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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: [email protected]
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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. Psychiatry9. Family Medicine
10.Student Evaluation of Attending
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1 Be open, honest, and empathetic to patient
2 Work effectively with health care team
Clinical Judgment:
0 Make appropriate diagnosis and formulate a suitable management plan
1 Suggest appropriate diagnostic investigation
2 Understand the pathophysiology of the disease
Organization/Efficiency:
0 Prioritize/succinct/organize and summarize
1 Advocate for quality patient care
Presentation:
2 Demonstrate satisfactory clinical judgment
3 Synthesize information in an effective manner
4 Practice cost effective healthcare that doesnt compromise quality care
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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)
Spartan Health Sciences University 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 Santa Teresa, NM 88008
Starting Date: _______________________ Ending Date: __________________________ (one week period)
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Date PatientInitial
Chief Complaint Procedure Diagnosis Attending/Resident Signature
8/13/13
8/14/13 Lecture- Toxicology and PoisoningsLecture-
819/13 PCOS lecture-I learned to check T4 free, LH and FSH
level, Glucose, Check testosteroneU/S of Ovaries to be done to check if thereare follicles but not diagnostic.MC environmental factor is obesityDiagnsosti- Rotterdam.May be linked to low Birth Weight
8/19/13 Childhood Obesity lecture50% chance that child will be obese if
parents is obese.AA and Hispanic and Low SES hasIncreased obesity rate.Adipose rebound- 4-6 yo. They are morelikely to be overweightPatients can have some insulin resistance,check insulin level and fasting Blood Sugar Behavior and Learning problems,
psychological problemsBMI: >95%=obese ;85-95% is overweightAge 7 or greater- lose 1 pound a week Under 7- no weight gain, only increaseheight.Cut computer and TVMeds: Sibutramince >16, orlistatPrevention:No clean plate policy, no sweetsor treats as positive reinforcementProvide healthy foods and encourage
physical activity, Pack own lunches, no fastfood.
8/19/13 Diabetes lectureLow birth weight is associated with insulin
resistance. Highest prepubertal body weighthas high risk for diabetes. Ketoacidosis and
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ATTENDING PHYSICIANS NAME: __________________________ SIGNATURE: ________________________ DATE: __________
DIRECTOR OF MEDICAL
EDUCATIONS NAME: _____________________________________ SIGNATURE: ________________________ DATE: __________
2
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Spartan Health Sciences University 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
Santa Teresa, NM 88008Telephone (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
Resident/AttendingsSignature
Yes/NoYes/No
Yes/No
Yes/No
Yes/No
Yes/No
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Yes/No
Yes/No
Yes/No
Yes/No
__________________________________ __________________________________________
Director of Medical Educations Name Attending Physicians Name
__________________________________ ___________________________________________
Director of Medical Educations Signature Attending Physicians Signature3
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Internal Medicine
Student Name: ___________________ Number of Weeks: __________
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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.
