Survive and Thrive in Clerkships and Clinical Work with Dr. Tanner Schrank

In this special episode, your host Dr. Tanner Schrank walks through what clinical clerkships are like for senior medical students. Using the AMBOSS Clerkship Survival Guide, he explains what each clerkship entails and the top 10 topics to prepare for to ensure success on the wards. Stay tuned until the end to hear how to write a patient note and a real example of a daily progress note!

If you like this style of episode and want more, leave us a 5-star review wherever you get your podcasts or send us a comment! 
 
AMBOSS Clerkship Survival Guide: https://www.amboss.com/us/knowledge/clerkship-guide/
AMBOSS Blog "How to Succeed in Your Clinical Clerkships":  https://blog.amboss.com/us/how-to-succeed-clinical-clerkships-amboss
AMBOSS Clinician Mode: https://www.amboss.com/us/students/clerkships 

Sign up for a free 5-day trial at https://go.amboss.com/pod-5day-trial. 
Read more at the AMBOSS blog: https://go.amboss.com/blog-ambosspod. 
Find out more about the AMBOSS podcast: https://go.amboss.com/int_podcast-23.  

Transcript

Tanner (2) 0:22

Hello, and welcome to this episode of the AAN boss podcast beyond the textbook. I'm your host today? Dr. Tanner shrank. And today in this special edition, we'll be walking through. The am boss clinical clerkship guide. To make sure that you're fully prepared for all of your different clerkships in the different wards. And. So that you can feel more confident in seeing patients. we'll cover the different clerkships that you can expect to find yourself in during last couple of years in medical school. We'll cover the top 10 topics for each of those clerkships to make sure that you're fully aware of what you need to know before. Getting on the ward. We'll take a look at how to write a patient note. And we'll see an example of a daily progress note. So. If you aren't in your clerkships yet, just a brief background on them. In the us and other countries with four year medical programs. Usually the last year or the third year is spent. between different wards, like internal medicine, surgery, pediatrics. spending between four and 12 weeks in each clerkship. Actually getting taste for what it's like to be on the medical team, to. Participate in inpatient care and outpatient care. And under the supervision of. Professors or preceptors or attendings. You get actual Hands-on experience. So in other places in six year programs, this is classically the last year or even the intern year after graduating, either way, we'll call this your clinical year in the wards. So, what you need to prepare for is Seeing patients, we call this pre-rounding and then rounding. You need to prepare to. Write up a patient note after you take a history and physical. And then usually your preceptors or attendings will ask you to present your patient. To the team, Would you can use your notes to prepare for. Sometimes you'll be able to place orders for your patients, or at least you can weigh in on what you think would be the best treatment options. Sometimes you have to do an overnight call duty And You might need to be evaluated with an exam. At the end or during your clerkship as well. So all of this is covered in the clerkship guide. Along with some very helpful ambitious study plans at the end. So we'll put a link to that in the description. So you can follow along or follow up after listening to this episode. now. We'll dive into the different clerkships. First up internal medicine. Typically, this lasts for eight to 12 weeks. your work will be inpatient. And. It can be anything from acute to chronic diseases among adults. The top 10 topics, you need to make sure, you know, To feel prepared would be diabetes mellitus. Acute coronary syndrome. Congestive heart failure. The ECG. Hypertension anemia. Pneumonia. Chronic obstructive pulmonary disease. Asthma and an overview of antibiotic therapy. So in this clerkship, you'll usually. Learn how to take a history and physical. You'll establish diagnoses. You'll see everything from diagnostic tests, ECG lab values. All kinds of imaging and you'll usually be able to. Assist with or perform actual procedures like placing lines. Or performing third coast and TCIs things like this. Next we have the pediatrics clerkship. This is usually shorter four to eight weeks also. It is usually inpatient care. But the skills are a little different because there are pediatric patients. You still need to know how to take a physical and a history. For newborns, infants, children, and adolescents, you'll also get to assist and perform procedures, established diagnoses. And the like, But the top 10 topics for this clerkship would be immunization schedule. Child development and milestones. Asthma. Rheumatic fever. A cyanotic, congenital heart defects. Cyanotic congenital heart defects. Congenital immunodeficiency disorders. The newborn infant. Congenital torch infections. And inborn errors of metabolism. Next up is neurology. Usually about a month, four weeks. You'll perform neurological examinations. You will also have to interpret neuro imaging studies. And you might even be able to assist in the lumbar puncture. It's important to know clinical neuroanatomy. And. All of the pharmacology that comes with neurology. Your top 10 topics would be overview of stroke. Neurological examination. Meningitis. Seizure disorders. Multiple sclerosis. Neuro cutaneous syndromes. Brain tumors, major neurocognitive disorder. Cranial nerve palsy. End. GBS or go in Bahrain syndrome. Now we come to psychiatry clerkship. This is four to six weeks. Usually you have to be familiar with the DSM five criteria in order to diagnose these disorders. You should know the mechanism of action Of any prescription drugs that will need to be prescribed. And there are side effects and signs of abuse. You'll also need to practice building a rapport with the patient and their family and work on your professionalism, And empathy. The top 10 topics for this clerkship are antidepressants. Anti-psychotics. Psychotherapy and defense mechanisms. Major depressive disorder. Bipolar disorder. Anxiety disorders, schizophrenia. Alcohol related disorders. Substance related and addictive disorders and suicidality. Now we move on to obstetrics and gynecology, clerkship, OB GYN. Four to eight weeks usually. Again, you're seeing inpatients. You can also be outpatient. You'll be Taking a history of a pregnant person. Reading and evaluating results of diagnostic tests when it comes to the fetus. Performing pelvic and breast examinations Practicing your suturing and knot tying skills. And. Preparing for complications of pregnancy and childbirth. So the top 