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  • I'm back!

    Andrea Knittel
    AMSA Member
    7th Year MSTP/M3
    University of Michigan

    Post #8 of the  "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

    Yesterday marked the start of my outpatient pediatrics rotation, the first of my third year of medical school, and the end of this series of posts on my transition from doctoral work in the School of Public Health to my third year clerkships. As I interacted with my M3 colleagues during general orientation last week, and pediatrics orientation yesterday morning, I was struck by the overall high level of anxiety. In spite of my perception that everyone (except maybe the other returning MD/PhD students) should be calmer than me because of their more recent completion of things like clinical competency assessments and Step 1 of the USMLE, all of us were talking nervously about seeing real patients, presenting histories and physicals in the inpatient and outpatient setting. Many of us noted with some trepidation that we don’t do any pediatric exams during our first two years of medical school. While I still believe that many of my colleagues were much more prepared than they believed themselves to be, orientation was nonetheless an important reminder that no matter how large or small the ...

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  • One small step for a current student, one giant leap for me

    Andrea Knittel
    AMSA Member
    6th Year MSTP
    University of Michigan

    Post #7 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

    On Monday and Tuesday of this week, an incredibly gracious current M3 let me shadow him on the first two days of his inpatient pediatrics rotation. I would highly recommend this before returning from an extended absence, as it not only gives you a better sense of what will happen in the months to come, but gives the more advanced student a unique opportunity to demonstrate everything he/she has learned and to teach a newer student.

    The logistics: The MD/PhD program identified a willing volunteer who was on an inpatient pediatrics rotation this month, which is what I’ll be doing in either May or June, and put me in touch with him. I decided not to go to orientation, as I knew I’d get my own orientation soon enough, but met up with him following orientation before rounds started for the day. I only spent a few hours with the team on Monday, but I got a good sense of how the team works in the hospital, and when I showed up for pre-rounding on Tuesday, I got a real sense ...

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  • It really does start to come back

    Andrea Knittel
    AMSA Member
    6th Year MSTP
    University of Michigan

    Post #6 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

    It’s hard to believe I’m already at post #6 in this series. I’ve been averaging about one each month, which means that almost half a year has gone by. In that time I’ve done a lot of things to prepare me for my return to the medical school! I’ve scheduled a dissertation defense, written a dissertation (only edits and formatting left…), and worked with two different internal medicine attendings to try to remember how to be a medical student. Believe it or not, I think that the last item on that list has been the most anxiety provoking. Something I can tell you for sure, however, is that it really does come back. Something else I can tell you is that apparently anything can feel normal after you try it a few times. If you had told me just a few weeks ago that I would casually walk up to one of the nursing stations in University Hospital, have someone help me identify a patient, and then take a reasonably competent history and perform a slow and imperfect, but ...

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  • Hello history taking

    Andrea Knittel
    AMSA Member
    6th Year MSTP
    University of Michigan

    Post #5 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

     

    Last week I saw a real patient by myself for the first time. Granted, my actions had absolutely no bearing on his care as I was only seeing him as part of my program's official reentry clinical experiences, but nonetheless, I saw a patient by myself. It was profoundly different from every other experience I’d had conducting a history and physical examination. Unlike practicing with a friend or a standardized patient, this patient wasn’t directly evaluating my skills.  There would be no debriefing with him at the end of the afternoon to discuss whether or not he thought I had adequately checked for organomegaly on the abdominal exam (aka, enlarged liver or spleen), or how I might have more carefully guided him through a recounting of his past medical history. Unlike previous sessions where I was observed directly by an attending physician, there was no doctor present. There was no instructor correcting my percussion technique or reminding me to ask about medication allergies, or noting carefully that I should have ...

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  • Changing great expectations

    Andrea Knittel
    AMSA Member
    6th Year MSTP
    University of Michigan

    Post #4 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations. 

    When I started medical school, there was substantial debate swirling about changing residency work hours, particularly for interns who were putting in untold hours at the hospital clearly to the detriment of their personal wellbeing, and potentially to the detriment of patient care.  These arguments sparked discussions of the best way to train physicians to work independently, how to maintain continuity of care without endless work hours, and even how to measure progress on these issues.  Ultimately, resident work hours were limited to 80 hours per week and shifts limited to 30 hours.  AMSA helped to draft the legislation that implemented these first changes, and continues to advocate for better conditions for residents and students. 

    As I’m preparing to return to the wards, the controversy has flared again, though this time regulations have already passed.  The 80 hour work week remains in place, but first year residents (interns) may only work 16 consecutive hours.  (In addition, as detailed in news articles here and here, stricter ...

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