once or twice during your 4 weeks of clinic duty.

UMC in LafayetteOf all the sites where you can do your inpatient month of medicine, UMC is probably the most laid back. The patient loads are lighter (less than 10 on most days), and there are opportunities to perform procedures such as thoracocentesis and paracentesis. How much you see and do depends on you and your team. The staff docs there are generally benign but you should be prepared for minimal pimping. The nurses are extremely helpful and willing to help you navigate UMC. The labs are usually printed out and placed in your patient’s chart, or you can use CLIQ.

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MORNING: A typical day begins with morning report at 7:00 am. The team on-call selects a case that they worked up the evening before and the 3rd year student typically presents it. Morning report lasts about one hour. Occasionally, the 3rd year student is asked to prepare a brief presentation on the disease process presented in morning report. The morning report is heavily geared towards students-you will be expected to contribute to the discussion significantly.

ROUNDS: Inpatient rounds usually start between 9-10 am. You are responsible for seeing patients, checking labs and x-rays and writing progress notes. Depending on the patient load, you can decide whether or not to write notes before or after morning report. The residents will follow behind you and sign off on your note, and then you’ll round with staff. Occasionally, you may have to see your patient(s) BEFORE morning report if your staff or resident had clinic immediately after morning report. Make sure to check with your team the day before for the plan.

LUNCH: There is usually a noon conference each day. The attendance is mandatory-there is a sign-in sheet. Most often, there is a free lunch for all attending. There is also a cafeteria for the hospital staff, but the selection is poor. There should be plenty of time to grab lunch outside of the hospital before noon conference-there are plenty of restaurants in the vicinity.

AFTERNOON: After rounds, you help the residents with whatever business there is to tidy up.

CALL: Call is every fourth night, and this is your opportunity to workup patients. You’re going to have planty of free time when you’re on call, so you can either study in the hospital library or chill in the call room, which has a big screen television and satellite. The residents will usually let you go home before midnight after the “case is on the board” for morning report. Your weekends are free unless you’re on call.

CLINICS: will include General Medicine Clinic, Endocrine, Cardiology, Heme/Onc, Pulmonary, GI, ID, etc. You will receive a schedule from Ms. Tonia (the medicine secretary in Lafayette) of which clinics are held on which days. Try to see a variety of things over the 4 weeks, and make sure to get your card initialed by staff each time.

CONSULTS: You will do 2 rotations lasting 2 weeks each in one of the following areas: cardiology, nephrology, infectious disease, and GI. You will usually work with staff and a resident or fellow. The staff doctors on these rotations are very willing to teach, especially cardiology, renal and infectious disease. You will be contacted regarding your preference ahead of time. Most students will get what they requested. There is no call and you are off on weekends. The living accommodations in Lafayette are at an apartment complex located across the street from UMC. They are clean and in a safe area. Most rooms are one-bedroom apartments with one bathroom, a living room and kitchen with a fridge and stove. There are also two bedroom/two bath apartments available if you’d rather share with a friend. All apartments are furnished with a bed, nightstand and dresser, a small dining table and a sofa. Be sure to bring along a TV, microwave, bed linens and towels, a shower curtain, bed covers and flip-flops for the bathroom. There is also a small workout facility on the property. There are plenty of coffee shops, bookstores, restaurants, a large shopping mall and places downtown and throughout the city to go out at night. There’s an enormous workout facility in Lafayette called Red’s, which has indoor and outdoor tennis courts, racquetball and basketball courts, indoor and outdoor pools, aerobics, coed and women’s-only weight rooms, and areas where you can sit and read or watch TV.

Overall, UMC is a nice break from the hectic schedule of 3rd year. The residents, faculty, and support staff (even the nurses) are all super-nice! You will have a pleasant experience, though the “medicine” itself may not be as strong as at other sites.

UMC Lafayette Renal ConsultsStudents on all consult services will follow the same daily schedule outlined in the section for Wards students. On renal service, you will be expected to see patients and write notes on them although there is no requirement to present patients to residents or attendings. However, the students are expected to be very familiar with their patients’ disease and to understand the underlying pathophysiology. Students are often pimped, but the atmosphere is light and conducive to learning. You will be asked to present a renal topic of your choosing to other students and residents. Note that renal staff is also in charge of running morning report every day. The morning

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report at UMC is extremely student oriented, so be prepared to think on your feet. There is no evening or weekend call.

UMC Lafayette Cardiology ConsultsIn addition to the daily schedule requirements, students are required to see new consults and complete H&Ps and to present them to staff. Students are expected to participate in cath lab procedures which are done on M, W, F, and to get involved in echo readings on Thursdays. There is a series of excellent highly interactive cardiology lectures given in the course of two weeks. Students are expected to take an EKG quiz at the end of their rotation. There is also a journal club where a fellow or resident presents an article and the discussion is encouraged. Students are expected to be familiar with the article and a quiz is given to evaluate everyone’s understanding of the material. None of the quizzes count towards the grade-all of this is done in the spirit of learning.

Earl K Long in Baton RougeMedicine at Earl K Long is great learning opportunity. Morning report begins at 7:30 in the new auditorium located directly behind the hospital (if using the exit near the cafeteria and head straight back under the walkway). Students from all three groups (clinics, consults, and wards) are expected to attend every morning. A member of the post-call wards team (usually the L3) presents an interesting patient that was encountered during the call night. Dr. Karam, Dr. DeJesus or one of the many other staff members head the discussion. As the presenter you are pretty safe from questions. However, there is a high expectation of audience participation. Please feel free to offer any knowledge you have because it is a warm environment to share your thoughts. Presenters need to be sure they know the case well. You can have the H & P in front of you but its good not to just look down at the table reading every word (keep it for specific lab values). Instead tell it like a story. When presenting, use medical terminology (ex. Pt had epistaxis and not “patients nose was running”) and remember to only use pertinent positives (you can leave the negatives out). Morning reports are great places to sharpen your clinical skills. And don’t be afraid to answer questions or give comments if you’re in the audience.

Call is every fourth night for those on wards. The residents will usually let you go home after a case has been chosen for morning report or after you admit a patient or two, depending on the resident. Wards are one of your best learning experiences, so be sure to get involved. Ask your resident if you can work up the entire patient (H&P, Orders, labs, etc) before reviewing it with them. Staying on call later tends to allow more opportunities for procedures, if you’re interested.

If you’re on wards you should typically have talked to your patient and grabbed labs BEFORE morning report. However, most residents allow you to write your note afterwards. By the time you write notes, round, and start whatever plans were in motion from rounds, it is lunch time. There are typically noon conferences with (good) food provided (Mondays, Wednesdays, and Fridays). Some of these are helpful but typically might go over your head. Staff and residents are pretty knowledgeable and will ask you questions. Most won’t try to grill you, but that is person specific. If lunch is not provided, the cafeteria is free for students, just be sure to sign in with the clerk. There is also a salad bar, but you must pay for it. If all of that does not satisfy your tastebuds, there are numerous fast food places down Airline Hwy. .

Since the Hurricane, mandatory core lectures have been spread throughout the week in the afternoons. As of the last block the lectures were split into Tuesday and Friday afternoons. There is a sign up sheet for all the lectures, so don’t skip these, as the course coordinator has been known to track a few students down who didn’t sign in.

Medicine is a wonderful experience at Earl K Long. Anyone interested in doing medicine should definitely consider doing it in Baton Rouge. Staff and residents really know what they are talking about and are enthusiastic and make it top priority to make students feels welcome and to teach them. Many students are convinced into doing internal medicine after working at such a strong medicine site. And if not, you will have a strong base for any other specialty you choose.

What to WearDress clothes, except on call, when you can wear scrubs.

Notes : Notes are the most detailed on Medicine, but they still follow the same SOAP format, you will probably just be writing more:

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S: Find out how your patient did overnight (any complaints, ambulation, episodes of nausea, vomiting, fever, chills, bowel habits, food toleration, pains, etc). You will learn to tailor your questions based upon your patient’s condition and reason for hospitalization. Often you will have to focus the patient; they can tend to go on and on.

O: Record vitals and present them as ranges. It is not uncommon for vitals to be incomplete in the morning when you get there – ask a nurse or do them yourself if you have to – it will often save time and energy. Ins and outs should also be here if they have been recorded.

The physical exam is next- don’t go crazy, but make sure you are thorough. The basics include Gen, HEENT, CV, Chest, Abd, Ext, +/– GU, and a brief Neuro exam.

Labs will follow - write that days labs in the note. If they are pending - write pending, but make sure to go back later in the day and add a lab addendum.

A and P: For the assessment and plan, ask your residents what they expect of you. In the beginning, you will probably be a little unsure, but you will get the hang of what is expected. Medicine A/P tend to be much more descriptive and detailed than some of the other clerkships, so don’t cut corners on these notes!

On rounds you will present your patients just like a SOAP note. Include the subjective comments, vitals, physical exam findings, labs, assessment and plan. Try not to use notes (except for the vitals and labs). You CAN do this –think about how much information you stuffed into your head for Step One – this is not that much. You will be much happier if you start early and get better. Plus, you will appear interested – which is always a good thing!

See next page for sample SOAP note!

Example Progress Note (Medicine Wards)

6/16/06 L3 Progress Note – Medicine Firm 2A HD #2, ABX #2 (PCN)7:00

S: Patient is a 65 yo AAM admitted to EKL for CHF exacerbation. Patient complains of sweating, palpitations, and insomnia. No chest pain, + SOB, + cough with green sputum production, no N/V. Patient continues to be febrile overnight. Tolerating PO well, ambulating daily without assistance.

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O: Vitals: T 98.3-101.7(Tmax @ 2200) HR 84-102 RR 12-18 BP 120-135/68-82 O2 sat 98-99% I: 2200ml 31.2 ml/kg O: voids x4; stool x1

PE: Gen – obese male, A&Ox4, NADHEENT – PERRL, OP clear, no LAD, no JVDCV – RRR with II/VI SEMChest – bilateral crackles at bases, improved since yesterdayAbd – soft, NT/ND, +BS, no HSMExt – no cyanosis, no clubbing, 2+ pedal edema bilaterallyNeuro – CN II-XII intact

LABS:133 101 9 Ca – 8.9 14.1

106 Mg – 2.0 18.7 2503.5 24 0.7 Ph – 3.2 39.1

N62 L30 M5 E2 B1

Blood cultures x2 –

Sputum Cultures –

A/P: 65 yo AAM with CHF and possible pneumonia.1. continue to monitor temp and follow WBC count2. check for culture and sensitivity results3. repeat CXR in AM4. CBC in AM5. discuss further management with team

What to StudyThere are tons of textbooks which cover Medicine. The books that you use are going to largely be determined by you – it isn’t whether or not you have the right book, it is whether or not you are reading it. One of the best pieces of advice is to read about the conditions your patients have – know them better than anyone else on the team. You will pick up tons of information that way and be less likely to forget what you see. Plus, you will be prepared for the fun of pimping. One of the best sources that you should already have is Cecil’s Essentials of Medicine. This is a great reference book – I’ve actually heard of a few people reading the entire thing, but that may be overkill for most of you.

Some students recommend Karam’s Review. Dr. Karam in Baton Rouge compiled everything you need to know from multiple sources in addition to his own huge, gigantic wealth of knowledge. Use it and use it often- when you think you have used it enough, read it again. There is also a high yield version of this floating around called Lee’s Review. It is very high yield for the night before the test. First Aid for Medicine and Step Up Medicine have recently been released, and some students are using them. They cover most of the same topics as Karam’s Review, but are in the familiar chart and study guide format. The Medicine department recommends MKSAP Essentials of Medicine, which is a new text that supplements the MKSAP question book that most students complete for this clerkship. Case Files: Internal Medicine is one of the Case Files book series that is newer and that many students are using throughout all of their rotations. Most people find it is an easy read, and it presents 60 most commonly encountered cases with explanations and questions.

Many people also carry around pocket sized books. These are pretty interchangeable – just find one that you like and stick to it. Cecil’s has one, so does Harrison’s. There is the Washington Manual that you will get from Ms. Lindy, and there are also composite books such as Boards and Wards that can be used for several rotations. In addition, there are several palm resources such as Merck that are freely available for students with PDAs.

P

P

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For the shelf exam, read and do as many questions as you can. There are the general step two question books and the topic specific books. The most popular question books for medicine are MKSAP, PreTest, and NMS. The favorite question book of my class was MKSAP. These questions are much more difficult and complex but will prepare you for the exam. The explanations are very detailed and thorough (much more so than PreTest) and make it a long read, but the explanations help highlight things you might not realize are important.

Other resources for the medicine rotation can be found online – Up-to-Date, MDConsult, Pub-Med. These will come in handy for presentations and for patient specific reading. If you do not have access to one or both of these, your residents often do and they can help you out. Use these resources – you will begin to love them.

The test is difficult, but manageable. For many people the most difficult part is the time limit, you have two hours and ten minutes to answer one hundred questions, often containing very long vignettes. The name of the game is pacing yourself; several students were surprised that they didn’t finish the test.

Miscellaneous Pearls: Third year is often team dependent, but it is also directly related to how you start off your rotations. Stay

open minded and be ready to work. DON’T ask when you can go home, but if someone tells you to go home – do so. There will be plenty of

time to work and learn, so take advantage of still being a student. Be prepared to go in on the weekends – you will often be expected to do so. Even though you are tired and need to study, remember the residents are tired too – they stay on call when you go home and often let you go home hours before their day ends. Be helpful and mean it. Your medicine rotation will be busy and somewhat overwhelming with the quantity of information, but with reading and questions and learning everyday – you can do it.

A note from the course coordinator: The main thing to let the new L3s know is that in their third year, they are required to attend all conferences and duties outlined in their rotation schedule. First and second years have the note-taking service, and aren't required to attend all of their conferences; third years are. Morning Reports are mandatory no matter which service you are on.

Clerkship Coordinator Contact Information:The current Course Coordinator is Melanie Brown.

The Course Directors are Dr. Reed (EKL), Dr. Lamarche (UMC), and Dr. Zee Ali (UH), Dr. Lopez (UH), Dr. Jain (UH).

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SurgeryThe Surgery block is 3 months long: 6 weeks of either trauma or general surgery and two 3-week subspecialty electives. As a disclaimer, here is the information I have for the various options for subspecialties. However, you will see that some of these options change throughout the year. Dr. Bazan, who was the clerkship director, was always very receptive to student comments after each rotation, and as a result, details changed throughout the year in order to give everyone a better experience. I am sure that the new clerkship director will be the same way.

General/TraumaGeneral Surgery is offered at EKL in Baton Rouge, UMC in Lafayette, and Ochsner in Kenner. Trauma Surgery is combined with General Surgery at UH in NOLA.

SubspecialtiesThe possibilities include:

ENT at EKL, OLOL, UMC, and Children’s Hospital Orthopedic Surgery at UH, EKL, UMC, Children’s and Kenner RegionalVascular Surgery at West Jeff or OLOLCardiothoracic Surgery at UHPediatric Surgery at Children’s HospitalPlastic Surgery at UHUrology at UH, Ochsner and EJGHNeurosurgery at West Jeff

A Typical Day on a Surgery WardYour days will vary on each service. It is never predictable what time you will be done or what time you will start. Usually you will arrive at the hospital at around 5:00 am. The first thing you do is to see your patients and write SOAP notes. Give yourself at least 45 minutes per patient in the beginning. You usually will have about 3 patients that you are responsible for keeping track of. As the weeks go on, you will become more efficient and quicker about finding what is important and what needs to be done. Don’t hesitate to ask your residents questions when you need help. They are usually very friendly and they are there to help you learn. Acting Interns (AI’s) are another good source of information. Biggest words of advice told to me by my staff: “You don’t know what you don’t know”…ask your resident or AI if you have questions rather than assuming the wrong things. Make sure you talk to the residents about your patients every morning BEFORE you round with staff because they often know things about your patient that you WILL NOT know because they live at the hospital. This will make a good impression in front of the staff when you know EVERYTHING about your patient.

Time at which rounds begin is entirely service and hospital dependent. Rounds are much quicker than most other services and take an hour or so. After rounds, your team will disperse and complete unfinished business – check pending labs, write new orders, complete discharge summaries, etc. On most days, students will be able to scrub into surgery, but keep track of time and be sure to attend lectures on the scheduled days. After conference, you meet back up with your team and check in to see if any more unfinished business needs to be done. This will be additional time to scrub into surgeries.

The residents are always working much longer hours than you are so the last thing they want to hear is whining. Be a team player, don’t be lazy, keep on top of what’s going on with your patients, be on time, be nice to the nurses, etc., and you will have no problem.

Call varies at the institutions. There is “home” call at EKL and UMC. You basically sign up for call and leave at the end of the day. You are usually expected to meet your resident at in the ED for consults (but this is usually at the discretion of the resident and you won’t likely be called in for minor complaints) and you will be expected to scrub in for emergency surgeries. At UH in NOLA, 1-2 students are expected to take call when an LSU team is on call. Depending on your residents and the other students, you will work out your own call schedule – for example, they may only want 2 students to stay each call night due to lack of beds. Some nights will be slow, some nights you won’t sleep at all. You are expected to do H&Ps, scrub in for surgery, and participate in all trauma activations.

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Site Specific Info:

UH – New OrleansUH General Surgery – Students are assigned to the black and red general surgery teams (white is Tulane). The teams usually have 3-4 third year medical students, possibly a fourth year student doing his/her AI, an intern, and an upper level resident. At the beginning of the rotation, you will make up a call schedule with your fellow 3 rd year students on your team. Each student will probably have to work a weekend each. Call nights will vary. Some nights will have lots of traumas and keep you up all night, others will just be busy with emergent surgeries from the ER such as gallbladder removals, and if you are lucky, some nights will be slow and you may get a few hours of sleep. Usually, it’s the student’s responsibility to pick up dinner for the team since it is not critical that we stay at the hospital at all times (you don’t have to pay for everyone!)

