AutoRecovery Save of Peds Clinical Rotation Clerkship Booklet

Medical Student Clerkship
Procedures & Checklist

Log Book
Spartan Health Sciences University
Please send these forms to
P.O. Box 324
P.O. Box 989
Vieux Fort, St. Lucia
Santa Teresa, NM 88008
West Indies
Email: spartanmed@aol.com
Table of Contents
1. Medical Students Self-Assessment
2. Weekly Log-Form
3. Medical Student On-Call Form
4. Internal Medicine
5. General Surgery
6. Obstetrics & Gynecology
7. Pediatrics
8. Psychiatry
9. Family Medicine
10.Student Evaluation of Attending
Medical Student Self-Assessment

(ACGME Competencies)
Professionalism:
0
Welcome the patient using full name
Be polite and attend to their comfort
Be aware of social and ethical principles
Maintain confidentiality of patient information, informed consent
Demonstrate respect, compassion and integrity
History:
0
Use effective listening skills
Ask appropriate questions to obtain accurate, adequate information
Respond appropriately to verbal and non verbal cues
Physical Examination:
0
Follow a logical sequence
Examination has to be appropriate to the clinical problem
Be sensitive to the patients comfort and modesty
Explain what you are doing to the patient
Communication:
0
Use jargon free language and effective writing skills
Be open, honest, and empathetic to patient
Work effectively with health care team
Clinical Judgment:
0
Make appropriate diagnosis and formulate a suitable management plan
Suggest appropriate diagnostic investigation
Understand the pathophysiology of the disease
Organization/Efficiency:
0
Prioritize/succinct/organize and summarize
Advocate for quality patient care
Presentation:
2
Demonstrate satisfactory clinical judgment
Synthesize information in an effective manner
Practice cost effective healthcare that doesnt compromise quality care

1
Student Name: ____Anish Pithadia_
Hospital: Norwegian American Hospital
Student I.D. #: ________________________
Address: ________________________________
Rotation: ___Pediatrics_______
_________________________________
In-Patient List: ________________________
________________________________________
Out-Patient Clinic: _____________________
WEEKLY LOG FORM

(Activities and Duties Performed)
To Expedite mail service to St. Lucia,
P.O.Box 324
please send this form to: P.O.Box 989
Vieux Fort, St. Lucia, West Indies
Starting Date: _______________________
Ending Date: __________________________ (one week period)
Date
Patient Chief Complaint

Initial
Procedure
8/13/13
8/14/13
Lecture- Toxicology and Poisonings

Lecture-
819/13
PCOS lectureI learned to check T4 free, LH and FSH

level, Glucose, Check testosterone
U/S of Ovaries to be done to check if there
are follicles but not diagnostic.
MC environmental factor is obesity
Diagnsosti- Rotterdam.
May be linked to low Birth Weight
8/19/13
Childhood Obesity lecture

50% chance that child will be obese if
parents is obese.
AA and Hispanic and Low SES has
Increased obesity rate.
Adipose rebound- 4-6 yo. They are more
likely to be overweight
Patients can have some insulin resistance,
check insulin level and fasting Blood Sugar
Behavior and Learning problems,
psychological problems
BMI: >95%=obese ;85-95% is overweight
Age 7 or greater- lose 1 pound a week
Under 7- no weight gain, only increase
height.
Cut computer and TV
Meds: Sibutramince >16, orlistat
Prevention:No clean plate policy, no sweets
or treats as positive reinforcement
Provide healthy foods and encourage
physical activity, Pack own lunches, no fast
food.
Diabetes lecture
Low birth weight is associated with insulin
resistance. Highest prepubertal body weight
has high risk for diabetes. Ketoacidosis and
8/19/13
Diagnosis
Attending/Resident Signature
ATTENDING PHYSICIANS NAME: __________________________
SIGNATURE: ________________________
DATE: __________
SIGNATURE: ________________________
DATE: __________
DIRECTOR OF MEDICAL
EDUCATIONS NAME: _____________________________________
To Expedite mail service to St. Lucia,
P.O.Box 324
please send this form to:
Vieux Fort, St. Lucia, West Indies
P.O.Box 989
Telephone (575) 589-1372
Student Name: ___________________________________
Hospital: ________________________________
Rotation: _______________________________________
Address: ________________________________
From: _______________________To: ________________
________________________________
______________________________
MEDICAL STUDENT ON-CALL FORM
Date
Time In
Time Out
Acceptable Work Ethics?

Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Resident/Attendings
Signature
Yes/No
Yes/No
Yes/No
Yes/No
__________________________________
Director of Medical Educations Name
__________________________________
Director of Medical Educations Signature
__________________________________________
Attending Physicians Name
___________________________________________
3
Attending Physicians Signature
Internal Medicine
Student Name: ___________________
Number of Weeks: __________
Hospital Name: __________________
Date: ________ to _________
Student Name: ___________________
Number of Weeks:__________
Hospital Name: __________________
Date: _______ to _________
Internal Medicine
0
Emphasize integration and application of patho-physiology of the diagnosis and management of
patients.
Focus on the bedside care of the patients.
0
Write ups: You need to turn in a minimum of (6) History & Physicals and (6) SOAPs that includes
the following :
0
Perform an admission history and physical examination
Write the admissions note
Write patient orders, including admission orders, daily orders
Interview and examination of the patient
Write a daily progress note
Any clinical procedures performed
Ordered tests
Obtain and record test results
Short Call
Day
__________
__________
__________
Date
__________
__________
__________
Dr. Signature __________
__________
__________
I.C.U. Posting
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
E.R. Posting
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
(B) PROCEDURE CHECK LIST
NG Tube (Observed/Performeda minimum of 3)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
Foley Catheter (Observed/Performeda minimum of 3)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
ECG (Observed/Performeda minimum of 3)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
Phlebotomy (Attend a minimum of 1 class)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
Echo/Treadmill (At least 2 days)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
Dialysis (Observed at least for 2 days)
10
11
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
MRI (Observed at least for 1 day)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
Chest X-Rays (Reviewedat least for a minimum of 4 days)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
(C) List Case Presentations done
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________
4. _________________________________________________________
5. _________________________________________________________
6. _________________________________________________________
General Surgery
Student Name: ___________________
Hospital Name: __________________
Date: ________ to _________
10
General Surgery Rotation
Student Name:
Hospital Name:
# of Weeks:
Date:_______ to _______
Ability to interact with the patient, family and members of the surgical team
1
Overall knowledge of surgical illnesses and important steps in the decision process of treating these
conditions
2
Understand physiology of an acutely injured patient, whether this injury is from trauma, burn, infection
or surgery itself
3
Basic principles governing wound care, suturing and management of tissue infections
11
(A)
General Surgery
Student Name:
# of Weeks:
Hospital Name:
Date:________ to ________
List and Report of Observing or

Assisting any of the following Surgeries
Surgical Procedure
1
2
3
4
5
6
7
8
9
1
0
1
Appendectomy
Cholecystectomy
Thyroidectomy
Nephrectomy
Ileostomy
Mastectomy
Adrenalectomy
Parathyroidectomy
Splenectomy
Total hysterectomy
Lumpectpmy
Date
Sex
Age
Observed (#)
Assisted (#)
Surgeo
n
Signature
1
1
2
Inguinal Hernia Repairs
12
(B)
General Surgery
# of
Weeks:
Date:________ to ________
Student Name:
Hospital Name:
Procedure
# Observed
List of Procedures Performed

(a minimum of 3 are required)
# Performed
Date
Dr's. Signature
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
Cannulations/NG tube
Intubations
Blood Withdrawal
Arterial Blood Gas
Central Lines
Chest Tubes
Sutures
Foreign Body Removal
Abscess Drainage
Clean & Dressing
Casts
Collar & Cuff
Tubi-Grip
Peak Flow Meter
Foley's Catheter Placement
13
General Surgery
(C)
Student Name:
Hospital Name:
Case Presentations Done

1
2
3
4
5
6
# of Weeks:
Date:_______ to _______
14
HISTORY & PHYSICAL FORM
PROGRESS NOTES- WRITING
Date:____________________________________
M/F
Date:_______________________________________
M/F
Indication:________________________________
Age:
Age:
Physician Signature:________________________
Date:_______________________________________
Date:____________________________________
M/F
Indication:________________________________
Age:
Age:
M/F
Indication:________________________________
Age:
M/F
Indication:________________________________
Age:
Physician Signature:___________________________
Date:_______________________________________
Date:____________________________________
Age:
Indication:___________________________________

