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University of Utah School of Medicine
Clerkship Survival Guide For students, by students
Founders Rachel Tsolinas (MS 2021) & Sam Wilkinson (MS 2021)
Introduction
What is The Clerkship Survival Guide’s Main Purpose?
In an increasingly collaborative era of medicine that is dependent upon rapid advances in
technology, navigating these medical systems requires a basic understanding of the
predominant values and daily workings of the environment.
This unspoken cultural process with its own rituals and traditions that socializes students to
what is valued in medical practice is called the hidden curriculum (HC). It is a concept in
medical education that describes the powerful effect of unspoken learning on professional
identity formation. Often the HC quickly usurps the formal curriculum as the “true
educator” early in clerkships, and maintains this position throughout a physician’s career.
Therefore, early awareness of the HC is advantageous. However, in traditional medical
education, these tacit processes of values, beliefs, expectations and social practices are not
formally taught to students.
The goal of the Clerkship Survival Guide is to tangibly assist students in bridging the divide
between the formal curriculum and the HC before clerkships. The document systematically
addressed important aspects of clerkships including performance evaluation examples,
study resources, targeted advice for core rotations, anonymous reporting of mistreatment
and recommendations that range from guidance on rounding etiquette to what constitutes
both appropriate and inappropriate behavior.
Disclaimer
This guide was created by students and does not necessarily reflect the views of the
clerkship directors or the University of Utah School of Medicine. It is a superficial overview
of educational purposes only, and is not meant to serve as a comprehensive guide to
therapy selection nor prescribing. Please consult current drug references, the resources
listed, and your attendings/residents. Also, this is not a substitute for the rotation syllabi.
You need to read each rotation syllabus to be adequately prepared.
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Special Thanks & Acknowledgements
MS 2019
Andrew Kithas Angie Schwartz Guinn Dunn Hailey Shepherd John Downie Julie Weis Troy Teeples
MS 2020
Ali Etman JJ Ward Lily Boettcher
MS 2021
Adelheid Langner Veronica Urbik
MS 2022
Abbie Luman Gina Allyn
MS 2023
Jake Winter Amanda Cooper Jordan Nishimoto
Faculty Project Mentor
Dr. Kathryn B. Moore
Faculty & Staff
Dr. Adam Stevenson Dr. Danielle Roussel Dr. Jorie Colbert-Getz Dr. Lee Chung Dr. Peter Hannon Dr. Rebecca Lish Dr. Steven Baumann
Ashley Crompton Carol Stevens Dellene Stonehocker Jeanette Church Jessica Bickley Julia Price Kenya Kay Arnett Kylie Christensen
Rachael Smith Reed Esparza Stacey Leventis Tammy Llewelyn Tom Hurtado
Other
University of Texas Veritas Mentors in Medicine (MiM) Project
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Table of Contents
Introduction 2 What is The Clerkship Survival Guide’s Main Purpose? 2 Disclaimer 2 Special Thanks & Acknowledgements 3
Clerkship Contact Information 6
Some Honest Advice 7
Structure of Third Year 8
Succeeding as an MS3: Dos & Don’ts 9 The “Do” List 9 The “Don’t” List 14
MD/PhD: The Transition to Rotations 15
Idaho Students 16
Resources 17 Mistreatment 17 Scutsheets 21 Academic Success Program 21 Mobile Apps - Clinical Resources 22
Clinical Evaluations on the MSPE 23
NBME Shelf Exams 25
Electronic Medical Records (EMRs) 27
Main Clinical Sites 28 University of Utah Hospital 29 Primary Children’s Hospital 31 George E. Wahlen Department of Veterans Affairs 32 LDS Hospital 33 University of Utah Neuropsychiatric Institute 34
Failed Clerkships 35
General Day Outline 36 Day 1 36 Pre-Rounding 37 Rounding 37
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Resident Consults 38 Ways to Shine 38
Internal Medicine Clinical Clerkship 39 Inpatient Medicine 39 Outpatient Medicine 39 Elective rotations 39
Vitals 40 Ins & Outs 41 Routine Labs 41 Acid/Base Status 42 Emergent Dialysis Indications 43 Risk Scores 43 HIV Primary Care 101 44 Study Resources 46
Surgery Clinical Clerkship 47 General Advice for all services 47 Ways to Shine 48 Study Resources 50
Family Medicine Clinical Clerkship 51 Ways to Shine 51 Study Resources 53
Obstetrics & Gynecology Clinical Clerkship 54 Labor & Delivery 55 Gyn 55 Gyn-Onc 55
Study Resources 57
Pediatrics Clinical Clerkship 58 Ways to Shine 58
Outpatient 58 Inpatient 58 The Well Baby Nursery 59 Shelf Resources 62 OSCE 62
Psychiatry Clinical Clerkship 64 General Advice 64 Ways to Shine 64
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Evaluations 68
Neurology Clinical Clerkship 68 Ways to Shine 69 Study Resources (suggested by past students) 71
Electives 72 Rural & Underserved Utah Training Experience (RUUTE) 73
APPENDIX 74 The VA Hospital 74 Intermountain Medical Center 75 The U’s Emergency Contact Information 77
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Clerkship Contact Information Administration
Danielle Roussel, M.D. Assistant Dean, Clinical Curriculum [email protected] 801-581-6393
Rachael Smith Clinical Curriculum Program Manager [email protected] 801-585-6125
Internal Medicine
Katie Lappe, M.D. Director [email protected] 801-581-2401
Carol Stevens Coordinator [email protected] 801-585-7716
Surgery
Luke Buchmann, M.D. Director [email protected] 801-585-7143
Claire Griffin, M.D. Director [email protected]
Dellene Stonehocker Coordinator [email protected] 801-581-8833
Family Medicine
Marlana Li, M.D. Director [email protected] 801-585-5984
Kathryn Hastings, M.D. Director [email protected]
Ashley Crompton Coordinator [email protected] 801-662-5710
Obstetrics & Gynecology
Tiffany Weber, M.D. Director [email protected] 801-213-2995
Ibrahim Hammad, M.D. Director [email protected]
Natalie Moore Coordinator [email protected] 801-581-5501
Pediatrics
Brian Good, M.D. Director [email protected] 801-662-3653
Tiffany Passow Coordinator [email protected] 801-662-5755
Psychiatry
Paula Gibbs, M.D. Director [email protected] 801-585-1575
Stacey Leventis Coordinator [email protected] 801-560-8956
Neurology
Pete Hannon, M.D. Director [email protected] 801-339-4480
Lee Chung, M.D. Co-Director [email protected] 865-850-3589
Jeanette Church Coordinator [email protected]
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Some Honest Advice
At some point in rotations you will feel overwhelmed. These feelings of ineptitude and
frustration may leave you thinking that you are a terrible student. This is normal.
Third year is a humbling experience for everyone. There is much you don’t know, and you
are perpetually the new one. Embrace it. The residents, attendings, nurses, PAs and
everyone else know you are there to learn and they were once in your shoes.
Throughout third year you will wonder “what should I be doing right now?” or “do they want
me to be doing X, Y, or Z?” We are here to tell you that you are doing exactly what you are
supposed to be doing, and that is: learning on the job.
You are not expected to be a seasoned health care provider.
Also, there are going to be many things during clerkships that are outside of your control.
Nothing is going to be how you imagined it. Whether it be a global pandemic or a mean
scrub tech, you are going to have to learn how to adapt and make the most of the
situation. Instead of asking yourself “Why is this happening to me?” on the bad days,
instead ask yourself “How can I make the most of what is happening right now?” Do not
take the bad or good days for granted. Each day on a rotation is precious in it’s own right.
Remember that.
Be respectful, take initiative to look things up on your own, stay eager and receptive, and be
aware of your surroundings. Keep in mind that you are supposed to be there, asking
questions and building the skills to help you take excellent care of people!
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Structure of Third Year
You are held responsible for keeping a log of specific conditions seen throughout the year
in order to graduate. The log can be located in Canvas.
Clinical Clerkships Important Dates
Internal Medicine 6 weeks USMLE 1/Phase 3 Prep/Vacation - EPIC/iCentra Training - VA Credentialing - Badging - Phones/Pagers
04/18/20 - 06/06/20
Surgery 6 weeks Transition to Clerkships 06/06/20 - 06/10/20
Family Medicine 4 weeks Winter Break 12/28/20 - 1/10/20
Obstetrics & Gynecology 4 weeks Class Meeting 12/11/20; 3-5pm
Pediatrics 4 weeks Class Meeting 1/22/21; 1-5pm
Psychiatry 4 weeks Clinical Assessment 05/17/20 - 05/30/20
Neurology 4 weeks
Other Requirements
Elective Coursework Variable, 2-4 weeks
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Succeeding as an MS3: Dos & Don’ts
The “Do” List _______________________________________________________________________________________
DO Work with the rotation coordinators
Top 5 things the coordinators (and directors) would like you to do:
❖ Read the syllabus before orientation and bring questions.
❖ Read emails (daily if possible) and reply to the individual ones that are sent to you.
Even if it is just to close the loop by saying “got it”.
❖ Ask questions, no matter how small or large. All coordinators and directors are
excited for you to succeed. Coordinator is your first point of contact.
❖ Let your coordinator/director know in advance of the rotation if you have a
conference, presentation, or personal event during the clerkship. Excused time is
not permitted in third year, but they will try to modify your clinic schedule.
❖ Let the coordinator, director and your team know if you will not be in the clinic (ex:
illness, flat tire, etc.)
DO Study every day
Make a study plan at the beginning of each clerkship (pro tip: Academic Success is an
excellent resource, especially the fourth year tutors). You won’t be able to see everything
you need to know during your clinical rotation nor during didatics, so fill those gaps.
