MS3 Survival Guide 2016-2017 - Texas Tech University .
MS3 Survival Guide2016-2017Your treasure map to surviving the 3rd year of Medical SchoolBy the TAs of the Medical Student Teaching Center1st Edition
DisclaimerThis manual is designed to be used as a guide for the student enteringtheir 3rd year of medical school, which at our school begins the clinicalstage of medical education. Opinions presented here do not necessarilyrepresent those of TTUHSC Paul L. Foster School of Medicine and oftenrepresent common knowledge and opinions provided by past students.Information presented is not final nor absolute and is subject to change atthe discretion of all overseeing bodies including, but not limited to: TheDepartment of Medical Education, the program directors, the programcoordinators, Student Affairs, Student Services, or The Dean’s Office. Thismanual should be used as a guide and not in the place of syllabi andinformation provided by the rotations.
ContributorsPaul L. Foster School of MedicineClass of 2017 TAs of theMedical Student Teaching CenterJeremy StewartTA CaptainBethany Janssen EldridgeEmily Collins NesPatrick O’MalleyLaura PalmerMegan ParmerDana Zhao PotterLoryn WilsonAcknowledgementsThank you for special contributions by Tammy Salazar, Ph.D.,David Briones, M.D., Laura Cashin, M.D., Lynn J. Hernan, M.D.,Heidi Lyn, M.D., Charmaine Martin, M.D., Stacey Milan, M.D.,Silvina Tonarelli, M.D., Virginia Hinojos, M.Ed., Maryann Dennis
Table of ContentsGeneral Information . 1I. Common Clerkship Rules And Policies .1II. Important Contacts .3III. Professionalism .5IV. Common Clerkship Locations And Directions .6V. What Was That Code? . 10VI. EMR. 10VII. How To Succeed In 3rd Year . 11VIII. Always Be A Team Player . 11IX. How To Present A Case . 12X. How To Read Your Resident/Attending . 14XI. Pimping Ain’t Easy: Your Guide To Getting Pimped . 14XII. Managing Life Outside Of Rotations . 17XIII. How To Work When Rotating In Your Chosen Specialty . 19XIV. How To Do Well On Shelf Exams . 20XV. Easy Mistakes That Will Prevent You From Honoring Rotations. 21XVI. How To Do Well On Osces . 21XVII. Where Is The FOOD? . 22XVIII. Step 2 Preparation . 23XIX. Dos and Don’ts . 25XX. MS3 Resources. 29XXI. FAQs . 31Family Medicine . 34I. Important Contacts and Titles . 34II. The Residents . 34III. General Principles . 34IV. How to Succeed . 36V. What to Keep in Your White Coat . 37VI. Requirements and Assignments . 37VII. Specialty Rotations. 40VIII. Addresses and Locations . 41IX. Common Notes and Scores Used . 41X. Don’t Miss These Findings . 41Table of Contents - i
XI. How to Present . 42XII. How to Rock the Shelf . 43XIII. Tips If This Is Your Chosen Specialty . 43XIV. Common PIMP Questions . 43XV. Good Resources. 43XVI. FAQs . 44General Surgery. 46I. Important Contacts and Titles . 46II. The Residents . 46III. General Principles . 46IV. How to Succeed . 50V. What to Keep in Your White Coat . 51VI. Requirements and Assignments . 51VII. Specialty Rotations . 54VIII. Common Locations . 56IX. Common Notes and Scores . 56X. Don’t Miss These Findings. 57XI. How to Present . 57XII. How to Rock the Shelf . 58XIII. Tips If This Is Your Chosen Specialty . 59XIV. Common PIMP Questions . 59XV. Good Resources. 59XVI. FAQs . 60Internal Medicine . 61I. Important Contacts . 61II. The Residents . 61III. General Principles . 61IV. How to Succeed . 64V. What to Keep in Your White Coat . 65VI. Requirements and Assignments . 65VII. Specialty Rotations . 66VIII. Common Notes and Scores . 70IX. Don’t Miss These Findings . 71X. How to Present . 71XI. How to Rock the Shelf. 72XII. Tips If This Is Your Chosen Specialty . 72ii – Table of Contents
