Newport wrote:bulochka wrote:
Насчет того, что это негусто за такие деньги - а что, думаете надо за два года выучить на специалиста, например анестезиолога или хирурга? Как я понимаю, за третий и четвертый год мед. студенты получают много навыков, но недостаточно, чтобы самостоятельно вырезать аппендикс, к примеру. Думаете, это неправильно? Пусть режут?
Ученик мясника учится вырезать аппендикс за 3 месяца. Сидя за книжками не научишься, конечно.
С дантистами ещё проще - могут на живых лошадях тренироваться.
Они учатся не сидя за книжками, а сначала препарируя кадавров, потом помогая резидентам, ну а потом уже оперируя самостоятельно. Вот, например, описание хирургической ротации во время третьего года обучения.
With that in mind, rounds typically start at 6:30am on weekdays. With cases starting at 7:30, there is no more than 1 hour to round on the entire service, which can be anywhere from 10-30 patients. The only way this can be done successfully is for the team to work together. Teamwork enables us to be efficient and accurate. So, here are some tips to help you be a part of the team and make rounds run smoothly.
Presentations:
Each student is generally expected to follow 3-4 patients. You should know everything about why these patients are in the hospital, what their relevant past medical history is, and where they are in the course of their work-up, treatment, and recovery. It is best to follow patient’s whose surgeries you saw or people you saw in clinic who were admitted. Obviously, this cannot take place in the beginning of the rotations, but should be how you pick up patients without residents having to assign them to you.
You will generally be expected to pre-round on your patients. This includes gathering vitals and recent labs and evaluating your patients with a directed history and physical exam.
Present each patient in S.O.A.P. format. Start with a ONE LINE statement about who they are, why they are in the hospital, and where they are in their course. Your presentation should be an update on significant events since the last time the team rounded. It should include a directed history, pertinent physical exam findings (including vitals), and an assessment and plan.
If your patient has never been presented on rounds before (i.e. they are a new patient), give a brief introductory H&P, including relevant PMH and meds.
Vitals are presented as Tmax, Tcur, HR, BP, RR, Sat or pulse ox, and ins and outs, including Urine Output and Drain Output (usually presented as over last 24 hours and over last 8 hours).
Try to review new labs prior to presenting. Knowing trends is important (e.g. is the WBC increasing or decreasing?).
A directed physical examination should include the heart, lungs, abdomen, surgical wound, extremities. Although you should definitely examine all of these areas, you may be asked to only present the most relevant on rounds.
The Operating Room:
Be on time for each case. You should arrive with the patient or even before. Cases typically start at 7:30, except on Wednesdays when they start at 8:30 because of grand rounds. You are not expected to be on time to the first case as you have class, but you are expected to show up after your lecture.
Try to meet the patient preoperatively in the Pre-Care area.This is a great time for procedures – learn to place a foley, start an IV, prep the patient, etc.
Be attentive during the case – how much you can help is directly related to your being aware of what is going on.
At the end of the case, you can help the resident close and then help get the patient transferred to the PACU – this includes getting the bed, helping move the patient, and learning to write post-op orders and prescriptions.
3. Clinics
Each attending/service will have clinic at least one day each week. If you are assigned to a particular attending, you should plan to be in clinic with that attending. If you are not assigned to a particular attending then the chief of the service will direct you as to which clinic you should attend. Clinic is a great opportunity to meet patients preoperatively. It also provides a chance to follow patients through the entire process from preoperative evaluation through to the post-operative visit.
4. Call
Call is still a very real part of surgical training and practice. Therefore, students will be required to take call during the clerkship. This is a great opportunity to see the urgent and emergent cases that rest at the heart of surgery. This is also a great time to pick up patients for your write-ups.
"If you thought that science was certain - well, that is just an error on your part." Richard Feynman