During the rotation, you will be assigned patients to see in the morning before the 7am morning report and write SOAP notes, check labs, change dressings, etc. Depending on the size of your service and how many patients you are following will determine what time you have to get there in the morning. Typically it will be ~5-5:30am. You are to get your team list off of the computer in the TICU office. Please try and remember to update the list. Pay attention during rounds so that you can update the list on all patients, not just the ones you are seeing. After the morning report (last year students were not invited to MR so just go with the flow), you will round on your patients. Get the charts for the residents and if you can, check on labs that were pending from the morning (labs are usually not ready at 6 am). Some days you will have to go straight to surgery or your staff doctor may be rounding with the TICU team, so you will not round until later in the afternoon.

After rounding, you will have to write orders, discharge summaries, and have other floor duties to do with your team. Try to anticipate these things and have them prepared ahead of time. You will look really good! Each day will vary depending on how many surgeries you have scheduled for the day. My recommendation is at the end of the day, talk with your intern or go ask the surgery desk clerk what surgeries are scheduled for the next day so you can read up on them and so you will know where to be at all times! There are instances when your residents will just disappear and go to a surgery that you didn’t know about. Usually one student will scrub in per surgery while the others observe and you just rotate. Call nights are your best opportunity to get hands-on experience with surgeries because you are the only student.

Monday mornings are surgery clinic days for every team. These days are typically horrible and really long. In the past, there were only a few rooms so it went very slowly. If you are not busy, you may have to ask if you can get lunch because the residents seem to forget what time it is or better yet bring your lunch on Mondays. Tuesday mornings at 7am are student lectures. Make sure to see your patients beforehand and then go find your team afterwards. Thursday mornings are resident lectures/conferences and grand rounds for everyone. This begins at 6:30 a.m. at 1542 Tulane Ave. so you usually have to get to UH to see your patients earlier. Usually, surgeries were not scheduled on this day, but it will depend on your resident and staff. The team usually gets to leave around 12-1 on post call days (even if you were not the student on call). However, on clinic Mondays, only the student who was on call with the resident Sunday night will get to leave because there will be other residents there to supervise the remaining students from that team. Fridays, students are responsible for attending Cohn’s conferences at 3 pm. Each Friday, a few students are assigned to present various surgeries they have encountered. Be prepared to get pimped from the faculty member running that conference, especially if you have Dr. Cohn. The time at which you are finished will vary daily. So many factors come into play-surgeries, size of service, time you round with staff, how long your staff rounds, etc. You may spend a lot of time waiting around for surgery because the OR is pretty inefficient at UH so bring a book to study, materials to practice knot tying, etc.

UH Cardiothoracic Surgery – On the CT surgery rotation, you will likely work with one other student and one 3rd year surgery resident. The surgeons at UH rotate weeks, so you will be with Dr. Heck (staff) one week then the private docs the next. For Dr. Heck, observe during surgery and act interested…but don’t ask questions in the OR. DO ask questions outside of the OR when you are seeing consults together or when he is explaining a cardiac cath or an echo to you. On this rotation, you will likely get some stitching experience…as some of us were asked to sew the graft removal site (ankle to hip). Ask your resident for help if you don’t feel comfortable, but definitely use the opportunity! With the private docs, things are very laid back. They do typically ask you for a brief presentation at the end of their week when you meet them at Friday clinic, but everyone gets a good grade from them.

Hours on this rotation are not bad but will vary depending on your resident. We got there between 5:00 and 6:00, depending on how many patients we had. Initially, on post-op day 1 the patient will be in the ICU and will require a longer ICU note. Dr. Heck likes to know all the pulmonary artery catheter values so be sure to record them!! Also

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record the patient’s weight and weight change from the previous day. After rounding with staff, you go to surgery. One student will scrub in and the other will see any new consults…this alternates. Surgery typically lasts anywhere from 2-5 hours, so please eat breakfast. The day for us ended between 2:00-3:00 each day, depending on how many consults had to be seen. You will not have to work weekends.

Overall, this is a good opportunity to see coronary artery bypass grafts, valve repairs, and occasional pulmonary procedures. Act interested, ask questions, read about your patients, and you’ll do fine.

UH Ortho – Orthopedics spots are generally filled by students who are interested in going into Ortho and the rotation is different for those who are not. There are 2 Ortho teams at UH – 1 from LSU and 1 from Tulane. Call alternates nightly between the 2 teams and both teams meet each morning to go over films from the inpatients, recent cases, upcoming cases, and trauma cases from overnight. Students are not required to take call on subspecialty rotations but it is beneficial to do so whenever possible. Ortho call is valuable for everyone but especially those considering Orthopedics (call is a must). If you are considering family medicine, PMNR, Sports, Neuro or ER it is also a good idea to take call.

The LSU team is composed of an intern, 3 or 4 HOII/III/IVs, and one chief for a total of five or six residents. The number of students varies but it should be no more than 2 this year. A typical day starts around 5-5:30 am with you helping the intern see patients, change dressings, and ambulate patients. It is best to bring a bag with you and fill it with all of the dressing materials (ace wraps, 4x4’s individual and packs, abd pads, tape, cast padding, fluffs, kerlex). You may or may not write daily notes depending on the intern on service. They may prefer to have you help out doing other things while they write notes. The residents for both teams meet at 6:30 in a room with x-ray capabilities on the 4th floor to discuss patients then it is off to the OR or clinic depending on the day. Clinic is twice a week but the residents operate almost daily on add-on and trauma cases. You will typically scrub on cases of your choice unless you are needed in a specific room to retract or hold extremities in position. You should try to write orders for the cases but only do so once you have looked at the type of things that ortho orders contain. You will quickly notice ortho notes and orders are short and concise. Try to write the best orders that you can based on other orders that you have seen and leave the section blank if you don’t know what to put. Rounding usually occurs after all cases are finished and you are usually done after rounds. A typical day lasts until 4pm but could be anywhere from lunch to the following day depending on the call night. Another advantage of taking call is that you will be second assist on any case going on that night which affords you a great opportunity to get your hands in there. Scrubs are required everyday except for Clinic days which are once weekly. On clinic days dress clothes are required, men collared shirt and tie, women dress pants- no dresses or skirts because you often have to get on the floor to assess injuries and perform exams. Conference is Friday around lunch and students are required to attend.

If the residents are putting on the knee high boots, you should do the same. Actually wear knee high boots no matter what the case is, it is better to be safe than soaked. Always double glove. Always pull your residents gloves for them. Always be there to help prep and position the patient before surgery. Overall, this is a good group of residents and they will let you get your hands dirty if you ask.

UH Plastic Surgery – As with all rotations, hours vary depending on residents and volume, but this one can be pretty good for your study schedule. The bread and butter of this service is facial reconstruction on the trauma pts (GSW to the face, etc.). You will have one plastics fellow and one general surgery intern. Some of the surgeries do last a long time but you generally do not have to do that much paperwork. You may write SOAP notes in the morning but are generally not responsible for orders or discharge papers (be sure to check with your intern or fellow about this first!). During the surgeries you’re allowed to do as much as you want so speak up! Otherwise they will let you just stand there. This rotation is very much whatever you make of it.

Dr. St. Hilaire and Dr. Wise are the attendings and both are very nice and willing to explain things. Operating days are Tuesday (Dr. St. Hilaire) and Thursday (Dr. Wise). Clinic is on Friday beginning at 8:30 at Lord & Taylor. The fellow generally has lots of other stuff going on at other hospitals that you are welcome to tag along on when the team is done at UH.

UH Neurosurgery- The staff at UH is the same as that at WJ.  There is a smaller case load at UH, but more trauma cases.  Your schedule, again, will depend on your resident.  Some residents won't expect third years to write notes.  Generally, days start at 7am with rounds, then OR cases if scheduled, with some teaching by the residents if you have time.  There is not as much staff interaction time here versus WJ, but hours are much better.  You may be told you can head over to WJ on slow days to see the surgeries there.

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The main surgeries you will see are pituitary tumors and cranial/spinal fractures.  You will get to suture the scalp, dress the wound, and remove JP drains (again, with a resident present). 

West Jefferson Hospital WJ Plastics-Bottom line: Plastics at WJ is less work than Plastics at UH. The staff you follow is Dr. Dupin and there is one fellow around (most of the time). I was never required to write SOAP notes on patients in the AM, so there is no waking up before sunrise. Clinic days are Monday and Wednesday, starting at 9AM and usually finishing up around 4pm. At lunch (2hrs) on those days, the student will usually tag along with the staff as he rounds on his few hospital patients. Surgeries are done on Tuesdays and Thursdays and sometimes Fridays. They usually start at 7:30am and are either at the Same Day Surgery center at WJ or at Meadowcrest Hospital (Ochsner West Bank). You show up to the OR after student lectures and the day can last until about 3pm on average. Friday mornings are Plastics Conference/lectures on campus (allied health bldg) and are from 7-9AM. After that, there will usually be a one or two minor surgeries to scrub into, and Fridays are usually done by about lunchtime.

During surgeries, Dr. Dupin lets the students sew quite a bit. The fellow isn’t always around, so most likely you will be first assist. He doesn’t pimp on too many things during surgery, oddly more during clinic, and they’re never really hard questions. There is no call for students on this rotation, and rarely any emergency or trauma during normal hours (since these cases are almost always done at UH). Overall, I enjoyed this rotation, because the light workload allowed plenty of study time, and I was able to see a lot of really cool surgeries (lots of breast cancer reconstructions and breast reductions). The staff and fellows are all really nice, and working at a private hospital is generally very cush.

WJ Vascular Surgery- The staff at WJ consists of the Dr. Batson, Dr. Palit and the Sheahans (husband and wife team). On the first day of the rotation you will have a 2 hour orientation. You can park in the garages generally above the 5th floor. Typically, the day starts at 7:00am to write notes on patients. Surgeries start around 7:30–8:00am. Clinics are on Tuesdays and Thursdays and only last a few hours. Scrubs may be worn except for Dr. Batson’s clinic- wear dress clothes. Usually, the medical student goes into the room first and obtains a history and performs a physical exam. Then, he/she presents the patient to the attending and both go in together to talk to the patient. The whole day usually lasts from 7:00am–3:00pm and varies by a couple of hours each day. There is no weekend work or call. Vascular conference is each Wednesday from 7-8 a.m. I think.

The main surgeries you will see are CEA (carotid endarterectomies), AAA (abdominal aortic aneurysm) repairs, and shunts in the leg for the treatment of claudication. Know these procedures before going into the surgeries. Also, know the stages of leg claudication, the risk factors of claudication, and what to do for each stage. For AAA, know the risk factors and when surgery should be performed. For CEA, know signs and symptoms (ex. mini-strokes), tests to perform, and when to treat. They LOVE to pimp on these topics. During the surgeries you will be allowed to do little things like suturing and cutting.

The staff likes to take students out to lunch at least once during the three weeks to get to know them better. During the week you usually eat in the doctor’s lounge which is free. Lunch is a great opportunity to ask questions and to get to know your attendings better. The staff may want you to give an informal presentation- Dr. Palit will say you can’t honor this rotation unless you present a case. The staff treats medical students respectfully.

WJ Neurosurgery- The staff at WJ consists of the Dr. Culicchia, Dr. Dawson, Dr. Richter, Dr. Steck, and Dr. Tender.  Your schedule is highly dependent on your residents, but you will meet with the team by 5:30am to go on morning rounds.  You may have to have your patient(s) seen or lab values ready for everyone by that time, but again it depends on your team.  After rounds you hopefully get to grab breakfast with the team in the cafeteria before OR time starts at 7am.  For third years, they want to get you in the OR, so you won't have to do much floor work during the day.  After the OR is finished for the day, you will round again on all the patients.  Getting off time was very variable--some days by 4pm, others as late as 10pm if emergencies came in. Scrubs may be worn.  Depending on your team, you may have weekend call.

The main surgeries you will see are spine cases (fusion, nerve release), pituitary tumor resections, brain biopsies, and intracranial vascular coiling/clipping.  You will be frequently asked what the 5 layers of the scalp are.  During surgery you will get the opportunity to suture the scalp, screw in hardware, and maybe even drill/saw through the cranium.  You will be taught how to remove JP drains on the floor, but a resident will need to be there when you do it. 

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Professor rounds at 10am on Fridays are your opportunity to interact with staff, as they generally will not pimp you in the OR.  Be prepared to present a patient and know the surgical recall answers to the questions about the subject you present. 

You will get to eat in the Doctor's lounge for lunch, and you can eat in the cafeteria for free if you are with a resident who will swipe his/her ID for you.

Children’s Hospital – New OrleansChildren’s Peds General Surgery – Compared to many of the general surgery rotations, this is relatively hands-off. You will not be allowed to do as much in the OR as at the adult hospitals, but you will see some really interesting procedures. The staff is very friendly – almost no pimping to speak of, but they’re happy to answer your questions. On a typical day, the first case is scheduled for 7:30. You’ll see your patients beforehand & then go to the 2nd floor Same-Day Stay area and do the Pre-Op H&P for any patients who are there. Clinics are on Tues. & Thurs. afternoons at 1pm in the ACC. Thursday mornings, you’ll see your pts. and then head across town for lectures, so dress-up! For lunch, same rules apply as on Peds – Get the $1.50 lunch by saying, “Yes, I’m a resident.”

Children’s Peds Ortho Surgery – This is a good rotation for someone who is not interested in orthopedics, but rather someone interested in pediatrics. The reason I say this is because someone wanting to do Ortho wants to see knee surgeries, hip replacements, etc. You will not see this here. At children’s it’s a lot of broken bones and scoliosis. There are several faculty members and a few PA’s, so there’s always a clinic going on. Morning report is on the 4th floor, up the yellow elevators, near the HemeOnc office at 6:30AM. It will depend on your residents, but I was actually not required to see patients. I just had to show up for morning report then it was off to clinic or surgery.

If you have to see patients, it will most likely be just 1 or 2, and it’s basically can they wiggle their fingers and toes and how is their pain. The PA’s are great at teaching how to read basic X-Rays, do a basic musculoskeletal exam, treat fractures and dislocations, and stuff like that. If you show an interest, the faculty will show you more sophisticated things on X-Rays (for example, Dr. King had me doing bone ages based on a patient’s hip film by my second day on the rotation). I learned a lot of things that I don’t think I would have gotten elsewhere that will be useful for me in a pediatric residency. The surgeries, however, are looooong, sometimes up to 6-8 hours for a complicated spinal surgery, so be sure to wear super comfortable shoes. And be prepared to retract. And retract. And retract.

Multiple SitesUrology - This is a highly recommended choice for subspeciality because you will learn a lot about various common urological problems which you will probably see no matter what field you wind up doing, whether it’s primary care, ER, surgery, etc. Urology probably has the cushiest schedule as well; you’ll never get more sleep on your surgery block than when on this service (no call, and usually no inpatients to see in am, except post-op pts at UH). Some downsides, however, would be that you’ll be doing a lot of driving, as you’ll be going between different hospitals in the area, and usually the private hospitals have more restrictions on what students can do, so unfortunately things are a little more hands-off in the OR. However, in clinic you’ll have numerous opportunities to master the prostate/GU exam! The faculty are superb; they are very friendly and approachable as well as enthusiastic teachers! The schedule is as follows:

Monday Tuesday Wednesday Thursday FridayAm Clinic @ Baptist or

EJClinic @ UH OR UH OR EJ OR UH

Pm Clinic @ EJ or Ochsner

Clinic @ UH OR UH OR EJ conferences

There’s also a boatload of conferences to attend as well as your Surgery small group meetings, Cohn’s Conference, etc. so you will put some miles on your car. Once a week Dr. Fuselier (course director) meets with the students to discuss an assigned topic and work through some cases, and once a week Dr. Winters (dept. chair) will do the same. The urology website www.nolaurology.com is an excellent resource containing lots of reading material for the students, humorous cases, as well as links to online textbooks, etc. Plus, at orientation you will be provided with some pocket guides which are good reading as well.

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EKL – Baton RougeEKL General Surgery Get ready to work. Staff physicians are present almost solely to supervise in the OR. In 6 wks, I rounded with staff twice. The unique aspect of training at EKL in Gen Surgery is that the residents run the show so be prepared to work closely with/for them. A noteworthy advantage of that setup is that if you work hard for your residents you’re certain to be rewarded with extraordinary OR opportunities for a 3rd yr medical student. The hierarchy for the clerkship included one team with two 5th, two 3rd , and two 1st year residents. Making a total of 6 residents. As with most educational opportunities you can expect to learn the most from those closest to you in training so you need to determine what your interns expect and/or need. Remember also that it’s not about being a sycophantic weasel; it’s about efficient utilization of available man-hours.

What’s an average day like? While this is largely intern-dependant you can expect to arrive ‘around’ 5AM +/-. Initially it will obviously take more time to become accustomed to seeing/writing notes on patients. Later in the rotation as you become more competent or if your patient census is lower, 5:30 might be OK. So you arrive, head to the OR lounge to print a current patient list (saved on the desktop) and start seeing patients. The good thing is that as far as progress/SOAP notes go surgery believe me less is more. However, until you have a good understanding of the salient features of each type of patient err on the side of MORE. Vitals, drains, I/O’s, meds, dressings, IVF’s…these are all objective data in addition to your physical exam with which you need to be familiar – or rather KNOW about your patients. AM labs won’t be in until 9 AM or later (well after you write your note) so be sure to go by later and write a lab addendum in the chart. Some residents prefer a ‘lab book’ be kept with all patients labs each day. If this is the case you’ll have to work together to record these labs in b/w OR or clinic…or simply whenever you can. Your intern is likely to want notes done by 6 AM or thereabouts. You’re likely to round w/ a 3rd year resident pre-7AM then run the list later with the 5th’s.