Didactics will help with the highest-yield topics, but you need to take responsibility of your
learning to cover each subject well. Typically didactics occur for a half-day each week, but
this depends on your rotation. Select one or two shelf resources (including a question bank)
early in the clerkship, and slowly work through it. You will be tired, but try to study for at
least 30 minutes a day but this might not be feasible (especially in surgery). This time will
add up by the end of the clerkship.
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DO Be flexible and adapt
Attendings and residents vary greatly in personality, expectations, and teaching styles. Also,
team dynamics will be very different for each rotation. From the beginning, learn your
expectations and preferences so you can adapt to work well with them.
❖ Ask your resident about their expectations: arrival time, student’s role, how you can
add value, etc.
❖ Ask your resident about the attending and how they like to run the team.
❖ Read body language and tone for positive and negative feedback.
❖ Ask for feedback early, so you can make appropriate changes to improve.
❖ If the attending or resident are stressed, avoid asking for feedback. It is not the right
time. Patient health and safety come first.
❖ Show that you can accept feedback and improve.
DO Be a team player
Medicine is a team sport that requires many disciplines, including physicians, nurses, PAs,
OT, PT, RT, OR techs, admins, medical assistants, maintenance staff, and many more.
❖ Be willing to help with any task.
❖ Help your classmates and don’t call attention to it when you do. Attendings and
residents will notice when you work as a team player.
❖ Work hard during all of your rotations, not just the ones you are interested in.
Program directors talk, and all of your evaluations matter.
❖ Take initiative to make sure all of your patients are taken care of.
❖ Maintain a positive attitude always. Even if everyone else is being negative, don’t fall
into the negativity trap.
DO Be friendly and respectful
Simple, but very important: be kind and respectful to everyone, always.
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DO Be punctual and prepared
Be on time every day. Plan on being early so you are never late. And never walk in late
holding a Starbucks cup.
DO Dress the part
Bring your clean, pressed white coat along with you on the first day. For many rotations it
will not be mandatory to wear, however always check in advance. Always wear either
professional dress or scrubs. For most clerkships, wear professional clothing for
orientation, and bring a pair of scrubs in your backpack.
DO Communicate with your team
On day one, write your name and cell phone number on the team whiteboard. Also, add
dates and times when you won’t be there due to didactics or other clerkship requirements.
DO Show interest and ask questions
Ask questions and show your curiosity, even if you know you don’t want to pursue that
specialty. Your interest shows your investment in patient care and becoming a
well-rounded physician. Also, you may learn something that changes your perspective on
that specialty.
The majority of your learning should come from clinical rotations. If you don’t feel like you
are learning enough, ask more questions to the resident, attending, or other medical staff.
DO Manage your time
Allow for more time to pre-round on your patients at the beginning of each rotation. Ask
other students or residents on how to improve your efficiency.
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DO Tailor your physical exam to the clerkship and the patient
You will get a lot of experience doing pertinent physical exams. Use Bates to review
relevant physical exams prior to each rotation. Check the specific rotation syllabi for further
details.
Clerkship High-Yield for Physical Exam
Internal Medicine Full physical exam. Be sure to review MSK. Pulm/CV/ABD on most patients
Surgery Full physical exam. ABD is most important for general surgery; Trauma assessment and ABCDEs (airway, breathing, circulation, disability, exposure)
Family Medicine Full physical exam. Be sure to review MSK. Pulm/CV/ABD on most patients
Obstetrics & Gynecology
Prenatal exams, fetal heart tones, pelvic exam, breast exam
Pediatrics Healthy newborn exam, APGAR, developmental milestones
Psychiatry Mental status exam, neuro exam
Neurology Full neurological exam (Mental status exam, cranial nerves, peripheral nerves, reflexes, gait, coordination), ophthalmologic exam
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DO Balance work and life
Good luck. We all know that a healthy balance between work and life is important, but it is
very difficult to achieve during this year. So take advantage of every opportunity you have
to invest in your happiness and take care of your own health. Absence policies are taken
very seriously. You may miss weddings, birthdays, and other important events. However, if
something is really important to you, contact your clerkship director immediately at the
beginning of the rotation to see if you can arrange a specific rotation, schedule a call day,
or trade shifts with a peer to accomodate an important event. Patients and teams depend
on you to be there.
Physical & Mental Health
❖ Exercise when you can! Exercise will help clear your mind and improve learning.
❖ Eat real food. Pack your own snacks and meals if you can.
❖ See the doctor when you need to.
❖ Wash your hands.
❖ The importance of sleep cannot be overstated.
❖ If spirituality is a priority, find a plan that works for you.
❖ Most Importantly: If you find yourself struggling with depression, anxiety, stress
management, time management, career planning, substance use, or anything else,
seek help! Unfortunately, many students try to deal with these issues on their own.
Every year, medical students, residents, and young physicians end their life
too soon, so please ask for help. Talk to clerkship directors, deans, or the Medical
Student Wellness Program. If you don’t take care of yourself, you can’t take care of
others.
Medical Student Wellness Program
❖ Phone: 801-585-1207
❖ Email: [email protected]
❖ Website: https://medicine.utah.edu/students/current-students/wellness/
❖ FAQs
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➢ Who is eligible? Any medical student, spouse, significant other, or first-degree
relative living with the medical student.
➢ What does it cost? It is free.
After-Hours Mental Health Emergencies
❖ UNI Crisis Line: 801-587-3000
❖ Mental health hotline: (800) 273-8255
❖ Suicide hotline: (800) 784-2433
The “Don’t” List _______________________________________________________________________________________
DON’T Act like you know everything
Even if you know a lot about a topic, you don’t know what you don’t know. It is
inappropriate to argue with an attending when you disagree. Open discussion and offering
contributions is good, but it is not okay to imply you know more than they do.
DON’T Make other medical students (or residents) look bad
Making your peers (or residents) look bad or calling added attention to their mistakes will
reflect poorly on you. Do your best to help each other become better doctors. This is
another opportunity to show you are a team player. Never quiz/test another medical
student in front of residents and attendings.
DON’T Make excuses
Own your mistakes and learn from them.
DON’T Be on your device all the time
Do NOT use your phone to access social media or other personal apps during work hours.
You may use your device to look up clinical information, but be aware this may look like you
are looking at something else. Make it obvious you are looking up something medical by
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stating what you are going to look up and laying your phone flat so everyone can see
what you are doing.
DON’T Lie about the specialty you are interested in
Being honest about your interests will allow for residents to adapt their teaching to your
interests. For example, if you are interested in oncology, they may make more of an effort
to put you on cases with cancer patients, then ask you to investigate a certain aspect of the
case to present to the team. It pays to be honest.
MD/PhD: The Transition to Rotations
The MD/PhD program holds a “Transition to 3rd Year” course every spring for students who
plan to return to medical school that summer.
Questions about this course and other resources available to MD/PhD students should be
directed to Janet Bassett or Rob Taylor.
Resources
❖ Janet Bassett, Program Manager: [email protected]
❖ Rob Taylor MD, PhD, Program Director: [email protected]
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Idaho Students Idaho students are required to do their family medicine rotations in Idaho.
To set up family medicine rotation contact [email protected] and
Does the RUUTE program have different requirements for Idaho students?
Other rotations may be completed in Utah. Idaho students can participate in both
the RUUTE program and the Idaho Family Practice Clinical Clerkship.
Must have prior approval:
❖ The UUSOM pays students mileage for one trip to and from the location in Idaho.
❖ If a student drives more than 15 miles each way to the clinic where they complete
their Idaho family medicine rotation, the UUSOM may pay for the mileage for each
day the student drives.
❖ The UUSOM may pay up to $125 per week if a student needs to rent a place to stay.
❖ If the student stays with family or friends, the UUSOM may pay up to $75.00 for a
host gift. An itemized receipt is required.
❖ The UUSOM may pay up to $75 for a gift for the student’s proctor. An itemized
receipt is required.
Students must turn in receipts within one (1) month of the last day of their rotation to
Tammy Llewelyn. Unfortunately receipts turned in after this point may not be reimbursed.
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Resources
Mistreatment
When possible it is always best to raise a concern/give feedback which allows for follow-up
(such as your name, who the other involved party was, specifics about the incident). This
can be done in many ways to protect you from retaliation. The University of Utah has a
zero tolerance policy in regard to retaliation.
Mistreatment of a Patient
File an RL6: Anonymous or not. Up to you.
❖ RL6 is a U of U hospital form for reporting Unusual Occurrences (ranging from
patients having an unexpected outcome, receiving the wrong medication, all the
way to unprofessional behavior).
➢ Located on Pulse (Directions for adding RL6 to your homepage on pulse).
➢ Direct link to RL6 report form (Behavioral Event): See bottom of
document for images of RL6.
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Mistreatment of a Student Reporting Options
In person, email or phone: Not anonymous.
❖ Directly with person by whom they’ve been mistreated.
❖ Course Director, Associate Dean of Student Affairs, Associated Dean of Student
Affairs, Associate Dean of Curriculum, Vice Dean for Education, Hospital
Representatives (e.g., nurse manager or Associate Administrator for Patient Care
Services, chief residents, chairs, School of Medicine Officials).
End of Course Surveys: Anonymous or not. Up to you. UUSOM recommends using this
reporting route for specific mistreatment.
❖ Helpful when specific.
❖ If mistreatment has occurred, these get “flagged” for prompt follow up by SOM.
Preceptor Evals: Not anonymous. UUSOM recommends NOT using this reporting route for
specific mistreatment. The report is sent only after the rotation ends and when 3 or more
students provide ratings.
❖ Not anonymous, but helpful as directly tied to individual of concern.
❖ No retaliation tolerated.
❖ Not given to individual right away (long after grades/evals are submitted).
❖ Batched so less identifiable/de-identified.
