Daily Schedule and Description of Daily Program

8/3/2019 Daily Schedule and Description of Daily Program

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Daily Schedule and Description of Daily Program

Daily Schedule

TIME PROGRAM

08:0008:40 (SunWed)

08:0008:40 (Thursdays)

Morning Report

Clinical Pharmacology

08:4512:30 (SunThu) Ward Round with AAH/FMHS Staff

12:3013:30 Lunch Break

13:3014:00 (Sun - Wed) Preparation of Clinical Cases

14:0016:00 (SunWed) Ward Round - Bedside Teaching (FMHS Staff)

17:00Evenings Night On-Call DutyDescription of daily program:

Morning Report: Sunday - Wednesday

Clinical Pharmacology: Thursdays

(08:00-08:40)

Morning report starts daily at 08:00 AM and finishes at 09:00 AM. A tutor from the faculty ofmedicine conducts this session. The venue for this session is the teaching room adjacent to

medical (4) ward (MM4) in Al Ain Hospital. The student on call the previous day should present

a case to the tutor. The student on call the previous day should come 10 minutes early and be

ready to start the session.

Dont forget to get your logbook signed by the faculty tutor at the end of the session. OnThursdays, instead of the Morning Report, students should attend the Clinical Pharmacology.

Ward Round with Al Ain Hospital (AAH) Tutors: SundayThursday

(08:45-12:30)

You have two protected hours to take part in the Units ward round. Each one of you should

present his cases during the ward round. Utilize this session to learn the art of history taking, thecorrect method of clinical examination of different systems, to arrive at a clinical diagnosis and

differential diagnosis and to list active problems in a given patient etc. You need to be proactiveand engage yourself in the team. You will be exposed to tutors with good clinical experience

from various specialties of medicine. Please get your logbook signed by the AAH tutor at the end

of the session.


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Preparation of Clinical Cases(13:30 - 14:00)

After a quick lunch break, please come back to the ward and follow up your assigned patient.Medical residents in the male and female medical ward and CCU can help you on patient work

up. After identifying suitable patients, write a full history, do a clinical examination, differentialdiagnosis and laboratory investigations and document in the book provided. In addition students

should write daily follow-up notes until the patient is discharged. This follow-up should bewritten in the following format:

S : Symptomschange in symptoms since admission.O : Observationinclude change in clinical signs and laboratory reports.

A : Assessmentyour assessment about the patients condition.

P : Plan your treatment, new investigations, discharge date and follow-up plans.Whenever a patient under your care is discharged, find another patient for follow-up so that at

any given time, you should be following two patients.

For the How to Examine and How to Approach sessions, students are required to prepare cases

to facilitate the best benefit out of these sessions, always better preparation yields better teaching.

Ward Round - Bedside Teaching with FMHS Staff: Sunday - Wednesday

(14:0016:00)

These sessions will be taught by the staff of the Department of Internal Medicine. They are

bedside medicine based sessions (History taking and Clinical Examinations).

In these sessions, students will present 1-3 cases to the FMHS tutor. The cases will be in-patients(male medical ward, female medical ward, CCU or other specialty wards), worked up in the

period 13:3014:00, or possibly admitted by the student while on-call from the previous night.

In addition the Faculty Staff will cover How to Examine and How to Approach patients withcertain clinical problem. For example How to Examine Gastroentestinal System, students are

expected to prepare relevant clinical cases for these sessions. The objective of these sessions is to

improve your clinical skills and approach to patients.

Dont forget to get your logbook signed by the faculty tutor at the end of the session.

Specialty Day

The spectrum of disease seen by physicians in ambulatory care differs markedly from that seenon the inpatient service. Medical surveys have demonstrated that the leading causes for patient

visits to general internists include fatigue, abdominal pain, back pain, extremity problems,


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cough, dizziness, headache, URI's, and nervousness. You will gain expertise in the diagnosis andmanagement of these, and other, "undifferentiated" complaints as well as the outpatient

management of the most common diagnoses seen by general internists and subspecialists, such

as hypertension, Asthma, stable coronary artery disease, diabetes, and osteoarthritis.

