All About Rehab Medicine

Clerkship Day 204 to 216: Rehabilitation Medicine

Continuing on our ever-delayed journal on “How to survive Clerkship in UP-PGH” (I made up that book title), let us talk about the things to know about clerkship in Rehab Medicine.

General Info (What you need to know):

Duration of Rotation:
2 weeks
Number of students:
8 (sub-block)
Important hours:
Time in: 7:30 AM (They’re strict on this!)
Time out: 4:30 PM (Yup! It’s that early)
But students preparing for the G rounds the next day will usually stay until 8 to 9PM.
Wearing uniforms
REQUIRED!
Duties:
At least once a week for each student. 2 students will have only 1 duty for the whole rotation.
Weekdays: 5PM to 7AM the next day
Weekends: 8AM to 8AM the next day
No true posts. Post-duties to stay until 4:30PM except weekends.
SIC work:
At most 2 patients each student, with one “G” patient each.
With interns?
Yes, but only during night duties. They have OPDs during the day and all patients in the ward are handled by the clerks. Learn more on Ward Duties.
Residents
Some are toxic especially during “G” rounds but most of them are really kind and approachable. They will really teach you if you show interest to learn something. High yield mentoring.
Call room
Yes. Pretty decent, good airconditioning, enough chairs but no beds -_-
Two restrooms just outside the call-room. Clean and well-maintained.
Wi-Fi connection is moderate. I recommend bringing your own LTEs.
What’s unique?
·  The “G” rounds, once a week.
·  You have to attend the PT and OT sessions of your patients every day. Don’t forget to take videos of their sessions! You will show this to your RICs.
·  There are three different charts: Orders chart (the regular chart), the PT/OT Charts and the White chart for SIC clerks.
·  SIC clerks have separate charts (the “White chart”) to input your SIC notes and progress notes.
What to watch out for:
The “G” Rounds. Learn more about it below.
Required Paper works:
·   Index card/attendance
·   Patient log and endorsement sheets
·   Reflection paper
·   SIC notes (handwritten!) 24 hours after receiving the patient.
·   Updated Progress notes of your patients every Friday
·   Outgoing notes by the last Sunday of your rotation
Other activities
·   4 SGDs
Toxicity level
6/10
It’s actually chill



I think I have tackled most of the important things above. I will just then give more details on some points.

The Ward Duty

Update: Starting April 2016 (our rotation) ER Duties are no longer required. So YEAYY!!! 

There are only 16 beds in Rehab Ward which is the "deeper" half of Ward 5 (the other half occupied by Neurology). Each clerk is assigned with 2 patients each. 

The Ward duty begins at 4:30 PM and ends by 7AM the next day during weekdays. On weekends when most students are free, the duty team are expected to be in Rehab Ward from 8AM to 8AM the next day. Students on duty (one clerk and one intern) will be in-charge of conducting chart rounds on all patient and carry out all orders during their duty. There are minimal procs (blood extractions) and they are usually done by the non-duty SICs during the day unless they are time-bound. Conducting to Radio for XRays, UTZ, MRIs are rare. There are usually no monitoring unless there’s a toxic patient (usually only one in a week). You can basically take turns monitoring and have enough time to sleep in the call room and wake up at around 5AM to carry out any procs.

Each duty student is required to present and endorse a new case (usually referrals) to the Senior resident on duty the next day. It’s a one-on-one teaching endorsement, so it’s cool and you will learn a lot :) Just be sure to inform your resident ahead of time so that he/she will be able to schedule a meeting with you.

What to bring? The usual PE Stuff: BP App (sphygmomanometer), a thermometer, your pulse oximeter and stethoscopes are often enough. Bring a laptop and lots of movies if you feel like watching any, or your unfinished books to read. This is perhaps one of the best duties to spend those.

The callroom with the round table. It also serves as the "Research Room" so a lot of journals and research papers are "kept" here.

Don't forget to write your name and your contact number on the white board located at the nurse station whenever you're on duty!

The entrance door to the PT and OT Gyms. It's supposed to be locked during the night. Ask the ROD for the keys. 