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Suspected Patient Abuse
If you encounter a patient you suspect has been a victim of physical or sexual abuse, there
are algorithms on the University of Utah PULSE website that can guide appropriate action.
Utah’s state law requires mandatory reporting for the populations outlined below.
Children Vulnerable Adults Competent Adults
Qualifiers < 17 yrs > 65 yrs OR > 18 yrs with disability
Not a child Not a vulnerable adult
Who reports? Every adult citizen Every adult citizen Healthcare providers
When to report? Suspected Child Abuse OR Witness to Domestic violence (does not have to have an injury to report)
Suspected violent abuse (does not have to have an injury to report)
Assaultive Injury
Who to contact? Department of Children and Family Services Law Enforcement
Adult Protective Services Law Enforcement
Law Enforcement
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How to access PULSE resources:
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Scutsheets
Having a template that works for you is very important during rounds preparation. Some
rotations will provide you with templates to use, however others will not. For the ones that
will not here is a resource of premade scutsheets: http://medfools.com/downloads.php
Academic Success Program
Meet with Academic Success early. They have access to resources and a vast array of items
that can be checked-out for the rotation. Below are a few items they want you to know
about:
❖ Popular Question Banks
➢ Online MedEd
➢ AMBOSS
➢ UWorld
➢ PreTest
➢ Casefiles
➢ American Academy of Family Practitioners Question Bank (Family Med only)
❖ 2 NBME Practice Test Vouchers for:
➢ Family Medicine
➢ Internal Medicine
➢ Pediatrics
➢ Psychiatry
➢ Surgery
➢ OB/GYN
❖ 1 NBME Practice Test Voucher for:
➢ Neurology
If you need more vouchers for NBME’s then email Academic Success to see if they can provide
you with some
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Mobile Apps - Clinical Resources If you want an app talk with the library staff … they will probably buy it for you.
App Purpose Cost
Point of Care Medical Resources
AHRQ ePSS USPSTF preventive care guidelines Free
CDC Vaccine Schedule ACIP detailed immunization schedule Free
DynaMed Medical equations, clinical criteria, decision trees, statistic calculators, units & dose
converters, search by specialty
Free*
Medline Plus US National Library of Medicine: encyclopedic information on medical conditions,
medications, medical services.
Free
Medscape Less dense version of UpToDate Free
UpToDate Evidence based clinical information and guidelines Free*
US MEC US SPR US Medical Eligibility Criteria (US MEC) for Contraceptive Use Free
Medication References
Epocrates Medication dosages, reasons for use, side effects, contraindications Free^
Good Rx Prescription Drug Prices Free
Differential Diagnosis Resources
Diagnosaurus Organ system, symptom search for differential diagnosis $4.99
VisualDx Symptoms, signs, demographic search for targeted differential diagnosis $39.99/mo $399.99/yr
Other Useful Resources
Eye Chart Pro Snellen, Sloan, ETDRS, Near Vision Free
Canopy Speak Multilingual medical translator to explain complex medical concepts in internal medicine, emergency medicine, OB/GYN and surgery specialties.
Free
Journal Club Studies/Papers in bulleted format $6.99
MDCalc Medical Calculator Free
Journal Wiki Club Summarizes and reviews landmark studies across medicine and surgical specialties Free
*University of Utah login identification: https://library.med.utah.edu/# ^In-App Purchases: Create an account as “medical student” for free access. Call customer service if problems arise
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Clinical Evaluations on the MSPE
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NBME Shelf Exams At the end of each clerkship there will be an
NBME shelf exam. Refer to course syllabus
for exam score required to pass. Further
information regarding scoring will be
provided in each clerkship orientation. Shelf
exam scores are included in residency
applications.
Content & Structure
NBME shelf exams are more clinically
oriented than USMLE Step 1 and are best described as short specialty-specific Step 2 CK
exams. Content is similar to NBME Comprehensive Clinical Science exam. The shelf exams
will test common, high-yield topics in a clinical vignette format with one of the following
questions:
❖ ...Which of the following is the most
➢ likely diagnosis?
➢ likely explanation for this patient’s symptoms?
➢ likely underlying cause of this clinical/lab/radiographic finding?
➢ likely causal organism?
➢ likely to improve the underlying condition?
➢ likely to have prevented the patient's condition?
➢ appropriate pharmacotherapy?
➢ appropriate course of action/response? (patient counseling, ethics)
➢ appropriate next step in diagnosis/management?
➢ accurate interpretation of this result?
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NBME Study Resources
Although your best resources are clinical rotation and didactics, supplementation with
books and practice questions are necessary. There will not be a study week during
clerkships, and rarely you will receive a half or whole day prior to the shelf exam.
NBME Sample Subject Exams
The NBME subject exam website has sample test questions and specific information for
each shelf exam: https://www.nbme.org/students/Subject-Exams/subexams.html
Clerkship Study Guide Resources
Pick one or two study resources for each clerkship and complete it thoroughly. Many
rotations will provide you with a study resource (i.e. Case Files or Blueprints) to use during
the rotation.
❖ Questions: The practice questions provided by these companies for each clerkship
does not correlate well to NBME shelf exam questions. NBME has more difficult
questions, so refer to NBME sample test questions!
➢ Uworld Qbank
➢ Pre-Test series
➢ Specialty organization test prep resources (e.g., ACOG)
❖ Case-based
➢ Case Files series
❖ Textbook/reference
➢ Blueprint series
➢ Step Up series
➢ First Aid series
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Electronic Medical Records (EMRs)
EMR training will be provided in Transitions to Clerkships week. This will take some time to
learn, but once you can navigate one EMR you will be able to navigate the rest. To submit
tickets, go to Pulse and select the blue button titled “Submit Hospital/Clinics IT Trouble
Ticket”.
EMR System Where it is used IT Department
Epic University of Utah 801-587-6000
iCentra Intermountain Healthcare 801-442-5731
CPRS VA Hospital 801-582-1565 x1293
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Main Clinical Sites
There are many other clinical sites, but these are the main ones:
Site IM FM OB/GYN NEURO PEDS PSYCH SURG
University of Utah Hospital X X X X X
Intermountain Medical Center (Murray) X X X
Primary Children's Hospital X X X X
VA Medical Center X X X X
Huntsman Cancer Hospital X X
LDS Hospital X X
University of Utah Neuropsychiatric Institute X
12 Community Based Hospitals & Clinics X X X
Rural X X X
Site Specific Hospital Maps
❖ Map for University of Utah Hospital can be found here.
❖ Map for Primary Children’s Hospital can be downloaded with this link.
❖ Map for Huntsman Cancer Hospital can be found here.
❖ Please see Appendix A for the VA Hospital and Intermountain Healthcare.
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University of Utah Hospital
General Information
Phone: 801-581-2121
Location: 50 N Medical Dr, Salt Lake City, UT 84112
Safety Escorts: 801-585-2677
Since the University of Utah Hospital opened in 1965, it has expanded into an extensive
health care system that boasts more than 1,400 board-certified physicians and 5,000 health
care professionals at the following locations:
❖ University Hospital
❖ Huntsman Cancer Institute
❖ University Orthopaedic Center
❖ University Neuropsychiatric Institute
❖ Cardiovascular Center
❖ Clinical Neurosciences Center
❖ Utah Diabetes Center
It is consistently ranked #1 in national quality among academic medical centers.
Parking
❖ University Parking Permit
❖ Trax
ID Badge & Access
You should already have a University of Utah badge, but if you have lost it go to The
University Hospital UCard office is located on the A Level by the south entrance to the
School of Medicine, Room AC143C. Please look for the “U Card Office” sign posted in the
main hallway. Office Hours: Mon-Fri 7am-7pm.
A word of caution, the badges do not always work so be careful. Many students have
gotten locked in the stairwell, especially at the Huntsman Cancer Institute!
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Dining Options
Main Hospital
Main Cafeteria Level A by the escalators 6:30 am - 10:00 pm Mon - Fri 8:00 am - 8:00 pm Sat - Sun
Starbucks Coffee First floor main hospital 24 hours 7 days a week
Huntsman Cancer Institute
Starbucks Coffee Floor 6 inside The Point Restaurant 7:00 am - 6:00 pm Mon - Fri
Lobby Espresso A Level at the base of elevators 6:30 am - 10:30 am
The Point Restaurant Floor 6 7:00 am - 10:30 am Mon - Fri 11:00 am - 2:00 pm Mon - Fri
The Point Bistro Floor 6 6:30 am - 8:30 pm Mon - Fri 11:00 am - 7:00 pm Sat - Sun
The Night Bistro Level A at the base of the elevators 10:00 pm - 3:00 am
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Primary Children’s Hospital
General Information
Phone: 801-581-2121
Location: 500 Foothill Drive, Salt Lake City, UT, 84148
Primary Children’s Hospital is a level 1 pediatric trauma center ranked among the best
children’s hospitals in the nation by U.S. News & World Report.
Parking
❖ University Parking Permit
❖ Trax
Dining Options
Primary Children’s Hospital
Mountainside Cafe Level 1. Eccles Outpatient 7:00 am - 4:00 pm
Treetop Cafe Lobby. North side of hospital 8:00 am - 3 pm Mon - Fri
Rainbow Cafe Level 1 by north entrance 6:30 am - 2:00 am
Brews on 3rd Level 3 south of main elevators 6:00 am - 7:00 pm
Vending Machines Level 4 south of main elevators and in south entrance lobby
24 hours 7 days a week
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George E. Wahlen Department of Veterans Affairs
General Information
Phone: 801-581-2121
Location: Main Hospital is building 14. 500 Foothill Drive, Salt Lake City, UT, 84148
Visitor’s Guide: Numbers, Maps, Hours
The Veterans Health Administration provides care to 9 million Veterans each year at 1,243
health care facilities.
