Friday, July 18, 2008

Friday Didactics

The last couple of days have been pretty crazy, but I'm really enjoying my family med rotation. The preceptors are really into teaching, the nurses are encouraging, and the patients have been a varied and interesting bunch. They've also been super about letting me interview and examine them. I think the key is to start by first asking the patient if they mind talking to you for a few minutes. I've never had a patient tell me no. What better thing do they have to do while they wait on the doctor anyway? Asking if you can talk to them first gives you a chance to build up enough rapport with the person to then ask if they'd mind letting you examine them. I've never had a patient refuse the exam afterward either, even after I've been asking them detailed questions about their sex lives or drug use.

Today I had class all day instead of clinic, and this will be the schedule for every Friday throughout the block. We started at 7 AM with a surgery morning report. One of the students in my group who is doing his surgery rotation right now presented a patient, and the group went through a differential, talked about what tests we should order, and evaluated the results. I didn't really know what I was doing a lot of the time, but it was fun to try to come up with a diagnosis and plan anyway. Afterward, one of the students on internal med presented a patient, and we did the same thing for the IM patient. The IM morning report ended at 9 AM, and then we went through two hours of acute renal failure cases. This was a seminar led by one of the internists, and it was a really good review of the material that we had covered back in May.

There is a huge difference in how the surgeons run their morning report versus how the internists run theirs. Surgeons are much more formal and want everything done a certain way. The preceptor went around the table and asked everyone to answer a question. (I had to interpret the blood test results.) The internist, on the other hand, was much more laid back and informal. Unlike the surgery presentations, which have to be done with powerpoint, the internal med presentation was more like a group discussion. People could jump in and make comments or suggestions whenever they wanted instead of having to wait to be called on by the preceptor. I can see pros and cons to both methods. I like how organized and efficient the surgeons are, but at the same time, they don't seem to have as much room for individuality and creativity as the internists do.

This year, CCLCM has a new buddy program to pair up first years with upperclassmen. I went for lunch with my buddy, and we talked for about an hour until I had to go for my FCM class. Yes, FCM does continue on even after second year. The third year FCM class alternates with the third year POD class. (Note: POD is actually called ARM now.) We have all new groups for FCM that I think will stay together for the next two years. The groups are a mixture of third and fourth years. The thought had occurred to me last year that it would be interesting to have mixed-class PBL sessions. This isn't exactly the same thing, but now I'll have a chance to see what mixed groups are like. Most of the session was in a big group. We were asked to write a paragraph about one of our experiences at the end of it, and then several of us read our paragraphs out loud. I wrote mine about the last patient I saw at the end of second year. That was the one where I picked up an MI by going through the review of systems, which is the kind of experience that tends to make a lasting impression on you.

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