After early rounds you might have time to eat then you either go to clinic or the OR. Clinics are only a couple days a week and occur concurrently w/ OR cases. Anyone not in the OR should be in clinic seeing patients. Clinics are extremely busy and there’s nothing I can impart to prepare you…just remember it gets MUCH easier as the rotation progresses. Monday clinics are new surgery patients and take a while to see each patient but Wednesday clinics are half day post-op clinics and are very short visits where you take out stitches, staples, and assess for any complications since surgery. Thursday clinics are half day and are vascular patients- normally over our heads but the residents and staff help you through these patient’s complaints. The OR is full of opportunities to help/excel. Try to get together with your colleagues in the afternoons and acquire the next day surgery schedule. You can assign the cases and have a chance to read beforehand. Keep ‘Surgical Recall’ in your coat and be ready to cram about cases…or read the night before if possible. Be respectful of supportive staff and your peers…and try to set up a system that’s fair re: who scrubs on what cases. You’ll figure the OR out on your own. The basics are somebody needs to be scrubbed in on every case (including colonoscopies), always help move the patient before and after, cath those that require it when you can and shave patients that are having inguinal hernia repairs before the resident gets there… Also if you make friends with the anesthesiologists, and they don’t have students themselves, they may let you insert IV’s or intubate patients. My longest days lasted ‘til 9 PM or so but that was uncommon. The average was probably 5:30-6:30 or so.

Work hard, have fun, and try to appreciate the fact that you’re getting to do things many MD’s didn’t get to do. Ultimately, the value of Gen Surgery at EKL is that if you make the effort you’re functioning very much like an intern. When you leave this rotation you’ll be confident you can handle any intern year.

Pearls:Show up early (even 15 min makes a difference). On day one of the rotation find out if students can do the pre-op H&P’s for the surgicenter/same day surgery patients if the chief resident says yes then do what is said in the next several sentences if they say no disregard the next few sentences. It depends on your chief residents. If you finish your notes early in the AM go by the ‘surgicenter/same-day surgery’ on the 4th floor and make sure pre-op H+P’s have been done. If they haven’t been there do them…without asking. Your residents are working their tails off so if you can run down a film or old chart then do it. Also make sure all consents are printed, placed in the chart, and are signed by both the patient and resident. In the OR, write post-op orders and Rx’s (outpatients) for patients (if you don’t know how ask someone to show you)…either before you scrub, after, or even if you aren’t involved w/ that procedure. But always check to see if the particular resident who you are working with allows you to write orders or not, some do some don’t. If you’re comfortable learn how to write/dictate discharge summaries (again, someone

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will show you if you ask). Be a good colleague – if your fellow L3 is behind offer to check labs/vitals or write a note on a patient. You’ll be glad you did when you oversleep and the favor is returned.

EKL Ortho – The orthopedics rotation at EKL as of spring 2008 does not require you to participate in ANY outside hospital requirements such as student conference, lectures, or anything, anywhere. As a student at Earl K long you may or may not be expected to help write SOAP notes on patients, depending upon the residents, it is likely that you will. Do not expect to have regular formal rounds, but always be ready to present a patient if you saw a patient that morning because sometimes the residents like to have "upper level rounds", which is the lower level Ortho resident proving to the upper level that he/she is handling the floor correctly. Usually there will be two Emergency medicine interns working on the service with you. Typical duties here involve scrubbing in on cases beginning at 7:30 AM and helping to make sure that most pre-operative duties have been taken care of such as the H&P being updated within the last 30 days, antibiotics being given to patients preoperatively, consent forms have been signed, patient surgical sites have been marked (make sure this has been done, if not, you can not do it yourself, but inform your residents or interns of this). You will probably be expected to show up at 6:30 AM but this can vary a lot depending on what you are expected to do each morning. Scrubbing in on cases is no joke in orthopedics and extremely meticulous attention to sterile technique is observed (remember you are putting hardware into these patients and if this gets infected, it typically results in a very bad situation).

Residents pretty much run the service of orthopedics at EKL and I recall rarely seeing staff around, especially in the operating room. Eat lunch when you can. Remember, on most surgery rotations, there is no established time to eat lunch. Lunch at EKL is free for medical students. Often your residents will tell you to go grab lunch quickly. EKL orthopedics also has clinic duties which go on during operating time. The clinic is located within the main EKL hospital and is just down the hall from the main operating room. Usually one resident (the highest level resident) stays in clinic and the ER interns will be in clinic as well. The ER interns do what they are capable of by themselves, but often have to pop their heads into the operating room to ask the residents what needs to be done with patients. When cases are completed before clinic is complete, it is expected that you will go to clinic and help see the remaining patients for that day. I would not expect that students will ever be sent to clinic while there are still ongoing procedures taking place in the operating room. After clinic you should volunteer to write a post op note on the patients whose operations you scrubbed in on that day.

On particular days there will be no operations and you will be in clinic all day (This was Tuesday in spring 2008). In clinic, you will be asked to see patients quickly, examine them, and write a note in the clinic chart regarding the patient and tell the residents about it. You will see patients continuously until clinic is finished. Make sure you stay to the point because Ortho residents are rarely interested in non pertinent information. It is expected usually that you see patients prior to viewing images such as X-rays and CTs (for some reason the residents consider this cheating and would get annoyed when they saw you looking at images on patients you had not seen in person yet) Also maintaining the patient list should be a student's responsibility. Do not make the ER interns maintain the list as this makes them very unhappy. The computer in the OR lounge has the orthopedics and general surgery list saved on a floppy disc. Make sure you save the list to the floppy disc, if you do not, it will save to a random person's desktop and will not be on the desktop when someone else logs on to the computer, so save the list to the floppy drive!

There were no responsibilities on weekends for me, but that is not guaranteed as that depended upon the resident's preference at that time. Friday afternoons during spring 2008 required that the residents (not students) be in New Orleans for conference and therefore no cases were booked in the OR beyond 11 AM and there was no clinic on Fridays as well which usually led to you getting off early on Fridays. Typically on other days, you could expect to leave by 5:30 PM, but this completely depended upon how long clinic lasted, how many patients needed to have post operative notes written, and how long it takes the residents to tell you to leave. Tuesdays had no operations, only clinic. All of these things that happened on particular days (only clinic Tuesday, and leaving early Friday) could potentially change.

I recommend not blowing off the concept of paging your residents a day or two before and letting them know the day you will be starting. This is important for all rotations across the board and should be emphasized. Overall this is a very cush rotation due to likelihood of having weekends off, getting off early on Fridays, and not having staff around. Highly recommended for students interested in orthopedics as this is probably the best opportunity you will find third year to really participate in procedures. Also do not forget that overall, surgeons are very hard workers and expect no less from you. Always be willing to do anything asked of you, it keeps the residents happy. Once they see you are a hard worker, it is hard to mess things up!

Ochsner Kenner

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General Surgery: Even though this is a general surgery rotation, it may as well be named “Neuroendocrine tumor subspecialty.” In Kenner the group of doctors you will be working with are Dr. Boudreaux and Dr. Wang, who run a Neuroendocrine Tumor clinic that is known nation wide. The majority of the patients they see are patients with really rare neuroendocrine tumors such as carcinoids (mainly) but also things such as gastrinomas, glucagonomas…. you will think carcinoid tumors are very common because you will see so many, but you will also notice that you meet people from all over the US who have gone elsewhere and no other facilities would even attempt the surgeries that these 3 surgeons are performing on a daily basis. The typical carcinoid tumor debulking takes about 8-10 hours, so prepare to not eat, drink, or urinate for that length of time, but will be some of the best anatomy and most intense surgical procedures you will see. These guys are the last chance for most of these patients and therefore push the envelope with what can be removed safely. Typically you will see one case a day at this rate but since Dr. Boudreaux also was a transplant surgeon in his earlier years and he manages all of his previous transplant patients surgical concerns such as AV fistulas (yes it is a vascular procedure) and even takes transplant call on occasion which you are welcome to tag along for if he takes call while you are there. So you can see a broader range of cases than just carcinoids.

The typical day on this subspecialty starts at around 6 am depending on when cases have been scheduled for. It is a rotation with one 3rd-5th year resident and 2-3 students so there is a lot of one on one interaction with staff and the one resident who you will get to know well for 3 weeks. All patients are on one floor of the hospital and the clerk for the floor prints out lists in the morning for the team to pick up. Normally there are about 9-10 patients and you and the resident divide them up to see them all before surgeries or clinics begin in the morning. Normally there is time for breakfast and if it is a surgery day I highly recommend eating something in the morning. Clinics are once or twice a week where you either see new patients to be operated on or follow up post op patients. Clinics aren’t bad at all and usually only have about 10-12 patients. Days ended up depending on the surgery schedule. If there was a long carcinoid debulking it could be 5-6 pm but if there were shorter cases you may get out around 3-4pm. It all depends on those carcinoid tumor cases, and whether you have lectures in the afternoon in which they never made me come back afterward since the drive to Kenner from UH is considerable.

You are expected to take call at UH if you are assigned to Ochsner Kenner, figure out the call schedule schedule with those students. Call at UH starts at 7am and goes until 7am the following day (or whenever you were done rounding with your team). If you are in Kenner, you go to UH to start call whenever you are done with your responsibilities in Kenner. If you are on with another student, make sure you have their number beforehand so you can find out where to meet the team at UH.

Ortho Kenner- This is a fairly laid back rotation. You will be working with attendings: Dr. Dasa, Dr. Krause (1-2 days/wk), and possibly a new spine surgeon, and a 2nd, 3rd, and 5th year resident. You will never really see the 5th year resident- they are usually in clinic or don’t really know what they do all day (maybe research?), but they will still grade you based on the 2 and 3’s recommendations. Beware you may also be graded by one or more attendings even though your individual interaction with them is limited. Occasionally, other attendings and residents will come from UH for cases. Your days start around 7 a.m. helping the 2nd year see all the patients on the floor before OR/Clinic. You will rarely be asked to see patients on your own, but if would like to do ortho/want some autonomy, ask to be assigned patients to see. I do believe most resident would let you help them. In the OR, you will mostly be retracting… the cases can be long particularly with certain attendings. If you ask, they may let you do more, especially sewing up at the end of the case. Clinics happen for part of the day most Tues-Thurs. You will participate if there are no OR cases. Clinics usually have between 10-15 patients and they often let you get any H&P and check out to the attending, who will then go see the patient with you. Take initiative and ask the faculty questions! Ask before you do anything to the patients in clinic… one of the attendings made a nurse watch me take out a patient’s staples! Usually, this is the ortho resident’s least favorite rotation so help them fix the list (found in the OR lounge computer), bring them coffee, go get x-rays, whatever you can do to help out! No call or weekends unless you want to do ortho- ask for that! You can wear scrubs except for clinic days.

Our Lady of the Lake – Baton RougeOLOL ENT – This is an intense rotation, but an opportunity to work with some stellar faculty in a nice facility.  All of the faculty on this rotation like to teach, and are excellent at it.  You will not get to do much in the OR on this rotation (this is true of ENT rotations in general), partly because of the type of work being done, but also because you are in a private facility.  This is offset by the variety of cases you get to see, the pathology involved, and the technology utilized in the OR.

On the first day you have to meet with the OLOL GME office staff, who will give you a computer tutorial, as well as your log-on information and your ID badge.  The typical day starts at or before 5 AM.  You will generally see 1-2 patients each morning, and then go to pre-op with the residents.  The notes for this service can be somewhat

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detailed, but are made very easy by the OLOL computer system – you print your progress note each AM, with recent labs, vitals for the past 24 hrs, diet orders, the patients meds, everything you could desire preprinted – all you have to fill in is a brief subjective, physical, and A/P.  During the day you will be in and out of the OR (starts at 7), see consults and patients in the ER.  Rounds usually occur at the end of the day, which usually ends around 7-8 PM. 

Operations on this rotation can be very long (24 hrs) but faculty is very reasonable and sensitive to the fact that you are a student.  ENT Grand Rounds/didactics and Tumor Board are held every Wednesday afternoon.  Clinic is Tuesday afternoon in the adjacent Physicians Tower, and students are expected to dress up (i.e. shirt and tie for men).  Otherwise you wear OLOL scrubs (they are anal about this).  Breakfast and lunch are available in the doctors lounge every day, and the food is pretty good.  No need to bring your own otoscope, but a penlight is important.

Surgical Oncology BRG/OLOL - On this rotation, one works primarily with Dr. Dupont, one of the most respected surgeons in the state. The hours were very, very good (twice a week you only work for an hour), but the learning experience suffers a little because the student does not go to clinic. I would recommend this rotation if you want short hours and will not be offended by Dr. Dupont’s intense style. Student involvement in the OR is mainly as a retractor. A major positive is there may be some surgeries preformed that one would not normally get to see, ie. esophagectomies, gastrectomies, and Whipples.

UMC – LafayetteUMC General Surgery – More so than many other hospitals, the staff at UMC encourages students to do as much in the OR as you are capable – not just retracting. You should have plenty of chances to practice suturing and other basic skills. However, if you really want to do something, it is your job to speak up and say so – don’t wait for them to ask if you’re interested.

On the first day, you should be split into 2 teams, Purple & Gold. They do the same thing, just alternating call days. Monday, Wednesday, and Friday are all scheduled operating days (although add-ons can happen any day). The first cases typically start at 7am, so you will need to have all of your patients seen well before then so your intern has time to round after you. On these days, grab lunch whenever you have the chance – either bring it, or go to the cafeteria. Before you leave for the day, make sure the intern knows which student is on call that night.Tuesday is clinic all day in Central Clinic, starting at 8am – the nurses are typically very helpful. You will see the patient on your own, then present it to a resident. Typically, Dr. Frey pulls all of the students out of clinic for a short lecture at some point in the day. Lunch might be provided, but bring money for the cafeteria just in case.Thursday is conference day – dress up. Grand rounds (tele-conferenced in from NO or BR) start at 7am, so again, you’ll need to have all patients seen earlier than that. Grand Rounds is followed by Pre-Op Conference, M&M, and Student Case presentations (2 students will present a pt. each week). Afterwards, you are free until Breast Clinic starts at 1pm.

Pre-Op Conference – the biggest headache of the week for the students. Students make sure all papers, reports, and films are available at the pre-op conference for each pt. scheduled for an operation in the upcoming week. Check with your residents about what they want included in their folder – and for instructions on ordering breakfast!! (No one wants a conference without breakfast & coffee!)

** Dr. Augustine (head of anesthesiology at UMC) typically pulls the general surgery students out of their work at least twice to go over airways/intubations, and IV access. From then on, students are allowed/encouraged to practice starting IVs & intubating the pts. before surgery – just ask the anesthesiologist/CRNA working with that pt. With no residents/CRNA students competing for the spots, it’s a good chance to practice!

UMC ENT – If assigned to ENT at UMC, you will most likely be the only student for those 3 weeks. This is a very resident-dependent rotation. You will be with whichever LSU-NO ENT residents are also assigned to ENT for that rotation. Since it is a small service, you will most likely see all of the patients (1-5?) before the residents get there in the mornings. Mondays and Fridays are the main operating days (starting at 7am), with other cases being scheduled as needed. Tuesdays and Thursdays are clinic days in the East Clinic. Wednesdays, you will round with staff (Dr. Chastant – very nice!), so dress up but bring scrubs b/c minor procedure clinic is also that morning. You’ll also have Grand Rounds and ENT Tumor Board teleconferenced at Our Lady of Lourdes downtown Wednesday afternoon – ask your residents for directions (and put your dress clothes back on!). Bring your lunch or money for the cafeteria & just eat when the residents eat. Don’t worry about your own otoscope/ophthalmoscope – there’s one in every room for you to use.

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UMC Orthopedics – Orthopedics at UMC is VERY laid back. It is mostly a clinic/sports medicine type experience, as you will only be operating one day a week (Thursday mornings). Surgeries performed at UMC are all minor – you may see knee and shoulder scopes, carpal tunnel surgeries, and trigger finger releases. You will have different staff doctors running the clinics on different days, all of whom are VERY nice. The residents only do one clinic every other Wednesday at UMC so you will have minimal interaction with them. There is a Nurse Practitioner who also runs the clinic on some days. Days usually start around 8am and run till 1 or 2pm, with the exception of surgery days which start at 6:45am. You will not be seeing consults on the floor or writing inpatient notes, so just relax! The attendings like to make you look things up and report back. Ms. Anne Campbell has an excellent book that is available for lending to students in which you can find most of the answers they expect you to come up with.

Lectures/ConferencesYou will have a schedule of lectures that you are REQUIRED to attend. Sign in sheets are at every lecture. There are also several weekly conferences you are required to attend; these include Morbidity/Mortality report given by residents to Staff, Grand Rounds given by Staff, and student conference where you will present cases to staff.

Dress CodeDress up the first day. Scrubs can be worn on most workdays. However, the staff likes for the students to be dressed up for most lectures, conferences, and grand rounds. Sometimes you will be changing in and out of clothes so often that it is better to just dress up and have a pair of scrubs at all times. Gentlemen wear shirt and tie. Ladies dress in slacks/long skirts. Open toe shoes are NOT allowed due to sharps. You should consider purchasing a very comfortable pair of shoes because you will be on your feet more than you ever have in the past (I recommend Dansko’s). No short skirts, low cut blouses, or see through blouses, etc. You are in a professional setting and it would not do you any good to make a bad impression with staff and/or residents due to what you are wearing (or not wearing). Use common sense! As a general rule, if you are not sure what to wear, just ask your intern or resident! Remember to be professional throughout the year on all of your rotations. The temperature in most places is quite cold so keep that in mind when picking out your attire for the day!

E*ValueThis is the site the clerkship uses to keep track of your clerkship competencies and clinical conditions – things that you are expected to do and see during the course of your rotation. On every other rotation, you will be given booklets to have your resident or faculty physically sign, but during this rotation, you will have to sign on to this site and fill out the form for every skill or procedure. Try not to wait until the very end of the rotation to fill these out. Residents and Faculty members will also use the site for evaluations, and you will be able to read what they write once they have completed your eval.