Parking
❖ University Parking Permit
❖ Trax
Dining Options
The VA
Canteen (Cafeteria) Building 8 near the gym 7:30 am - 3:00 pm Mon - Fri (grill closes at 2pm)
TOP Cafe Building 5 5:00 pm - 6:15 pm Mon - Fri 7:00 am - 8:15 am Sat - Sun 11:15 am - 1:00 pm Sat - Sun 5:00 pm - 6:15 pm Sat - Sun
Patriot Store Building 8 across from Cafeteria 7:30 am - 3:30 pm Mon - Fri
Coffee Bar Building 1 7:00 am - 4:00 pm Mon - Fri
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LDS Hospital
General Information
Phone: 801-408-1100
Location: 8th Ave C Street, Salt Lake City, UT, 84143
LDS hospital has provided healthcare for 110 years and is now operated by Intermountain
Healthcare.
Parking
Main Hospital
Valet Parking (Free) Main entrance (8th Ave and C street) 7:30 am - 3:30 pm Mon - Fri
Street Parking Fills up quickly
Visitor Parking Structure Across the street from main entrance
Dining Options
Main Hospital
8th and C Café Second floor by central elevator 7:00 am - 8:00 pm Mon - Fri
33
University of Utah Neuropsychiatric Institute
General Information
Phone: 801-583-2500
Location: 501 Chipeta Way, Salt Lake City, UT 84108
The University of Utah Neuropsychiatric Institute (UNI) treats conditions ranging from
anxiety to schizophrenia. It is comprised of the following clinics:
❖ Autism Spectrum Disorder Clinic
❖ Consult Clinic (Downtown)
❖ Same-Day Psychiatry Clinic
❖ Behavioral Health Clinic
❖ Recovery Clinic
❖ Treatment Resistant Mood Disorder Clinic
Parking
❖ University Parking Permit
❖ Trax
Dining Options
UNI
Dining Room 7:00 am - 8:00 pm Mon - Fri 7:00am - 6:00 pm Sat- Sun/ Holidays
34
Failed Clerkships The following information in this section has been taken directly from the UUSOM Student
Handbook (January 2019). Please refer to the latest version of the student handbook for
further details. This information can, and does, change over time.
Trigger Situation Consequence
One (1) Failed Standardized Exam Any Core Clerkship ❖ Academic Warning ❖ Not reported on MSPE
Two (2) Failed Standardized Exam Same Clerkship ❖ Course Failure ❖ Academic Probation ❖ Referral to Promotions Committee ❖ Course Failure and all Standardized Exam
Failures Reported on MSPE
Two Failed Standardized Exam Any Combination ❖ Academic probation ❖ All Standardized Exam Failures Reported on
MSPE
Three (3) Failed Standardized Exam Any Combination ❖ Academic probation ❖ All Standardized Exam Failures Reported on
MSPE ❖ Referral to Promotions Committee
One (1) Outstanding Failed Standardized Exam
Past the Winter Break OR Past the end of Phase 3 Break
❖ Academic Probation ❖ Reported on MSPE ❖ Withdrawn from Current Coursework
Two (2) Outstanding Failed Standardized Exams
Any Combination Any time
❖ Academic Probation ❖ All Standardized Exam Failures Reported on
MSPE ❖ Withdrawn from Current Coursework
35
General Day Outline
Day 1
❖ Email the resident 1-2 days before to find out when and where to meet them, and
what time you should be ready to present your patients by. Usually on the first day
you do not pre-round.
❖ Remember to ask how notes should be written, and form to use in the EMR.
❖ Set up EPIC filters to create your patient list and pick up the patients you will see in
the morning, so that you can hit the ground running the first day.
Pre-Rounding
❖ Day or morning before rounds (rotation specific) look up your patients.
❖ Chief resident assigns you 1-2 patients on your first day.
❖ Arrive at designated time determined before with resident: bring white coat,
stethoscope, snack.
➢ Yesterday’s progress note (tiny font, fold in half)
➢ Patient List (for you and residents)
❖ Check yesterday afternoon
➢ Overnight Events
➢ Consult notes
➢ Imaging
➢ Overnight vitals (be able to explain why and any abnormalities)
➢ Medications given (Google unfamiliar drugs)
➢ Pending orders (plans may have changed since you left)
➢ Specialty specific daily assessments (ex: Conners ADHD rating, In’s and Out’s,
daily weights, lochia).
❖ Talk to night nurses about medication, concerns, ideas about plan before they sign
out to day team.
❖ See patient #1
➢ Wake them up
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➢ Ask: how the night went, pain, walking, urinating (look for Foley), bowel
movement since surgery/admission, look at incision, listen to heart/lungs,
poke belly, check feet, check what meds/fluids hanging
❖ See remaining patients.
❖ Sit down at computer to consolidate notes and formalize plan. Be sure to run plan
past resident prior to rounds. Start note if you have time using team template.
➢ Write down the plan: orders, consults, discharge date if mentioned
❖ Where to sit:
Rounding
❖ Bring printed patient lists and progress note to recite for presentation
❖ Listen to other residents’ presentations and adapt
❖ Go over 24-hour vitals. State ranges “Tmax 37.8, HR 70-98, BP 132-150 over 70-90”
and most recent measurement (especially on OB/GYN).
➢ Discussing labs is team dependent:
■ Internal Medicine usually lists off every CMP value
■ Surgery “CMP this morning within normal limits, K+ is downtrending
from 5.2 to 4.2”
❖ Observe: if they look bored, go faster.
❖ Rounding Types:
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Resident Consults
A guide to when and how to page residents can be found here.
Ways to Shine
❖ Writing notes:
➢ Designate attending and/or resident as your co-signer so they can use your
notes directly. **Rotation/attending specific. Check with resident on day 1.
❖ Find which note template to use.
❖ Get added to team’s pager (call hospital operator).
❖ Page others and consults (smartweb).
❖ Email resident a few days before.
❖ Feedback: end of first week, midway, end of service
❖ Ask intelligent questions: “why did you choose this treatment over x?”
❖ Look at every patients’ radiology image yourself.
❖ Place yourself in as many uncomfortable conversations as possible (end of life,
unsatisfied patient).
❖ Thank you cards.
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Internal Medicine Clinical Clerkship
Inpatient Medicine
Four weeks of inpatient medicine at either the University of Utah Medical Center,
Intermountain Medical Center, or the VA Medical Center.
❖ “long” or “call” days: every 3-4 days where your team will admit patients until later
in the day, You will leave around 6-8 pm.
❖ “short” or “golden” days: every 3-4 days, where your team is not admitting new
patients. Typically get home between 2-4 pm.
❖ Attire (weekday): business casual, white coat (follow resident example)
❖ Attire (weekend/night): scrubs
Outpatient Medicine
❖ Two weeks of outpatient medicine at community clinic. This will be Monday -
Friday with weekends off. You will typically work 8am - 5 pm.
Elective rotations
❖ Two weeks of inpatient electives. You will work six days a week, but frequently
with shorter hours than your general inpatient medicine rotation.
❖ Cardiology (UU and VA), Pulmonology (UU), Hematology (Huntsman), and
Oncology (Huntsman)
Typical Inpatient Day
05:30 - 05:45 06:30 06:30 - 08:00 08:00 - 12:00 12:00 - 13:00 13:00 - 17:30
Wake Up Arrive at Hospital (Team specific) Preround Formal Rounds Noon Conference (lunch) Finish Documentation: Follow-up patients, new admits, teaching
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Vitals
Report vitals in 24-hour ranges (7am yesterday to 7am today)
Vitals
Temperature Focus on Tmax over past 24 hours and general trend: ❖ Afebrile ❖ Medicine Fever: > 100.4 F (38C) ❖ Surgery Post-Op Fever: >101.4 F (38.56C) ❖ Hypothermia: <96.8 F (36C)
Heart Rate & Blood Pressure Stable or change? If tachycardic, is it associated with fever/exertion/pain/other?
Respiratory Rate Important if O2 is low and/or hypo/hyper and leading to acid/base disorder
O2 O2 >92% is fine. Note if it is less than this. Report as “XX% on [mode of delivery]” ❖ Room air: FiO2 = 21% ❖ Nasal Cannula: How many liters? For each liter add about 3% O2
Example: Patient is on 3L O2
FiO2 = 21% + (#L O2)(3%) = 30% FiO2
❖ Assisted: mask, BIPAP, CPAP, Vent w/settings
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Ins & Outs
There is an EPIC tab that gives you all this information, and it prints out on the rounding
forms so there is no need to write it all out. There is also a MedCalc for Urine Output
calculations described in the box below.
Ins & Outs
Ins Include oral and IV fluids
Urine Output (UOP) Urine Output (mL)/patient’s weight (kg)/time (mL/kg/hr) UOP should not be less than 0.5 mL/kg/hr in adults ❖ Example: Patient puts out 1000 mL of urine in 24 hours, patient
weighs 60 kg UOP = 1000 mL / 60 kg / 24 hours = 0.69 mL/kg/hr
Routine Labs
Fishbone Diagrams
Here are shorthand diagrams for recording routine labs.
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CBC
WBC Neutropenia: calculate the absolute neutrophil count (ANC) if the patient has a low white count and/or is at risk for neutropenia. ❖ ANC = (%segs + %bands) x WBC ❖ Neutropenic fever tx:
➢ First: Cefepime x 48 hrs ➢ Still fevering: Vancomycin x 5 days ➢ Still fevering: Antifungals
Leukocytopenia: Examine which predominates (neutrophils, lymphocytes…), ❖ Remember, steroids increase white count
Hgb/Hct Hgb/Hct should be 1:3 ❖ General Goal >7:21 ❖ ObGyn Goal 10:31 in severe conditions ❖ Transfusing 1 U of pRBCs → increase of 1 in Hgb and 3 in Hct
➢ If patients H/H drops ⅓ then they have lost 1 U blood.
