Introduction to Clinical Medicine ICM

1. Introduction to Clinical Medicine (ICM) Joyce Pickering, MD Nov 10th, 2010

3. Topics Schedule and Logistics Important Principles in ICM Marks in ICM Summer 2011 Intro to Clerkship/Clerkship

4. Nicole Guedon, ICM and Clerkships Coordinator

5. Schedule and Logistics for ICM

6. Schedule and Logistics Sign up on line for your sequence of choice, giving reasons (such as life events)if applicable. www.mcgill.ca/medicine http://www.medicine.mcgill.ca/ugme/curriculum/icm_general_form_en.htm Opens Nov 10th , closes Nov. 17th, midnight. You should get your results by the end of Nov. Family medicine clinic preference: BCLS plus defibrillator training must be done during the following dates If you have your CPR certification please give proof to Nicole by Dec 10th Jan 15 OR 16 OR 23 (half day) http://www.medicine.mcgill.ca/ugme/curriculum/bcls_form_en.htm Opens Jan 5th, closes Jan 7th.

7. Schedule and Logistics . . You may already have �Textbook of Physical Diagnosis�, Swartz, MH Will be used early in Introduction to Clinical Sciences (January) Bates Textbook of Physical Diagnosis is another alternative. Note: Bates physical exam videos now available as an e-resource through the Life Sciences Library. http://mediasite.campus.mcgill.ca/bates/disc1/index.htm For many courses, material is available on-line

8. Books/Preparation You will need to buy or borrow: Bates or Swartz- for Professional Skills Blueprints in Medicine � for Internal Medicine Lawrence (Essential of General Surgery, Essentials of Surgical Specialties)- for surgery Other reading material as recommended by course directors Looking through Swartz or Bates, or watching the Bates videos online during your holidays is a good preparation for Professional Skills. You must read the section (or watch the section on-line) on head and neck physical exam for your first tutor session (Jan 5th) Your history taking skills should be well on their way, thanks to Physicianship 2.

9. Transportation We recommend the BMW � Bus, Metro, Walk Parking is not always available to students and can be expensive. Lakeshore and LaSalle hospitals are used for some rotations You are expected to be function in French for your clinical rotations.

10. Important Principles in ICM This is the transition period between BOM and clerkship. You will be in the hospitals, but will not have responsibilities for direct patient care. Some rotations do not include direct patient contact (peds, radiology) Teaching will be more individualized, but you will also have to take more personal responsibility to ensure you have met the objectives. A solid ICM experience makes for good clinical clerks!

11. Introduction to Clinical Medicine

12. Professional Issues Dress Behaviour Punctuality Responsibility to patients, to colleagues, to the profession.

13. Dress Wear your white coat and name tag NB: hospital ID card also required MUHC card � which you should all have now Bring McGill ID � for libraries No jeans/shorts Men: shirts should have collars No exposed abdomens Shoes Avoid perfumes/colognes etc.

14. Behaviour Be courteous � even if people aren�t courteous to you. You have to behave BETTER than others Everyone has a right to be treated politely - patients, cleaning staff, secretaries, your peers (and of course your teachers/attending staff)

15. Punctuality Punctuality is considered part of professionalism. Students have failed rotations and been asked to leave the program because of being repeatedly late Medicine is an �early� profession � check the start times for your rotations. In general, you will be finished by 5:00 p.m. But if the clinic is still working, the operation is ongoing etc. stay until the end. If you have an appointment and have to leave by 5:00, let them know ahead of time that you will have to leave. Always notify both the teaching office at the hospital (usually where you will be oriented, phone number will also be in manual) and your tutor if you are ill and cannot attend a session. Bring a medical note.

16. Weekends/evenings Maybe family med clinics evenings or weekends Sim center patients with patient teachers (pelvic exam teaching)

17. Shadowing Some rotations include a �shadowing� experience � you will �shadow� a clerk (3rd year student) or resident for an evening. Surgery, internal medicine On these days you may be asked to stay until about 11:00 p.m.

18. Attendance Attendance at all sessions is required. Whole class teaching sessions, including those at McIntyre are not taped.

