Rolling Handover: your very own Rotation Guide
Year Level Rotation Hospital/location Home Ward Admin Contact Dept/Level Phone E-mail Rotation Contact Dept/Level Phone E-mail Current Key Staff CNC Intern(s) Registrar(s) Fellow(s)
MBBS IV
Medical Home Unit Modbury Hospital General Medicine (Level 3 East) Ms Lynne Markwick (Secretary) Discipline of Medicine, Level 5 East 8161 2090 lynne.markwick@adelaide.edu.au A/Prof. Julian McNeil (Director of Medicine) Discipline of Medicine, Level 5 East 8161 2565 julian.mcneil@adelaide.edu.au
NA NA NA Dr Cheug, A/Prof. McNeil, Dr Norton, Dr Morton, Dr Ninan, Dr Wong
Assessment Criteria/Tasks
One formative observed case (history and directed physical examination) performed in front of your registrar or consultant (needs to be done before the end of the third week of the rotation) Three case write ups, including a section on the evidence-based approaches to a medical issue of your choice identified in your patient (two formative and one summative) Two ward reports completed by your consultant (a formative one in the middle of the rotation and a summative one at the end) Diary of “patient encounters” (need to have 32 entries) Participation mark for Dr Morton’s tutorials Six station end of rotation OSCE (3 clinical and 3 data stations)
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Timetable
Please mark compulsory tasks with an asterisk (*). MONDAY
TUESDAY
WEDNESDAY
THURSDAY
8.30 am ward rounds*
8.30 am ward rounds*
8.30 am ward rounds*
8.30 am ward rounds*
12.30 pm radiology case discussion
12.30 pm “lunch and learn” (free lunch) 3 pm bedside tutorial with Dr Morton*
11.30 am general medicine case discussion 12.30 pm grand rounds (free lunch)
10 am bedside tutorial with A/Prof McNeil* 3 pm cardiology tutorial with Dr Huynh*
FRIDAY SMTS or RAH tutorials*: - Radiology - Cardiology - Clinical pharmacology (You will get sent a timetable.)
Extra (weekend/after hours) Nil. You may want to stay later if you’re on take but there’s no obligation to. Tips
Make a list early on of the things you want to cover over the 9 weeks. It’s easy to get complacent and not do any study because it’s such a long rotation and no one chases you up. There is no ‘syllabus’ as such but there is a list of medical conditions you should be familiar with (see below). Stick with your registrar on take days. It’s there job to admit new medical patients from ED. Volunteer to perform the admission (i.e. take the initial history and exam) under supervision. It’s good practice, plus it makes for good case write-ups. You can then present the patient to your consultant on the post-take ward rounds, which the consultants really like. Let your intern know that you are keen to perform any procedures that might come up, e.g. venepuncture, IV cannulation. Once ward rounds are over it can get very quiet. Some things you might want to do: o o o
o
Compare patient lists with the other students and visit patients with notable signs. Check with your registrar and consultant for when they do their outpatients clinics and ask if you can sit in. Join Dr Luan Huyhn (consultant cardiologist) for his cardiology ward rounds – he’s usually happy for students to join. Check with the Acute Assessment Unit (Level 3 West) registrar or resident for what time he will be starting but it’s usually some time between 2 and 3 pm. Dr Huyhn enjoys teaching and it’s a good opportunity to practice taking CVS histories and exams. Go home and relax!
Key Topics
Cardiology: IHD, APO, CCF, arrhythmias, HT Respiratory medicine: COPD, asthma, respiratory tract infections, PE, lung cancer Gastroenterology: GIT haemorrhage, PUD, constipation, diarrhoea, alcoholic liver disease, cirrhosis Neurology: cerebrovascular disease, meningitis, seizures, dementia, Parkinson’s disease Endocrinology: diabetes mellitus, DKA, thyroid disease Nephrology: acute and chronic renal failure, UTIs and pyelonephritis
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Haematology: anaemia, coagulopathies, anticoagulation Other: electrolyte disturbances, falls, discharge planning and psychosocial issues, alcohol withdrawal
Resources
The Bible of clinical skills, i.e. Talley & O’Connor. Many of the consultants refer to it. A smaller “pocket-sized” book, e.g. the Oxford Handbook, or the iPhone or iPad apps for eMedicine or Best Practice, for use at hospital. Any thorough internal medicine textbook, e.g. Harrison’s, Cecil, Kumar & Clark, for home. Evidence-based medicine websites, e.g. Best Practice, Up to Date (perfect for the evidence based medicine section of your case write-ups) A lot of the interns recommend On Call: Principles and Protocols which covers step-by-step approaches to most medical problems on the wards from a junior medical staff perspective.
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