Introduction to Clinical Medicine ICM

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Introduction to Clinical Medicine (ICM)

• Joyce Pickering, MD
• Nov 3, 2008

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You are here
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Topics

• Schedule and Logistics
• Important Principles in ICM
• Marks in ICM
• Summer 2009
• Intro to Clerkship/Clerkship

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Nicole Guedon, ICM and Clerkships Coordinator
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Schedule and Logistics for ICM
Course directors and administrative contacts for
each course will be in handbooks, and will also
be available on line (Web-CT).
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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 3rd , closed Nov. 12th, midnight.
• You should hear result by Nov. 25th.
• Family medicine clinic preference
• BCLS plus defibrillator training must be done
  during the following dates
• Jan 17 OR 18 OR 25 (half day)
• http//www.medicine.mcgill.ca/ugme/curriculum/bcls
  _form_en.htm
• Opens Jan 5th, closes Jan 8th.

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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/inde
  x.htm
• For many courses, material is available on-line

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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.

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Transportation

• We recommend the BMW Bus, Metro, Walk
• Parking is not always available to students and
  can be expensive.
• Lakeshore hospital may be used for some rotations

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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!

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Introduction to Clinical Medicine
Bedside teaching during Introduction to Internal
Medicine
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Professional Issues

• Dress
• Behaviour
• Punctuality
• Responsibility to patients, to colleagues, to the
  profession.

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Dress

• Wear your white coat and name tag
• NB hospital ID card also required
• MUHC card day
• Friday November 14th 21st from 1300 to
  1700 _at_ the MGH room E4-166
• Bring McGill ID for libraries
• No jeans/shorts
• Men shirts should have collars
• No exposed abdomens
• Shoes
• Avoid perfumes/colognes etc.

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Behaviour

• Be courteous even if people arent 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)

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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 500 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
  500, 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.

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Weekends/evenings

• Maybe family med clinics evenings or weekends
• Sim center patients with patient teachers (pelvic
  exam teaching)

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Shadowing

• Some rotations include a shadowing experience
  you will shadow a clerk (3rd year student) or
  resident for an evening.
• Surgery, psychiatry, internal medicine
• On these days you may be asked to stay until
  about 1100 p.m.

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Responsibility

• Clearly identify yourself
• Wear your name tag
• Say Im 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. Tellier, Dr. Pickering

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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.

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• 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 daide
  aux medecins of the College des medecins du
  Quebec to get involved, as well as appropriate
  disciplinary action.

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

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Topics

• Schedule and Logistics
• Important Principles in ICM
• Marks in ICM
• Summer 2009
• Intro to POM/Clerkship - Clerkship

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Marks in ICM

• Most courses are pass/fail
• Exceptions
• Intro to Internal Medicine 5 categories
• Intro to surgery 5 categories
• Family medicine, ethics 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 Deans Letter)

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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.

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

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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 Deans 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.

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Its all in the Red Book!
And other booklets to follow . . .
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Hes not even in medicine, and he finds it a
fascinating read . . .
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His brother has picked up on this exciting trend,
and even reads it on the bench. . .
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MSPR

• The Medical Student Performance Record (MSPR),
  a.k.a. Deans letter, compiles your evaluations
  (among other things) and is sent out when you
  apply for a residency position.
• A sample Deans 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

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• Introduction to Clinical Sciences (ICS) hospital
  orientation and tutor sessions start 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.

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Summer 2009 June 20 to July 19, 2009

• 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.

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• 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 20 to 24th)
  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.

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Topics

• Schedule and Logistics
• Important Principles in ICM
• Marks in ICM
• Summer 2009
• Intro to POM/Clerkship

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Core clerkship starts here
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Core Clerkship starts July 27th , 2009

• In February I will meet with you again about
  clerkship issues.
• Assignment to sequences will be at random,
  although again we will ask for life events.
• Dr. Tellier and Andrea McDaniel will also talk
  about career planning at that time.

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Have fun in ICM!
(And good luck with the rest of Unit 8)