Platelets ❖ Goal >50K so clots can form ❖ Consider transfusing <20K
Chemistry
Na+ If low, think about... ❖ Volume overload ❖ Hyperglycemia
Corrected Na+ = measured Na+ + [1.6 (glucose -100) /100]
If high, they’re dry.
K+ If low, then replete with… ❖ 10 mEq IV → increase in 0.1 K to goal
(20-40 mEq at a time) ❖ There must be adequate Mg2+ in
order to replete K+.
If high “C BIG K, Die” ❖ Calcium gluconate (stabilize myocytes) ❖ Bicarb ❖ IG (insulin/glucose) ❖ Kayexalate (poop out excess K+)
Cl/Bicarb Refer to “acid/base” status below
BUN/Cr Calculate GFR ❖ Prerenal AKI: BUN/Cr >20, FeNa <1% ❖ Intrinsic AKI: BUN/Cr <15, FeNa >2% ❖ Postrenal AKI: BUN/Cr >15, FeNa <41%
If patient is on dialysis, Cr does not matter
Glucose Give the last 3 glucoses
Ca2+ Always correct Ca2+ for albumin. Ca2+ = [0.8 x (4-Alb)] + Ca2+
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Acid/Base Status
This is very high yield both clinically and on NBME shelf exams. Make sure you understand
this.
❖ pH & Bicarb/CO2: determine acidosis/alkalosis
❖ Anion Gap = Na+ - Cl- - HCO3- (normal 8-12)
❖ Winter’s Formula (metabolic acidosis): PaCO2 = (1.5 x HCO3-) + 8 + 2
Emergent Dialysis Indications
AEI(SLIME)OU
❖ Acidosis (metabolic: MUDPILES)
❖ Electrolytes (mainly K+)
❖ Intoxication: Salicylates, Li+, Isopropanol, Mg2+ containing laxatives, Ethylene glycol
❖ “Osis-es” (volume overload): “cardiosis” (CHF), cirrhosis, nephrosis
❖ Uremia: pericarditis, encephalopathy, and/or GI bleed
Risk Scores
The MDCalc app can calculate these for you.
Condition Score Condition Score
STEMI/NSTEMI TIMI Score Liver Disease MELD Score
Pneumonia CURB-65 Stroke NIH Stroke Score
Pleural Effusion Light’s Criteria Risk of Stroke s/p TIA ABCD2 Score
Pulmonary Embolism Wells Score Risk of Stroke w/AFib CHADS2 Score
Statin Need ASCVD
Pancreatitis Ranson’s Criteria, Apache II
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HIV Primary Care 101
Initial Visit/Admission
❖ Duration of infection?
❖ History of AIDs-defining illness?
❖ CD4 nadir?
❖ Prior medications used? Adherence?
❖ Prior genotype/resistance testing?
Treatment
❖ Resistance Testing
➢ Prior to initiation of therapy for treatment-naïve patients ➢ Order HIV genotype (includes sequencing of RT and protease genes) and
separate integrase sequencing and analysis if concern for integrase mutations.
➢ To evaluate potential treatment failure if viral load >500, ideally while on regimen or within 4 weeks if discontinued.
➢ HIV often reverts to wild-type in absence of selective drug pressure, and previously gained mutations may not show up on genotype, but are ‘archived’ and reappear when meds with resistance are restarted.
➢ Expert consultation recommended ➢
❖ Uncomplicated/Non-resistant Disease Basic Rules: 3 active drugs from multiple
classes, don’t miss doses, begin as close to diagnosis as possible
❖ Preferred regimens for initial therapy in treatment naive patients: 2 nucleoside
reverse transcriptase inhibitors and either a protease inhibitor, NNRTI, or integrase
inhibitor.
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Integrase Strand Transfer Inhibitor (INSTI) - based
Dolutegravir/abacavir/lamivudine (Triumeq) Only if HLA-B*5701 negative
Dolutegravir (Tivicay) plus tenofovir/emtricitabine (Truvada)
Elvitegravir/cobicistat/tenofovir/emtricitabine (Stribld) Pre-therapy CrCl >70
Elvitegravir/cobicistat/tenofovir alafenamide/emtricitabine (Genvoya)
Raltegravir (Isentress) plus tenofovir/emtricitabine (Truvada)
Protease Inhibitor (PI) - based
Darunavir/ritonavir plus tenofovir/emtricitabine (Truvada)
Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) - based
Efavirenz/tenofovir/emtricitabine (Atripla) First single-pill formulation, still in wide use
Rilpivirine/tenofovir/emtricitabine (Complera) Rilpivirine/tenofovir alafenamide/emtricitabine (Odefsey)
Only if pretreatment HIV RNA level < 100,000 copies/mL
Single-pill once-daily co-formulations are in bold
❖ Salvage therapy: fusion and entry inhibitors
❖ Infection prophylaxis
➢ Vaccines, including yearly inactivated influenza ➢ PCV-13 >8 weeks ➢ >PPV23 once then booster PPV23 x1 at 5 years if age <65 at first dose ➢ HAV, HBV, (everyone) and HPV if age 13 - 26 ➢ CD4 < 200 (prophylaxis should be continued until CD4 count >200 on two
readings at least 3 months apart) ■ Pneumocystis pneumonia: TMP-SMX one SS or DS tab daily
➢ CD4 < 100 ■ Toxoplasmosis in IgG positive patients: TMP-SMX one DS tab daily
➢ CD4 < 50 ■ MAC: Azithromycin 1200 mg weekly
Follow-Up Visits
❖ Adherence? Missing doses? Check for issues of tolerability/side effects, cost,
insurance, ready access to refills, etc.
❖ Lab monitoring
➢ Viral load: every 3 months, or if long-term suppression then every 6 months
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➢ CD4 court every 3 months until suppressed 2 years, then every 12 months if
300-500, optional if >500
➢ BMP every 3-6 months with UA if on tenofovir DF
➢ Yearly A1c, lipids
❖ Screen/treat other STIs
❖ Assess drug/supplement interactions (especially Ca2+/Mg2+)
❖ Routine cancer screening as indicated for non-HIV infected
HIV Resources:
❖ NIH guidelines
❖ UCSF HIV InSite
Study Resources
Wards
❖ Pocket Medicine (Quick Clinical Reference - very useful for wards)
❖ Maxwell Quick Medical Reference
Shelf
❖ UWorld Medicine Section
❖ Step Up 2 Medicine
❖ NBME Practice Subject Tests
❖ Online MedEd videos
OSCE
❖ First Aid for the USMLE Step 2 Clinical Skills
❖ Form differentials: heart problems (chest pain, heart failure), lung problems
(pneumonia, COPD), GI problems
❖ Demonstrating empathy is always important.
❖ Don’t forget to articulate a summary statement, education and plan to the
standardized patient at the end.
46
Surgery Clinical Clerkship
Eight weeks of ward work, operating room experience, lectures, case presentations,
and rounds. Students spend six weeks on general surgery (two of these weeks are with
an outside preceptor) and two weeks in specialty areas.
Rotations
General Surgery Electives Outside Preceptorship
UTES (Utah Trauma and Emergency Service) CRABS (Colorectal/Abdominal Surgery) Foregut/Bariatric Surgical Oncology IMC General Surgery VA General Surgery Primary Children’s Hospital General Surgery
Cardiothoracic Surgery Breast Health Burn Head and Neck Plastic Surgery Transplant Urology Vascular at U Vascular at VA
St. George Provo Ogden Salt Lake City area
General Advice for all services
❖ Almost all services do team evals
❖ Residents look at who last updated patient Handoff (toolbar above pt list on Epic)
❖ *Hint: nothing is a fever unless >38.3C
❖ Attire: Scrubs
Typical Inpatient Day
04:45 05:00-05:30 05:30 - 06:30 06:30 - 07:30 07:30 - 12:00 12:00 - ****
Wake Up Arrive at Hospital (Team specific) Preround Formal Rounds OR case or clinic (varies) OR case or clinic (end time difficult to predict)
47
Ways to Shine
In the OR
❖ Get to the OR early and write your name, title, and glove size on the board.
❖ Be kind to the scrub tech, pull your gloves and put your hands where they tell you.
❖ Before entering: look up the OR schedule, know the patients, skim Surgical Recall for
potential questions, mask/hair cap ready.
❖ Write your OR cases, answers to potential questions, and even little anatomy
drawings on a list or note card that you can keep in your pocket to refresh your
memory between cases.
❖ Upon entering, write your name on board, ask to write pt’s name/info on board if
needed, ask to grab gloves/gown, get eye shield if needed, pull up images on
computer, help transfer patient, grab warm blankets, put SCDs on, get razor and
tape ready, get iodine prep ready
❖ While waiting: ask to intubate for every patient
❖ OR Etiquette
➢ Introduce yourself.
➢ Tuck hair entirely into hair net.
➢ Make sure you have glasses or eye
shield, tape if needed
➢ Scrubs tucked in, no shirt under scrubs.
➢ Always let others dry hands/gown
before you.
➢ No hands in armpits.
➢ Don’t grab from scrub tech unless asked.
➢ Don’t. Break. Sterile. Field. Ever.
➢ Ask to place hands on circulator tray.
➢ “May I ask a question?”
➢ Suction, then get out of there.
➢ Cutting suture - brace hand, tilt, and pause.
❖ Scrub when your resident scrubs and try to do it for a bit longer than they do.
❖ Remember your anatomy for when they ask you questions.
❖ Suturing and knot tying: Two handed tie, One handed tie (at your own risk and
with permission from your attending!), Instrument tie, Running baseball stitch,
Subcutaneous stitch.