XIII. Common PIMP Questions . 73XIV. Good Resources . 73XV. FAQs . 74Obstetrics & Gynecology . 75I. Important Contacts and Titles . 75II. The Residents . 75III. General Principles . 75IV. How to Succeed . 77V. What to Keep in Your White Coat . 77VI. Requirements and Assignments . 77VII. Specialty Rotations. 78VIII. Common Locations . 78IX. Common Notes and Scores . 79X. Don’t Miss These Findings . 83XI. How to Present . 83XII. How to Rock the Shelf . 84XIII. Tips If This Is Your Chosen Specialty . 84XIV. Common PIMP Questions . 85XV. Good Resources . 85Pediatrics . 87I. Important Contacts and Titles . 87II. The Residents: . 87III. General Principles . 87IV. How to Succeed . 89V. What to Keep in Your White Coat . 89VI. Requirements and Assignments: checklist (see appendix) . 90VII. Specialty Rotations. 91VIII. Common Locations . 92IX. Common Notes and Scores . 92X. Don’t Miss These Findings . 93XI. How to Present . 94XII. How to Rock the Shelf . 94XIII. Tips If This Is Your Chosen Specialty . 94XIV. Common PIMP Questions . 95XV. Good Resources . 95XVI. FAQs. 95Table of Contents - iii
Psychiatry . 97I. Important Contacts. 97II. The Residents . 97III. General Principles . 97IV. How Succeed on this rotation . 99II. What to Keep in Your White Coat.100III. Requirements and Assignments .100IV. Specialty Rotations .100V. Common Locations .102VI. Common Notes and Scores .102VII. Don’t Miss These Findings .102VIII. How to Present .102IX. How To Do Well On Shelf Exams .103X. Tips If This Is Your Chosen Specialty .104XI. Common PIMP Questions . 104XII. Good Resources .105XIII. FAQs.105Appendix . 106I. MAPS .106EPPC .106Kenworthy Clinic .107Providence – East Campus . 109Texas Tech Clinical Sciences Building .110UMC. 112WBAMC .113II. Notes Examples .114II. Requirement Checklists .121III. Setting up the VPN .126IV. Absence Form .128iv – Table of Contents
DedicationWe would like to dedicate this guide to all past, prior, and future teachers,educators, and mentors who foster growth and learning of the student.We owe our knowledge and experience to those who dedicate their life tothe passage of information.
GeneralInformation1I. Common Clerkship Rules and PoliciesA. Absences1. All clinical duties and didactics are MANDATORY: Do NOT test this.a) Excused absences(1) No more than FOUR per 16 week block.OR(2) No more than 12 during third year(3) Either/or result in discipline - repeat block or rotationb) What counts as an Excused Absence?(1) Illness(a) When do I need a doctor’s Note?(i) More than 2 consecutive days missed(ii) Missing Orientation Day(2) Family Emergency(3) Death in the Family(4) Religious Holidays (See Holy Day Policy in Student Affairs Handbook)(5) Presenting at a National Conference(a) Must notify Associate Dean for Student Affairs in as far in advance aspossible(b) If a participant in conference (not presenting), you must notify theinstructor of record and/or the Associate Dean for Student Affairs beforeor after the absence.(6) Interview for Residency (as MS4)c) MS3 Pearl(1) If you know you might be absent for any reason, discuss this with theclerkship coordinator and directors as far in advance as possible. Always dothis in person (if possible) AND in writing (email).d) Always notify of absence BEFORE a shift begins.e) If the absence is the result of an emergency, you must notify BOTH theClerkship Coordinator office AND the Office of Student Affairsf) Clerkships also have an absence form that needs to be filled-out and signed byan attending. (Form in Appendix)B. ClinicalgradesGeneral Information - 1