19. Responsibility Clearly identify yourself Wear your name tag Say �I�m a second year medical student�. Take the initiative to contact your tutors about OR times, clinics etc. Report issues that you are concerned about To your tutor Rotation director Dr. Gupta, Dr. Pickering

20. A story . . . An ICM student was doing anesthesia, and in the operating room with the anesthetist. Shortly after the case began, the surgeon was notified that his car was parked in an illegal zone, and he was asked to move it immediately. As the case had already begun, and it would have been difficult for the surgeon to leave, the anesthetist volunteered to go and move the car. He invited the student to come with her. He left the OR and not only moved the car, but as it was a particularly nice car, went for a 5 or 10 minute drive before coming back to the OR. The student felt obliged to follow him, and so was a passenger in the car during the drive.

21. On returning to the OR, the anesthetist was quite open about the incident, including joking with the surgeon that he �almost got him a ticket�. The student was very uncomfortable with this incident. He noted that �someone much less critical than the anesthetist could have moved the car�. The student did say that in other ways the anesthetist was an excellent teacher � in fact, he probably gave the best teaching that week. The student came to see Dr. Pickering about this incident. Dr. Pickering contacted the Director of Professional Services (DPS) at the hospital. The DPS was aware of other issues with this physician and arranged for the �Programme d�aide aux medecins� of the College des medecins du Quebec to get involved, as well as appropriate disciplinary action. 

22. If it feels wrong to you, it probably is. Talk to your peers, a teacher you feel comfortable with, Dr. Gupta or Dr. Pickering

23. Topics Schedule and Logistics Important Principles in ICM Marks in ICM Summer 2011 Intro to Clerkship - Clerkship

24. Marks in ICM Most courses are pass/fail Exceptions Intro to Internal Medicine � 5 categories Intro to surgery � 5 categories Family medicine� pass/fail/honors Details of marking scheme for each course are in your package � also available on line. Comments are transcribed onto the Medical Student Performance Record (aka Dean�s Letter)

25. Marks in ICM Please ask for feedback at the end of a rotation. Final evaluations are often not ready by the end of the rotation.

26. Most evaluations are �viewable� on line. You are encouraged to come in and view any evaluations in your file that are not on line.

27. ICM marks If you feel your ICM mark has been unfair Speak to your tutor/rotation supervisor first You may appeal an evaluation within 8 weeks of the Dean�s office receipt of it Suggestion: discuss with Dr. Pickering before requesting a formal appeal. Dr. Pickering will ask to meet with anyone who receives a fail or below expectations in any rotation.

28. It�s all in the Red Book!

29. He�s not even in medicine, and he finds it a fascinating read . . .

31. MSPR The Medical Student Performance Record (MSPR), a.k.a. Dean�s letter, compiles your evaluations (among other things) and is sent out when you apply for a residency position. A sample Dean�s letter can be viewed on the McGill Faculty of medicine home page (www.medicine.mcgill.ca) - go to medical education, undergraduate education, student affairs, career planning office, documents

34. Introduction to Clinical Sciences (ICS) hospital orientation and tutor sessions start Wednesday January 5th. Read the section on Head and Neck physical exam before this. Missing ICS sessions could result in comments about attendance, reliability or professionalism on your MSPR.

35. Options: Take a vacation Do a clinical elective Do a research elective (8 weeks) Write the USMLE Step 1 Essential if you will be applying to the US for residency Useful to yourself as review and consolidation of material learned in BOM and ICM.

36. We will permit electives � however Unless you take an extra month of vacation later, you will be charged for the credits You must attend the one week (July 25 to 29th) Intro to Clerkship course. If you wish to do an 8 week summer research project, you can do so by doing 4 weeks research in the summer, attending the Intro to clerkship course (1 week), then returning to spend your first 4 weeks of clerkship as a research elective.

37. Topics Schedule and Logistics Important Principles in ICM Marks in ICM Summer 2011 Intro to Clerkship

39. Core Clerkship �starts August 1st , 2011 In February I or Dr. Cummings will meet with you again about clerkship issues. Assignment to sequences will be at random, although again we will ask for life events. Dr. Gupta and Andrea McDaniel will also talk about career planning at that time.