Study MaterialsThere are many study materials that everyone uses. I would recommend picking a couple of them to best utilize your time. Surgical Recall is a must to have with you every day in the hospital. There is a lot of information that is in this book that you will ultimately be PIMPED on by somebody. Read it for this purpose. I would not rely solely on it for the exams. Essentials for Surgery is the recommended text and it is LOADED with details. Most people do not read the text but they use it as a reference. Many students find the questions in Blueprints Q&A Step 2 for Surgery to be similar in difficulty to those on the Shelf Exam. Questions in Pretest: Surgery and A&L Review of Surgery are more difficult. One of the most used resources was Case Files: Surgery. The consensus was that you could read through this twice and be very prepared for the Shelf Exam. The surgery questions from USMLE World for Step 2 seemed to most accurately reflect the style and content of questions presented on the NBME Shelf Exam.

ExamYou will take the Surgery Shelf Exam at the end of the block. Concentrate on surgical management, trauma, and making diagnoses. There will be no questions regarding procedures. Students who have taken the Medicine Shelf prior to this exam seem to be more prepared.

You will also be required to write an ethics paper.

Writing Notes For Post-Op Patients At 5AM1. Check the chart first/ask nurses for updates

Read any new orders Read the admit H&P if there is one, find out why the patient is there?

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Scan through any new progress notes Look for consult reports in front of the chart and in the “consult” section

2. Outline your note Put the Heading such as:

L3 General Surgery Maes Team Post Op Day #/Abx Day #/Hosp Day# List the Meds in the margin At least glance at vitals, I/O’s even if you don’t write them down yet

3. Finally – see the patient: ask the standard post op questions if the patient has already had surgery. Is your pain well controlled? Flatus? Bowel movement? Have you eaten anything? If yes, did they tolerate eating without any pain? Any

nausea/vomiting? Are they walking around yet? Are they using the incentive spirometer? Physical exam: focused on whatever problem they were admitted for and any new problems overnight Take down dressings if it’s post op day 2; checked with your resident to know what needs to be done.

4. Write your Subjective & Objective of the “SOAP” note Subjective

How the patient feels. Basically the answers to the above questions or whatever is relevant if they are not post op.

ObjectiveVitals: Given in a range over the previous 24 hours for everything except temp. Record temp

maximum and the current temp. NOTICE TRENDS!!!Ins/OUTS: Total plus the breakdown by NGT output, Chest tube, JP drain if available and always UOP

in cc/hr. NOTICE TRENDS.Physical Exam, including HEENT, CV, Chest, Abd, Ext, Neuro

Indicate the condition of any wounds (incisions, central line placements, drains, etc.)

5. Check labs and or x-rays and add to note Circle abnormals and KNOW NORMAL VALUES. Also note any trends from previous days if available

6. Finish the A/P Hopefully you’ll be able to copy part of this from a previous note. If not, talk to your resident if you are not

clear on what the plan is for the patient. Always use the terms “will discuss with team” and the word “consider”.

7. Either copy entire note or just highlights onto a note card to present your patients on rounds.

Common Abbreviations For Surgery: (also see Surgical Recall)Exp lap: exploratory laporatomy NPO: nothing by mouth (orally) SBO: small bowel obstructionPE: pulmonary embolism N/V: nausea/vomiting PFT: pulmonary function testsUOP: urinary output Lap chole: laparoscopic cholecystectomy NTND: nontender, nondistendedPRN: as needed NABS: normoactive bowel sounds Rx: prescription for treatmentC/C/E: clubbing/cyanosis/edema UGI: upper gastrointestinal C/D/I: clean/dry/intactUS: ultrasound I/O: ins/outs PTX: pneumothoraxNGT: nasogastric tube SVC: superior vena cava CT: chest tubeRTC: return to clinic OC/OP: oral cavity and oropharynx CBD: common bile ductLAD: lymphadenopathy NS: normal saline S/Sx: signs/symptomsLR: lactate Ringer’s Ix: infection MAE: moving all extremitiesMMM: mucous membranes moist OOB: out of bed ABG: arterial blood gasFEN: fluids/electrolytes/nutrition ASA: aspirin I&D: incision and drainageBRBPR: bright red blood per rectum IVC: inferior vena cava CXR: chest X-rayLES: lower esophageal sphincter CP: chest pain HO: house officerCABG: coronary artery bypass graft EBL: estimated blood loss C/O: complains ofCVP: central venous pressure DVT: deep vein thrombosis MAP: mean arterial pressureFNA: fine needle aspirate Dx: diagnosis

Miscellaneous Surgery Pearls: Residents will usually expect you to take care of the list for the team. Usually there is a template stored on the

computers in the residents’ conference rooms or somewhere in the hospital.

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You will be expected to have everything ready to change your patient’s dressings. Either know where to get

these supplies on the floor or carry them with you: 4X4 dressings, tape, scissors, saline, peroxide, sponges, suture removal kits, lots of gloves.

In the OR- learn your glove size early and pull your gloves and the resident’s once you know their sizes. Generally, the third year student should be the last person to be gowned and gloved… just don’t go ahead of the chief and/or attending if they are standing right there. Ask the person highest on the chain where you should stand. Listen to the scrub nurses… they will help you out but BE POLITE!!!

You will be expected to see patients post-op if they go directly to the floor or to the SICU. L3’s are usually not responsible for ICU patients – this is covered by AI’s and the residents on the team. However, a sample note is included below. Note the difference in the format to a systems-based organization.

For the most frequent pimping question, “What’s the differential diagnosis of ______________? (Fill in the blank with everything). You can use “Vitamin C” to organize your differential in any situation.

VascularIdiopathic/IatrogenicTraumaA metabolic disorderMechanical (usually obstruction)InfectiousNeoplasmConnective Tissue Disease/Autoimmune processes.

Things helpful for your iPod/Blackberry/Palm: Epocrates, MedCalc, EZ Labs. Again, be a team player, have a good attitude and you’ll do FINE!!!!!! It is helpful to review some of the things you learned in skills lab prior to the rotation, including how to scrub,

knot tying, suturing, inserting foley in males and females etc. At orientation, you will have some lessons on those topics for your review.

Clerkship Coordinator Contact Info:Course Coordinator: Andrelle Butler

Course Director: TBD

The Department of Surgery is located on the 7th Floor 1542 Tulane Ave.

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PsychiatryPsychiatry is very different from the rest of third year and most medical fields. The general approach to the patient is the same. You start with the history and physical, run labs, make a diagnosis and treat with medication, but what is included in each aspect is completely different. The H+P for psych includes much more subjective documentation from the patient and his/her collaterals and the health care provider. For example, along with doing a physical on a patient, you will ask questions and complete a mental status exam (MSE). Many students find the psych experience unique and enjoyable. Regardless of your specialty, you will have a fair percentage of patients in your practice with a psychiatric issue or on a psychiatric medication. This rotation might be your only opportunity to learn about the field so take advantage it during these 6 weeks.

Rotation AssignmentsStudents are being assigned to sites in New Orleans at places such as Ochsner, University Hospital, and DePaul. Keep your eyes on your email, as this is way the department will communicate with you concerning where you will be placed.

Typical DayThis six-week rotation tends to be less demanding than many of the others during the third year. Generally, you work from 7am to about noon at your primary site. Occasionally, you have afternoon commitments in the hospital. One or two afternoons a week you have class until 2 or 3 p.m. in New Orleans. Additionally, one day per week is spent at a secondary site. This leaves the other afternoons completely free to lounge by the pool, play golf, or even study.

As with every rotation third year, the experience varies tremendously depending on the residents and staff with whom you work and the location where you are placed. The general day-to-day activities on the wards are very similar to other rotations. Most students follow between one and three patients. You will see your patients and write progress notes in the mornings before rounds. Staff will round with the students and the residents and make any adjustments to the medications. Some days, your team will have a group meeting with all the patients at one time; other days, staff may not see the patients at all. Everything depends on the style of the staff and how he or she runs the team.

Site Specific Info – PRIMARY sitesOchsnerOchsner is a great rotation because of the variety that you get to see and the laid-back environment.  The 6 weeks will be split into three weeks with Dr. Galarneau and three weeks with Dr. Keister.  They let the students work out among themselves which order they want to do it.  There is usually 1 resident on each team, and they are very willing to help and answer questions.  There is one social worker and several nurses/therapists who work with both doctors, all of whom are very nice and helpful.  You aren't expected to write notes in the morning, but they expect you to pick up 1 or 2 patients and talk with them on your own and write notes on them after rounds.  Dr. Galarneau does general psychiatry and you will see a similar mix of patients to other psych wards.  For this part of the rotation, you should arrive around 8:50am to print out labs on the patients for rounds, which start at 9am.  You aren't expected to interview the patients, but sometimes he will give you specific topics to talk about with your patient that afternoon.  Rounds are usually done by 12pm, so once you finish talking to and writing on your patient, you can leave.  Dr. Keister does Geriatric Psychiatry, so you'll generally be seeing older patients.  One of the most interesting parts of this rotation was getting to see and and help perform ECT (electroconvulsive therapy) on patients.  Dr. Keister does this on most mornings, before rounds, so you will be expected to be there for 6:30am.  Usually there are 3-5 patients and it's helpful to get the machine ready and get the equipment set up before everyone else gets there.  The resident will teach you the procedure and how to place all the leads and you'll get to see so many patients that you'll be a pro in a couple of days!  Usually after ECT, all of you will go up together to start rounds on the patients.  Dr. Keister always finishes before 12pm, so after you finish talking to and writing on your patients, you are free to go!  There are some afternoon group therapy sessions which are interesting to listen to, but are not mandatory. 

Other info:

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Call - There is no night call, but one student must be on call each weekend day.  The staff and resident will usually be someone you don't know, so look on the schedule to see who they are and try to contact them before the weekend to find out what time to be there.  Weekends are more involved and a good time to practice interviewing and writing on patients on your own.  You will usually get there around 8am, but depending on which staff you are with, you may leave as early as 11am or as late as 5pm.

MHERE – Students assigned to Ochsner have to spend one weekday evening during the six week rotation admitting patients to the MHERE. .  Parking - Unfortunately the parking lot is located on the other side of Jefferson Hwy and it's a good 10-15 minute walk between the lot and the hospital.  They do have shuttles every 5 minutes but this can take just as long as walking, so I'd recommend getting there early.  Don't park in the lot right next to the hospital, because they're strictly for patients and they do ticket. Food - The cafeteria has pretty good food, but it's pricey.  There is a doctor's lounge where you can eat what you want for a fixed price ($3 regular, $5 if you get any meat), and they usually don't have a problem with med students eating in there.  On Fridays, there is usually a talk with food provided for all Psychiatry staff, nurses, etc. in the Brent House.  I would recommend getting there before 12pm though, as food tends to run out.

University Hospital – MHERE MHERE, which stands for Mental Health Emergency Room Extension, is located in two trailers to the left of the hospital (if you are facing the front entrance). Life at the MHERE runs a little differently than any other site for this rotation. Since these patients are all acutely ill there is slightly more detective work that needs to be done (ie teasing out any prior diagnoses, figuring out why they are here now, and asking if they are having any homicidal or suicidal ideations). The director will give you a key to get in and out of the locked trailer – be sure to return the key when the rotation is over!

Work starts at 7 or 8 in the morning. There is usually one or two residents (both psych and neurology residents rotate through there) working with you. When you get there, usually run through all the patients left from the night before and see who needs a consult. Because we are an extension of the ED, all patients must be medically cleared before they are allowed to be transported over for evaluation (ie, they will have an ekg, urine and serum drug screen, etc). Also, since we are technically an emergency psychiatric extension, there are only two plans possible – discharge the pt to home or admit patient to psych facility with PEC (and hopefully CEC). We do not work out long term plans for these patients. All of this leads to a lot of waiting. If beds are available, pts will leave sooner. If beds are not available, they may end up waiting some time and so comes in the 24 hr follow up note – if a pt stays longer than 24 hours, they need a follow up evaluation. You may preemptively write these if you are looking for something to do. This is a very laid back rotation. The rounding time can vary depending on staff, so just be sure to ask your resident what time everything needs to be finished. All of this leads to around lunch time. One student does need to stay somewhere on campus every day until 4:30 (or 5). So if there are 3 or 4 students, this will only be once or twice a week. You can check in after lunch break to see if there are any patients and if not, you may go back over to the atrium or library to study. Leave your name and phone number on the dry erase board and they will call you when a patient arrives.

Students assigned to the MHERE have to have to spend one weekend day during the six week rotation writing notes at DePaul. Other than that one day, there are no weekend working days.

University Hospital – Consult/Liaison (C/L)At least one junior student will be placed on the C/L service at UH. On this service, you will see patients currently admitted as general medical inpatients at the request of the treating medical or surgical consultant or team. Issues that arise include assessing the capacity of a patient to consent to treatment, attempting to settle conflicts between patients with the primary care team, and the intersection of problems in both physical and mental health, as well as patients who may report physical symptoms as a result of a mental disorder, and assessing patients for abnormal illness behavior (wiki). Typical problems encountered include depression, anxiety, sleep disorders, bipolar, PTSD/ASD, delirium, and dementia.

Your day starts at 8 a.m. (though, depending on the number of patients and new admits, you might need to come in earlier so always be in contact with your resident!) In the morning, you report to the MHERE trailer to look at the consult book and make note of any patients that came in overnight and that you have to work-up before rounds. Call your resident to let him/her know if there are any new consults and discuss how to split your list of patients to

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be seen that day. All patients will be in UH on the floors (since they have been admitted to other services.) Go about seeing patients as you would on any other service – write your note in SOAP format with the addition of the MSE.

Rounds start around 9 or 9:30am depending on Dr. Conrad’s teaching/administrative duties. You meet with Dr. C, the fellow, resident, and any fourth years assigned to the service. Rounds follow the same format as other services in that you grab charts, present your patient, and discuss treatment options once Dr. C lays eyes on the patient. Once rounds are finished, you help your resident with any floor work that needs to be done and you’re usually dismissed by noon. However, depending on patient load and the presence of any fourth years on the service, you might have to help until 4 or 4:30 pm. If no consults were received during rounds, the resident will usually let you leave campus (as long as you’re a 10 minute drive away) and will call you if any consults are received. In the event that there are new consults, you return to UH to work-up the patient using the standard UH consult form then call the resident or fellow to meet you on the floor to discuss your impression of the patient and your proposed plan. The fellow or resident will assess the patient and then you will collaborate to finalize a plan of treatment. Patients seen after rounds are added to the list and presented to Dr. C at the next day’s rounds. If there is a fourth year student, you usually alternate “on-call” afternoons and whoever is “on-call” will update the list on Google docs at the end of the day.

As with MHERE students, you only have to spend one weekend day writing notes at DePaul during the six-week rotation. Your other weekends are free!

This is a great service to see the interface between other fields of medicine and psychiatry. Dr. C likes to teach and is very amenable to student suggestions for patient care.

DePaul HospitalAt DePaul, you’ll see a lot of personality disorders and acute schizophrenia. Your day will start at 7 a.m. on average, and you’ll see and write notes on approximately 3 patients. You will have at least one resident on your team. Rounds with the attending vary in start times from 8 a.m. to 11 a.m. On rounds, you will discuss each patient with the multidisciplinary team and then the group will interview any new admits, discharges, and patients with acute changes. One downside (if you’re interested in psychiatry): you don’t have a lot of say in the treatment plan (versus, say, UH C/L).

One or two mornings a week there is a group session with the residents on your floor and the team taking care of them that you will attend. After rounds, you finish up the paperwork, update the list, and then you can go home at the earliest around 12 noon- 1 p.m. depending on the needs of the team. One student from each team has to come in on the weekends to write notes and round with the on-call attending.

MHERE – As with Ochsner students, you are required to work one evening at the MHERE during the six-week rotation.

Outside ActivitiesYou will also have to attend one Alcoholics Anonymous (AA) meetings during the six weeks. You can go at any time, and I recommend going early in the rotation. There is a list of meeting info available on the Internet (http://www.aa-neworleans.org/) or you can look up a contact number in the local phone book. You may attend any “open” meeting that is located off-campus; they are held all over town all day long. This experience is extremely rewarding, so go with one other person in your class, be open minded and respectful, and enjoy.

As noted above, you have to spend one day per week at a secondary site. Your current choices are: Central City Behavioral Health Center, Chartres-Pontchartrain MHC, Child and Adolescent Behavioral Health Access Clinic, LSU Behavioral Science Clinic, NO Behavioral Health Center, Odyssey House, St. Charles Community Health Center (Tuesdays only). You’ll be able to rank your choices for secondary sites, and Ms. Erina will assign you to one. Each site is different with regard to your daily duties so make sure you ask what will be expected of you because you will receive an evaluation from your secondary site resident or staff.

Study MaterialsPsychiatry, Current Clinical Strategies This little green pocket book is totally awesome must-get and can be found in our bookstore. I don’t remember how much it costs but it contains a LOT of information. Not only does it provide a couple of pages on each disease and treatment, it gives outlines for notes and interviews. If you have friends doing Psych at different times, pitch in a few dollars each and pass the book around. It will definitely come in handy, and it does not take up much space.

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Case Files: PsychiatryThis book is simply just a presentation of cases vignette style and goes into more detail of the disease process presented. I thought this book was pretty good in giving you an idea of how many different ways a patient can present since a lot of psychiatry overlaps each other. This book is not all-conclusive however, so you may also want to use another source to study.

Blueprints in Psychiatry This book is a good foundation for your psychiatric experience but tends to leave out a lot of the important details. It is worth reading in the beginning to obtain a basic understanding of the diseases and the drugs. The questions at the end are good, but they tend to be a little simpler than those on the test. Also, there are not a whole lot of questions. You will most likely want an additional source to prepare for the exam.

Blueprints in Psychiatry Question & Answer BookThis book contains an additional 100 vignette style questions. The questions are pretty good. You can decide if it is worth spending the money for only 100 questions. If you can find one for cheap or free, go for it.

BRS Psychiatry This book has it all. Although it is fairly long and denser than Blueprints, it is fairly comprehensive. It provides adequate explanations of the diseases, drugs, and theories associated with Psychiatry. The questions at the end of the chapters and the comprehensive test in the back are excellent. Some students felt these were the most representative questions for the exam.

PreTest for PsychiatryThe questions in this book are not really vignette style and the information tends to be a little random and very detailed. Doing these questions might be more frustrating than anything else. Some of the content is good; so if you have extra time, do select sections in your weakest areas.