1. Honorsa) Passes NBME at 60th percentile or above on 1st attemptb) Passes OSCE on 1st attemptc) “Honors” in 4 of 8 of individual competencies evaluated ond) No competencies rated as “needs improvement”2. Passa) Passes NBME at 6th percentile or above on 1st or 2nd attemptb) Passes OSCE on 1st or 2nd attemptc) “Pass” in 6 of 8 competenciesd) No more than 2 “needs improvement”e) Professionalism concerns not bad enough to cause a “Fail”3. Faila) 3 or more “Needs improvement” for competenciesb) Below 6th percentile after 2 attemptsc) Fail OSCE after 2 attemptsd) Professionalism concerns deemed worthy of failing4. Incompletea) Not completing required assignments, exams, clinical obligations, or additionalwork assigned.5. When you would go before Grading and Promotions Committee (GPC)a) “Needs improvement” in 3 or more clerkships in the same categoryb) Failing 3 NBME’s or 3 OSCE’s in third yearC. Op-Log1. Not optional anymore (compared to medical skills in 2nd year)2. Complete at least WEEKLY or you can’t HONORa) BUT each clerkship has its own policy(1) Check minimum requirements, deadlines, andspecific diagnosis requirementsb) If you make up patients, you will get caught. DON’T DO IT(1) This is academic dishonesty and can result in punishmentD. Duty Hours1. IMPORTANTa) Duty hours must be submitted within 48 hours(1) Failure to do this more than 5 times can affect your professionalism2. Hour Restrictionsa) No more than 80 hours per weekb) No more than 16 continuous hoursc) It is YOUR responsibility, not go over this, but it is their responsibility torespect it.3. 1 day off each week averaged over a one-month perioda) i.e.: 4 off days per monthE. CMEcredits2 – General Information
1. Total of 10 CME credits needed before you graduatea) 5 must be “Live”b) UpToDate articles can count:(1) a2. If not on campus, you will need to provide documentation of the attendance toLourdes Davis3. MS3 Pearls: Take pictures of your signature on the sign-in sheets because theyoccasionally go missing.II. Important ContactsA. Office of Medical Education Contacts1. Richard Brower, MD - Associate Dean for Medical Educationa) Richard.Brower@ttuhsc.edub) 915-215-4392 (Barbara Stives)2. Maureen Francis, MD - Assistant Dean for Medical Educationa) Maureen.Francis@ttuhsc.edub) 915-215-4392 (Barbara Stives)3. Lourdes Davis - Course Coordinator, Years 3 & 4a) Lourdes.Davis@ttuhsc.edub) 915-215-4393B. ClerkshipDirectors and Coordinators1. Family Medicinea) Clerkship DirectorDr. Charmaine Martin (Charmaine.Martin@ttuhsc.edu)b) Clerkship CoordinatorNadia Hernandez (Nadia.Hernandez@ttuhsc.edu)Office - 915-215-5599Cell - 915-543-13012. General Surgerya) Clerkship Director:Dr. Stacey Milan (stacey.milan@ttuhsc.edu)b) Clerkship Coordinator:Priscilla Delgado (priscilla.delgado@ttuhsc.edu)Cell: (915) 412-1891Office: (915) 215-55833. Internal Medicinea) Clerkship DirectorDr. Laura Cashin (laura.cashin@ttuhsc.edu)b) Clerkship CoordinatorMarissa Tafoya (marissa.tafoya@ttuhsc.edu)c) Emeritus Clerkship Director (still around to teach)General Information - 3