10 topics are prenatal care. Pregnancy. Hypertensive pregnancy disorders. Childbirth. Congenital torch infections. The menstrual cycle and menstrual cycle abnormalities. Benign breast conditions. Breast cancer. Cervical cancer. And ovarian tumors. We move on to the surgery clerkship. Eight to 12 weeks, usually. You will practice all that comes with surgery, obtaining a full medical history and physical before the operation. one of the most important things you'll need to practice is how to scrub in. And. Learning about sterility and maintaining a sterile field. will, of course assist in surgeries, whether that's suturing. Retracting guiding laparoscopic cameras. And you'll need to know. Common acute and chronic diseases that require surgical evaluation. The top 10 topics that you should prepare for would be skin and soft tissue infections. Acute abdomen. Cola diocese. At diocese Cola status and Colin Jadus. Bowel obstruction. Acute appendicitis. Diverticular disease. Colorectal cancer. Gastric cancer. inguinal hernias. And thyroid cancer. And finally we come to the family medicine clerkship. which usually lasts about four weeks. This one you'll need to practice in depth, how to counsel. Individual patients and their families. And you might assist and perform small procedures. But mostly you'll need to. Prepare for. all kinds of acute and chronic diseases. Preventative measures and health maintenance. Your top 10 topics for this clerkship. have some overlap with the previous clerkships. They are diabetes mellitus. Overview of antibiotic therapy. Congestive heart failure. Pneumonia. Breast cancer. Anemia. Hypertension. Chronic obstructive pulmonary disease. Asthma. And the menstrual cycle and menstrual cycle abnormalities. Now. One of the most important skills you'll need to practice is a hundred, write a patient note. The purpose of the patient note is to keep track of what happened to document. Your thoughts and your medical decisions. Usually it's divided up into the history and physical. Or admission note and then progress notes. A classic way to organize a patient note is with the soap format. So stands for subjective objective assessments and plan. You can practice a picture note within the ambulance platform. There's a link in the clerkship guide on how to do this. Now let's go over the soap format. First, the subjective part. You start with the chief concern. Why did the patient come in today? You present the patient's history. As they tell it. Their past medical history, surgical history, family history. Social history, which includes travel sexual and drug use. Pet exposures, occupational exposures, current medications and allergies. And then you will need to do a review of systems. So for new patients. You could do a detailed review of systems. And one of the best mnemonic is to just start from the top of the patient and move down. Cover their head, neck, eyes, ears, and throat. Then you move on to the heart. So cardiac and vascular. Moved down to pulmonary conditions. Gastrointestinal disorders. Urinary issues. And then you zoom out to cover a musculoskeletal issues. Skin. And finally neurological. When you perform a daily progress note, you don't need to cover the entire system, but just note, if there are any changes. That's the S subjective. Now the O objective. You start with vital signs things you can objectively test. If it's an emergency. List the settings from your readings, your ventilator, your monitor, your fluid balance, List the patient's general appearance. They're pertinent, physical examination findings. Any lab findings that you may have. Include any imaging such as x-rays. And other diagnostic measures. And now the, a, the assessment. Here you can state the probable diagnosis possible etiologies and list a differential diagnosis. If you come up with it. And we come to the P the plan. This is where you outline the next steps in the patient's management list out each of the patient's problems. And explain what's needed to diagnose it and treat it. Including specific treatments for certain disorders. And management plans for their current symptoms. If the patient has multiple concerns, rank them according to their severity and acuity. Group conditions together if possible. And Look at the previous day's plan to help determine today's plan. finally let's look at an example of a daily progress note. So this patient has come in, they've been in the ward Let's say we're on the Surgical clerkship. This is how you might write your progress note. As subjective. No acute events overnight. The patient noted, no nausea or vomiting. No diarrhea or constipation. And reports mild, right? Upper quadrant pain. The O objective. Vital signs. temperature 37.2 degrees. Celsius. Pulse 84 beats per minute. BP 1 24 over 82 millimeters of mercury. Respiratory rate. 19 breaths per minute. General appearance. And a D or no apparent distress resting comfortably in bed. CV or cardiovascular. R R R stands for regular rate and rhythm. Normal S one and S two, no S3 S four. No M R G stands for no murmurs rubs or gallops. Next is lungs. You could write clear to auscultation bilaterally, no wheezes, rales, or Rocky. Abdomen soft, mild tenderness in the right upper quadrant. Positive bowel sounds in four quadrants. No masses palpable. No, organomegaly post-op wounds clean. Skin. No rashes lesions or PTA. Extremities. Two-plus Peatal pulses, bilaterally. No C, C E or a cyanosis clubbing edema. Now we move on to the EI assessment. The patient is a 42 year old woman on post-operative day one For laparoscopic cholecystectomy improving. Well. Now the plan, advanced diet follow up with abdominal ultrasound. Monitor CBC. Or complete blood count electrolytes. B U N or blood urea nitrogen. And creatanine daily. It's as easy as that. Keep it simple. And don't forget to include your date, time, signature, and name of the patient. You can take a look at the AAN boss, clerkships survival guide. In the link below. You'll find this clerkship survival guide under library articles. Clerkships. If I have a guide and clerkship guide. We also have ambitious study plans for every clerkship. And you can practice writing a patient note from any of the clinical cases we have under library. Articles. clinical skills and clinical cases. We hope that's helpful for Improving your clinical work and making sure that you're prepared and confident. For handling patient care. If you like this style of episode, Let us know by leaving a five star review, wherever you listen to podcasts and leave us a comment or send us an email. All the links are in the description below. Thanks so much. I'm Dr. Tanner shrank. And this has been beyond the textbook.