6
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1 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 includesthe following :
0 Perform an admission history and physical examination
1 Write the admissions note
2 Write patient orders, including admission orders, daily orders
3 Interview and examination of the patient
4 Write a daily progress note
5 Any clinical procedures performed
6 Ordered tests
7 Obtain and record test results
1 Short Call
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
2 I.C.U. Posting
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
3 E.R. Posting
Day __________ __________ __________
Date __________ __________ __________
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Dr. Signature __________ __________ __________
(B) PROCEDURE CHECK LIST
4 NG Tube (Observed/Performeda minimum of 3)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
5 Foley Catheter (Observed/Performeda minimum of 3)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
6 ECG (Observed/Performeda minimum of 3)
7
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Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
7 Phlebotomy (Attend a minimum of 1 class)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
8 Echo/Treadmill (At least 2 days)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
9 Dialysis (Observed at least for 2 days)
8
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Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
10 MRI (Observed at least for 1 day)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
11 Chest X-Rays (Reviewedat least for a minimum of 4 days)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
(C) List Case Presentations done
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________
4. _________________________________________________________
5. _________________________________________________________
6. _________________________________________________________
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General Surgery
Student Name: ___________________ Number of Weeks: __________
Hospital Name: __________________ Date: ________ to _________
General Surgery Rotation
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Student Name: # of Weeks:Hospital Name: Date:_______ to _______
0 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 theseconditions
2 Understand physiology of an acutely injured patient, whether this injury is from trauma, burn, infectionor surgery itself
3 Basic principles governing wound care, suturing and management of tissue infections
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(A) General Surgery
Student Name: # of Weeks:
Hospital Name: Date:________ to ________
List and Report of Observing orAssisting any of the following Surgeries
Surgical Procedure Date Sex Age Observed (#) Assisted (#)Surgeo
n Signature
1 Appendectomy2 Cholecystectomy3 Thyroidectomy4 Nephrectomy5 Ileostomy6 Mastectomy7 Adrenalectomy8 Parathyroidectomy9 Splenectomy10 Total hysterectomy1 Lumpectpmy
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112 Inguinal Hernia Repairs
(B) General Surgery
Student Name:# of Weeks:
Hospital Name: Date:________ to ________
List of Procedures Performed(a minimum of 3 are required)
Procedure # Observed # Performed Date Dr's. Signature
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1 Cannulations/NG tube2 Intubations3 Blood Withdrawal4 Arterial Blood Gas5 Central Lines6 Chest Tubes7 Sutures8 Foreign Body Removal9 Abscess Drainage1
0 Clean & Dressing11 Casts12 Collar & Cuff 13 Tubi-Grip14 Peak Flow Meter 15 Foley's Catheter Placement
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( C ) General SurgeryStudent Name: # of Weeks:Hospital Name: Date:_______ to _______
Case Presentations Done1
23456
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HISTORY & PHYSICAL FORM
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
HISTORY & PHYSICAL FORM
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
HISTORY & PHYSICAL FORM
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
HISTORY & PHYSICAL FORM
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
PROGRESS NOTES- WRITING
Date:_______________________________________
Indication:___________________________________
Physician Signature:___________________________
PROGRESS NOTES- WRITING
Date:_______________________________________
Indication:___________________________________
Physician Signature:___________________________
PROGRESS NOTES- WRITING
Date:_______________________________________
Indication:___________________________________
Physician Signature:___________________________
PROGRESS NOTES- WRITING
Date:_______________________________________
Indication:___________________________________
Physician Signature:___________________________
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
15
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FOLEY CATHERTER PLACEMENT
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
FOLEY CATHERTER PLACEMENT
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
FOLEY CATHERTER PLACEMENT
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
FOLEY CATHERTER PLACEMENT
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
FOLEY CATHERTER PLACEMENT
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
NG TUBE PLACEMENT
Date:_______________________________________
Indication:___________________________________
Physician Signature:___________________________
NG TUBE PLACEMENT
Date:_______________________________________
Indication:___________________________________
Physician Signature:___________________________
NG TUBE PLACEMENT
Date:_______________________________________
Indication:___________________________________
Physician Signature:___________________________
NG TUBE PLACEMENT
Date:_______________________________________
Indication:___________________________________
Physician Signature:___________________________
NG TUBE PLACEMENT
Date:_______________________________________
Indication:___________________________________
Physician Signature:___________________________
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
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ARTERIAL BLOOD GAS
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
ARTERIAL BLOOD GAS
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
ARTERIAL BLOOD GAS
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
ARTERIAL BLOOD GAS
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
ARTERIAL BLOOD GAS
Date:____________________________________
Indication:________________________________
Physician Signature:________________________
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
M/F
Age:
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Obstetrics & Gynecology
Student Name: ___________________ Number of Weeks: __________
Hospital Name: __________________ Date: ________ to _________
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Obstetrics and Gynecology Rotation
Student Name: # of Weeks:Hospital Name: Date:_______ to _______
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0 Familiarize with signs and symptoms of normal and abnormal reproductive function and basicexamination of Obstetrics & Gynecology.
