Sunday, July 19, 2009

Quick Tips for the VA Rotation

Disclaimer: You might not want to read this post if you're not a med student at my school. The information will be boring and useless. However, if you are, you might find it of a little value. I'm post-call though, so be warned.

How the VA Works:
*Disregard most of this for tomorrow. They're just going to spend the whole day giving you the tour and getting you set up on the VA computers.

*M/W/F are surgery days. T/Th are clinic and education round days.

*If you don't have VA scrubs, show up the 1st day in blue scrubs, go down to the basement to the OR control desk, and ask for VA scrubs. They will give you a pair. You will not have access to a machine, so you will have to wash them yourself.

*When you arrive on a normal morning, you will go to the residents' cubby hole in either 2045 or 2035 (sorry, can't remember!) and pull up the list. You will then put your initials by the pts you would like to see.

*Print several copies of the list and leave them laying by the computer you were just working at. Be warned, the list will print at the nurses station, about 30 ft away. Just go grab them and put them by the computer in the residents cubby hole or be sure you have 2 copies with you - one for yourself and one for the chief when it comes time to "dry round."

*Go see your pts (usually 2, sometimes 3.) Check the white board on the floor before you barge into the room. They switch rooms a lot without letting you know.

*Once you've seen both of your 2 pts and asked about pain/f/c/n/v/BM/flatus/diet/ambulation/check drains, tubes, and restraints, find a computer. There's 3 in the room where you'll sit around and do the dry round in the morning. There's more at the nurses station or on the 4th floor.

*At the computer, find your pt. Sign in under the resident's name that is seeing the pt (because we're not allowed to have our names on charts at the VA). Don't worry. The resident has to review the chart and sign it before an attending sees it.

*Everything you need, such as vitals and labs will be posted on the computer. Vitals will already be filled in on the note when you go to write it. Then just do the whole SOAP note thing. It's got a template there for you. You CAN look back at older notes while in the middle of writing yours and it won't close yours out. So if you get confused, just look back at an older one.

*Be prepared to do a quick run-through of your pt at dry rounds, but the residents will most likely do it. We did it 2-3 times in our 2 weeks there, towards the end when they figured we were competent.

*For T/Th education rounds, you need to know your patient's medical history pretty well. You don't have to KNOW it, but you do have to have it available on a sheet in front of you. Especially know their vitals and presentation on admission, as well as their normal and current weight and bathroom habits (diarrhea today, but have they had it for 30 years? Is that normal for them? For a lot it is...) Know family/social history as well. You can find A LOT of this by digging around in their chart on the computer. Also, have a differential, but don't mention it in your presentation. You'll probably get asked about it. Know how you would rule out those possible diagnoses - what tests/procedures you would use. This sounds overwhelming, but the attendings are usually nice about it all. If they're quizzing you, it's so they can teach you something you don't know.

That's about all my info. If y'all have questions, post them in the comments and I'll try to answer them. Good luck and have fun!!!

P.S. - Dr. Wofford might be the cutest little old retired cardiothoracic surgeon I've ever seen. He's going to give y'all lessons 2x a week. He repeats himself a lot, but he's really funny and you'll probably learn something.

Wednesday, July 15, 2009

It's a PASS!!!

Never in my life have I been so happy to have passed a test!!!

Sorry the posting has been pitiful lately. Surgery is working me to the bone. That being said, today was an incredibly rare exception to the rule and we were finished with surgery by 10:00 this morning. Checked our STEP scores (in the surgery lounge, where I screamed "PASS!!!" and slammed my fist on the table. Then my good friend A came running up and we sort of did a jump/chest bump/hug in mid-air. I thought I got a pneumothorax from one of her pens jabbing me in the chest. The surgery residents thought we were crazy.) Then after the crazy rush of it all we had to give presentations and then we went with our team (residents + us M3 students) to Mugshots to have some burgers. All in all it's been a pretty good day so far.

Decided I should treat myself to a little reward, so I stopped at my favorite boutique - Target, and got a nifty bag that I can put my laptop, pens, wallet, books, and a change of clothes in. Essential for the surgery rotation. I've needed it the last 6 weeks!

To make the day even better, I got home and Netflix had brought me Bride Wars. Cha ching! About to sit back in the recliner with the fan on, a blanket, a pup, maybe a cold beverage, and a movie. Does it get much better?

Hope everyone else's day has been wonderful and if it hasn't, I'll be sending up some special prayers for you :)