Brittany will give you a weekly schedule of your assignments.  The assigned "students for rounds" will pre-round and write notes at 5:30am on in-patients, then meet at the L&D board at 6:30am.  After board sign-out, you will round with the attending and he/she will sign your notes.  You should know everything about your patients!  Be prepared to present and answer questions.

Night shift student duties:  The daily progress notes are in a template form.  During the night, you need to record on each post-op (post cesarean) note the meds, labs, and vitals.  This should be done by 5:30am.  At about 5:30am, your fellow students will arrive and see the patients and finish the notes.

Women's Health Clinic:  Make sure the 1st prenatal visit sheet is filled out as completely as possible.  When presenting to the attending, make sure you have the 1st prenatal visit sheet out for them to see.  Keep the problem list updated.  All exams need to be chaperoned. 

"TIPS FOR STUDENTS" by Dr. Myers, DO rotating at ARMC (2006)

TIPS FOR STUDENTS:

Just some things that I wanted to mention but haven’t had the time to share with the students.  You can read or ignore this if you like…there will not be a test.  And this is not directed at any particular student, but may help some people who are new to the service.

1. I was a student and know what its like.  It’s hard to be able to show your knowledge, etc. What helps is having a complete note because it reflects on your care and shows your thought process.  So I would suggest that you make sure everything is complete.
1. Urine outputs, and best to document cc/hr(or cc/kg/hr), although I know with new charting system on computers this is difficult to figure out.  I sometimes I have trouble figuring out the nurses’ system.
2. Vitals, and include ranges if indicated.  Ex.  If patient has BP issues, what are the systolic ranges/diastolic ranges.  Temperature max’s if indicated, etc.
3. Time, date and sign your notes.
2. Important to ensure that prenatal labs and PPD’s have been ordered if indicated and documented if necessary.
3. If patient is on antibiotics, document “Day 2” or whatever day of antibiotics they are on.  You’ll need to do this on most services, not just OB/Gyn.
4. Document whether patient has staples or subcuticular sutures, but most students are doing that now which is great.
5. Please make sure stickers are on the note.
6. If Blood Sugars are needed, document, or print out from EMR.
7. Don’t forget that most physicians look at Assessment and Plan to see what your recommendations are so it’s good to summarize this and please include all pertinent information in any format that you are used to or feel comfortable with.
1. Example:  (some do it all in a nutshell like below & some based on

individual assessments.  Find out what works for you.)

                                                               i.      A/P:  33 y/o G10P10 at 38 wks s/p repeat C/S POD #2 with history of syphilis

1.      Encourage ambulation

2.      Encourage Incentive Spirometry use

3.      Continute post-op care

4.      BTL in future(consent signed 10/3/05) and refuses other postpartum contraception

5.      F/U FTA-ABS for VDRL

6.      Read PPD on 10/6/05

8. FYI:  Your note is a communication of your care to other providers and to yourself in the future, so if you need to remind yourself to do something the following day you can always put it in your plan so that you, or someone else, can see your intentions.
9. Some patients have medical problems that they came to the hospital with so you can also address these if you wish and it’s good practice.  If someone had gestational diabetes/hypertension during pregnancy, do you want to start/stop a medication?, do you want them to have certain follow-up and when?.  These are things to consider and will help make you a better physician because you will always be thinking about “what to do next.”
10. If a patient is POD #3, you can ask them if they would like to go home and if so you can document in your note…”Patient wants an early discharge.”
11. If you see something that needs immediate attention while you are seeing your patients in the morning, whether this be on OB/Gyn or another service, don’t hesitate to ask the intern/resident.  Maybe a test needs to be ordered stat that way it will be back in time for rounds.

I remember being a student and how easy it was to get in the habit of becoming a subjective/objective information gatherer for the attending physician, but if you can start thinking about assessment/plans early on during rotations and asking yourself questions like “what would I do next” or “what else does this patient need?” you’ll be ahead of the game.  Keep these things in mind but don’t dwell over them too much because especially as a MS-III, its important to become proficient at history taking and the physical exam, but as much A/P stuff that you can pick up along the way, the better.

If any of you have any questions, about this stuff or other stuff, just catch me in the hall or page me.

Kirk Myers, DO

(Do not page me at 3:00am).  J