0 Deliveries PerformedYou 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 withthe care of women in labor.)
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(e.g. twin delivery, premature labor, etc.)
S. No. Date Age Obstetric Problems &Outcome Signature of Docotor
3 Gynecological Procedures Observed(e.g. operations for urinary incontinence, ectopic pregnancy, etc.)
S. No. Date Age Type of Examination(e.g. VE, speculum, smear) withreason
Signature of Healthcare Professional
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4 Surgical Termination of Pregnancies
Doctors Name:_____________________________
S. No. Date Age Problem Case Management
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6 In-Vitro Fertilization Clinic
Doctors Name:_____________________________
S. No. Date Patient ID# and Age
Problem Case Management
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7 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
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8 Write Ups
0 You are required to write up three (3) history of physical examinations with a discussion of individual patient care.
1 Obtain a complete history and physical examination of at least one (1) obstetric patient.
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Pediatrics
Student Name: ____Anish Pithadia Number of Weeks: ______6____
Hospital Name: Norwegian American Date: ________ to _________
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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
1 Recognize normal patterns of growth and development
2 Be able to generate differential diagnosis for common pediatric complaints
3 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 adulthistory taking)
1 Understand child health surveillance & immunizations
2 months 4months
3 months 12-14 months & Pre-school
2 Develop ability to relate to children and their family to get their cooperation
3 Learn how to use Growth Charts
4 New born Nursery/ICU (1 week)
5 Understand major milestones e.g., speech, language, communication, fine and gross motor skills and social & emotional development.
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6 Factors important to normal growth and development e.g., normal infant feeding, weaning andimportance of optimal physical, emotional, and psychological well being.
7 E.R. and Floor Calls (a minimum of 2-3)
(B) PROCEDURE CHECK LIST
0 Arterial and Venipuncture (Performa minimum of 3)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
1 IV Catheter Insertion (Including CVP) (Performa minimum of 3)
Day __________ __________ __________
Date __________ __________ __________
Day: _________ _________ _________
Date _8/13/13__ _________ _________
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Dr. Signature __________ __________ __________
2 NG Tube Intubation (Observed/Performeda minimum of 3)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
3 Endo-tracheal Intubation (Observe/Perform a minimum of 2)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
4 Lumbar Puncture (Observe/Perform a minimum of 2)
Day __________ __________ __________
Date __________ __________ __________
Dr. Signature __________ __________ __________
5 CSF Analysis (Performa minimum of 1)
Day __________ __________ __________
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Psychiatry
Student Name: ___________________ Number of Weeks: __________
Hospital Name: __________________ Date: ________ to _________
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Student Name: ___________________ Number of Weeks: __________
Hospital Name: __________________ Date: ________ to _________
Psychiatry
0 Fundamental understanding of psychiatry as a medical specialty
1 Ability to perform a competent basic psychiatric diagnostic interview
2 Ability to formulate a psychiatric differential diagnosis, problem list, and initial treatment plan.
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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 usingDSM 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
0 Psychosis: Schizophrenia, Mania, Depression, Organic Brain Syndrome
1 Neurosis: Anxiety, Depression, Personality Disorders
5 Ability to perform a minimum of two (2):
0 Mental Status Examination
1 Complete Neurological Examination
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Family Medicine
Student Name: ___________________ Number of Weeks: __________
Hospital Name: __________________ Date: ________ to _________
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Student Name: ___________________ Number of Weeks: __________
Hospital Name: __________________ Date: ________ to _________
Family Medicine
0 Gain experience in ambulatory practice in urban, suburban and rural settings
1 Learn core skills and knowledge essential to the practice of Primary Care:
0 diagnosis and treatment of common outpatient complaints
1 management of chronic medical conditions
2 strategies for health promotion and disease prevention
2 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
1 Submit case reports and presentations (minimum 1 per week)
2 Submit the Weekly Log Form for all patients seen in the inpatient and outpatient clinic
3 Any seminars attended
__________________________________
__________________________________
__________________________________
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Spartan Health Sciences University
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
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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:
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