Andreasen and Black This is the recommended text. It’s a good primer on psychiatric illness and treatment. You will be assigned readings from this textbook for the afternoon faculty lectures; however, Ms. Erina will send a file of the scanned chapters so you don’t actually have to buy the book. Only purchase it if you are interested in pursuing a psychiatry residency.

DSM IV-RThis book is the bible of Psychiatry. Every diagnosis is made based on the criteria explained in the DSM IV-R. You will hear it mentioned all the time and it is important to be familiar with the diagnostic criteria, but not necessary to buy the book. There is a pocket version if you are really interested in keeping up and learning the technicalities of the diseases. You should be able to find a copy somewhere on the ward if you need to look up something specific.

OthersIf you have any other Wards or Step 2 books (First Aid for the Wards, Boards and Wards, etc.) I am sure these have general sections for psychiatry you may want to read. Also, addition questions from Step 2 books (NMS for Step 2, etc.) may be useful. Other students recommend First Aid for Psychiatry.

Miscellaneous Psychiatry Pearls Scrubs are typically not appropriate so dress up a little. Girls, you may not want to wear scarves, short

skirts, low cut tops, long dangly jewelry (earrings/necklaces), or high heeled shoes. Guys, even though most rotations want you to wear a tie, the psych attendings & residents will not want you to wear a tie. These are all for safety reasons – if you get my drift.

Don’t leave ANYTHING lying around (such as pens, keys, reflex hammers) that may be used as a weapon. There are lots of abbreviations specific to psychiatry. Carry the pocket book for Psych to help decipher

these during your rotation.

Clerkship Coordinator Contact InformationPsychiatry Course Coordinator: Erina Rivarde erivar@lsuhsc.edu

The course director is Dr. Mark Townsend.

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Obstetrics/Gynecology

OB/GYN is a six-week rotation that introduces the medical student to the basics of labor and delivery (L&D) and the gynecological exam. Students are currently being assigned rotations at UMC in Lafayette, EKL in Baton Rouge, UH, East Jefferson and Touro in New Orleans. They are no longer sending students to Chabert in Houma. Although the daily schedules are different at each of the locations, students will learn how to perform basic pelvic exams, deliver babies both by c-section and vaginally, and observe/scrub-in on various gynecologic surgeries like hysterectomies.

This is one of the tougher rotations during the junior year in terms of free time. While call varies among the sites, students can expect at least 5-8 call nights. During these calls, students will help residents write admit H&P’s, check labs, assess a patient’s ongoing labor, aid in the delivery, and handle routine postpartum issues.

The busier you are, the more you will learn while on the job. The shelf exam presents many typical clinical scenarios that you may see while on call or in outpatient clinics. Although study time is less than on other rotations, the amount of testable material is slightly less than other blocks. There is quite a bit of internal medicine on this test (as well as every other one). If you have done medicine already, you probably have a slight advantage. As is the case during the entire third year, you must make efficient use of free time to read and do practice questions in order to do well on the test. Get in there and get dirty! Have fun, and good luck!

Site Specific Info

University Hospital – New OrleansAt UH, students spend the first Monday–Thursday in lectures and basic skills clinics (suture clinic, delivering babies on the simulator, and practicing using laproscopic instruments). On Friday, call schedules are made and students are divided up into groups and start on one of gynecology, obstetrics, or gynecology-oncology services. You will rotate through all 3 services.

Call is designed to be every fourth day, but may vary depending on the number of students. Weekday call starts when the day teams hand off to the night float team at 5pm. On post-call days during the week, you should be allowed to go home at noon. For weekend call days, call the team the night before to find out what time they want you to come in. You will stay until the next morning after notes have been written. Only on-call students work weekends. Study materials and snacks are good to bring on call days, as well as cash if you want to order dinner with the night team. The call room for students off of the L&D OR gets wireless internet.

Your main responsibilities as a student are writing morning (and sometimes afternoon) notes on your team’s patients, observing/assisting in surgeries and deliveries, seeing patients in clinic, and attending student lectures/grand rounds on Friday afternoons. Mornings will start anywhere from 5–7 am depending on the service. Residents will let you know the afternoon before by what time you should have your notes written. The day ends around 5:30–6pm after responsibilities have been handed over to the night float team. Scrubs are acceptable attire for all occasions except for those noted below.

Monday, Tuesday, and rare Friday mornings are for surgery primarily. Any time not occupied by surgery is normally spent in clinics. A student will scrub in for most surgeries. Offer to open a gown and gloves for yourself if you’re scrubbing in, and help set up the table once the patient is asleep. This is a good time to learn how to place Foley catheters and feel pathology on a pelvic exam. Ask the resident for an outline for writing post-op orders (some are in the handouts given in orientation). Before surgeries, it is good to become familiar with the pre-op H&P, indications for surgery, and pertinent anatomy.

Wednesday mornings have pre-op conference at 7:30. As a student, you only have to sit, listen, and DRESS UP. Wednesdays and Thursdays are primarily clinics. Students are generally expected to do a complete history or history of present illness and a general physical exam and then present the patient to a resident. The resident and a chaperone will do the pelvic exam with you. After you formulate an assessment and plan with the resident, you will present the patient to staff.

Friday there is time for students to study in the morning after writing notes and rounding. In general you are asked to return at 1:30 pm with the EJ and Touro folks for student presentations with staff, followed by Grand Rounds which lasts until 4. The student presentations are 10-15 minutes—usually with powerpoint—on a topic that interests you, is relevant test material, and was not covered in the initial lectures by staff. Some examples of topics from last

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year: common STD’s, psychiatric issues in pregnancy, trauma in pregnancy, post-partum hemorrhage, HPV and cervical cancer, and managing shoulder dystocia. You must DRESS UP for Friday afternoons.

Each student needs at least 1 evaluation from staff. Residents are a good resource to find out which staff to ask for kind evaluations. If you have not worked closely with staff, you can have a resident write an additional evaluation to be added to your file. The same advice is relevant for this rotation as for all: be interested, helpful, and energetic. It’s an investment in your education, your happiness, and your grade.

Touro – New OrleansIf assigned to Touro, you will work closely with the LSU residents and assist them in following patients of both LSU staff and some private physicians. With them, you will visit inpatients, attend deliveries, and observe or assist in various surgical procedures in the OR. Each day in the hospital you will also follow patients, typically assigned by the residents. You will continue following your patients throughout their hospital course, which includes writing progress notes on them each morning. Because working in a private setting is somewhat different than other rotations, it is important to ask previous students how they made the most of their 6-week experience. This rotation gives you a good feel for life as an OB/GYN in private practice. And just because it’s private practice does not mean it’s entirely hands-off – most of the docs are willing to let you see patients on your own, so don’t be afraid to take that initiative.

Additionally, students at Touro Hospital will work with residents in the mornings and on call nights. Expect to arrive around 5:00 to 5:30AM and help examine and write notes on antepartum, postpartum, or gyn patients in time for rounds at 6:30. Ask the residents about documenting in the chart, as some of the private attendings prefer that the students not write in their patients’ charts. You can arrange a call schedule with your fellow students (which is usually every fourth night). Call nights typically begin at 5:00PM after checkout. While on call, you will help with deliveries, obstetric emergencies, and admits that arrive throughout the evening. Students typically do not stay overnight because there is not a call room available for them. Students are usually dismissed by 10:00PM but are encouraged to stay if they feel it would be a beneficial learning opportunity. Remember, the residents can really be your ally if you are respectful and enthusiastic.

East Jefferson students will also take call nights, but may not stay overnight because there are no call rooms for students. You will create a schedule with your fellow students. Please make friends with the L&D nurses at East Jeff because they will likely be the ones to inform you of deliveries and such on the unit.

All students are expected to attend Grand Rounds on Friday afternoons at the LSUHSC campus. You will be expected to arrive an hour and a half early for student presentations or lectures. You will be assigned a topic to present and a presentation date at the beginning of the rotation. In addition, this past year the first week of the OB/GYN rotation was filled with didactic learning, skills workshops, and lectures. This takes place in the MEB, and is a good opportunity to get ahead on reading, as this clerkship can be one of the most time-consuming. We actually strongly recommend that you get ahead in your reading during this week.

East Jefferson Hospital – New OrleansFor all students doing OBGYN in New Orleans, the first week of the rotation is filled with didactic learning, skills workshops, and lectures. This takes place in the Lyons Building, and is a good opportunity to get ahead on reading as you will be getting out around 2:00pm or 3:00pm each day.

If you are assigned East Jefferson General Hospital, your clerkship experience will follow a preceptor model. You will be assigned to a private OB/GYN or group, and they serve as a preceptor in the field. With them, you will visit inpatients, attend deliveries, and observe or assist in their private practice office during most of the day. This rotation gives you a good feel for life as an OB/GYN in private practice.

There are two different groups at EJ, the Dr. Weidemann group and the Drs. Nobles, Kennedy, Hevron, and Champlin group. The “Weidemann” group has typically been a lighter workload, and the student is expected to be responsible for his or her experience and can do as much or little as he or she would like. Both groups are expected to arrive around 7:00am each day, and every student from both groups is required to stay overnight once per week in the call room on the 4th floor where you will follow along with any deliveries that occur during the day and assist in all C-sections. Make friends with the L&D nurses as they will help keep you informed of upcoming deliveries. The call schedule is made by the students, and only one student stays per night. When you are post-call, you are expected to work with the Perinatologist until noon and then you are free to go. Additionally, every student is required to come in one weekend during the rotation and write notes on the patients in the hospital in

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your call group (which is larger than your preceptor group). This typically only takes about two hours and then you are free to go. The “Nobles, etc” group requires one day per week where you will be in the OR, one day per week on call, one day post call with the perinatologist, and two days in clinic. One student will also be responsible for seeing and writing notes on the patients on the floor each morning. Only one student is required to write morning notes per day, so this schedule is worked out among the two students in that group.

You will also be expected to attend Grand Rounds on Friday afternoons. For the first few weeks you will be expected to arrive an hour and a half early so that students can present selected topics that are given at orientation. Each student will give one presentation during the rotation. It is not given to the entire program, only fellow classmates and the program director.

UMC – LafayetteStudents will spend part of their time on Gynecology, and part on Obstetrics, but will take OB call throughout all 6 weeks. The schedule varies depending on which part of the rotation you are on. Typical duties include: patient notes, rounds, attending conferences, and working the associated clinics for your service. GYN tends to be more demanding time-wise, with operations on Tuesdays and Thursdays, while covering assigned OB-call. GYN has clinic all day on Wed., but lunch is usually provided. On any given day, as soon as you are finished with operations/clinics, head straight upstairs to write the afternoon progress notes. Your residents will love your head-start (and maybe you’ll finish & get to go home sooner!). A schedule will be given during orientation. Call nights are supposed to be ALL NIGHT (this is very resident dependent—some may send you home) and are about every 3rd or 4th night. Students deliver babies with the Family Medicine Residents either on call or during L&D days on OB. There is a call room on the L&D unit.

The staff will have you prepare a presentation on a relevant OB or GYN topic to present to the team. As the lecture schedule is a bit off right now, you may want to check out the DVD lectures from the library. You will also attend any conferences or lectures that the residents attend.

Scrubs can usually be worn on most days. I’d still recommend dressing up the first day to make a good impression. BRING SCRUBS because someone will be on call the first night. Plan to be there on the weekends, as well.

Helpful tip: There is a list of commonly asked questions that the staff GYN doctor, Dr. Elias, asks every student. If you know the answers to all of these questions, it will boost your evaluation substantially. Contact a fourth year student who rotated in Lafayette to get this list.

EKL – Baton Rouge Students rotate through three two-week rotations: prenatal, postpartum, and GYN/Oncology. The schedule varies depending on which part of the rotation you are on. Typical duties include: patient notes, rounds, attending conferences, and working the associated clinics for your service. You will scrub in on GYN surgeries on Tuesdays and Thursdays when you are on the GYN/Oncology section the rotation. A schedule will be given during orientation. This rotation is very organized and they tell you essentially what they expect of you at orientation.

Call nights will be on labor and delivery and usually only one student is on call with staff (and possibly residents). This is a great opportunity for catching babies!!

Scrubs can be worn at all times in Baton Rouge.

A schedule for a typical day is something like this:5:45 am Arrive and write notes on patients for your service. If you finish early, help other classmates. There will often be more post-partum patients than the other services, so everyone helps out.7:00 Rounds on M, W, F or to the OR for surgery Tues, Thurs (if on GYN/Onc service)or rounds M-F (if on OB service) 8:30 Clinics / Lecture on Wednesday & Fridaysnoon Lunch1:00 Clinics/Lecture/Surgery (depending on the service and day of the week).4:00 Write afternoon notes on post-op patients

**Call is 8:00 AM to 8:00 AM. On weekdays, you should arrive to see your patients in the morning and round with the team, and then check with L&D to see if anyone is in active labor. If any deliveries are going on or pending, you should be in L&D. Otherwise, go to clinic with the other students but make sure the L&D nurses have your cell

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number and tell them to call you in advance of a delivery. When you are in clinic, make sure you check out to all of the staff members, and don’t cherry pick. They will notice if you are just checking out to one staff member.

On the weekends, arrive at whatever time the staff from the night before wants you to arrive. Get the call student from the night before to check and see what time the staff wants to leave the next day, and arrive an hour –hour and a half early to do get notes written for rounds. Assume your duties for the rest of the day. Only the on-call students work the weekends.

**Lectures are mostly made up of student presentations on assigned topics as well as some staff lectures. You will be expected to prepare two 15-30 minute presentations on two different subjects related to the OB/GYN specialty. Tip: make a handout to pass along to your classmates so they can use it to study for the shelf. Preparing these presentations is a great way to review for the shelf exam for those particular topics!

You will get a lot of hands on training at EKL since they currently only have one ER resident that rotates through the service monthly. You will be working with faculty mostly, especially on call nights! You will get a little shadowing on the first day, but otherwise, the staff will pretty much let you fly solo in clinics and on L&D. Don’t be afraid to ask questions though of the staff or the L&D nurses; they will always be there for help with an exam if you are unsure. The L&D nurses are a goldmine of information on how to do cervical checks and anything else you may have a question about. The GYN OR is mostly observation, but you may get to suture and you will be first assist on c-sections that come in while you are on call. The best way to approach this rotation is to be an active participant in your learning and do as much as you can, it will only add to your experience.

Notes and Things to Carry In your white coat you should always carry a pregnancy wheel as well as a guide to writing the various

types of notes for each service … MAXWELL’S green pages rock! Call nights – find the call room when you start the rotation. Whether or not you get called in the middle of

the night for a delivery will be resident dependent. Be clear that you WANT to see deliveries, and they should call you.~ BR – you share a call room with the residents~ UMC – on the L&D unit~ East Jeff – call rooms on the L&D unit and you get your own lockers to keep your things safe

Study Tools Most students used Blueprints and Case Files as their text. Good question books include the NMS Step II

Book and Blueprints’ questions. The new recommended text is small and easy to read! It also has good pics. Great tool!!! Be sure to read about amenorrhea. It’s a topic not covered too well by Blueprints.

Miscellaneous OB/GYN PearlsIf you have had surgery already, you should shine in the OR and in caring for post-op patients because you already know these basics. On the other hand, this rotation is a nice preview of the surgery rotation. You can expect to learn how to scrub, practice sterile techniques, learn basic instruments, and practice basic suturing. Also, you will learn about the basics of writing post-op notes.

It is important to help the residents by writing prescriptions and discharge orders in order to facilitate the quick turn over of patients on OB/GYN services. Vaginal deliveries usually go home on the 2nd day. C-sections wait until the 3rd day to go home.

Post-Operative Orders Day #1 - Remember to take down dressings on Day 1 D/C IV and IM pain meds D/C foley Heplock IV when tolerating PO diet Advance diet to clears Percocet 5/325 mg 1-2 PO q 4-6 PRN pain Motrin 800 mg PO q 8 PRN pain Milk of Magnesia 30cc PO q 4-6 PRN constipation Mylicon 80 mg 1 PO q 4-6 PRN gas Ambulate with assistance Incentive spirometry once per hour

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Clerkship Coordinator Contact Information:Thomas Nolan, MD, Chairman, Department of OB-GYN Jaime Alleyn, MD, Clerkship Director Kathy Cantrell, Student Clerkship Coordinator

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PediatricsThe pediatrics block is a two month long rotation, usually broken into three different sections:

1. Wards (four weeks)2. NICU (two weeks)3. Clinics/Ambulatory (two weeks)

You may be placed at Children’s Hospital in NO or UMC in Lafayette. Keep in mind, too, that your family medicine rotation may fall in the middle of the two months that you are assigned to complete pediatrics.

Your Peds rotation is one in which you will learn a great deal about common pediatric problems, as well as having the opportunity to work in the sometimes intimidating NICU. Remember to wash your hands OFTEN during pediatrics…this will not only protect the patients, but also the medical student (who is historically known to contract quite a few colds & “GI bugs” during their pediatrics rotation).

The pediatric rotation has small group learning into its curriculum. You will meet with 4-5 of your classmates and 1 faculty mentor once a week during your rotation. You will be given a folder during orientation with all of articles and reading assignments for your small groups. You will need to read before each group. Usually the staff will go around the group and ask questions based on the assignments – so save yourself some embarrassment and read prior to your meeting. These small group meetings are designed to help you study for the shelf exam at the end of the block, use them to your advantage!