Dr. Harry Davis (Harry.Davis@ttuhsc.edu)d) Beaumont Medical Student CoordinatorLori Pritchard (lori.a.pritchard.civ@mail.mil)(915) 742-3243e) Providence Medical Student CoordinatorBecky Aranda (Rebecca.Aranda@ttuhsc.edu)(915) 577-75934. OB/GYNa) Clerkship DirectorHeidi Lyn (heidi.lyn@ttuhsc.edu)b) Clerkship CoordinatorVeronica Anaya (veronica.anaya@ttuhsc.edu)c) Residency DirectorMelissa Mendez (melissa.mendez@ttuhsc.edu)d) Department ChairVeronica Mallett (veronica.mallett@ttuhsc.edu)5. Pediatricsa) Clerkship DirectorDr. Lynn Hernan M.D. (lynn.fuhrman@ttuhsc.edu)b) Clerkship CoordinatorJohn D. Ramirez (john.d.ramirez@ttuhsc.edu)Cell: 915-274-05446. Psychiatrya) Psychiatry Clerkship DirectorDavid F. Briones, MD (David.Briones@ttuhsc.edu)(915) 215-5319b) Psychiatry Assistant Clerkship DirectorSilvina B. Tonarelli, MD (Silvina.Tonarelli@ttuhsc.edu)(915) 215-58587. WBAMCa) GME/Medical Student CoordinatorLori Pritchard (lori.a.pritchard.civ@mail.mil)(915) 742-3243C. Texas Tech Police Department and Security1. 915-215-7111D. Information Technology (IT)1. 915-215-41112. ELP.HelpDesk@ttuhsc.edu3. Centricity (Clinic EMR) – (915) 215-40204 – General Information
III. ProfessionalismA. Punctuality1. Be early, and not just on timea) Use this mantra:“If you’re early, you’re on time. If you’re on time, you’re late.”2. THE UMC PARKING GARAGEa) This garage is notorious for making people late at peak hours.b) Rule of thumb - Get to the garage at least 25-30 minutes before your shift,and you will to be on time, guaranteed.c) Although not common, people have been late when arriving to the garage (orinto the line of cars entering the garage) at 7:40AM for an 8AM startB. Dress code1. Know dress code before each rotation. Ask residents before fellow students(sometimes different attending have specific preferences).2. General rule:a) Clinic: Wear Professional Attireb) OR, nights, or long call: Wear Scrubs(1) See Scrubs section for more information3. IMPORTANT: Wash your white coat at least weekly.a) If you do not think you have time for this (see time management), buy anotherwhite coat to alternate.C. Patient Interaction1. Generally, if you follow the medical ethical principles ofrespect for autonomy, non-maleficence, beneficence, and justice then you will notrun into any problems.2. Be respectful, polite, listen, do not interrupt, respect privacy, know familystructure, do not give diagnosis without permission from attending or resident (i.e.know your limitations as a medical student).3. If there is ONE thing you take from this guide:DO NOT VIOLATE HIPAA!!!!4. You CANNOT, under ANY circumstances, date your patient. Do not test this. Thiswill most likely lead to expulsion from school.5. Do not take pictures, post Instagram, send snapchats, tweet, make Facebookposts, or use any other social media that would compromise the privacy ofpatients at the hospital.a) If the resident asks you to take a picture or video of something, refuse withoutexpress written consent from the patient and without using a HIPPA compliantcamera app.(1) Although it is their responsibility for keeping you out of trouble, it is yourresponsibility for keeping yourself out of trouble as well.D. AssignmentsGeneral Information - 5
1. Know what is due and when it is due BEFORE you start the rotation and planaccordingly2. Each block has different assignments and requirements. See each section forspecifics.3. If you are late or anticipate being late on an assignment, contact the clerkshipcoordinator.4. Late Assignments affect professionalism. See block for specific policy.E. Read about your patient1. This is a good habit to start, which shows you are a professional and competentclinician who cares about your patients.2. Third year is designed to TEACHa) Even if you think you know everything about a patient’s disease, the attendingsand residents will still ask you questions to test how much you know.