Medicine Rotation at UofT

[AZG]

What is a typical day like for an internal medicine rotation at UofT - what is a typical start time, number of patient you carry and student expectations. I've heard that students dont have to pre-round? Is this true? Any help would be appreciated!

 

Thanks!

[cheech10]

Typical day:

Morning report from 8-9.

Bullet rounds with allied health/discharge planning right after.

Round on your own patients until noon.

Lunch rounds (lecture from staff, lunch provided) from noon-1.

Finish up work in afternoon followed by team rounds/cardflip (depending on staff/senior resident) as well as teaching.

Signover at 5.

 

No pre-rounding in Toronto. In fact, vitals and labs are often not charted until much later in the morning (nurses do the vitals first thing in the AM, but sometimes carry them around with them on a slip of paper all day and only chart them at shift change - extremely frustrating). Most clerks carry 2-4 patients at any given time, average team census is 20-25ish. Usually see 1-2 consults per call night, call is 1 in 4 and runs from 0800 to 1000 the next day. UofT 3rd year clerks get to go home at midnight (so they are well rested for studying) but I recommend elective clerks to stay overnight.

 

As a clerk, you should try to function as a junior resident: see your patient in the AM, do a relevant history and examine them, review vitals and labs, and write the SOAP note. Most importantly, try to synthesize the information into a problem list and develop an itemized plan for the day - too many clerks just do an H+P and wait to work out a plan with their senior resident. You should review your plan of course, but before you do that, read about your patient's problems and develop your own plan (and document it - worst that can happen is you go back and write an addendum to your note in the chart). This is the best way to show interest, motivation, and hard work, and is much more appreciated by the seniors than downloading and distributing journal articles. Similar suggestions for call nights, write your note with your own assessment and plan, write your own orders, THEN get them reviewed/co-signed by your senior. Other duties will include: calling in consults, reviewing radiology, filling out home care applications, etc. Also, read up on your patients problems after work. Do all of these things and you will look like a star.

[Siamak]

Typical day:

Morning report from 8-9.

Bullet rounds with allied health/discharge planning right after.

Round on your own patients until noon.

Lunch rounds (lecture from staff, lunch provided) from noon-1.

Finish up work in afternoon followed by team rounds/cardflip (depending on staff/senior resident) as well as teaching.

Signover at 5.

 

No pre-rounding in Toronto. In fact, vitals and labs are often not charted until much later in the morning (nurses do the vitals first thing in the AM, but sometimes carry them around with them on a slip of paper all day and only chart them at shift change - extremely frustrating). Most clerks carry 2-4 patients at any given time, average team census is 20-25ish. Usually see 1-2 consults per call night, call is 1 in 4 and runs from 0800 to 1000 the next day. UofT 3rd year clerks get to go home at midnight (so they are well rested for studying) but I recommend elective clerks to stay overnight.

 

As a clerk, you should try to function as a junior resident: see your patient in the AM, do a relevant history and examine them, review vitals and labs, and write the SOAP note. Most importantly, try to synthesize the information into a problem list and develop an itemized plan for the day - too many clerks just do an H+P and wait to work out a plan with their senior resident. You should review your plan of course, but before you do that, read about your patient's problems and develop your own plan (and document it - worst that can happen is you go back and write an addendum to your note in the chart). This is the best way to show interest, motivation, and hard work, and is much more appreciated by the seniors than downloading and distributing journal articles. Similar suggestions for call nights, write your note with your own assessment and plan, write your own orders, THEN get them reviewed/co-signed by your senior. Other duties will include: calling in consults, reviewing radiology, filling out home care applications, etc. Also, read up on your patients problems after work. Do all of these things and you will look like a star.

 

Thanks very much for your helpful suggestions. I have couple of questions:

 

1. How many calls do elective clerks do in a period of 2-3 weeks?

 

2. Is it better to do CTU vs medicine consults for electives?

 

thanks

[cheech10]

It's 1 in 4 call with Fridays and Sundays lumped together, so in 2 weeks, you would do 3-4 calls; for 3 weeks, you would do 4-6 calls, depending on the schedule.

 

CTU vs med consults is a difficult question to answer. Med consults gives you close to 1 on 1 face time with a staff person, and makes it pretty easy to get a reference letter. It's also an experience that is not a required part of clerkship at many schools. The workload is often lighter, and it definitely involves less scut as a consulting service. CTU is the more common rotation, and can be worthwhile if you can stand out relative to other residents; it's much easier to compare clerks directly on CTU. Your primary supervision however will be your senior resident, and your staff is somewhat removed from the situation, although should still be able to write good reference letters. Also, morning report is a pretty big deal at UofT, especially Sunnybrook - be prepared to answer questions and be put on the spot.

 

My preference now would be med consults if I'm looking to impress the staff. Having said that, CTU is more common (and what I and most people ended up doing for electives). If you do decide on med consults, read up on pre-operative cardiac risk assessment (ACC/AHA guidelines, Lee Revised Cardiac Risk Criteria) as this comes up a lot on the rotation. The "Miscellaneous" section in Approach to Internal Medicine by David Hui is very good for med consults (as is the entire book, BTW. I recommend it over Pocket Medicine for learning approaches and key elements of H+P for common presentations, although Pocket Medicine has better concrete recommendations for management).