A Typical Day

WardsThe hospital wards are viewed by most L3’s as a positive experience. Attendings, residents & interns tend to be very nice, for the most part benign and generally helpful. You will function as a member of a team and see patients, write notes, round with staff, and take call. During this month you will also be expected to complete a staff observed H & P. This H&P must be written/typed up and evaluated by an assigned staff doctor. For most students this a positive experience and a great opportunity to gain feedback from a staff physician regarding improving your H&P skills. My advice would be to do this early during your wards month so that you can get an idea of how to do a proper pediatric H&P and find out exactly what staff is looking for. Also, you must receive a passing grade on it; if you fail it you have to redo it. On your first day of wards (or if you do something else first this block, about a week before you start wards), email your H&P preceptor (you’ll find out who this is at orientation) and schedule a time early in the rotation. That way, if you need to redo it, you’ll have time. You will usually have to see your patients before going to morning report at 8 a.m. You will arrive around 6:30a.m. to get check out from the night float team and learn about new admits overnight. Then you will have the opportunity to see your patients and can usually write notes during morning report or you will have some time after morning report. Sign-in sheets are present for every morning report and noon conference. Students are required to attend during their wards month and most also attend during their NICU rotation. Rule of thumb: follow your residents.

Important things to include in any pediatric history (in addition to normal questions): If running a fever, how the temperature was taken (oral, rectal, axillary, etc.) If running a fever, any pulling on ears, sick contacts, day care attendance, or rash If sick at all, how are they sleeping, eating, and are they playing normally If still in diapers, are they producing a normal number of wet diapers in a day (a ↓ number can signal

dehydration), normal appearing/smelling urine. How many dirty diapers and are the stools normal. Diet: breast or bottle fed; if bottle fed, ask specifically how they prepare the formula (if they dilute it too

much in order to make it last longer the baby may not get enough calories); how many ounces they take (or how long on each breast) and how often; any table or baby food

At what age did they roll over, smile, sit up, etc (milestones are important) Immunizations – are they up to date or have they missed any shots. If they missed shots, why. (Did the

parents request the shots be held, were they sick at that appointment, etc.) Birth history - Were they premature (less than 37 weeks) or full term? Was there any NICU or prolonged

hospital stay? Vaginal or C-section delivery? If C-section, why did they do it (repeat C-section, baby was in distress, mom was sick, etc.)

Don’t forget to ask about any medical problems, surgeries, medicines, or allergies.

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Ambulatory ClinicsThis is the portion of your Peds rotation that will allow you to have the most free/study time. Make the most of your study time during clinics, even if you have them first! Wards prior to the shelf exam can be extremely busy and you will regret not taking time to study during clinics. Each weekday morning and afternoon you are assigned to a different Peds clinic (Ortho, Genetics, Endocrine, Renal, Cardiology, Rheumatology, Pulmonary, etc.). Furthermore, one of your ten days will be spent at a private pediatrician’s office in the city. You will receive your clinic schedule and private pediatrician assignment during orientation.

You will receive a clinic signature card that needs to be initialed each time that you attend a clinic (AM and PM) unless you have lecture or small group forum. Ambulatory is pass/fail, so be sure to turn in the card to Ms. Margaret, because if you lose it or do not turn it in, you can fail this portion of the rotation.

Site Specific Info

Children’s Hospital – New OrleansStudents are randomly/alphabetically divided into four teams; you will spend a total of two weeks on two of the four teams (either Gold/Silver, or Purple/Heme-Onc), thereby giving you a total of one month on wards.

1. Purple: General Peds with hospitalist physicians, Endocrinology2. Heme-Onc3. Silver: Renal, Cardiology, Pulmonary, and General Peds (private physicians)4. Gold: GI, Neurology, Rehab, and General Peds (private physicians)

Morning report is at 8AM daily on the 2nd Floor in the conference room- take the blue elevators. You will typically see each one of your patients and complete notes prior to morning report. Your arrival time will depend on the number of patients you are assigned to see, but most students usually arrive at 6:30am for night float check out. Morning report typically consists of a case presentation – the case will be presented and discussed and then typically there is a short 10-15min powerpoint covering the highlights of whatever disease was discussed during the case.

Rounds typically take place between morning report and noon conference. Some teams do family-centered “walk rounds” where the attending, residents, students, and possibly a charge nurse or social worker will walk from room to room and discuss the patient. This is typically viewed as a positive experience (and makes it less likely that you’ll fall asleep) but be conscious when you present your patient in their room – avoid medical jargon and be sensitive to issues that may not have been discussed with the parents. Other teams do traditional table rounds where the team sits in a conference room to discuss each patient on the service. There may be a combination of walk rounds and table rounds throughout your ward month.

Noon Conference is held Monday through Thursday in the 2nd floor Conference Room. Lunch is occasionally provided but if you are late (and therefore the lunch is gone) or if no lunch is being served, be sure to stop at the Cafeteria where you can get lunch for $1.50 daily ~ simply say you would like the resident discount. (This is per Dr. English. She says that there is nothing underhanded about doing this, but it’s just the way the system is set up).

Call is usually q4 (every 4th day) and students are responsible for arranging their own call schedules at the beginning of each block. The exception to this is for NICU where the call schedule will be already set at the beginning of the rotation. You are expected to assist with admits and ward work with the residents until about 9:00 PM although this is highly variable. You may stay later if you wish. You are typically asked for each 2 week rotation to stay 2 weekday nights and come in on 2 weekend days to either just write patient notes or to write notes and round with staff.

UMC – Lafayette Like other ward months, much of your experience will be staff dependent. There are no pediatric residents assigned to UMC, so Family Medicine residents will rotate through the service like the med students. You will interact with the residents if you are on call with them or scheduled in a clinic with them, but they will not be your direct upper level in the sense of other rotations. For example, if they tell you to go home on a call night, DO NOT go home until your scheduled time. Staff is in charge of you and will not be happy if they know the student is supposed to be there and you aren’t there.

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The patient load is much lighter than that at Children’s, but your day is a mixture of ward rounds and clinic, and call is every 4th night throughout the whole 2 month rotation. Call is until 10 PM but can often become later if you are busy or have an admit. Your hours vary depending on which of the three services you are on: Nursery, Dr. Howes’ team, or Dr. Dalal’s team. On your two weeks in the nursery, you will probably arrive around 7:30am and be released around noon, unless you are either on call or scheduled for an extra clinic. On Dr. Dalal’s team, you will round on patients in the morning (usually arrive around 8am) and be done at 2 or 3pm most days unless you are on call or scheduled for an extra clinic. Dr. Howes’ team is the most time intensive and demanding – you may be there until 7 or 8pm on days you are not on call. When on services, you normally write patient notes in the morning and round, then go to clinic with your attending. Some services round twice, others just once. Sometimes you might be scheduled for a “Walk In Clinic” in the afternoon, in which you along with staff and the Family Medicine Residents see the unscheduled walk in patients. Take advantage of these days because this is where you will see the common complaints of “earache”, “fever”, and “sore throat”.

Also, since the hurricane, staff from Children’s Hospital in NO have been holding subspecialty clinics (ie. neuro, endocrine, GI, etc.) at a Burdin Riehl, a private clinic about 5 minutes from UMC. Students will rotate through these, as well as spend a day at a private pediatrics practice in town.

The daily routine includes the following – see patients, gather labs and radiology reports, and write SOAP notes first thing in the morning. You will round that morning and/or afternoon depending on when staff is available and what lectures, meetings, or clinics you have scheduled. Afterwards, you work on writing orders, discharge summaries, etc. with the residents. Occasionally, you may be required to speak briefly on a subject assigned by staff.

Neonatal Intensive Care UnitThe NICU will probably be the most intense experience that you have on pediatrics. It can obviously be very intimidating as most of the infants in the NICU have a multitude of very serious medical problems. In the NICU you will be assigned anywhere from two to four patients daily. You should read on your patients disorders the first night and be prepared to discuss the pathophysiology, treatments, and prognostic indicators by the next day. Typically after writing notes on your patients & taking care of any loose ends, students, residents & staff will round on the patients in the NICU. You should have all the input, output, TPN/PPN calculations done before rounds.

Some pearls to help you transition into the NICU Ask for help! The nurses and residents realize you are in very unfamiliar territory & most NICU staff are open to

questions regarding almost anything. At EJGH, you can also ask the Nurse Practitioners for help. You are required to scrub with surgical scrub for 3 minutes each morning before seeing your first patient. If your

nails go beyond your fingertip, clean under them EACH MORNING when you scrub in. Many NICUs do not allow artificial nails or nail polish to be worn when caring for babies.

Do not wear your coat or jewelry while examining the infants. Hang your coat up on one of the hooks as soon as you walk into the door. Wash you hands immediately upon entering the NICU and before seeing each patient. If it’s cold outside and you’re wearing a long sleeve shirt under your scrubs, roll your sleeves up.

Bring a calculator – this will be needed to calculate nutritional requirements on each of your patients daily. See included explanations on the next page of HOW to calculate needed information, it is best to review this

early on as you will be expected to correctly calculate needed information after a couple of days in the NICU. Ask the residents to teach you how to do the calculations. Fill out the TPN/PPN form with the residents.

The NICU may be your first and only chance during your junior year to manage patients who are ventilator dependent. Use this rotation as an opportunity to get a clearer understanding of ventilator usage and management.

The NICU is the only part of your peds rotation where you are allowed to wear scrubs on a daily basis. You are still expected to attend noon conference and grand rounds while on the NICU service, however you will

usually not be required to attend morning report. The NICU nurses are VERY territorial and can be very difficult to work with. Always ask before taking

something and ask when they are going to do their exam in the morning if the patient is especially sick. Coordinating exams reduces the stress on the infant but not being able to coordinate the exam with the nurse does not mean that you don’t have to do one.

There is no call for NICU and most days end around mid afternoon/early evening. Be prepared to stay late. It is your responsibility to fill out discharge summaries and other discharge paperwork. Most of the important

info can be found in the on/off service notes in the chart. Like everything else, give it your best shot before asking the residents for help.

In the NICU, whenever possible we try for “grouped care”, meaning that we do blood draws and diaper changes right before the baby eats because they’re awake anyway. This way, the babies get some good sleep time between meals as sleep is extremely important for them to grow. So, know when your baby eats and try to

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your morning assessment about 30 minutes before they’re fed. A wonderful way to make an enemy of a nurse is to wake up a baby to do an assessment and then leave them crying and unwrapped in an incubator or crib, especially if said nurse just got said baby to sleep. Obviously, if your baby is NPO this won’t work, so ask the nurse when would be best; most will say around the time they do their own morning assessment (around 7 or 7:30). It will show you’re looking out for the interest of your patient PLUS it will make the nurse like you.

At Children’s, you are expected to write notes on patients and round 2 weekend days. You have to e-mail the coordinator to get your grade at the end of the rotation because the internet and school

e-mail are “not safe or secure.” You won’t even know that your grades are in unless you e-mail her.

Important NICU Formulas – These are calculated for EVERY NICU BABY and appear in daily progress notes

INTAKE:(# cc’s of fluid intake in past 24 hours) / (weight in kg) = cc/kg/d

**This includes ALL fluid intake (IVF’s and formula)KCAL: (always separately calculate infant formula and TPN kcals)

1. Formula: (# cc’s of formula past 24 hours) * (kcal of formula / 30cc) = kcals from formula

**kcal of formula may be 20, 22 or 24; Check the formula label for each patient

2. TPN:Carbs: (% dextrose) * (3.4 kcal / kg) * (# cc’s of TPN in 24 h.) = kcals from TPN carbsLipids: 2 * volume of lipids received = kcals from TPN lipids Protein: ignore ~ not calculated

**Add kcals from formula, carbs, and lipids = total kcals**Divide total kcals by patients weight in kilograms = kcal/kg/d**Common pimp question: A baby needs at least 120kcal/kg/day in order to grow.

OUTPUT:(cc’s output) / (24) = cc’s/ hr(cc’s/hr) / Weight in kg = cc/kg/hr

**remember to include the quantity and quality of stools in your note **An adequate Urine Output = 1cc/kg/hr

EXAMPLE CALCULATION:22 cc’s of dextrose 12.5%? Calculate kcal’s… 1. (22 cc) * (12.5g/100cc) * (3.4 kcal/g) = 9.35 kcal of carbs

185.6 cc’s of D 10 & 38 cc’s of PEF 24? Calculate the kcal/kg/day… (the pt weighs 2.01 kg)1. (185.6 cc) * (10g/100cc) * (3.4kcal/g) = 63 kcal from carbs2. (38 cc) * (24 / 30) = 30 kcal from formula3. 63 kcal + 30 kcal = 93 kcal total 4. 93 kcal / 2.01 kg = 46 kcal/kg/day

Books/Study Aids1. Blueprints in Pediatrics – you will need this book on peds; simple, basic concepts that are frequently

tested are covered. Read it once or twice and be sure to complete all of the questions at end of book ~ they are very high yield

1. Kristin Nelson’s study guide – really great review given by one of the chief residents. Copies are floating around, or it is emailed out by classmates.

2. NMS Step 2 Question Book – you really will need this question book for every rotation, so if peds is your first rotation, you should invest in it now if at all possible. Completing all of the peds questions will be of great value to you when taking your shelf exam

3. Pretest: Pediatrics – has 500 questions with explanations. Most people will tell you that the key to doing well on shelf test is doing a lot of questions. This is an easy read and can be found at the book store.

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4. NMS Pediatrics – more in depth, nice backup book to have; questions at end of each chapter give nice

subject specific review

5. Harriet Lane Pediatric Handbook – purchase this if you are interested in becoming a pediatrician, otherwise it is unnecessary since almost all ward floors, NICU and resident’s have copies that you can access at any time. Also, if you purchase this, it usually comes with a code where you can download the book to your PDA.

Pearls From Ms. Margaret Regarding Third Year Pediatrics RotationBecome a team member. Residents have a great amount of input into your final grade. All written comments on evaluation forms become part of your senior Dean’s Letter.

Take constructive criticism with the attitude that you are being told something for your benefit.

Prepare to begin studying the first day of the block. There is too much material to cram into your head in the last two weeks of the rotation. You will have full time Ward/Nursery/Ambulatory responsibilities during the entire block. Only the Thursday before exam Friday is given off as a study day.

Please try to resolve any problems promptly. Don’t wait until they are extreme to approach Dr. English, your senior resident or me.

I have jars of candy on my desk for you. Please feel free to take some at any time.

Check email regularly. It is the means by which I notify you of notices/changes/etc.

Wash your hands often. Unfortunately, the children are very generous with their germs. I carry a small bottle of the “no water needed” antiseptic hand cleaner with me at all times. It would be a good idea for you to do the same.

We are not interested in your personal business, however if that will adversely affect your performance, attendance, etc. it is wise to make your attending, Dr. English or me aware of the situation. It is always better to be up front and honest about a situation than to try to “handle it” on your own.

NEVER make airplane travel reservations before 2:00 PM on exam day. Students tell us the exam seems very long. There are 100 questions that you have 2 hours and 10 minutes to answer. Most students take the entire time allotment. You don’t want to feel rushed causing you to not do well on the exam. It counts for 30% of your grade.

Please wear nice casual clothing with your white coat for all activities. Scrubs may be worn in the nursery and at other times when necessary. Men, please wear a shirt and tie for the private physician’s office visit. Ladies, please dress appropriately. Children’s Hospital does have a dress code. No thong sandals are allowed. Ladies short skirts are not allowed.

Absences: The clerkship director or Margaret Fanning must approve prior to the absence or on the day of the absence any excused absences. On ward and nursery rotations, the senior resident must also be notified. If missing a day with the private physician the student must call the office to let them know. The student must present a doctor’s excuse if more than 2 days are missed. Voice mail will pick up my telephone messages. The number is 568-2862. If you must leave town for an emergency, call my office at any time to leave the message. Please keep us aware of the status of your return.

There are required activities: Morning Report while on wards, Pediatric Forums and Wednesday morning Grand Rounds. Please do not schedule appointments during these required activities.

Please inform me well in advance of any special needs that you have for events (weddings, graduations, etc.).

My door is always open. You are welcome at any time to come to my office. My only request is if you are ill, please stand in the doorway – I have had a liver transplant and am immunocompromised. Thankfully, I have done very well but don’t wish to chance catching a contagious disease! I’m always happy to educate students about the transplant process from a patient’s prospective.

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Clerkship Coordinator Contact InformationMargaret Fanning, mfanni@lsushc.edu (Retiring after 2010 school year)

The course directors are Dr. Robin English, rengli@lsuhsc.edu and Dr. Amy Creel, acree1@lsuhsc.edu.

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Family Medicine

Family Medicine is a four-week block that is one of the most variable of all the third year rotations. Paired with Pediatrics, students rotate either before, after, or in between their 2 peds months. Each student is assigned to a general practitioner (GP) preceptor, from across the state of Louisiana, to spend the four weeks. Most of these preceptors are located in rural areas to allow the student to experience the full scope of practice that many GPs perform. The one on one assignment with a physician makes for a unique educational experience, significantly different from any other third year rotation. Primarily in the outpatient setting and primarily in the private sector, it is highly individualized with a large emphasis on clinical skills and teaching.

Typical DayThe rotation is generally an ambulatory rotation, in which you will see various patients of all age groups with both acute and chronic problems. Ideally, you will begin the first day or two shadowing your preceptor, and eventually move on to seeing your own patients then checking out to your preceptor. As mentioned, this is variable from preceptor to preceptor; however, the goal is to have you involved in direct patient assessment and care. While each student’s day will undoubtedly vary, most begin at around 7–8am and end between 4–5pm. Many doctors will see a steady stream of office patients during this time, usually with a one hour lunch break. Many of the preceptors will also make hospital rounds at some point in the day and depending on your location, may have small surgeries, procedures, and even OB deliveries during your rotation. The course schedule is also well defined.

Week One, you will have 2 days of orientation, plus 3 clinic days with your preceptor. Week Two entails of 5 clinic days. Week Three consists of 4 clinic days plus 1 day for the midcourse seminar where we present patient cases. Week Four will have 4 clinic days and you will take the Family Medicine shelf exam.

Dress CodeGenerally as you will be in an office/private setting, the norm will be professional dress; shirt and tie for gentlemen and corresponding attire for the ladies. If you have any doubts, you should ask your preceptor when you arrive.

