Clerkship essentials

[Guest JSS02]

To those who have completed clerkship, were there any particular pocket references that you found especially helpful in carrying around with you on the wards?

[Guest therealcrackers]

1. A Tarascon Pharmacopoeia --- green this year. Invaluable.

 

2. Pens. Several.

 

3. Paper, at least one sheet, with which to record key stuff including phone numbers, lab values, names and dates, etc.

 

4. Some quick reference guide that you are familiar with, like the Current Clinical Strategies series, a pocket Washington Manual, Surgical Recall, etc.

 

everyone else will have a different idea, and various different books will have different merit depending on the rotation and the person. But you can't go wrong with the first three.

[Guest Ian Wong]

If you're starting out clerkships, I would recommend:

 

1) Maxwell's (list of normal labs, how to write admission notes, etc)

 

2) On Call: Principles and Protocols (lots of stuff on first-call issues)

 

3) Pocket Medicine: (Great for Internal Medicine call especially)

 

4) Sanford's (guide to antibiotic choices).

 

5) Tarascon's (they should just give this thing to all clerks along with your white coat)

 

Ditto on the paper and pens. You need to figure out a way to track all of your patients, and do so in an organized fashion so you don't miss stuff out. Each person figures out their own way, usually this ends up being hundred's of stupid little pieces of paper stuffed into your white coat, each with an unrelated phone number or patient lab value/to do list on it.

 

 

Ian

[Guest UWOMED2005]

This what is currently in my LHSC scrubs breastpocket:

 

1) 2 or 3 pens

2) a penlight (not as bright as the ophthalmoscope, but extremely useful when one is not within reaching distance.

3) a dozen index cards - essential. great for patient tracking, writing notes, or even just getting that PT's digits. . .

4) The LHSC lab values book. You'll get one during Clerkship O-week - it's got antibiotic sensitivities and all normal lab values. If you caught 2 mm off the margin, it fits into the scrub pocket without issue.

5) Calipers. Yeah, I look like a cardiology nerd with those. But it's so easy to whip them out when looking at EKGs, rather than fumbling for paper and drawing out a ruler

6) Scissors. You wouldn't believe how key it is to have these on you so you're not scrambling every time you need to cut a steri-strip or piece of tape.

7) My Palm Pilot. On this I have Tarascon's ($2.29/month, essential, and takes less space than a paper copy!), ePocrates, 5M-CC, and a whole slew of other programs/references. The real advantage to a palm pilot is that you can fit 10+ references into the size of one pocketboot.

 

I also keep a reflex hammer sinched under my scrub-bottom waist-tie or belt, and of course my stethoscope slung around my neck.

 

During peds I stick the pink peds dosage book (you'll see what I mean during peds) in my back pocket. The PCCU also offers a great card with emergency peds info (ETT cuff tube sizes, ACLS dosages, basic workups for DKA etc) which fits nicely as a bookmark to the Peds book.

 

This is probably way more stuff than most clerks carry. But I find it all useful, and as it all fits onto your clothes no prob (and without a lab coat.)

 

I didn't find carrying all that stuff cumbersome at all. And there's nothing else I'd want to add.

 

But you could survive with nothing more than a pen, Tarascon's, and a stethoscope.

[Guest Kirsteen]

Hi there UWOMED2005,

 

I hope you don't mind if I ask: which Palm is it that you tote?

 

Cheers,

Kirsteen

[Guest moo]

Kirsteen, most people recommend the Palm Tungsten E, which is what I have. I believe it goes for about 200-250 nowadays. It's really all you need.

[Guest Ian Wong]

Man, I'd sooner shoot myself in the head than be caught carrying around a pair of those weeny calipers!

 

Ian

[Guest mying]

Wait wait I want to tell you what's in my pockets too! Besides the pen, patient list, money, ibuprofen, scissors, penlight, gauze, steristrips, etc.

 

I actually find paper faster than the Palm sometimes. So I have Tarascon's Pharmacopeia and the Sanford Guide in paper.