➢ Suture Skills Course (19:45 minutes - Duke Medical School)
➢ Surgical Knot Tie Booklet (Penn Medicine)
❖ Read about the case beforehand and prepare 1-2 questions to ask either about the
procedure, the patient, why they are doing something; however, be smart with the
48
timing of your questions. For example, don’t ask questions if you see a lot of blood
or during a very delicate part of the surgery like sewing onto a beating heart.
❖ Ask someone for the case list at the beginning of the week so you know how to
prepare.
During rounds
❖ Be early
❖ Offer to print off the patient list in the morning for residents and what is format
preferred.
❖ Know your patients and their social history, past medical history, drug history, family
history, etc.
❖ Know the numbers and details for post-op days 1 and possibly 2. After that, they
want to know:
➢ Pain?
➢ PO intake?
➢ BM? Passing gas?
➢ Walking?
➢ Can they go home?
➢ Indwelling lines (ex: right peripheral IV, L IJ central line)
➢ In’s and Out’s
➢ Suture site: is the incision dry? Clean? Intact?
24 Hour Shift - Trauma Surgery
❖ Night before: pack toothbrush/toothpaste, granola bars, study material, comfortable
shoes
❖ EPIC Templates: Important to use the right ones. In the manage smartphrases tab,
search "Elisha Haroldsen". You want these:
➢ .iptraumaadmit for trauma admits
➢ .ipgreenconsult for consults
➢ .iptraumaprogress for trauma progress notes
➢ .ipgreenprogwcustomexam for other inpatient progress notes
➢ .iptraumadischarge for discharges
49
❖ Arrive in scrubs at SICU (2nd floor of main hospital) at 05:45
❖ Handoff is at 06:00 in the big conference room next to PACS. If you are on UTES,
preround on your patients. You will present that day. If you are NOT on UTES,
introduce yourself to the team and ask how you can be of service.
❖ Traumas: You will receive a page. Go to trauma bay in the ED. Get gloves and a mask
on ASAP. Pull up a computer and drop a trauma admit note (dot phrases above).
Write down everything you hear. After trauma, tidy up the note and take a stab at
the plan. Don’t sign the note, ALWAYS pend it. Go to CT room after and assist with
transportation of patient.
❖ Consults: Do the full H&P with physical exam. Particular emphasis on prior
surgeries, family history of bleeding disorders or malignant hyperthermia, allergies
to medications, anticoagulation use, etc. Essentially anything that could kill the
patient on the OR is important to ask about. Check vitals, interventions in the ED,
relevant labs/imaging. Make a plan. Present to chief resident.
Study Resources
SICU/OR
❖ Surgical Recall (the ultimate guide to nailing those questions attendings will ask you)
Shelf
❖ UWorld Medicine Section
❖ PESTANA (book + all youtube videos)
❖ NBME practice tests, UWorld, AMBOSS
❖ Surgery by Julia DiVergilio
❖ NBME Practice Subject Tests
OSCE
❖ First Aid for the USMLE Step 2 Clinical Skills
❖ Form differentials: GI quadrants (appendicitis, cholecystitis, diverticulitis, bowel
obstruction)
50
❖ Type up the H&P in the following order to score the most points: top 3 differentials >
diagnostic tests > HPI > Physical Exam,
Family/Social/Surgical/Medical/Medication/Allergies Histories
❖ Demonstrating empathy is always important.
❖ Don’t forget to articulate a summary statement, education and plan to the
standardized patient at the end.
Family Medicine Clinical Clerkship Six weeks with a community-based family medicine preceptor. The majority of the time
is spent with the preceptor in the clinic, hospital, nursing homes, and on house calls.
Time is also spent learning about and experiencing other elements of the health care
system in the community served by the preceptor.
❖ Attire: Business Casual
Typical Outpatient Day
07:00 - 09:00 09:00 - 12:00 12:00 - 13:00 13:00 - 17:00
Clinic Starts Morning Clinic Lunch (ask for this!) Afternoon Clinic
Ways to Shine
❖ Ask all patients a personal question. If there is time then share the information in
the subjective portion of your presentation. If clinic is rushed then just present
pertinent findings.
➢ How is work going?
➢ How are their children?
➢ Are they following the Utes in the playoffs?
❖ Ask about medication compliance:
➢ Side effects
➢ Did they fill the prescription?
➢ Taking as prescribed? When symptomatic? When they can remember? If they
can afford it?
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❖ Diabetes Management: ABCDDEEFGH’s
➢ A1c: When was the last one? What was it? What is the goal?
➢ Blood Pressure: Today? If elevated, was it repeated? What is the goal?
➢ Cholesterol: Lipid panel in last year? On a statin?
➢ Diet: Overweight/obese? What does their diet consist of? Working
refrigerator at home?
➢ Diabetic Nephropathy: Urine microalbumin checked in past year? If
proteinuria is present and CKD established then do not check urine
microalbumin.
➢ Eyes: Diabetic retinopathy screening in last year?
➢ Exercise: Able to? Safe place to do so? Create short and long term goals.
➢ Feet: Diabetic foot exam with monofilament in past year? Ask about and
examine the feet each visit. Help patient obtain diabetic shoes if the following
exists: foot deformity, prior amputation, pre-ulcerative callus, neuropathy,
poor circulation.
➢ Glucose: Do they check? What time of day (am, pre-meal, post-meal, etc.)?
When is sugar high/low? Did they bring a log?
➢ Home Meds: Oral? Insulin? Have them detail their regimen for you (what type
of insulin, units, when is it administered, etc.)
❖ Live and breath these guidelines: diabetes, hypertension, dyslipidemia
➢ UpToDate
➢ AAFP (American Academy of Family Practitioners) website
❖ Review: vaccine schedule, health maintenance ages (PAP, colonoscopy, etc)
➢ USPSTF Recommendations, especially Grade A and Grade B
recommendations.
❖ Assignments: Family Med has a number of assignments in addition to clinic work.
Start working on the assignments early so they don’t interfere with Shelf/OSCE study
time at the end of the rotation.
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Study Resources
Outpatient
❖ Pocket Primary Care
Shelf
❖ AAFP Questions (American Academy of Family Practitioners)
❖ Case Files
❖ StepUp to Medicine (Ambulatory most helpful section; MSK, Rheum,)
❖ Online MedEd
❖ Other Resource Options: PreTest, Blueprints, Pocket-Family Medicine, ABFM In
Training Exams, NBME Practice Tests, UWorld Medicine Questions (Not as helpful for
FM)
OSCE
❖ Form Differentials: MSK problems (shoulder/knee pain, etc.), lung problems
(asthma, pneumonia, etc.), heart problems (palpitations, chest pain, etc.), neuro
problems (numbness, dizziness, etc.)
❖ Type up the H&P in the following order to score the most points: top 3 differentials >
diagnostic tests > HPI > Physical Exam,
Family/Social/Surgical/Medical/Medication/Allergies Histories
❖ Demonstrating empathy is always important.
❖ Don’t forget to articulate a summary statement, education and plan to the
standardized patient at the end.
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Obstetrics & Gynecology Clinical Clerkship Six weeks of inpatient and outpatient experiences in addition to lectures, seminars, and
review of gynecological pathology.
❖ Attire: Scrubs inpatient, business casual outpatient.
Typical Inpatient Day - Gyn
05:30 06:00 - 06:30 06:30 - 07:30 07:30 - 08:00 08:00 - 16:00
Wake Up Arrive at Hospital Preround Wait for attending to present your patients OR case or clinic (varies) OR cases, occasionally clinic, teaching, Pre-op write ups, study
Typical Inpatient Day - Labor & Delivery + Antepartum
04:15 05:00 05:00 - 06:30 06:30 - 07:30 07:30 - 17:30
Wake Up Arrive at Hospital Preround Postpartum Rounds Deliveries, Admits, Teaching, C-sections
G-TPAL
❖ G = gravida = # of pregnancies
❖ P = para “TPAL”
➢ T = term deliveries (twin/triplet delivery counts as one delivery)
➢ P = pre-term deliveries (<37 weeks)
➢ A = abortions (spontaneous or elective)
➢ L = living children
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Labor & Delivery
❖ Take histories on new patients being admitted to deliver. Check out the appendix
for L&D history and physical template.
❖ Postpartum Rounding: fever, AM Hct labs, estimated blood loss, breastfeeding,
mood, sleep, vaginal discharge, bowel movement, incision site dry/intact/clean,
lochia, is pain adequately controlled on medication, PRN’s.
❖ Write the 2-hour Fetal Heart Tracing (FHT) strip notes. You will be taught how to
do this on day 1 of L&D.
❖ Spend time with patients waiting to deliver and try to always be present.
Gyn
❖ Take histories on new patients:
➢ this pregnancy
➢ annual preventative care: pap smears, mammograms, routine labs (TSH,
Hbg, lipid panel, A1c), immunizations (Flu, Tdap, HPV, MMR, VzV)
➢ Menstrual history/ Menstrual History: last menstrual period, duration,
cycle, pain, STI screens, number of partners, sexual practicies (oral/
vaginal/ anal/toys).
➢ Obstetric history: GTPALS, age at each pregnancy, date of birth, newborn
weights, delivery type, complications during pregnancy/ delivery/
postpartum, transfusions).
➢ Social history: HEADSSS, domestic abuse, psychological stressors,
exercise, seat belt, access to food/transportation).
❖ Learn to use the doppler ultrasound and estimate fetal position/weight.
Gyn-Onc
❖ Cheat sheet of potential questions will be sent to you by the coordinator.
❖ Have your clinic notes finished promptly.
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Study Resources
Wards/L&D/Outpatient
❖ Pocket Ob/GYN
❖ American Academy of Obstetricians and Gynecologists (ACOG). This is more
accurate than up-to-date.
