How to Become a Part of the Medical Team

00:00 Welcome back to the 4th Year of Medical School lecture series. Today, we're going to discuss the importance of being a part of the medical team as a 4th year medical student. We'll also discuss how to prepare to see a patient, how to present a patient as a 4th year medical student.

00:18 We'll also discuss the importance of working with your team and the resident when you're trying to prepare to see a patient and when you're about to present a patient. We'll also discuss the importance of having strategic resources available to you readily as a 4th year student. Now let's discuss becoming part of the team. Without a doubt, medicine is a challenging profession.

00:41 The hours we work are long and sometimes situations can become very stressful. If you think about the academic hospital like a machine with gears and oil running, the residents and interns are really the gears that run this whole academic hospital machinery and they often feel the most amount of stress and turmoil. So it's important that when you work in this kind of stressful environment, you're able to relieve your stress to keep yourself balanced and also try to have fun. So given that it is a working job to be in a hospital and residents run their stress, the actual academic hospital splits into 2 clicks. One is the resident and intern who is working a job, they've matched into that program. The other side is the medical student, the 3rd and 4th year.

01:29 Now the question here is "Well, does the 4th year really fit into the second group? or Where do they fall on the spectrum?" Without a doubt, the intern is here and the residents and the 3rd year student here. Does the 4th year student need to be in this category or should they be somewhere else and the key is that you want to be seen and accepted into the resident and intern pool as a 4th year medical student. You want to remove yourself from this 3rd year pool and move yourself into the adult working resident pool. Remember, we talked about this earlier. You'll always want to function one level higher than your current status in your position so if you're a 4th year student, function like an intern. So you're put into this different group. Now, before you arrive to your rotation, you should reach out to your senior resident or the intern on service. You need to find out people's phone numbers and you'll need to text them saying that "Hi, I'm the 4th year sub-intern and I'll be rotating with you guys." Ask if there's anything that you need to do to prepare for the rotation beforehand or before you come in on the first day.

02:36 Ask "Where do you guys meet, what time do you want me to arrive?" Asking these questions beforehand will just make your first day of 4th year that much easier. It will also show that you're an active member of the team who is ready to work on day 1. Imagine that they tell you "Hey, we want you to read these few chapters before coming in. Here's what time we want you to be there. Here's what we want you to bring with you." This just makes life easier. You don't want to show up on day 1, you know, confused. Where do you go, what do I bring with me, should I have read something.?" Asking never hurts and also asking will be seen as impressive because they're going to say "Hey look, this kid's reaching out, he is willing to work. This is good. Good start for this guy. I'm already happy." So it's going to be impressive, not negative. Now, when you arrive on day 1 and you already asked, you know, where do you need to be and what time, just come a little bit earlier. It never hurts on day 1 to come a little bit earlier and be more ready and come ready to work. Once you get there, introduce yourself to the residents and ask them "What can you do to start working?" You will see that the transition of becoming a resident is becoming and asking "What should I be doing?" Not "What do you want me to do? Do I have be here? Can I go read?" As a 4th year student, I want you to have the mindset that you are here to work. That's how you make the transition into the resident pool. You're no longer a student of "Hey, what do you want me to do?" You're a 4th year student "Hey, how is it going? I already talked to you, I'm ready on day 1, I'm here early. What do you guys need done?" Be aggressive, start thinking "I'm, already an intern, I have responsibilities." Now, let's discuss how you prepare to see a patient as a 4th year student. Let's take for example that you are on your internal medicine sub-internship and you just got texted by your resident to see a patient.

04:33 Since you are smart enough to text your resident beforehand, you got numbers, you already have this constant communications in place. You have good rapport with the resident and you're seen as an active worker. Now, you get that text and you're about to start preparing to see a patient. As a 3rd year student, the focus was on gathering information, focusing on the right questions to ask and starting to kind of think about management. Now as a 4th year student, the focus is largely going to be on management because asking pertinent questions and performing relevant physical exam techniques are skills that you should really be comfortable with now as a 4th year student. When you're asked to see a patient, think about the questions and physical exam techniques that you wish to perform. This should be kind of a more quick process because you spend all of 3rd year thinking about it but now spend much more of your time thinking about how are you going to work up and manage the problems of the patient. This is what residents and doctors do on a daily basis and this is the core of doctoring. Patients come in with a complaint, we quickly have to figure out what's going on and then the question becomes "What do we do to like work it up and manage them and solve the problem?" Now, you may have just heard me say "This is what I expect you to do during 4th year, you should have already had all these done during 3rd year." It can seem daunting to be focused on management as a 4th year student. That's okay, it's supposed to be daunting. Remember, we talked about going from 3rd year to 4th year is that big leap. It's okay if this is intimidating. It's actually supposed to be. This is how we want you to grow. In the next few topics, we'll talk about key resources that you should have access to that will help you in these situations. What you will do is use resources and help yourself look up the workup and management of various medical problems. After you've then reviewed these resources, you will go to see the patient with your resident. During your time with the resident, share your ideas with them. Let them know what you're thinking. Try to discuss management out loud with them. This way, they will notice that you're trying to grow as a student to the next level and they'll actually say "Hey, look he's done some basic research look up." They have some building blocks. Not only does that help you with the building blocks of having a conversation with them but they're going to say "Hey look he is trying, I'm going to get and help that kid." Alright. Presenting a patient as a 4th year student. Presenting as a 4th year student is very different than a 3rd year student and to be frank you're not really allowed to make fundamental errors on simple presentations. Presentations need to flow smoothly and make logical sense.