Your ambulatory care experience is designed to provide you exposure to the process andspectrum of outpatient care in Internal Medicine. Multiple clinics will be used but all will

provide you an experience in a common process. You will have the opportunity to observe andparticipate in the following goals:

1. Observation of procedures such as Coronary angiography, Endoscopy, Imaging Modalitiesand specialized investigative tools.

2. Evaluation of patients with chronic medical problems, assessing efficacy and complications of

therapy, progression of the disease and its complications, the patient's adherence to the

prescribed regimen, and the impact of the illness and therapy on the patient's daily functioning.

3. Evaluation of patients with new complaints. Many of these diagnostic workups will take place

solely in the outpatient setting and never require inpatient procedures and/or treatment. Hence,

you'll be exposed to a spectrum of disease not encountered in your ward work and learn the wayin which diagnostic evaluations are planned and executed in the outpatient setting. Important

elements of this care include the judicious use of laboratory tests, emphasis on patient education,

use of empiric therapy, and response to therapy as gauged on a follow-up visit.

4. Appreciation of the need to "tailor" an evaluation (focused history and physical) to provide a

time-efficient exchange, rather than performing the comprehensive history and physicalapplicable on the wards.

5. Importance of cost effective care and the practical ramifications of your management

decisions. You will face questions such as "Can this patient afford this medication? This test?

Will the result change my management? Is this patient sick enough to require a hospitalization?

Should he/she be excused from work or school? If so, for how long? Is this a work-relatedillness? Should anyone else be notified? Or treated?

Bedside Procedures Performed or Observed During the Posting:

During the course of JMC, there will be ample opportunity to observe or perform certain

procedures. It is essential for you to continue to practice intravenous (i.v) blood extraction and

starting an i.v infusion. You should learn about the precaucautions you need to take, when tryingto take blood from one of the arteries (usually the radial artery) for arterial blood gases (ABG).

After observing a few, attempt to do procedures under supervision.

The FMHS Adjunct at Al Ain Hospital will be your supervisor. You should keep a record of all

the procedures observed or performed in your Log Book and get it counter signed by the

supervising doctor. (See forms in page 64 of the Log Book).Here are some examples of the procedures that you need to observe and perform:


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- Endoscopy Unit: Upper GI Endoscopy and Lower GI Endoscopy

- Starting an I.V. line

- Drawing blood for biochemical analyses and cultures

- ECG recording

- DC shock (for arrhythmia)- Obtaining arterial blood for gases

- Lumbar puncture- Abdominal tapping

- Thoracocentesis

- Arthrocentesis and others

- Attend coronary angiography/Balloon Dilatation (PTCA) procedures / Tredmill Exercise Test

You should keep a record of all the procedures performed or observed in your Log Book and get

it counter signed by the supervising doctor.

Description of Outpatient Experience

During the clerkship each student is expected to attend outpatient clinics to be exposed to both

general internal medicine and subspecialty medicine.

Preceptor Responsibilities

Each Faculty member on the speciality day will distribute the students to optimize their exposure

to various setting. We are expecting students to be proactive and make the best out the available

opportunities.

Each preceptor will incorporate you into the clinic as best fits the needs of the patients, othercaregivers, and trainees. Although in some clinics you may be assigned your own room and have

the opportunity to evaluate patients independently before presenting, this will be impossible in

others because of shortage of rooms, the complexity of patients, and/or rapid sequencing of

appointments.

Self-Directed Learning:

Utilize this time to revise and consolidate what you have learned during your day sessions. Make

full use of the National Medical Library via computers in the teaching room or hospital library.

Night on call: (according to on-call schedule)

Students should arrive for night on call at 17:00 PM every day. You should remain on the

hospital premises till 23:00 PM. After 23 students have the option to stay overnight in the

Students On-call Room located in Medical 2 Ward.


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Every student has to do one on-call for acute admissions at least once a week from 08:00 am to10:00 p.m. Students have to keep a brief record of every case they have seen during the oncall

hours.

The record has to reflect the students level of involvement in every case in the following areas:

1. History taking,2. Physical examination,

3. Management plan,4. Review the result of requested invistigations

Every case record has to be counter-signed by one of the on call-team doctors and reviewed by

faculty the following day before submission to clerkship administrator at the faculty.

Cases may be used for faculty clinical teaching the following day

dont forget to get your evaluation form signed by the registrar on call.

Documents

Daily Schedule and Description of Daily Program