Shelf
❖ Online cases
❖ Online MedEd
❖ NBME practice tests
❖ UWorld
OSCE
❖ Form differentials: vaginal discharge, abnormal uterine bleeding, missed period,
abdominal pain.
❖ Know to offer such things as: rape kit, social work services, emergency
contraception, contraceptive counseling.
❖ Type up the H&P in the following order to score the most points: top 3 differentials >
diagnostic tests > HPI > Physical Exam,
Family/Social/Surgical/Medical/Medication/Allergies Histories
❖ Demonstrating empathy is always important. Be prepared for a crying standardized
patient.
❖ Don’t forget to articulate a summary statement, education and plan to the
standardized patient at the end.
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Pediatrics Clinical Clerkship Six weeks divided into two three-week blocks. Three weeks are spent on the inpatient
wards at Primary Children's Hospital (PCH). The other three-week block includes one
week on a pediatric subspecialty service, one week in well baby nursery at the
University of Utah and Outpatient.
❖ Attire (weekday): business casual out/inpatient, scrubs on well baby nursery.
❖ Attire (weekend/night): scrubs
Typical Inpatient Day
05:00 05:45 06:00 - 07:00 07:00 - 08:00 08:00 - 12:00 12:00 - 13:00 13:00 - 17:00
Wake Up Arrive at Hospital Preround Morning Report Round Lunch Help others, call PCP, update tracker, hospital course, etc.
Ways to Shine
Outpatient
❖ Know immunization history
❖ Know developmental milestones
Inpatient
❖ Obtain history from parents and kid
➢ Sick contacts? school, daycare, siblings
➢ Has this happened before? Might find pattern of illness indicating underlying
process
❖ Get phone/fax numbers of child’s primary-care-physician
❖ Conduct full physical exam on sleeping child. Most are heavy sleepers, and there
really is not a need to wake them up at 5 am.
❖ Know immunization history
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❖ Watch out for fevers: Were they on Tylenol? Need to be afebrile 24 hours before
discharge
❖ Calculate kcals/kg/day based on formula
❖ Report & Examine: activity level, breathing (accessory muscles), skin color, rashes
The Well Baby Nursery
Typical WBN Day
07:00 07:00 - 08:30 08:30 - 09:00 09:00 - 12:00 12:00 - 13:00 13:00 - 17:00
Arrive at Hospital in blue scrubs Preround Teaching Round Noon Conference (Bring food back to WBN for the residents) Finish-up work, conferences, teaching, pediatric topic reading
❖ Be assertive to get deliveries.
❖ Babies are not always in the nursery. Check the mother’s room.
❖ Bili light: is it on?
❖ Know these backward and forward:
➢ Newborn VS: HR 12-160, RR 40-60, BP 65/50
➢ Newborn exam
➢ Breastfeeding benefits
➢ Ortolani and Barlow Maneuvers
➢ Dysmorphic features: Down, Turner, Fragile X
➢ APGAR: you will be asked to calculate this in the delivery room or OR
■ 1 minute: conditions during labor/delivery. Indicated resuscitation
need.
■ 5 minutes: Effectiveness of resuscitation, prognostic of survival.
● Low APGAR score does not predict cerebral palsy
❖ Pre-Rounding
➢ All the babies are listed on Epic WBN Shared Handoff List
➢ Sign up with an intern and remain on the same team.
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➢ Coordinate the physical exam with the team so that the mother and baby are
not disturbed more than necessary.
➢ Gather the following data for each patient you are presenting
■ Resuscitation method: warm, dry, tactile, OP suction, CPAP, PPV
■ APGAR: at 1 minute, at 5 minutes
■ Daily weight, calculate weight gain/loss, calculate percentage of birth
weight, and NEWT score (newborn weight loss trend) for babies with
weight loss.
■ Temperature, heart rate ranges
■ Glucose and other labs
■ Number of feedings and which were breast vs. bottle
■ Number of urine and stool diapers
■ Circumcision Plan
■ Health screenings that have been completed
❖ Rounding
➢ For new patients present: delivery history, maternal issues, family and social
history as well as overnight events. Always give your plan.
➢ For older patients present a one liner: “This is a 48 hour girl born to a 31 year
old ...the vitals, the weight and percent of birth weird and pertinent findings
on exam…” Always give your plan.
➢ Aim to be done presenting your patient in under 3 minutes.
❖ Discharge Planning
➢ Hearing test, newborn metabolic screen sent , Critical congenital heart
disease screen, Hep B vaccine (if parents consent).
➢ Follow-up appointments occur within 3 days of discharge
❖ Documentation
➢ The intern or resident will write the note. This is a compliance rule, don’t take
it personally.
❖ Deliveries
➢ There is a medical student resuscitation pager. Hand it off to the next
medical student at each birth.
➢ Stay late one evening until 9 PM to see more deliveries.
❖ PICO Presentation Guidelines: aim for a 3-10 minute presentation
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➢ Describe the case or problem
➢ Explain how you found the article
➢ Describe the study
➢ Describe the research question
➢ Describe the methods
➢ Answer the critical appraisal questions on validity
➢ Summarize the primary results
➢ Describe why the results can/cannot be applied to WBN
➢ Conclude with your own decision about the utility of the findings in your
practice
❖ Important Conditions:
➢ Jaundice timeline/management
■ Requires evaluation if <24 hours of life or direct/conjugated bilirubin.
■ Transient hyperbili peaks at 2-3 days of life, (60% newborns, 80%
preemies)
➢ CN Palsies
■ Duchenne-Erb: C5-C6 (lose axillary nerve, musculocutaneous nerve)
■ Klumpke: C7-T1 (lose ulnar nerve, associated with Horner’s)
➢ Sepsis
■ Early: GBS, E. coli, Listeria
■ Late: coag neg staph, E. coli, GBS
■ Tx: IVF, Cx, Abx (Amp, Gent, Cefotaxime)
➢ Respiratory distress In Newborn
■ More common in premies (lethicin:sphingomyelin ratio)
■ “CTAB with good air movements throughout, subcostal/intercostal
retractions, head bobbing, nasal flaring, scant scattered coarseness
with end-expiratory wheezes throughout”
■ Transient Tachypnea of the newborn (TTN) is more common in Hb S/C
babies (benign condition in term infants)
■ Meconium Aspiration
■ Pneumothorax
➢ Bronchiolitis: report O2 need and suction need
➢ Croup
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➢ Newborn rashes and skin findings (malignant vs. benign): ‘angel kisses’,
neonatal acne, milia, ‘stork bite’, e. Tox, etc.
➢ Gastroschisis vs omphalocele
➢ Necrotizing enterocolitis
➢ Intraventricular hemorrhage
➢ Neonatal syndrome
➢ Pros/cons of O2 supplementation
Study Resources
Shelf Resources
❖ Pretest
❖ BRS Pediatrics
❖ UWorld Pediatrics
❖ Other: Blueprints, First Aid Pediatrics, online MedEd videos, Step Up to Pediatrics,
NBME Practice Subject Tests
OSCE
❖ Form differentials: URI, respiratory distress, diarrheal illness, sepsis, fever
❖ Know your rashes.
❖ Know how to describe how to do a physical exam: dehydration, pulse, work of
breathing, swollen tongue, cracked lips: “Do you know how to measure a pulse?
Place two fingers over the wrist when the child’s palm faces upward” or “take a
picture of the rash and bring it to your next visit/emergency room”. You will not
conduct a physical exam on a child.
➢ Place physical exam findings in the history section: “per patient/parent…”
❖ Be efficient at collecting histories: Immunizations, Where does child spend days
(caregiver, School), Asthma (meds, how often, when do you use)
❖ Quantify urination, stool and vomit the best you can: Eating, Drinking, Bowel
movements/color, Number of wet/dirty diapers,
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❖ Type up the H&P in the following order to score the most points: top 3 differentials >
diagnostic tests > HPI > Physical Exam,
Family/Social/Surgical/Medical/Medication/Allergies Histories
❖ Demonstrating empathy is always important.
❖ Don’t forget to articulate a summary statement, education and plan to the
standardized patient at the end.
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Psychiatry Clinical Clerkship For six weeks students attend mental health court, electroconvulsive therapy, and grand
rounds. One to two afternoons each week is devoted to a core lecture series and case
conferences. Rotations will either be inpatient or consultations.
❖ Attire: business casual
Typical Inpatient Day
06:30 07:00 - 07:15 07:15 - 08:30 08:30 - 12:00 12:00 - 13:30
Wake Up Arrive at Hospital Pre-chart Round Documentation (can take longer)
Please note some residents/attendings will ask you to arrive as early as 06:30 or as late as 09:00. Alway arrive earlier than requested to pre-chart and read about the patient. Also, there will be days when you are required to attend Grand Rounds and mandatory didactics.
General Advice
❖ Your patient should look to you when team enters room
❖ Sedative in alcoholic patient - don’t use benzo, use Hydroxyzine
❖ Get collateral information on patients by calling family
❖ Pink sheet = Social Work or Police - hold for 24 hrs
❖ Blue sheet = Doctor - hold for 24 hrs
❖ White sheet = Hold after 24 hrs for MH court
Ways to Shine
❖ Remember Mental Status Exam
❖ DSM-V diagnostic criteria for depression, schizophrenia (vs. schizoaffective vs.
schizotypal, vs. schizoid), bipolar disorder, PTSD
❖ Ask orientation every day. The patient may fool you into thinking they are aware of
where they are, but they might actually think they are in a hospital in space
❖ If they don’t know the date, ask the month, if they don’t know the month, ask the
year; if they don’t know that, ask the season or the weather outside
❖ You lose your orientation in the order of: time, place, person
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❖ Oriented x4 means you know why you are in the hospital
❖ Ask patients SI/HI every day
❖ Suicide is a sensitive and scary topic, but ask details. How long have they felt this
way?