(1) Do not let this discourage you. They are trying to teach you how important itis to investigate as much as possible.IV. Common Clerkship Locations and DirectionsMaps of Common Locations can be found in the AppendixA. UMC/EPCH (adjacent to EPPC and connected by the basement)1. Address4815 Alameda AveEl Paso, TX 799052. Directions from Westa) Head East on I-10b) Take Exit 23Ac) Right onto Raynolds Std) Right onto Alameda Avee) Right onto Boll Plf) Right onto Alberta Aveg) Parking garage is on your left3. Directions from Easta) Head W on I-10b) Take Exit 23Ac) Head West on I-10d) Left onto Raynolds St.e) Right onto Alameda Avef) Right onto Boll Plg) Right onto Alberta Aveh) Parking garage is on your left4. Parkinga) Park in the parking garage only6 – General Information
b) Swipe UMC ID with badge hole facing down and black strip facing the inside ofthe garageB. Texas Tech Clinic Building1. Address5001 El Paso Dr.El Paso, TX 799052. The building is directly across the street from UMC and the AECC. WBAMC1. Address5005 N Piedras StEl Paso, TX 799202. DO NOTE TYPE “WBAMC” into Google/Apple Maps. You will get lost.a) Type the address above or “William Beaumont Army Medical Center”3. Directions from Westa) From I-10 E, take exit 22B (right 2 lanes)b) Keep left to continue toward US-54Ec) Get in the left lane once access road merges and get on US-54d) Take Exit 24 toward Fred Wilson Rd/Railroad Dr.e) Stay left and get into left 2 lanes as it merges onto Gateway N Blvdf) Turn Left onto Fred Wilson Aveg) Turn Left onto Pipes Dr.(1) This will take you all the way to the hospital4. Directions from Easta) From I-10 W, take US-54 E to Gateway N Blvd.b) Take Exit 24 toward Fred Wilson Rd/Railroad Dr.c) Stay left and get into left 2 lanes as it merges onto Gateway N Blvdd) Turn Left onto Fred Wilson Avee) Turn Left onto Pipes Dr.(1) This will take you all the way to the hospital5. IMPORTANT:a) Always bring your driver’s license and insurance informationb) ALWAYS get there 15-20 minutes early in case your car is one of the randomcars searchedD. KenworthyClinica) Address9849 Kenworthy St.El Paso, TX 799242. Directions from West (2 ways that take about the same time)a) From I-10 E(1) Take US-54 E (Exit 22E) and stay left(2) Continue onto US-54 E(3) Take exit 28General Information - 7
(a) 2 options from here:(i) Take a right onto Diana Dr. then left onto KenworthyOR(ii) Continue on Gateway N Blvd and take a right onto Cohen Ave andcontinue on this until you hit Kenworthy Clinicb) From Transmountain Dr.(1) From I-10W, exit for TX-375 Loop to Woodrow Bean Transmountain(2) Continue on Transmountain Dr. all the way until Kenworthy St.(3) Right on Kenworthy St.(4) The clinic will be on your right3. Directions from East(1) Take US-54 E (Exit 22E) and stay left(2) Continue onto US-54 E(3) Take exit 28(a) 2 options from here:(i) Take a right onto Diana Dr. then left onto Kenworthy(i) OR(ii) Continue on Gateway N Blvd and take a right onto Cohen Ave (afterthe old baseball stadium) and continue on this until you hit KenworthyClinic on your left4. Park in the spots designated during orientationE. TheHospitals of Providence1. Memorial Campus (by UTEP)Address2001 N Oregon St,El Paso, TX 79902a) Directions from West(1) Either by I-10 E or from Mesa(2) Turn right onto Rim Rd (if going toward I-10) or Left onto Rim Rd (if goingaway from I-10)b) Directions from East(1) From I-10 W, exit Mesa and turn right onto Mesa(2) Turn Left onto Rim Rd.c) Parking is on Rim Rd. after El Paso Street2. East CampusAddress3280 Joe Battle Blvd,El Paso, TX 79938a) Directions from West and East (unless far East)(1) Take I-10 E or W to US-54(2) Exit 24B for TX-601 Spur E toward Airport(3) Take Texas 375 Loop S exit8 – General Information