The hallway of the Mezzanine going from the callroom. 
 The SGDs
There will be four sets of SGDs: Neuro, Burn, Spine and Pedia. We were told that Neuro SGD would be done bedside, but we prepared Powerpoint presentations to all of them anyway. It turned out we could use the PPTs in all SGDs. The division of labor would depend on how your group (esp your LO) would agree upon. What we did was assign 2 students for each SGD who will take care of getting the History and PE and acquiring copies of the chart and lab results. Ideally, those who will not be in G rounds on that week will be the ones to be in-charge of the Hx and PE. We had a flexible assignment of tasks though because there was a sudden change in our sched so we swapped roles along the way.

The SGDs are quite toxic. Sometimes the case will be given to you 2 days before the SGD and there are patients that are not in Ward 5 (Burn and Pedia patients particularly). Everyone must know the case: as it should be, but let’s face it, we usually end up dividing the task and focusing on thing only. The consultants are particularly keen on Hx and PE and not much on pathophysio and management but most of them are quite forgiving if you failed to do one or two tests. One of them is pretty notorious for grilling students during SGDs but he/she teaches well. Always be prepared and read up on your patients’ case days before the SGDs. Never appear sleepy during SGDs or you will end up getting the attention of your consultant!! Always be sure to have your Resident monitor check your presentation the day before your SGDs, their tips and suggestions are really helpful.


Rehab Clerks preparing for the SGDs

While waiting for our preceptor, we had enough time to fool around ^_^

The “G” Rounds

Once a week, the dreaded “G” rounds would swamp and wreak havoc to the ever-peaceful Rehab Ward. It is the longest 4 hours of a clerks’ life in Rehab Medicine. The “G” stands for the surname of the well-known (and most feared) consultant in Rehab Medicine in PGH. Everyone knows her. And everyone knows that you should never, ever face her during G rounds unprepared. And worst, it’s GRADED! (-_-)

Each student will be assigned one G patient (they are from beds 1 to 8) and each week, 4 students will be “sacrificed” to present to her their assigned case during the G rounds. The students are expected to know everything about the patient assigned to him/her especially the History, the pertinent Physical examination findings and the course in the ward. Knowing by heart the patients’ condition (from pthophysio to treatment options) and the service’s management goals is a bonus.

Reading scripts or your patients’ records are not allowed. You are required to memorize everything and report to her right then and there. It’s OK to glance on your script if you miss something, but more often than not, looking at your notes is a big no-no. You must always appear interested but never, ever laugh or even smile! We were told that that is something she never liked students doing during her rounds. She would often ask questions in the middle of everything and you must answer that question to move on. If you cannot answer it, she will turn the questions to your fellow clerks/students. And if all else fail, the Residents will be there to save you (or get drowned with you). Your RIC will surely help you prepare for G rounds. They will ask you to prepare your script and practice with them days before your G rounds, so always follow what they ask you to do. They are your greatest comrades in this battle.

Academically, the G-rounds are actually one of the best opportunities to learn about your patients’ condition. There are things that you and your RIC might have missed that would certainly come out during G rounds. Just the mere “fear” of failing would push you beyond your usual self, to read on about your patients’ case. And you will never forget those that you learned in G rounds ever again (after experiencing the stress of course!). But fret not! If you have prepared well days before it, you will surely survive the G rounds without a smile!

There's this kiddie park fronting the entrance to the PT/OT gym. This is where I practiced my script for the G rounds. I kept repeating my script while walking around here. I think I made around 8 laps tops. 

Before the G Storm: Trying to stay sane while refining our scripts for the G rounds

After the storm: The first four "tributes" to the G Rounds. Survived without smiling!


Readings/References:
Not required but good-to-have. Really useful during SGDs and G rounds.



ENJOY REHAB!

I think that’s all for Rehab Med. One last tip on how to maximize your stay in Rehab:

Talk and spend time with your patients :) As you will have at most two patients only, you will have enough time to know them more. I only had two patients during my whole stay in Rehab Medicine and their stories are always worth listening and looking back into. You can read about them here: "Disabled" and "A blessing".

Hope this mini-guide would help those who will enter clerkship in Rehab Medicine in the future. I now these things often change every now and then, but most of them are the same. If you think I missed anything, lease do inform me so that I can edit this post. You can easily contact me thru my FB Page: AhmadHajiri.

Thank you for reading and Maasalaam! (with Peace!)
-Ahmad ibn Hajiri

Comments

  1. What kind of rehabilitation equipment do you use? I'm planning to open my own clinics but I am not sure what devices are essential for the start and what can be purchased later?

    ReplyDelete

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