❖ Know details about their drinking and drug history.
❖ Don’t be satisfied when they say 4 drinks a day--of what (beer vs. wine vs. liquor),
how much (12 oz, 24 oz, 32 oz, 1 shot, 1 double shot, 1 24 oz bottle of wine vs. 1 L
bottle of wine). For drug use, ask how much, how long, and have you ever tried
quitting.
❖ Know when they had their last drink. Important for symptoms of detox – you have
to worry about seizures for up to 72 hours
❖ Have they tried rehab in the past? How many times? Why didn’t it work? Why are
they motivated to do it now?
❖ Strong social history: who do they live with, h/o abuse, relationships, social support,
religion, kids, pets
❖ Know your medications: first-line treatments, side effects, contraindications, etc.
Evaluations
Shelf
❖ First Aid for Psychiatry
❖ NBME Practice tests, UWorld, AMBOSS
OSCE
❖ Form differentials: depression, anxiety, acute vs chronic psychosis “x, bipolar,
substance induced”
❖ Begin ruling stuff out from beginning of encounter (if depression - need to rule out
history of mania)
❖ For all psych workup include: CBC, CMP, TSH, urine tox
❖ Practice typing up Mental Status Exam. This takes a lot of time, so type quickly.
❖ Ensure to clarify “I see things” → hallucination? Delusion? Drugs?
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❖ Type up the H&P in the following order to score the most points: top 3 differentials >
diagnostic tests > HPI > Physical Exam,
Family/Social/Surgical/Medical/Medication/Allergies Histories
❖ Demonstrating empathy is always important. Gender awareness (ask preferred
pronouns) is a score booster. Don’t forget to articulate a summary statement,
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education and plan to the standardized patient at the end.
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Neurology Clinical Clerkship The clerkship consists of four weeks divided into two weeks inpatient and two weeks
outpatient. Inpatient rotation consists of direct patient care, daily ward rounds,
participating in select ‘brain-attack’ stroke-codes, procedures such as lumbar puncture and
participation in clinical conferences. The outpatient experience occurs in general and
specialty neurology clinics. All students are expected to attend all weekly didactic sessions
scheduled on Wednesdays. At the end of the scheduled didactic sessions on Wednesday
(3pm), there is built in dedicated study time for the remainder of the afternoon.
Clinical locations include the U of U Hospital, the Neurology Critical Care Unit (NCCU), the
Clinical Neuroscience Center (CNC), the Imaging & Neurosciences Center (INC), Primary
Children’s Hospital (PCH) and the VA Hospital. In some cases, community clinics may be
available.
The Neurology Directors would like you to know this rotation is different from the
others due to its brevity. You need to have a structured study schedule from day 1 in order
to be successful on the shelf exam. There will be 12 lectures on “big ticket” items during
this rotation, as well as 4 director-led sessions to review clinical skills, discuss specific
clinical scenarios and discuss OSCE expectations. The neuro exam and documentation will
be reviewed on day 1, and reinforced again during the director-led sessions.
For many of you, your neurology clerkship will be the only dedicated clinical neurology
training you will get! Regardless of what you specialty you go into, you will see a significant
amount of neurologic conditions! Beyond doing well in the clerkship and on your shelf, we
want you to leave with a strong foundation of how to recognize and manage common
neurologic conditions as well as neurologic emergencies.
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Ways to Shine
Be prepared
❖ Know before beginning your rotation:
➢ Review the neurology exam
➢ Review common neurologic conditions and neurologic emergencies from
Brain & Behavior
➢ Review the basics of MRI and CT imaging from Brain & Behavior
➢ Review neuroanatomy and pathways
❖ Have all the tools:
➢ Reflex hammer
➢ Large tuning fork (128hz)
➢ Pen light
➢ Stethoscope
➢ Sensation testing tool: Cotton swab, safety pin, etc, will be available in clinic
rooms
➢ Portable ophthalmoscope if you have one, otherwise these are available
(though not always working/clean) in clinic rooms
❖ Know neuroanatomy and neuroradiology:
➢ Circle of Willis
➢ Major tracts (corticospinal, spinothalamic, DCML, spinocerebellar, Papez
circuit)
➢ Dermatomes & myotomes
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CT MRI
CT is a series of X-rays used to measure bleeds, stroke, mass , calcifications ❖ Good for ‘blood, brain and bullets’ ❖ HYPERdense: calcification, bleeds ❖ HYPOdense: infarction, edema
(tumors may have surrounding edema)
❖ CT angio: vessel anatomy, occlusions, aneurysms, dissections
❖ CT perfusion: compare ischemic penumbra vs infarct core
MRI without contrast: look for acute strokes or old lesions, dementia patterns, structure With contrast to look for infection, inflammation or malignancy ❖ T1 ‘anatomy’
➢ CSF/water = dark ➢ White matter = white ➢ Grey matter = grey
❖ T2 ‘lesions’ ➢ CSF/water = bright ➢ White matter = dark ➢ Grey matter = lighter than white matter ➢ Shows old lesions as hyperintense
❖ T2/FLAIR: ‘lesions’ with fluid dark ➢ fluid attenuation inversion recovery uses
pulse sequence to null fluids--makes it easier to see hyperintense lesions
➢ CSF/water = dark ➢ White matter = darker than grey
❖ DWI ➢ For acute stroke, will be hyperintense ➢ Age stroke by comparing to ADC (acute =
dark) ❖ GRE
➢ Looks for blood (dark)
Rounds
Typical Inpatient Day
05:30 06:30 06:30 - 08:00 08:00 - 12:00 12:00 - 13:00 13:00 - 17:30
Wake Up Arrive at Hospital (Team specific) Preround, sign out from night float Formal Rounds Noon Conference (lunch) Finish Documentation: Follow-up data, procedures,, new admits, teaching
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Typical Outpatient Day
0700-0800 0745 0745-1200 12:00 - 13:00 13:00 - 17:00
Review patients if not done the night prior First patient commonly roomed Morning patients Noon Conference (lunch) Afternoon patients, finish documentation, teaching
Study Resources (suggested by past students)
Shelf
❖ Brain & Behavior notes and PPTs
❖ Step Up 2 Medicine (Neurology Section)
❖ UWorld, NBME Practice Tests, AMBOSS
❖ Online MedEd
❖ Other: UWorld Nervous System Questions, SAE Practice Questions, Blueprints,
Pretest, Case files, First Aid for Step 1 neurology section.
OSCE
❖ Uses the standard School of Medicine clerkship OSCE format
❖ 2 stations
❖ 15 min H&P, 10 min writeup
❖ OSCE expectations for the neurology clerkship will be reviewed! These will be
covered in the week 4 director-led session
❖ Demonstrating empathy is always important.
❖ Don’t forget to articulate a summary statement, education and plan to the
standardized patient at the end.
Final Thoughts
❖ Utilize your resources! The clerkship directors and clerkship coordinator are
available to answer questions or address concerns
❖ Be engaged! As with all of your clerkships, the best way to shine is to take ownership
of your patients and learn as much as you can about them. Be an active part of the
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clinical care team, and help with calling consults, following up results, getting
outside records, contacting PCPs, etc.
❖ Ensure that during your clerkship you nail down how to recognize and manage
common neurologic conditions and neurologic conditions.
❖ Make sure that during your clerkship you refine your neuro exam skills.
Electives Electives are your time to choose what you like to learn. If you are interested in a particular
specialty (e.g., endocrinology), send some emails and the administration may make an
elective for you.
Two blocks of two week electives are allowed during Phase III. Here are the introductory
courses (with links to their canvas pages):
DERM 7400: Introduction to Dermatology
NSURG 7375: Introduction to Clinical Neurosurgery
OPHTH 7595: Introduction to Clinical Ophthalmology
ORTHO 7435: Introduction to Clinical Orthopaedic Surgery (Non-Surgical)
SURG 7335: Introduction to Clinical Otolaryngology
SURG 7495: Introduction to Clinical Urology
SURG 7535: Introduction to Clinical Cardiothoracic Surgery
SURG 7565: Introduction to Clinical Plastic Surgery
SURG 7605: Introduction to Emergency Medicine
SURG 7775: Introduction to Pediatric Cardiothoracic Surgery
A more extensive list of electives can be found on the canvas course titled “2020-2021
Course Catalog.” Additionally, electives can occasionally be created. Talk to Mike Aldred if
you have a particular area of interest that does not currently have an elective.
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Rural & Underserved Utah Training Experience (RUUTE)
RUUTE Program: [email protected]
Currently, students have the option of doing family medicine, internal medicine,
general surgery and pediatric rotations in rural and underserved areas.
Why you should participate in the RUUTE program
The RUUTE program is an enriching experience that allows medical students to fully
immerse themselves in rural medicine, the challenges of practicing medicine in a
rural setting, and what it is like to live and work in a rural/underserved setting. Our
mission is to increase medical education opportunities in rural and underserved
areas of Utah by expanding interest and awareness of rural health, maintaining and
growing quality educational experiences, and developing and enhancing
community partnerships with stakeholders. Past participants have cited how the
experience has changed their outlook on their future practice by allowing them to
understand the variety of patient issues that rural/underserved providers face, the
barriers to providing quality care in rural/underserved areas, and the excitement
that comes with preparing for whatever comes in the door.
Students participating in RUUTE will gain:
❖ Firsthand experience working in a rural Utah setting ❖ Assist local providers with diverse and underrepresented patient populations ❖ Exposure to and interaction with the community in order to understand and
treat patients and get the most out of the experience ❖ Understand healthcare and community benefits and challenges when
working in a rural/underserved area ❖ A relationship with clerkship preceptors and communities that were served ❖ Opportunities for service learning through community integration activities
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APPENDIX
The VA Hospital
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Intermountain Medical Center
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The U’s Emergency Contact Information
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