[Apixaban85]

Wait, wait, wait.....lunch is provided everyday?

[cheech10]

It is for Toronto medicine housestaff

[Siamak]

It's 1 in 4 call with Fridays and Sundays lumped together, so in 2 weeks, you would do 3-4 calls; for 3 weeks, you would do 4-6 calls, depending on the schedule.

 

CTU vs med consults is a difficult question to answer. Med consults gives you close to 1 on 1 face time with a staff person, and makes it pretty easy to get a reference letter. It's also an experience that is not a required part of clerkship at many schools. The workload is often lighter, and it definitely involves less scut as a consulting service. CTU is the more common rotation, and can be worthwhile if you can stand out relative to other residents; it's much easier to compare clerks directly on CTU. Your primary supervision however will be your senior resident, and your staff is somewhat removed from the situation, although should still be able to write good reference letters. Also, morning report is a pretty big deal at UofT, especially Sunnybrook - be prepared to answer questions and be put on the spot.

 

My preference now would be med consults if I'm looking to impress the staff. Having said that, CTU is more common (and what I and most people ended up doing for electives). If you do decide on med consults, read up on pre-operative cardiac risk assessment (ACC/AHA guidelines, Lee Revised Cardiac Risk Criteria) as this comes up a lot on the rotation. The "Miscellaneous" section in Approach to Internal Medicine by David Hui is very good for med consults (as is the entire book, BTW. I recommend it over Pocket Medicine for learning approaches and key elements of H+P for common presentations, although Pocket Medicine has better concrete recommendations for management).

 

Thanks for your response. I actually have CTU and not med consults as my elective. I know of some students who are doing only med consults and not CTU. So I guess I would work much harder than them and they have an easier time getting reference letters. So does everyone get picked on during morning report? and how does this reflect in one's eval or reference letter?

[cheech10]

Don't worry about doing CTU. It's by far the more common elective, and you will still get plenty of staff exposure/opportunity for reference letters.

 

Morning report depends on the site. At Sunnybrook, they just go around from clerk to clerk in order asking questions, so everyone gets picked on evenly. At other places, it's more random, but as an elective clerk, expect to get asked questions fairly frequently (and if not, speak up - this is a good time to show knowledge). Performance at morning report is not really reflected in evals directly, AFAIK, but can go a long way to making a good impression with the staff, especially since the staff that do morning report tend to be the ones involved in the resident selection process.

[ploughboy]

Morning report depends on the site. At Sunnybrook, they just go around from clerk to clerk in order asking questions, so everyone gets picked on evenly...

 

And do not, I repeat, do *not* sit in Dr. R'meier's chair at Sunnybrook morning report (it's at the end of the table, opposite the screen and whiteboard). In fact, as a clerk or even a junior resident, you're best off not sitting at the table at all. The windows along the far side of the room are safe, and that's where most of the clerks sit.

[cheech10]

It's actually Shumak's chair, but I guess Redelmeier is inheriting it as Shumak cuts back on his clinical work.

[ploughboy]

It's actually Shumak's chair, but I guess Redelmeier is inheriting it as Shumak cuts back on his clinical work.

 

I stand (sit) corrected.

[bustylegs]

It's actually Shumak's chair, but I guess Redelmeier is inheriting it as Shumak cuts back on his clinical work.

 

Just when I was finishing Medicine a few weeks ago, morning reports are no longer taking place in the 4th floor conference room.

 

I guess there are new seating plans now for the new room...

[ploughboy]

It's actually Shumak's chair, but I guess Redelmeier is inheriting it as Shumak cuts back on his clinical work.

 

Speaking of Dr. Redelmeier...

 

http://www.nytimes.com/2010/08/31/science/31profile.html?_r=2&src=me&ref=homepage

[kaysersoze]

there's some hearsay that uoft internal meds admissions prefers more than one elective as opposed to one long one......some urban legends about ppl being turned down cause they did a month in GIM as opposed ot breaking it up into more than one perhaps in a subspec or something..

 

thoughts?

[KennethToronto]

Most of the original reply is spot on other than with the recent clerkship changes, CC3s are now 1in4 call overnight. Typical load has been 4-5 pts with census unfortunately creeping to 30(!) per team. Still no pre-rounding though!

[steelie]

Hey Guys - I'm planning on doing an internal medicine, 2 week elective at UofT this spring as I complete my 2nd year at NOSM, and was wondering if anyone would recommend a preceptor that works well with students (esp. 2nd year students?)

 

Thanks Guys

[leviathan]

Do you cover any ICU patients at UofT, or is it a closed ICU system? We cover all the non-surgical ICUs in my IM core and I'd love to find a rotation that is the same way, if possible.

[cheech10]

All the UofT teaching hospitals have closed ICUs.

[lostintime]

Would it make sense that CTU might be better to show your teamwork skills and ability to work hard vs. consult medicine where you're much more chill? But I guess consult med is good if you're super smart and can rant off a lot of knowledge etc.

[cheech10]

CTU will have more emphasis on teamwork, but you will also get less staff exposure compared to med consults.

 

I think med consults is a good choice - since everyone is going to do CTU anyway as a core rotation, why not do something more unique and get more staff face time, rather than dealing with the residents all day?