 

I like the Palm Tungsten T (or T2 or whatever it's up to now) in a sturdy aluminum case a lot because of its collapsed size. I use it as a scratchpad, datebook, phonebook, etc. I added WordComplete, Documents-To-Go, Eudora Mail, and Today (free, emulates the PocketPC dayplanner, can get a Jelly Belly skin). The medical software I use most often are: Cecil's Medicine, Dorland's Dictionary, Eponyms (free! and remarkably useful!), Epocrates, MedRules, Opioid Convertor, and a new one I just found called "Diagnosaurus" which is also free. I haven't had much luck finding a good surgery reference -- if anyone else has I wouldn't mind hearing about it. I never used the medical calculators on the Palm only because the one built into the hospital's patient tracking system is good enough.

[Guest UWOMED2005]

I use a Palm Tungsten E with the sturdy plastic case. It's more than powerful enough for anything you do in clerkship, and at the moment quite a bit cheaper.

 

Of course, wait 18 months and you might just be able to get a palm with a faster processor than the NASA mainframe, and for the price of a stick of bubblegum. . .

[Guest JSS02]

I ended up getting the Tungsten E with included aluminum case recently. Happy with it so far...

[Guest McMastergirl]

I also carry gum, little snacks, change to grab a drink if needed, and I like to fill in patient info in pencil, so it can be erased (meds and dosages can change frequently for inpatients so if you write in pencil you won't have scribbles all over your index card).

I also carry a small blank notebook to jot down everything and make to-do lists. It's so easy to forget things when you're so busy! And making to-do lists keeps me focused and allows me to prioritize.

[Guest UWOMED2005]

Yeah, a pencil is good.

 

Snacks? I didn't think you were allowed to eat when you are in clerkship!!

[Guest mying]

It's all about the stealth snack. Things which are flat or tiny work well. Like those fruit leather things. You can disguise them as a bookmark, but you'll want to leave them wrapped. If you put an unwrapped fruit leather thing between two pages in a book, it's like sealing the information on those two pages into a tomb for all eternity.

 

Or you could just get really good at volunteering to run get something from the clean supply room on a patient floor, since that's often where the crackers and jam are kept.

[Guest UWOMED2005]

Nice. Any tips on speeding up the lip-to-duodenum time?

 

It's all about risk reduction. ie reducing the risk you might get caught by someone with food or drink in your mouth!

[Guest shrinkage]

I was once an EXPERT at consuming large quantities of food / calories in situations when this is inconvenient or not allowed (I won't go into the damning specifics of the actual situations).

 

- If you don't mind "poor quality" calories, chug down a Coke (if you are a skinny guy like me, you can do this without guilt...if not, you'll want to consider other options)

 

- The fruit things mentioned above are a good idea, but if you eat too many of them...well, just remember that one 14 g piece of "Fruit-to-Go" is supposed to have about the same amount of fibre as 2 apples or something like that.

 

- Nuts are really good for satiety, if you don't mind that they can be fattenning (although most of the time, they are high in monounsaturates so at least they are somewhat "heart healthy")

 

- My personal favourite...admittedly not as portable as other ideas...carry around a waterbottle...I like those Rubbermaid ones with the wide mouths...pre-fill it with like 2 scoops of high quality protein powder, chuck in a couple of crushed multivitamins for good measure, and maybe a few caffeine and ephedrine pills...when you need energy and quality nutrients, just add water and guzzle away...you can also throw in some maltose or sucrose if desired...I used to prepare like 8 of these at once, and hide them in various places in the lab. where I worked (a note of advice...don't hide stuff in the ventilation ducts) for "emergency food"...if the assay didn't work, etc., and I had to pull a late night, I had at least SOMETHING to fill my belly.

 

Good Luck...

 

[Guest Littlest Zooropa]

Clerkship essentials:

 

Tarascon Pharmacopoeia +/- Sanford Guide

Pens

Tape (e.g. for IVs - like pens, there's never any around when you really need it)

 

A pen light is great - with a pen light and a stethescope you can execute almost any focused physical exam. You will lose your reflex hammer at least twice a week, but hang onto that pen light - by the end of clerkship you're going to be able to elicit reflexes with absolutely anything, anyways.

[Guest McMastergirl]

I know a guy who drinks the ensure from the patient kitchens on the wards. Ew. Apparently it stifles the hunger though.

[Guest therealcrackers]

Ensure? Ewwwwwwwwwww :x

 

But knowing someone in the support staff can really help. I got to know one of the food services staff, and she gave our floor (well, the residents and clerks) hot meals at odd hours if she was around... really helpful.