(4) Take Exit 38 toward Edgemere Blvd(5) Merge onto Joe Battle Blvd(6) Use left 3 lanes to turn left onto Edgemere Blvd(7) Turn right at Tierra Zafiro Drb) From 375 heading North (if from Far East)(1) Exit 38(2) Hospital will be on your right3. Transmountain Campusa) Located on Transmountain Road - address pending4. Sierra CampusAddress1625 Medical Center DriveEl Paso, TX 79902a) Directions from West(1) From I-10 E, Exit 20 for Dallas St toward Cotton St.(2) Continue on N Dallas St(3) Turn Left onto Arizona Ave(4) Turn right onto Rampart Pl(5) Turn left at the 1st cross street onto E Cliff Dr.(6) Turn Right onto Medical Center Stb) Directions from East(1) From I-10 E, Exit 20 for Dallas St toward Cotton St.(2) Merge onto E Missouri Ave(3) Sharp right onto N Cotton St(4) Sharp left onto Arizona Ave(5) Turn right onto E Cliff Dr(6) Turn left at the 1st cross street onto E Cliff Dr.(7) Turn right onto Medical Center StGeneral Information - 9
V. What Was That Code?These are the codes that are paged overhead. They will say“Code [Insert one from below]”Be prepared for each one as you hear it.Visit the Emergency Preparedness website for more up-to-date mergency.aspxA. UMC/EPCH1. Blue – Cardiac Arrest 186. Pink – Child Abduction2. Black – Bomb Threat7. Red – Fire Emergency3. Brown – Severe Weather8. Strong – Potential Violence4. Green – Internal Disaster9. White – Building Evacuation5. Orange – Aggressive Situation10. Yellow – External DisasterEPPC – Pay attention to codes at orientation, these may varyWBAMC1.2.3.4.5.6.Black – Bomb ThreatBlue – Cardiac or Respiratory ArrestGray – Disaster (activate plan)Green – Combative PersonOrange – HazMatPink – Infant/Child Abduction7. Red – Fire Green8. Silver – Child/Adult – Lost/Eloped9. Violet – Staff/Employee Workplace Violence10. White – Armed Intruder/Active Shooter11. Yellow – Utility Failure1.2.3.4.5.6.Adam – Infant/child abductionBlue – Cardiac Arrest 18Gray/Black – High Winds/TornadoGreen – Cardiac Arrest 17Heart - Acute Cardiac EventOrange – Bomb Threat7. Pink – Imminent Delivery8. Rapid Response – Patient in Crises9. Silver – Active Shooter10. Strong – Potential Violence11. Red – Fire or Smoke12. Trauma – Trauma PT in EDSierra ProvidenceVI. EMRA. Home accessMost consistent option is the Chrome browser, but it works in Safari for others1. Connect to VPN first (See Appendix for specific instructions)a) Instructions can be found by searching “VPN” here:https://solveit.ttuhsc.edu/portal/ss/(1) IMPORTANT: In the step for “Server Address” usesvpn.elpaso.ttuhsc.edu instead of svpn.ttuhsc.edu2. Cerner (UMC and EPCH patients)a) http://159.140.84.81/Prod/auth/login.aspx3. Centricity (Texas Tech Clinics)a) http://awsctx/Citrix/XenApp/auth/login.aspx (bookmark this link)10 – General Information
VII. How to Succeed in 3rd YearA. Read every day - MOST IMPORTANT TIPB. Always be professionalC. Be preparedD. Show that you WANT to learnE. Take InitiativeF. ListenG. Stay organizedH. Manage your timeI. CommunicateJ. Take care of yourself1. “Eat when you can, sleep when you can” - House of God by Samuel ShemK. Follow the Dos and Don’ts BelowVIII. Always Be a Team PlayerA. This is something that comes natural to some, but others are completely oblivio
MS3 Survival Guide 2016-2017 Your treasure map to surviving the 3rd year of Medical School By the TAs of the Med
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