M/F
Date:_______________________________________
Date:____________________________________
Age:
Indication:___________________________________

M/F

M/F
Indication:___________________________________
Indication:___________________________________
15
WOUND CARE MANAGEMENT VAC - CHANGE
WOUND CARE MANAGEMENT VAC - DRESSING CHANGE
Date:____________________________________
M/F
Age:
Indication:________________________________
Date:_______________________________________
M/F
Age:
Date:_______________________________________
Date:____________________________________
Indication:________________________________
Age:
M/F
Indication:___________________________________
M/F
Age:
Indication:___________________________________
Date:_______________________________________
Date:____________________________________
M/F
Indication:________________________________
M/F
Indication:___________________________________
Age:
Age:
Date:_______________________________________
Date:____________________________________
M/F
Indication:________________________________
Age:
M/F
Indication:___________________________________
Age:
Date:_______________________________________
Date:____________________________________
M/F
Indication:________________________________
M/F
Age:
Age:
Indication:___________________________________
16
FOLEY CATHERTER PLACEMENT
NG TUBE PLACEMENT
Date:____________________________________
M/F
Indication:________________________________
Age:
Date:_______________________________________
M/F
Age:
Date:_______________________________________
Date:____________________________________
Indication:________________________________
Age:
NG TUBE PLACEMENT
M/F
Indication:___________________________________
M/F
Age:
Indication:___________________________________
NG TUBE PLACEMENT
Date:_______________________________________
Date:____________________________________
M/F
Indication:________________________________
M/F
Indication:___________________________________
Age:
Age:
NG TUBE PLACEMENT
Date:_______________________________________
Date:____________________________________
M/F
Indication:________________________________
Age:
M/F
Indication:___________________________________
Age:
NG TUBE PLACEMENT
Date:_______________________________________
Date:____________________________________
M/F
Indication:________________________________
M/F
Age:
Age:
Indication:___________________________________
17
VENOUS BLOOD DARW - PHLEBOTOMY
IV PERIPHERAL PLACEMENT
Date:_______________________________________
Date:____________________________________
M/F
Age:
Indication:________________________________
M/F
Age:
Date:_______________________________________
Date:____________________________________
Age:
Indication:________________________________
VENOUS BLOOD DRAW - PHLEBOTOMY
IV - PERIPHERAL PLACEMENT
M/F
Indication:___________________________________
M/F
Age:
Indication:___________________________________
Date:_______________________________________
Date:____________________________________
M/F
Indication:________________________________
M/F
Indication:___________________________________
Age:
Age:
Date:_______________________________________
Date:____________________________________
M/F
Age:
Indication:________________________________
M/F
Indication:___________________________________
Age:
Date:_______________________________________
Date:____________________________________
M/F
Indication:________________________________
M/F
Age:
Age:
Indication:___________________________________
18
ARTERIAL BLOOD GAS

Date:____________________________________
M/F
Age:
Indication:________________________________
ARTERIAL BLOOD GAS

Date:____________________________________
M/F
Indication:________________________________
Age:
ARTERIAL BLOOD GAS

Date:____________________________________
M/F
Indication:________________________________
Age:
ARTERIAL BLOOD GAS

M/F
Age:
Date:____________________________________
Indication:________________________________
ARTERIAL BLOOD GAS

Date:____________________________________
M/F
Indication:________________________________
Age:
19
Obstetrics & Gynecology
Student Name: ___________________
Hospital Name: __________________
Date: ________ to _________
20
Obstetrics and Gynecology Rotation

Student Name:
Hospital Name:
# of Weeks:
Date:_______ to _______
0
Familiarize with signs and symptoms of normal and abnormal reproductive function and basic
examination of Obstetrics & Gynecology.
21
Deliveries Performed
You should perform to Observe/Assist in at least three (3) deliveries by yourself.

(We realize this may not always be feasible but use your time during the rotation to familiarize yourself with
the care of women in labor.)
S. No.
Date
Age
Essential Details of
Labor & Delivery
Signature of
Nurse/Midwife/ Doctor
Vaginal Examinations
You should perform to perform at least a minimum of three (3) vaginal examinations and two (2)
Pap smears.
(*Vaginal examinations should include both speculum and bimanual exams.)
S. No.
Date
Age
Type of Examination
(e.g. VE, speculum, smear) with
reason
Signature of
Healthcare Professional
22
Obstetrics Procedures Observed
(e.g. twin delivery, premature labor, etc.)