 

Back to the topic of essentials:

1. Good rapport with the nursing staff ESPECIALLY the charge nurse. Otherwise you could get paged every 15 minutes for every night you are on call. They know practical stuff and usually are willing to impart it to an approachable, sincere clerk.

 

2. Understanding of the jobs that pharmacy, PT, OT, social work, and community care liaison people do. A pharmacist is not a walking Sanford or Tarascon (that's why it goes in YOUR pocket), but someone who can look out for your patient's drug interactions and offer suggestions to optimize things. If you ever get to go to Kardex rounds (or multidisciplinary rounds), go at least once to see how it all meshes together.

 

3. Portable snacks and a spare $5.

 

4. Tarascon Internal Medicine and Critical Care Handbook. Also green, a little thicker than the pharmacopeia, but just as useful.

[Guest marbledust]

Ensure? Ewwwwwwwwwww

 

When I was in undergrad I broke my jaw in a car accident and had to survive on Ensure for several weeks. Yes, you can live on it for weeks on end...no it is not pleasant, but I did eventually learn to tolerate it. But beware--they try to trick you with "designer" flavors: orange cream, iced cappucino, wildberry blend, butter pecan. It doesn't matter though - all the flavors taste the same, like @#%$.

 

But apparently one can contains 25% of the daily recommended intake of vitamins, so if you are desperate....:rollin

[Guest MDCY]

Ensure shakes..that stuff is nasty tasting, however if you're really, really desperate, you could always down a 'fresh' bottle of Promote...:lol . Anyway, these are the things that I usually carry around with me at the hospital:

 

1. My Palm Zire71 with ABCD Lab Data, ePocrates, 5MCC, Harrisons, eMedicine, Surgery Recall, Stedman's and some games of course.

2. Granola bars and other small snacks.

3. Mini flashlight like a Mag-lite as those pen lights are too wimpy and die too quickly.

4. Maxwell's guide, Tarascon, and a small pocket-sized notebook to record and jot stuff down.

5. Trauma shears-these scissors definitely come in handy.

6. A set of butterfly needles, alcohol wipe pads, tongue depressors, blood drawing elastic band thingy.

7. Stethoscope and if I'm doing a medicine elective, my reflex hammer and tuning fork.

[Guest endingsoon]

Yeah I have a Palm Zire 71 but honestley it has too much @#%$ on it. I have maybe (no joke) over 30 medical programs (almost all the good skyscape library) and the key drug ones but I just find that nothing beats getting your hands on a computer with uptodate access. Thinking of upgrading to a pocket PC so that I can use that with UptoDate on the mem card.

[Guest Ian Wong]

Ditto crackers on the Tarascon's Critical Care book (but then again, I've done ICU on 3 of my last 4 months...) This is a bit of a sleeper of a book; it definitely doesn't have the notoriety or popularity of the Tarascon's Pharmacopeia (which I regard as the single most useful thing I carry with me in my coat), but it's jam-packed with lots of medicine info, and is just a little thicker in size than the Pharmacopeia (otherwise it's the same dimensions in height and length).

 

Ian

[Guest medicator007]

I will be a third voice for the Tarascon's Internal Medicine and Critical Care Pocketbook. It is an absolute lifesaver on any ICU or Internal Medicine ward, covers all those things that you wish you could memorize but just don't have the space for. I got mine as a package deal w/ my pharmacopea but even on it's own it is worth it's weight in gold.

 

Authors: James S. Winshall & Robert Lederman

ISBN1-882742-32-X

 

My Pockets contain:

 

1) Tarascon Pharmacopea & Int Med book

2) Newest Sandford

3) Reflex Hammer, tomahawk style!

4) Pens and Pencils and spiral notebook for my to-do lists

5) Decent penlight cuz I am always looking for a light source, especialy at night on call.

6) Tongue depressors and Swabs... i hate having to run to the supply room when i get this hankering to swab something.

 

Medicator

[Guest CaesarCornelius]

No PDA?

 

 

cc

[Guest therealcrackers]

No PDA here either... faster to flip through a small pocketbook or memorize... then you don't have a crutch. And if you need the additional information from a PDA program (I find), there's textbooks and the internet...