NotesSince everyone is assigned a different clinical preceptor, the notes you write will all vary. Many, if not all, physicians will have standard H&P forms for you to use for patient office appointments. They will likely go through these with you when you arrive. You will also quickly learn what your preceptor would like you to include in your notes. It may also be helpful to look at notes from previous visits to develop a style consistent with that of your preceptor. Most notes you write will be relatively short progress notes, very specific and problem oriented, unlike those you will write on your Internal Medicine in-patient ward services. Generally you will follow the SOAP note format, with the patient’s subjective complaints, followed by your objective findings on physical exam and any lab work, and finally your assessment and plan, which your preceptor will most likely help you with. Occasionally you may complete a full H&P, especially if it is a new patient visit. As this is an ambulatory rotation, you will rarely write any other notes (admit, discharge, procedure, etc.) as you will basically be in a clinic setting the majority, if not all, of your rotation. Remember to ask your preceptor for advice and how he/she wants things documented, and you should have no problems.

GradesYour grade will be determined from several components: the NBME exam, the final evaluation by your preceptor, and an oral case presentation,. The preceptor evaluations are generally high across the board. They are excited to have you and want to see you do well. Likewise, most people receive high marks for the case presentation. The variability arrives at the shelf exam; in Family Medicine, as in all L3 rotations, the shelf exam plays a huge role in all of your evaluations. Don’t stress out about it, but definitely take it seriously, as it is the usual denominator that separates Honors, High Pass and Pass for your final grade.

Case PresentationYou will have to present a case BRIEFLY at the midcourse seminar, for a grade. Pick something straight-forward and practice a 5 minute oral presentation before you come. You get points for keeping it short, for speaking clearly, for organizing the material appropriately, etc. Look over the check-list given by the course coordinator, and make sure you cover all that is required. Be familiar with the topic you choose as you may be asked questions based on your presentation.

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Site Specific Info

Family Medicine in Lake CharlesThe LSU Family Medicine clinic houses a residency program based in Lake Charles, so there you will work with several faculty members as well as residents. Reports are that everyone is super-nice and the clinic is top of the line and very well run, so it’s overall a very enjoyable experience. The clinic is primarily insurance patients, so you will get to see patients who actually control their medical problems, and you will also learn a great deal about the common everyday things you’ll see in a primary care clinic that we don’t learn about in lectures. The clinic uses EHRs which the faculty access on their laptops, so you don’t even have to write notes. You will work with different faculty and see different things depending on their area of specialty, such as Dr. Barootes (Sports Medicine) or Dr. Soileau (Adolescent Medicine). You will also have opportunities to participate in procedures such as colonoscopies, circumcisions, or I&D abscesses or cysts. Dr. Soileau also goes to the juvenile detention facility once a week, giving you the opportunity to experience medicine in the criminal justice system. The faculty are phenomenal teachers, and you will develop great physical exam skills you won’t learn anywhere else.

Recommended BooksThe department recommends Essentials of Primary Medicine, 4th ed. by Sloane, otherwise known as “the purple family medicine book.” It costs about $50 at the bookstore; however, very few people in our class used it. There are a couple of other books recommended at orientation that very few people actually buy. Boards and Wards is a quick read review book and has all the sections covered in Family Medicine.

The books frequently used include the NMS Family Medicine Q&A book and Family Medicine Casefiles. It was rated pretty well in the book survey. There is also a Blueprints Family Medicine, which a couple of people found useful, especially if you enjoy the Blueprints series.

This rotation, probably more than any other, is so general it is often difficult to find a good source to use. The NBME shelf test is somewhat difficult if you have it at the beginning of the year as it includes questions related to Internal Medicine, Peds, OB/Gyn, Psych, and Surgery. Those who rotate at the beginning of the year tend to do worse and those at the end of the year tend to do better, simply because they have gone through more rotations. However, they are all graded on a curve compared to other people who are in the same month as you, so it really doesn’t matter.

Miscellaneous Tips You are allowed to request the preceptor you wish to work with. You are likely to receive your request if you

have housing available (i.e. family) in the city where you request. This is a great opportunity to go home for a month if you are not from New Orleans. Many people choose the doctor that they worked with for AHEC or the one-week rotation during Christmas vacation of first year. However, you are not allowed to work with a parent or family member, per school policy.

The Family Medicine Department is very big into going to rural locations. Very few if any people get to stay in New Orleans, unless there are extenuating circumstances (i.e. really, just kids… BEWARE that husbands, wives, pets are not good enough for excuses to stay in town). Occasionally, people will be placed in Kenner or the West Bank, but very rarely in New Orleans or Metairie.

You can put in requests of where you want to be placed. E-mail the course coordinator Kristie Bellow .The earlier you go the better, at least 1-2 months before. As mentioned, having housing available is a huge plus and they can usually work with you if you do.

You will not find out where you have been assigned until approximately 2 weeks before you begin. It also helps to contact your preceptor beforehand, so that when the coordinator calls them to ask if they are willing to have you for the month, they can know you want to come, and hopefully agree to have you.

Relax. This rotation is generally one of the most laid back (other than Psychiatry). You are working with a preceptor that wants to have you there and you are getting one on one teaching. It is a great opportunity to improve your clinical exam skills and see a wide variety of patients and illnesses, no matter what specialty you choose to pursue.

Clerkship Coordinator Contact InformationThe clerkship coordinator is Kristie Bellow.

Dr. Herbert Muncie, hmunci@lsuhsc.edu, is the course director.

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Rural Track

Rural track students do all of their 3rd year clerkships in Lafayette at University Medical Center (UMC), except Psychiatry is at the Tyler Mental Health Unit a few streets down from UMC and Family Medicine can be done with a preceptor or at the hospital (Dr. LeBlanc can inform you of the options.) Other students from your class will also be rotating through UMC, so don’t feel so alone!

Books: a group of us decided to buy the books for our first rotation (since we would not be on the same rotation at the same time) and we swapped. In general, everyone at least bought the Case Files and Pretests. This usually works out since everyone stays in Lafayette. Regardless of what source you choose to study from, the best thing to do is questions, questions, questions, and reread texts (Kaplan/Qbank offer yearly subscriptions for STEP 2 questions which are great resources when studying). Ask your big buddies what they used or others you know who did well.

Medicine:Dr. Maximo LeMarche is the Chief of Internal Medicine. He is a nephrologist with his own Dialysis clinic, but he is the head honcho for Morning Report. In morning report, the team from on call the night before presents a patient they deem interesting or unique (teams only consists of residents/students currently doing wards). On a white board, they write everything from HPI, PMHx, PSHx, to ROS, PE, and labs. At times they may leave out pertinent information to not give away the diagnosis. The team goes through each section with interruptions from Dr. LeMarche, who asks questions of students and residents about what they think is going on. The idea is to foster learning by teaching the student to connect history with physical exam and labs and build differential diagnosis, eliminating from the list as pertinent negatives and positives are discovered.

Morning report begins at 7 am every morning (unless there is a known cancellation) and runs till ~8:30 am. It is supposed to end at 8:00 but as you will see, morning report can get a little crazy. Dr. LeMarche is a unique character and you need to have a good sense of humor!

Ward Rounds begin after morning report depending on your team and staff. Usually students round and write notes on their patients before morning report so they can help residents afterwards with anything before Staff comes to round. Rounds usually begin at 9 am if Dr. Hubbell is your Staff or at 10-11 am if Dr. Muthuswamy (pronounced Moo-Thoo-swahmee) is your Staff. Dr. Jaikeshen may begin rounds ~ 9-10 am as well. Sometimes rounds may occur after noon conference depending on if the Staff is on time or not. Just check with your team about what to do, where to be, and when to show up as a lot depends on your team as you will discover

Clinics typically last from ~8:00 to 12:00, break for lunch, and then start up again from 1:00 to ~5:00. When in clinic, it is your responsibility to get your attendance card signed each morning and afternoon shift. There is no mandatory amount of patients you need to see, as long as a staff person signs you out. Clinics are busy, but it’s a good chance to strengthen your skills in treating a paient.

Consults vary depending on what specialty you are rotating through. Your schedule is typically decided by the specific staff for that specialty. It’s best just to meet with your staff after morning report, and they will instruct you from there.

Mrs. Tonia Latiolais is the secretary for Internal medicine. All the other rotations run through the LSU Secretaries office, which is located down the main hall of UMC. The secretary’s office will give you instructions before each rotation and alert you to any paperwork you may have to fill out. You usually only have to fill out paperwork at the beginning since you do all your rotations at UMC. Mrs. Tonia will give you your schedule for medicine which lets you know what dates you are on what team and which residents and staff is on your team.Medicine subspecialties offered are pulmonology, cardiology, nephrology, infectious diseases, and gastroenterology. There may be more now. Check with Mrs. Tonia. Mrs. Tonia is your best source of help and information! She is very cool and willing to help. Ask senior rural track students for their perspective on the different subspecialties and other seniors who rotated at UMC whom you may know. On the subspecialties you are usually with one resident and the staff and the residents are usually cool and let you go early if there is nothing to do. Check with them about where to be and when because it may vary from your ward time, BUT YOU STILL HAVE TO GO TO MORNING REPORT AND NOON CONFERENCE!!!Call: on call Q 4 days and leave the next day after noon conference.

SurgeryGeneral Surgery is 6 weeks and is a lot more fast paced and longer hours but still can be fun! The head honchos are Dr. Chappuis, Dr. Frey (who is a transplant surgeon and has a private office; only see him for some lessons on Tuesday and in the OR if there are transplants or a private patient of his is having surgery), and Dr. Harkrider (very interesting man; the one you will see the most).

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Students are split into 2 teams. Mondays, Wednesdays, and Fridays are OR days. Tuesday is Surgery clinic ALL DAY and Thursday is Grand Rounds for residents and students, where residents present their scheduled surgeries for the upcoming week. This day is also student presentation day. Each student will present a surgical patient over the 6 weeks, so if you get a cool case, be there from start to finish, interviewing the patient yourself as you will be asked to present from HPI to surgery to outcome and Dr. Frey WILL ask you questions. So read up on your topic and understand everything from labs to the surgery. Thursday evening after lunch is Breast Clinic. Also, Tuesday and Thursday at 7 am, students have lecture given by a Staff or a Resident ranging from topics on Fluid and Electrolytes to Hernias.

Students have to see the patients before the residents. The students try to equally split the patients on their teams and often have to get there at 4:30-5:00 am to see them all and be downstairs in the OR for rounds which begin at 6:30 am as surgeries usually begin at 7 am. Check with your team for how they want things handled. The scrub nurses can be your best allies and if you want to do or try something don’t be afraid to ask. Work quick and smart and you should do fine.

The students decide amongst themselves which surgeries they would scrub in on depending on interest, availability, etc. We often looked at the upcoming surgeries after Grand Rounds and decided that way. Depends on who is on your team how you work it. As for call, we gave every student a weekend and then spread the rest of the days out as evenly as possible. The residents will also tell you how you can help them for Grand Rounds on Thursdays. Students usually spend the Monday – Wednesday gathering HPIs, labs, and pertinent radiology. This is a lot of work, but the group will get a rhythm. Requires EVERY student’s participation. Subspecialties: Cardiothoracic, Orthopedics, ENT. All are great. Depends on what you like.

OB/GYN:Dr. Fabacher and Dr. Nevils run OB and Dr. Elias runs GYN. You do OB for 3 weeks and GYN for 3 weeks. They do a good job at breaking down the schedule. It’s kind of hectic so I’ll leave it to them. The important thing is to keep up with all the stuff you have to turn in. On OB, just try to help as much as you can. On GYN, read the chapters given on Pelvic anatomy, etc because Dr. Elias WILL pimp you the last 2 weeks. He won’t ask anything the first week. Your big buddy will probably have a copy of the questions that Dr. Elias likes to ask. Surgery days for GYN are Tuesday and Thursdays. Clinic is all other days. For OB, deliveries can come whenever but C-Sections are usually on Wednesdays. The residents usually let you get in there and get your hands dirty if you ask.

Psychiatry:Pysch is 6 weeks at the Tyler Mental Health Hospital/Unit on Dulles Avenue/Street, a few 2 blocks down from UMC. This rotation is pretty laid back and the hospital staff is very nice. You only do inpatient. NO outpatient. Usually go in about 8:30 or 9 and see any new patients who need a HPI. It’s pretty simple as there is a yellow form to fill out and it’s pretty straightforward. After staff comes in and completes rounds, you’re free to go. Any questions, ask Joe or Jill the social workers and they will point you in the right direction.

PediatricsThis rotation is 8 weeks and will not yield the same experience as being at Children’s but don’t let that dishearten you. You have senior year to do your AIs at Children’s which really count. Dr. Howes is the head of the Pediatrics program at UMC and he is very intelligent and is specialized in behavioral and developmental issues in kids, i.e. ADD, autism, etc. There are a range of other pediatricians with who you will work. This rotation has THE MOST paperwork and stuff to turn in so make a system for how you will do it all and remember to turn it in at the appropriate time. Mrs. Debbie in the LSU Secretaries office is your main source of information and will help keep you on track. ASK questions anytime you need help. She gives you the schedule. Keep an updated copy in your white coat because it changes often! There are many clinics since the inpatient census is usually 1-2 patients, very low. There are no subspecialties either. You may have exposure to a few during the off-site clinic visits you will have, but that is just one day. Pay attention at the orientation and ask any questions.

Family MedicineThis rotation is 4 weeks. Goes by fast! You don’t have to do the orientation workshops in New Orleans at the beginning if you don’t want to. You can start at your perspective location. There are a couple of evals as well. Make sure to read the binder to make certain you get signed and turn in all you need. This section will depend on who you rotate with. Ask former classmates or seniors for advice accordingly. You also have the option of doing this rotation with the Family Medicine Dept at UMC. If you choose to stay at UMC instead of your preceptor, the staff will work to give you the widest variety of experiences possible – varying from sports medicine to hospice. It’s a great rotation if you want the full scope of family medicine.

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Mobile Devices

PDAs and smartphones can be very helpful during your junior year. You may use them to run medical applications or simply to keep up with members of your service as well as email. Purchasing a PDA can be daunting due to the many options. While there remain some standalone PDAs, most new devices have integrated phone capabilities.

Generally, you can divide PDA’s into four main categories: Palm, Windows Mobile, iPhone, and Blackberry. While Palm devices have been around the longest, the Palm operating system is antiquated. Palm recently released an updated version of its operating via the Palm Pre (currently available via T-Mobile; available from Verizon by 2010), but only time will tell if Palm’s slick new operating system lives up to the hype. Apple’s iPhone is really coming into its own and is able to run an ever increasing number of applications. Blackberry and Windows Mobile devices are also popular, though some students find Windows Mobile a bit klunky and difficult to use.

In terms of software, there are numerous applications including medical calculators, pharmacopoeias, pregnancy wheels, and much more available for the various devices. The following is a short list of mobile resources.

Epocrates Essentials : An integrated drug, disease, and diagnostic suite for mobile devices. While it normally costs $159 per year, LSUHSC-NO medical students can request a free license. You will receive an email with instructions on how to obtain your free license this summer. http://www.epocrates.com

USPSTF ePSS : Free tool allowing you to search and browse USPSTF recommendations on your mobile device. Currently supported for iPhone, Blackberry, Palm, and Windows Mobile. http://epss.ahrq.gov/PDA/

UpToDate : Evidence-based, peer-reviewed information resource for point-of-care. This resource truly lives up to its name. Updated quarterly, it contains thousands of “cards” useful for guiding diagnosis and treatment, as well as a number of patient handouts. A one-year student license costing $195 allows you to access UpToDate from any internet-ready computer in addition to installing it on your Palm or Windows Mobile device. While this would be a strong resource to carry around on your PDA, most students find the access to UpToDate provided by UH, EKL, and CH to be sufficient. http://www.uptodate.com

Etc : Check out Skyscape (www.skyscape.com), Thompson Clinical Expert (www.thomsonclinicalxpert.com) MerckMedicus (www.merckmedicus.com/pp/us/hcp/hcp_mobile_medicus.jsp), handango.com, palmgear.com, and medicalwizards.com (formerly handheldmed.com). You can also find tons of helpful information via the LSUHSC Mobile Software Portal: http://www.lsuhsc.edu/no/library/resources/guides/PDAdefault.html.

NOTE: While many students have found a PDA, particularly one with integrated phone capabilities, to be invaluable during the junior year, many have also relied primarily/solely on pocket references, e.g., Tarascon Pharmacopoeia. Before purchasing a device, we encourage you to consider not only the cost of the device and software but also the recurring cost of the service plan (including data), which can easily exceed $100 per month.

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L3 Resource Survey

When reading about your patients, as well as preparing for shelf exams, you will find there are numerous resources from which to choose. This survey conducted by the Class of 2010 is intended to help you choose. As always, it’s a good idea to talk to your big buddy and other students who have been there, and don’t panic! Leverage the study skills you have refined over the past few years. Are you the type of student who likes to use as many resources as possible, or do you prefer focusing on a limited set? Does taking notes while you read help? Some students find that doing as many questions as possible really helps while others focus on learning from books and patient cases. The best resources are those that work for you, but whichever you choose … start early!

The following survey results indicate how many students used a particular resource (in parentheses). If a student used a resource, they rated it from 1 (not useful) to 3 (generally helpful) to 5 (essential). Resources marked with an asterisk were not included in the survey but were write-ins by students who felt strongly about them. These results summarize responses from 152 students in the Class of 2010. We hope it helps!

