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Through t he L ooking G lass: Transitioning from Student to Practitioner

Through t he L ooking G lass: Transitioning from Student to Practitioner. Abha Khandelwal MS, MD Rush University Medical Center Department of Cardiology. My Background. CWRU Weatherhead OSU Rush Medical Center. Location Population Density Hospital Density Legal Density.

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Through t he L ooking G lass: Transitioning from Student to Practitioner

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  1. Through the Looking Glass: Transitioning from Student to Practitioner Abha Khandelwal MS, MD Rush University Medical Center Department of Cardiology

  2. My Background • CWRU • Weatherhead • OSU • Rush Medical Center

  3. Location • Population Density • Hospital Density • Legal Density

  4. Private vs. Academic • Less direct access of patients to Attendings. • More standard management strategies • More access to physicians with sub-specialized interests • Conferences where complicated cases can be discussed in a multidiscplinary fashion. • Allowance in time devoted to research and academic pursuits. • Established relationship amongst practioners • More variability in management strategies • More ancillary services • Established relationship between patient and pracitioner

  5. Adapt Attitude Acknowledge Success Apply Appreciate Abha’s 5 As

  6. So I start my first day… • Admit patients • Cross cover • Write orders • Communicate with RN • Write notes • Obtain medical records • Perform procedures • Run codes • Talk with families • Follow up on test results • Arrange Dispositions

  7. Adaptability/Efficiency • At home: • Schedule: Plan ahead • Outsource: When possible • Hobbies: Continue them • At work: • Organizing Data • H&P • Cross cover • Sleeping • Eating

  8. Be a Cheshire cat

  9. Adapt Attitude Acknowledge Success Apply Appreciate Abha’s 5 As

  10. Who are you????

  11. Doctor Pharmacy Nurse Patient Care Tech

  12. Nutrition Delivery Volunteers Pharmacy Wound care Nutrition NP Primary physician intern Nurse student resident fellow CNA PT/OT Specialists fellow fellow Transport Social Work techs Phlebotomy Radiology housekeeping RT

  13. Intern/Med Student • Accumulate data • H&P • OSH • Identify dangerous situations • Learn basic principles • To be a scapegoat

  14. Life of an Intern • AMI • SBO • DKA • Sepsis • GI bleed • ACLS/PALS • BM • BS • Pain • BP • Nausea • Insomnia

  15. Resident • Comprehend the clinical situation of the patient being managed • Master procedural/Exam/diagnostic skills • Manage dispo and social issues for the patient • Teach the intern/medical students • Keep charge nurses informed

  16. Attending • Manage the complex care teams that are involved in managing a patient • Ensure patient safety • Ensure education for all levels of the team

  17. Manage expectations • Set expectations at the start of month • Review progress in middle • Summarize at the end

  18. Adapt Attitude Acknowledge Success Apply Appreciate Abha’s 5 As

  19. How do I fix this? • A Give 80 meq of potassium • B Give insulin • C Do nothing this is normal • D Give hypertonic saline • E None of the above 124 100 29 400 13 1.0 2.6

  20. Apply • Talk to colleagues who have done the rotation. • Use evidence based medicine to guide you management decisions. • Websites: • www.uptodate.com,www.asco.org, www.shfm.org, www.scutwork.com , www.nejm.orgwww.idsociety.orgwww.cardiologysite.com, www.acponline.org, http://www.medicalstudent.com/#Handheld , www.medscape.com/

  21. CHF • Seattle heart failure model • Chads2 • TIMI Risk calculator in STEMI/NSTEMI • Ekg guide

  22. SHFM http://depts.washington.edu/shfm/macosx.php

  23. MICU • Understand • Acid/base • PNA hospital score • Score for sepsis for Activated protien C • Ventilator extubation criteria • Electrolytes

  24. Application • Rounds: • Identify pertinent information • Learn to group things together • (meds, labs, sx) • Synthesize a cohesive management plan based on guidelines • Procedures: • Know the indications and potential complications • Research: • Case Reports • PubMed: gastric massage

  25. Application • Heme/Onc: • Neutropenic fever, transfusion thresholds, oncologic emergencies • ID • Sanford, travel hx, antibiotic hx, immunizations • Surgery • Ileus, nutrition, anatomy, bm, pain control • Pediatrics • Milestones, congenital syndromes, embryology • Renal • Electrolytes, urine sediment, nephrotic, vs nephritic.

  26. Abha’s 5 As Adapt Attitude Acknowledge Success Apply Appreciate

  27. Patients are MAD

  28. Attitude

  29. In Summary

  30. In Summary • Adapt: and be efficient • Acknowledge: and learn your role in the team • Appreciate: and be respectful to all members of the team, understand their perspective • Apply: book knowledge into practical/clinical knowledge • Attitude: Stay positive

  31. Questions?

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