S. No.
Date
Age
Obstetric Problems &Outcome
Signature of
Docotor
Gynecological Procedures Observed
(e.g. operations for urinary incontinence, ectopic pregnancy, etc.)

S. No.
Date
Age
Type of Examination
(e.g. VE, speculum, smear) with
reason
Signature of
Healthcare Professional
23
Surgical Termination of Pregnancies
Doctors Name:_____________________________
S. No.
Date
Age
Problem
Case Management
24
Psychosexual Clinic
Doctors Name:_____________________________
S. No.
Date
Age
Problem
Case Management
25
In-Vitro Fertilization Clinic
Doctors Name:_____________________________
S. No.
Date
Patient ID#
and Age
Problem
Case Management
26
Seminar List
(e.g .Diabetes in pregnancy, induction of labor, obstetric anesthesia, Breech presentation, multiple
pregnancy, Urogynecology, Thromboembolism, etc.)
S. No.
Date
Topic
Presenter
Facilitator
Write Ups
0
You are required to write up three (3) history of physical examinations with a discussion of individual
patient care.
Obtain a complete history and physical examination of at least one (1) obstetric patient.
27
Pediatrics
Student Name: ____Anish Pithadia

Hospital Name: Norwegian American
Number of Weeks: ______6____

Date: ________ to _________
28
Student Name: __Anish Pithadia________
Number of Weeks: ______6____
Hospital Name: Norwegian American Hospital
Date: __8/12/13_ to _09/20/13_
Pediatrics
0
Learn and perform newborn and pediatric physical exams
Recognize normal patterns of growth and development
Be able to generate differential diagnosis for common pediatric complaints
Gain familiarity with the management of common pediatric diseases
Pediatrics Check List:

0
Submit at least 3-Pediatric history taking write ups. (learn concepts of differences from adult
history taking)
1
Understand child health surveillance & immunizations

2 months
4months
3 months
12-14 months & Pre-school
Develop ability to relate to children and their family to get their cooperation
Learn how to use Growth Charts
New born Nursery/ICU (1 week)
5
Understand major milestones e.g., speech, language, communication, fine and gross motor
skills and social & emotional development.
6
Factors important to normal growth and development e.g., normal infant feeding, weaning and
importance of optimal physical, emotional, and psychological well being.
7
E.R. and Floor Calls (a minimum of 2-3)

Day:
_________
_________
_________
Date
_8/13/13__
_________
_________
29
(B) PROCEDURE CHECK LIST
Arterial and Venipuncture (Performa minimum of 3)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
IV Catheter Insertion (Including CVP) (Performa minimum of 3)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
NG Tube Intubation (Observed/Performeda minimum of 3)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
Endo-tracheal Intubation (Observe/Perform a minimum of 2)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
Lumbar Puncture (Observe/Perform a minimum of 2)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
30
CSF Analysis (Performa minimum of 1)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
Culture and Sensitivity (with gram stain) (Performa minimum of 2)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
X-Rays (e.g. Chest, KUB) (Observed/Reviewed)
Day
__8/13/13_
__________
__________
Date
__________
__________
__________
__________
__________
Glucose Tolerance Test (Perform a minimum of 2)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
ECG Interpretation (Observe/Review)
Day
__________
__________
__________
Date
__________
__________
__________
__________
__________
10
Case Presentations (minimum 1 per week)
PCOS
Poisonings/Antidotes
Diabetes
Childhood Obesity
Autism
____________________________
31
Psychiatry
Student Name: ___________________
Hospital Name: __________________
Date: ________ to _________
32
Student Name: ___________________
Hospital Name: __________________
Date: ________ to _________
Psychiatry
0
Fundamental understanding of psychiatry as a medical specialty
Ability to perform a competent basic psychiatric diagnostic interview
2
plan.
Ability to formulate a psychiatric differential diagnosis, problem list, and initial treatment
Psychiatry Check List:
Student is expected to be familiar in the following:

0
Conducting an interview to obtain a psychiatric history and mental status examination
1
Organizing, recording and presenting the findings to generate a differential diagnosis using
DSM IV multi axial system for adult & childhood illnesses.
2
Formulating a treatment plan in accordance with the bio-psychosocial model
3
Write a minimum of three (3) psychiatric case workups with emphasis on primary method of
information gathering ( sample case write ups are provided)
4
Basic understanding of
Psychosis: Schizophrenia, Mania, Depression, Organic Brain Syndrome
Neurosis: Anxiety, Depression, Personality Disorders
Ability to perform a minimum of two (2):
Mental Status Examination
Complete Neurological Examination
33
Family Medicine
Student Name: ___________________
Hospital Name: __________________
Date: ________ to _________
34
Student Name: ___________________
Hospital Name: __________________
Date: ________ to _________
Family Medicine
0
Gain experience in ambulatory practice in urban, suburban and rural settings
Learn core skills and knowledge essential to the practice of Primary Care:
diagnosis and treatment of common outpatient complaints
management of chronic medical conditions
strategies for health promotion and disease prevention
Precepted by faculty in general medicine, general pediatrics, and/or family medicine
Check List
0
Perform histories and physicals in a concise manner geared to ambulatory (outpatient) setting
Submit case reports and presentations (minimum 1 per week)
Submit the Weekly Log Form for all patients seen in the inpatient and outpatient clinic
Any seminars attended

__________________________________
__________________________________
__________________________________
35

Student Evaluation of Attending
Attending Name: ________________________________
Date: ____________________________
Please circle the appropriate response:
1 Was the attending punctual and available regularly?
Yes
No
2. Did the attending show interest in teaching?
Yes
No
3. Did the attending communicate concepts clearly?
Yes
No
4. Did the attending prepare for teaching?
Yes
No
5. Did the attending conduct bedside teaching?
Yes
No
6. Did the attending treat students fairly?
Yes
No
7. Was the attending attitude good towards patient care?
Yes
No
8. Did the attending accept criticism and acknowledge his/her limitations?
Yes
No
9. Was the attending a good role model?
Yes
No
10. Would you recommend him/her to other students?
Yes
No
11. Did the attending behave in a professional manner?
Yes
No
12. Overall rating:
Excellent
Very Good
Good
Fair
Poor
Comments:
36

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Medical Student Clerkship

Procedures & Checklist

Spartan Health Sciences University

Please send these forms to

P.O. Box 324

P.O. Box 989

Vieux Fort, St. Lucia

Santa Teresa, NM 88008

Medical Student Self-Assessment

Welcome the patient using full name

Be polite and attend to their comfort

Be aware of social and ethical principles

Maintain confidentiality of patient information, informed consent

Demonstrate respect, compassion and integrity

Use effective listening skills

Ask appropriate questions to obtain accurate, adequate information

Respond appropriately to verbal and non verbal cues

Follow a logical sequence

Examination has to be appropriate to the clinical problem

Be sensitive to the patients comfort and modesty

Explain what you are doing to the patient

Use jargon free language and effective writing skills

Be open, honest, and empathetic to patient

Work effectively with health care team

Make appropriate diagnosis and formulate a suitable management plan

Suggest appropriate diagnostic investigation

Understand the pathophysiology of the disease

Prioritize/succinct/organize and summarize

Advocate for quality patient care

Demonstrate satisfactory clinical judgment

Synthesize information in an effective manner

Practice cost effective healthcare that doesnt compromise quality care

Student Name: ____Anish Pithadia_

Hospital: Norwegian American Hospital

Student I.D. #: ________________________

In-Patient List: ________________________

Out-Patient Clinic: _____________________

WEEKLY LOG FORM

Spartan Health Sciences University

To Expedite mail service to St. Lucia,

please send this form to: P.O.Box 989

Vieux Fort, St. Lucia, West Indies

Starting Date: _______________________

Santa Teresa, NM 88008

Ending Date: __________________________ (one week period)

Patient Chief Complaint

Lecture- Toxicology and Poisonings

PCOS lectureI learned to check T4 free, LH and FSH

Childhood Obesity lecture

ATTENDING PHYSICIANS NAME: __________________________

Spartan Health Sciences University

To Expedite mail service to St. Lucia,

please send this form to:

Vieux Fort, St. Lucia, West Indies

Student Name: ___________________________________

From: _______________________To: ________________

MEDICAL STUDENT ON-CALL FORM

Acceptable Work Ethics?

Student Name: ___________________

Number of Weeks: __________

Hospital Name: __________________

Date: ________ to _________

Student Name: ___________________

From: _______To:

Date: to _

Date: _ to ___

Date: to _