07:18 Stumbling on your presentations, presenting outside of the SOAP order is going to be just unacceptable as a 4th year student. In the 3rd year lecture series, we talked about the SOAP format so if you need a refresher please go there. Before your attending comes into round in the mornings, make sure that you speak with your resident at length about the plan for the patient. Now realize if you think about the SOAP format, I didn't emphasize focusing on subjective or objective, I want you to focus on assessment and plan. That's what we're going to be pushing on as a 4th year student. Now, when the attending is listening to the presentation of a 4th year student, they expect the history and physical to be smooth. They really want no error there. You should have that down. You are doing that every single day essentially as a 3rd year student. They are much more concerned now about your understanding and the rationale of your assessment and plan. As a 4th year student and as a resident, all the attending cares about is your plan and your rationale for it. This is the key. You not only have to have a great plan but you need to know why you're doing each component of your medical management. Okay, so for this you need to speak at length with your resident in the morning and look things up before you go on to rounds. Right? So think about it. You're going to be doing certain management techniques for problems. If you don't know why you're doing it, you're going to get asked and it's going to come out. So, speaking with your resident in the morning before rounds you can say "Hey, here is what I want to do for the patient's problems. What do you think?" They'll give you feedback and if you're not sure just ask them. "Why are we doing this? How did we pick this antibiotic? Why do we pick this imaging modality?" The why and the behind the management plan knowing that is what's going to separate you as a 4th year student. In this way, having a good plan for your patients and knowing why you're doing everything is essentially the core component of good doctoring and learning that now as a 4th year student is going to make you shine. Now a tip during your presentations is to include research findings within them to justify components of your plan. Now I'm not saying that’s' absolutely necessary to do this but if your plan contains content that's relevant to a research paper is only in your benefit to quickly mention the paper in your presentation. However, if you're willing to do this make sure you're ready for followup questions. Read the paper you're actually going to cite and be able to answer questions the attending may ask. Let me give you a quick side note and how I even came to this understanding.

09:55 When I was a 3rd year student I had an intern on my pediatrics rotation. The intern was presenting a patient and in her management she included a very unique management technique for a patient's infection and then she gave her solution and then right that moment she said "You know there was a research paper that came out in 2015, it showed these findings. The research was done at this institution." She gave a quick overview of the research, actual project, and the conclusions to justify why she was treating the patient the way she was. I remember being caught off guard, it was the beginning of my 3rd year. I was like "Wow, what just happened" and I looked over at the attending and the attending was like "Wow" and the attending actually asked the student "What's your name?"and wrote it down. It was so impressive that it actually shocked the whole group. I want you to have that insight. You don't need to do this for every single problem or every single patient you have but when you have cases in which you're treating things more on the cutting edge or that are research relevant, utilize your resources, show that you're looking at papers and share it with the team. It only helps everyone. Now let's talk about key resources that you need during your 4th year. Certain resources are absolutely valuable to have access to while you're on service in the hospital or clinic. You can have a pocket reference book from the bookstore or have them on your phone. Now, this is not unique but you may want to try having digital resources on your phone just because they make your life easier. You can get major reference textbooks on digital format. You can buy PDFs and then place them on your smart phone. So then when you're about to see a patient, instead of opening a book and trying to go through the index, you can just pull out your phone, use the search function, and find relevant topics to read about for your patient. Let's take an example of how to use these digital resources.

11:47 For example, there is a book that many of you are familiar with called Harrison's Manual of Medicine.

11:52 Now, this is a very valuable asset to have access to since you can have a big reference textbook and if you have the digital format on your phone you can simply use the search function to quickly search large books in instant time due to your phone's processing power and find just the section you need for your patient. Now, traditionally you would have had to go to library, find this reference book, flip through it or if you had a pocket reference you can find some little thing but with this technique of using reference books or any book that you like or you can get access to as a PDF and putting it on your smart phone and then puling these books up and searching them as you are seeing patients or preparing for rounds, you're then able to get really unique data immediately before rounds and this kind of goes to a principle of where medicine is today.

12:42 The students that do the best currently in medicine are not necessarily the smartest ones. The people that do the best today are those that have the easiest access to information and if you have good texts available to you whether in your phone or somehow on you in some way where you can quickly references lots of information, it only benefits you. You're able to target your thinking, target your reading immediately in real time and kind of grow yourself quickly before rounds. These are the kind of cutting edge techniques for using them. Alright, let's summarize what we've talked about today. When you start your sub-internship rotation make sure to make yourself part of the resident team and in that pool, no longer the medical school team. Focus on plan and management when you're seeing new patients. You're expected to do the history and physical flawlessly, work with your residents. Really speak with your residents and plan out presentations in the morning. Know why you're doing each component of the plan and the rationale behind it and use digital resources on your phone to differentiate your self from other students because you'll have access to difficult-to-find information readily and you can really sharpen your presentations and knowledge base. Thank you.