Family Medicine

1.0

3.3

3.2

5.0

3.9

3.2

4.0

4.2

4.3

0 1 2 3 4 5

Saunders Manual of Medical Practice (1)

Appleton & Lange Review (3)

Essentials of Family Medicine (5)

*Pretest (7)

Boards & Wards (15)

Blueprints (27)

NMS Case Files (28)

USMLE World Step2 Q-Bank (47)

Lange Case Files (98)

Internal Medicine

3.5

3.0

4.0

3.5

4.8

3.4

3.7

4.1

3.3

4.2

4.4

3.7

3.9

4.3

4.8

0 1 2 3 4 5

Appleton & Lange Review (2)

Harrison’s Principles of Internal Med (2)

NMS Case Files (10)

Blueprints (11)

*Step-Up to Medicine (13)

Pretest (21)

Boards & Wards (26)

First Aid: Internal Medicine (28)

Cecil Essentials of Medicine (31)

Pocket Medicine (50)

Lange Case Files (56)

Internal Medicine Essentials (60)

Dr. Karam’s Review (66)

MKSAP for Students (103)

USMLE World Step2 Q-Bank (106)

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Obstetrics & Gynecology

4.0

4.0

3.7

4.2

3.4

3.8

4.4

4.0

4.5

0 1 2 3 4 5

Appleton & Lange Review (4)

NMS Case Files (7)

Boards & Wards (12)

First Aid: OBGYN (20)

Essentials of Obstetrics & Gyn (22)

Pretest (41)

Lange Case Files (84)

Blueprints (86)

USMLE World Step2 Q-Bank (100)

Pediatrics

4.7

3.7

4.6

3.4

3.8

3.8

4.4

4.3

4.4

0 1 2 3 4 5

Appleton & Lange Review (3)

Pretest* (6)

NMS Case Files (9)

Harriet Lane Handbook (13)

Boards & Wards (17)

Blueprints (61)

Kristen Nelson’s Review (86)

Lange Case Files (94)

USMLE World Step2 Q-Bank (99)

Psychiatry

4.2

4.5

3.7

4.2

3.9

4.2

3.8

4.0

4.4

4.4

0 1 2 3 4 5

NMS Case Files (5)

Appleton & Lange Review (11)

Boards & Wards (12)

DSM-IV Manual (13)

Kaplan & Sadock Pocket Handbook (23)

First Aid: Psychiatry (31)

Blueprints (35)

Pretest (40)

Lange Case Files (88)

USMLE World Step2 Q-Bank (91)

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Surgery

4.8

3.7

3.4

3.9

4.5

3.8

2.8

4.4

3.8

4.3

4.0

4.5

0 1 2 3 4 5

*Kaplan/Pestana Surgery Review (6)

Appleton & Lange Review (6)

Essentials of Surgery (17)

Boards & Wards (20)

First Aid: Surgery (22)

Blueprints (22)

Cope’s Early Dx of Acute Abdomen (25)

NMS Case Files (47)

Pretest (62)

Lange Case Files (79)

Surgical Recall (90)

USMLE World Step2 Q-Bank (103)

Electronic Resources

3.5

3.9

4.5

4.6

0 1 2 3 4 5

Skyscape (13)

MDConsult (35)

Epocrates (101)

UpToDate (123)

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Hospital Guide

University Hospital2021 Perdido StreetNew Orleans, LA 70112

ORIENTATION: University Hospital is located on Perdido Street between South Johnson St. and South Prieur St., caddy-cornered to the third student parking lot from the MEB. You can enter through the front doors or the ER 24 hours/day. Be sure to have your LSUHSC ID at all times. The basic set up is an East and West side planned around a central set of elevators.

IMPORTANT LOCATIONS:8W --- Hospital Wards, some OB/Surgery/Medicine8E --- Social Workers7 --- Medicine/Surgery7E --- Also dialysis6E --- Medicine/Surgery Wards 6W – Short Stay Surgery5 --- Hospital Wards, Surgery Morning Report Room4 --- Hospital Wards, bridge to Seton building, lab and microbiology3E--- NICU, well baby nursery 3W--- Labor & Delivery, postpartum service2 --- OR, SICU, MICU, cath lab, cards recovery, Medicine meeting room with computers1 --- ER, PER, Radiology, DTD, File Room, Cardiology/Echo reports, Lost & Found, Call Rooms, Resident loungeBasement --- Medicine Morning Report Room, Conference Rooms, Residents Lounge, Cafeteria, FREE copier in purchasing deptOB/GYN Clinics – located cattycorner to UH on the corner of Perdido and S. Johnson

CONVIENT CODES: (these codes are subject to change, ask your residents!)NICU --- turn handle once, then 99-88-77, wait for beepPeds Call Room –- ask your residentsOB Call Room (3rd Floor) – 215

WHAT TO EXPECT: University is very similar to Charity in the personnel and daily operations. Unlike Charity, however, all of the patient’s vitals are located in their chart so you don’t have to go on a wild goose chase every morning. Computers are easily accessible and the building itself is easy to navigate.

A QUICK GUIDE TO MCLNO COMPUTERS:As a 3rd year student, one of your most crucial roles as a member of the team is to look up labs and radiology reports on the computer system. The purpose of this guide is to give you some quick written instructions for your first couple of days/weeks of 3rd year. You are going to use this system ad nauseam throughout the year, and you will eventually get the hang of it and learn more of the tricks to find exactly what you need. If you need any help with the computers, ask your residents, interns, 4th years, they will always help you. The computers can be found on any ward or clinic in a centralized location for quick access. You can connect to the network at any MCLNO component facility using your LSUHSC login and password.

The CLIQ (Clinical Inquiry) system is used at MCLNO. This computer program will allow you to check labs and reports on all of your patients; it is specifically designed for clinician use. You will receive training to this program during registration, but to log on, simply use your LSUHSC username and current password. Every floor of UH has computers at the nursing stations which are available for your use in the mornings.

RADIOLOGY FILMS:The computer based radiology viewing system (PACS) is used at UH, Charity, and the VA. Films can only be accessed on certain computers at UH, but the report from the radiologist will appear on CLIQ when completed.

PHONE CALLS:

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In house calls at University/Charity - dial "2" then the last four digits; off campus, dial 9. The prefix for the hospital is 903. Cell phones are not supposed to be used in the hospital – do what you wish but don’t talk on cell phones while your staff and residents are standing there watching you…bad form.

Earl K. Long Hospital5825 Airline HighwayBaton Rouge, LA 70805

ACCOMODATIONS: Fountainhead Apartments, 1221 Bob Pettit Boulevard. Baton Rouge, LA 70820-3098. (15-20 minutes away from EKL with no traffic). The apartments have a pool and laundromat. Usually students will share an apartment with one or two others.Apartments are furnished but consider bringing the following items:Bedding – sheets (single and full) because some apartments have single and some full beds, pillows and blanket.Bath – towels and toiletries – shower curtain is providedKitchen – plates, utensils, cups, microwave Miscellaneous – TV, radio, light bulbs, most apartments have a phone but you may want to bring one just in case, local calls are free.

HOSPITAL: Directions will be provided to EKL from the department sending you to BR. There is a library with computers and copier open 24 hours adjacent to the hospital. Connected to the library is the resident’s lounge with coke machine, cable TV, phone and sofas. Morning report, conference, and lectures are held in the LSU Building adjacent to the hospital.You can make free long distance calls from the hospital by calling the operator and asking for a link line

IMPORTANT LOCATIONS:1st floor – Cafeteria, ER, labs, OR, hospital administration, scrubs/linens2nd floor – ICU, medicine wards3rd floor – OB/GYN Labor and Delivery, OB call room, NICU, well baby nursery4th floor – medicine wards5th floor – peds, call rooms, dialysis

Lafayette – UMC2390 West Congress StreetLafayette, LA 70506

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ACCOMODATIONS: The living accommodations in Lafayette are at Bayou Shadows, an apartment complex located across the street from UMC. They are clean and NOT in the ghetto. Most rooms are one-bedroom apartments with one bathroom, a living room and kitchen with a fridge and stove. It’s furnished with a bed, nightstand and dresser, a small dining table and a sofa. Phones are not provided anymore, so make sure and have a cell phone. The apartments have a Laundromat (bring quarters!). Be sure to bring along a TV, bed linens and towels, a shower curtain, bed covers and flip-flops for the bathroom (or cleaning supplies?). There are plenty of coffee shops and bookstores, restaurants, a large shopping mall, and places downtown and throughout the city to go out at night. There’s an enormous workout facility in Lafayette called Red’s, which has indoor and outdoor tennis courts, racquetball and basketball courts, indoor and outdoor pools, aerobics, coed and women’s-only weight rooms, and areas where you can sit and read or watch TV. Many residents are members there. There are also any number of great restaurants to try – just ask around.

HOSPITAL: The cafeteria, on the first floor near the main entrance, is open for breakfast and lunch (closes at 1pm!!). Meals are reasonably priced. The call room is a trailer behind the hospital with satellite TV and a refrigerator. OB-GYN has a call room on the 3rd floor in the L&D unit. CLIQ works here as well – but you must change the bar at the top to University Medical Center or the patients won’t come up.

CODES: Medicine Call Trailer: press 2 and 4 simultaneously then 3Library: 1261 followed by a *Floors: press the floor number then 261

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Children’s Hospital200 Henry Clay AvenueNew Orleans, LA 70118

TRAVEL: Children’s Hospital is located at 200 Henry Clay Ave, approximately 5 miles from LSUHSC (school). The hospital spans 2 blocks, from Tchoupitoulas to the river. With traffic, construction, and school zones along S. Claiborne and the side streets, make sure you give yourself ~30 minutes to get back and forth between the school and hospital – it often takes this long!

PARKING: (2 options)Coming down Henry Clay, heading toward the river, cross the railroad tracks and park in the big lot just beyond the tracks. Beware, trains pass frequently, and students have been late. The security is crazy anal so don’t park in lots that are blocked by orange cones and in the first lot to the left park beyond the orange cones. They will literally come after you if they don’t like where you’ve parked.

IMPORTANT LOCATIONS:Acute Care Center Pediatric clinics are held here. This part of the hospital is on the corner of Henry Clay and Tchoupitoulas and connects to the rest of the hospital on the 1st floor. Take the Yellow elevators to get to the upper floors of the ACC.Room 308.

Hospital Floors6th, 5th, 4th, 3rd Wards (Blue Elevators)6th PICU (Red Elevators)5th NICU (Red Elevators)4th Heme-Onc (Red Elevators)4th Conference room, resident call rooms2nd Surgery Pre-Op1st OR/Recovery Room/surgery lounge (clean scrubs are in locker rooms down hall) ER (by red elevators),

Radiology (little hall by OR), Spinal Unit, Cafeteria

FOOD: The cafeteria offers a resident discount where you can get up to $4 worth of food for only $1.50. Students may get this discount, too: take off your student ID and answer “Yes” when the cashier asks if you’re a resident (chief residents say it’s okay to do so!). In the mornings, the 1st floor surgery lounge and the ACC Morning Report room often have assorted breakfast items, such as fruit, bagels, danishes, muffins, juice, and coffee.

COMPUTER SYSTEM AT CHILDREN’S HOSPITAL Ask your residents for their ID and password to get into the Lab and Radiology Systems.

Ochsner Hospital1514 Jefferson HighwayNew Orleans, LA 70121

TRAVEL: The hospital is located at 1514 Jefferson Highway (from school, continue down South Claiborne, which will turn into Jefferson Highway). The hospital will be on the left. The individual departments will give you instructions for the first day, regarding parking, food, and location.

The satellite hospital (for psychiatry rotations) is in River Ridge/Harahan. From LSU, take Earhart Blvd. all the way to the Clearview exit. (Like you are going to the Palace Movie Theater). Go south on Clearview towards the Huey P. Long Bridge. There will be a Home Depot on the right and you will see the hospital across Clearview on the left. Take the first U-turn and the hospital will be on the right. If you live in other parts of town, you can also get there from I-10 exiting Clearview south or from Jefferson Hwy. (Claiborne) going north on Clearview. There is free parking in the garage. The psych ward is on the third floor behind the elevators. If you cannot find the door, just ask someone. Buzz the nurses station and identify yourself, and they will let you into the ward.

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WHAT TO EXPECT: On the first day, just park in the visitors’ garage. Donna in Graduate Medical Education, located on the 6th floor of the Brent House, will give you an orientation on the first day and validate your parking for that day. Bring $10 cash for a gate key deposit, which you will get back the last day of your rotation when you turn in the gate pass.

Tyler Mental Health Center302 Dulles DriveLafayette, LA 70506

Located about 4 minutes from UMC in Lafayette. Turn right out of the UMC staff parking lot. Turn left on Dulles. Tyler is on the right side. Park in the front lot.

Your first day, there is usually a teleconference orientation. After that is finished, ask for Dr. Diggs or Dr. Strauss

You will spend your rotation on the locked in-patient ward on the first floor. You will have to buzz in and have the security guard let you in until you get a key. Once you get a key, you can come and go freely.

Baton Rouge General Hospital3600 Florida BoulevardBaton Rouge, Louisiana 70806

PARKING: There is an employee parking lot on the right of the hospital and a parking garage on the left that students can park in. There is also a doctor parking lot in front of the hospital in which students have been allowed to park. It requires a code that you can get from your residents the first day of your rotation.

IMPORTANT LOCATIONS:Hospital Floors5th floor—Surgery patient rooms4th floor—Burn Center—take a right off the elevator, go through the double doors and take the first left2nd floor—OR’s, pre-op, SICU—take a right off of the elevator. Just before the double doors you will see two rooms. The first is pre-op and the second is the doctor’s lounge where the residents typically meet in the AM. The boys locker room is inside the doctor’s lounge (scrubs, booties, masks, etc). The women’s is through the double doors to the immediate left.1st floor—Doctor’s cafeteria immediately to the left off of the elevators. Library on the right hand side (has copy machine typically opens between 7-8AM), Radiology, ER

FOOD: Free breakfast and lunch are provided in the doctor’s lounge daily. There is also an employee cafeteria on the first floor which you will have to pay for. There is a Subway on the first floor also.

VA Hospital of New Orleans (has not been updated post-Katrina)1601 Perdido StreetNew Orleans, LA 70112-1262

ORIENTATION: The VA Hospital of New Orleans is located across the street from the Charity ER ambulance ramp. You can enter via the VA’s ER or clinic entrance on Gravier Street or the main entrance on Perdido Street. ALWAYS HAVE YOUR ID WITH YOU AT THE VA, otherwise they will not let you in!

The OR suites, SICU, and Recovery are all located on the 6th floor. Take the main elevators up and there you are. A very quiet library is located on the 2nd floor at the front (Perdido St. side) of the hospital.

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The various VA clinics are scattered around the hospital; just follow your residents. The cafeteria is located on the first floor, main hallway. No special discounts or tickets here, just grab your food and pay!

ROTATIONS: 1. Medicine PM&R Consult Service

WHAT TO EXPECT: In general, the VA is a good place to do a rotation – especially if you have spent every waking moment at Charity or University. The main building is old, but well cared for. There have been numerous additions to the main building over the years and this has created a maze of hallways making it easy to get lost. Never fear, just keep the main elevators in mind, and you can always find your way around. The wings are lettered “A, B, C, D…” and it would be a good idea to spend a few seconds looking at the map in the lobby.

COMPUTERS: As a government institution, the VA is run a bit differently than other hospitals. One difference of importance is their computer system. All progress notes go on the computer system! Bottom line: no chasing after charts!! But, you will have to wait for a computer terminal, as everyone tends to write notes at the same time. One wrinkle to this rosy picture: your LSU NT logon IDs and passwords are useless at the VA, so you must sign up for a VA logon ID and password. The code you will receive is necessary for writing progress notes on patients and it acts as an electronic signature. The surgery department will tell you where to go for this service – do it before you start if possible because it takes a couple of days to go into effect. Once you are there, inquire about an informal orientation to the computer system…you never know what you might get until you ask!

Included For Nostalgia:Charity Hospital1532 Tulane AvenueNew Orleans, LA 70112

ORIENTATION: Charity Hospital is located on Tulane Avenue and covers almost the entire city block. The rear entrance houses the E.R. and faces Perdido street. The East side faces Tulane Medical School. You can enter from all four sides, but the security requires that you must have your ID.

The basic layout of CH is an H-shape. The side located closest to Claiborne/LSUHSC is the “West” side and the side closest to the Quarter is the “East” side. For completeness sake, everything else is in the “Center”. Room numbers and clinic locations are referred to by a letter and number (i.e. E228).

There are 3 sets of elevators, E, C, and W. E & W are restricted elevators and don’t go to the 3rd floor (Psych) or past the 12th floor. C elevators are always open and go everywhere.

IMPORTANT LOCATIONS:16 Center Student call rooms for Trauma Surgery rotation14 Center Resident’s Call rooms, Resident Lounge 12 Center OR, recovery/holding East Delgado side = surgical suites, amphitheater for Grand Rounds West Miles side = surgical suites9 West Infectious Disease ward8 One Day Stay

E

C

W

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7 East Blue Room - where all radiology films are stored for inpatients

Neurology patient beds6 West MICU4 Center SICU and SICA (surgical step down unit)3 Center Crisis Intervention Unit (CIU) = Psych ER East/West Psych inpatient wards2 Center GI Scope and Clinic East urology clinic, peds clinic, medicine subspecialty clinic1 Center Admit, ER, Fast Track, MER West Medical Records East Outpatient Radiology, U/S Basement Cafeteria, Morgue

CONVIENT CODES: (these codes are subject to change, ask your residents!)14 Center -- Resident Lounge = 3+room # backwards)East and West Elevator (to get to floor 12) = press #12 then 1-1-2 You will need to swipe your id when entering the west side of Charity from the TAV.

WHAT TO EXPECT: CHNO is intimidating at first, but easily manageable. The most important thing to remember: the nurses can be your biggest ally or your worst nightmare, so make friends with them early on. Use them to your advantage because most have been there a long time. Each patient has their own chart with progress notes, H & P, lab results, etc. There will also be a vitals chart or clipboard on each floor that contains pertinent info for all the patients on that ward.The chart should contain all the info you need to make patient lists for the team, write progress notes, and round with staff. If something is missing, ask a nurse or resident for help.

Example “Blue” Patient CardNumber at top left is some random billing number.Top Right is Medical Record Number (MOST IMPORTANT).Middle: Name, DOB, and Date of Admission/Treatment.“L” means that the patient belongs to LSU (not TULANE).Bottom Right denotes race, gender, type of insurance (or not).(ex. Hispanic, Male, Free care)

**Remember to stamp pages with this card when adding progress notes or orders to the charts.

5634678 90658649

Blow, Joseph4/15/1970 6/16/03

L H M F

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