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Tao T. Le, MD, MHSAssistant Clinical Professor
Chief, Section of Allergy & ImmunologyUniversity of Louisville
Senior EditorFirst Aid Board Series
USMLERx Test Bank Series
First Aid for the Wards:The Really Short Version
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Overview
Common Ward Mistakes The Team A Day on the Wards The Admission Key Tasks Survival Tips Getting Off to a Fast Start Q&A
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Common Mistakes
Not understanding roles, responsibilities, expectations
Not seeking timely feedback Not using appropriate texts and
references Not knowing how to be a team
player Inefficient organization and
execution of daily work
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The Team
Attending/Chief Resident Intern Sub-intern Nurse Ward clerk Pharmacist Other staff You
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Typical Inpatient Medicine Day
Prerounds: 7-8 am Work rounds: 8-9:30 am Work time: 9:30-11 am Attending rounds: 11-noon Conference: noon-1 Afternoon work: 1-? Signing out
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Typical Inpatient Surgery Day
Prerounds: 5-6 am Work rounds: 6-7:30 am Preop prep: 7:30-8 am Surgery/floor work: 8-5 Conference: noon-1 “Afternoon” rounds: 4-5:30 Postrounds work: 5:30+?
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Taking Call
Overnight call Short call Typically Q4
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The Admission
The “Call” Reviewing objective data Medical record review Interviewing the patient Physical exam Putting it all together Reviewing case with the
resident/intern
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Key Notes and Orders
Admit orders Admit to Diagnosis Condition Vitals Allergies Activity Nursing orders Diet IV fluids Medications Special studies Labs
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Key Notes and Orders
Admission notesOnset Progression Provocation PalliationQualityRegionRadiation Symptoms Severity Time course
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Key Notes and Orders
Progress notes Procedure notes Daily orders Prescriptions/DC orders
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Documentation Tips
Get everything co-signed Date/sign all pages No documentation = no
reimbursement Illegibility = no documentation Use only appr. abbrev.
“q.d." vs. “q.i.d” vs. “once daily” To CYA, never CYOA!
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Oral Presentations
Formal presentations 5-7 minutes (surgery: 2-3 min.) Should tell a storyCC/HPI/PE/Labs sets the stage A&P delivers the climax
Bullet presentations 1 minute 15-20 facts
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Daily Ward Activities
Procedures Patient/family
communications Consults Data collection Reading up on patients “Walking supply cart”
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Survival Tips
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Efficient Time and Patient Management
Commit all tasks to a to-do list Prioritize tasks Organize tasks by location Maximize hospital information
system Keep “scut” essentials on board Always be early!!
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Organizational Aids (“Peripheral Brains”)
Clipboard Binders Data sheets Note cards iPhone/iPad/Android
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Evaluations
Critical for dean’s letter Know the evaluation criteriaClinical performanceShelf exam?
Know who is evaluating you Clarify expectations Ask for feedback early on
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Difficult Situations
Needlesticks Abusive/inappropriate house
officers Inappropriate procedures “Gunner” classmates Patient death Sexual harassment
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Difficult Situations (cont.)
Difficult/violent patients Difficult family members “Narcolepsy” Personal/family illness
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Getting Off to a Fast Start
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Scheduling Rotations
Avoid most likely specialty in first/last block
Avoid back-to-back tough rotations
Do easy rotation before desired specialty rotations
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Choosing Rotation Sites
County VA Academic/university center Community/private hospital Outpatient clinic
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Before the Rotation
Classmates FA Wards specialty chapter FA USMLE Step 2CK FA Step 1 relevant content FA Wards recommended
pocketbooks/texts/software
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Your “Secret Weapons”
Enthusiasm/hustle Time Basic science knowledge “Low” expectations