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First Aid for Jefferson Clerkship Students

General Information about Clerkships at Jefferson Medical College

Contents:

Schedule

As you know, third year begins in July and ends the following year in late June. The difficult thing about third year is that you have to learn to live your life in "Six Week Segments." This means that without exception, you will only know your schedule for your current block; you do not get your schedule for the following block until that block started. For example, Block 1 can run from July 10th to Aug 19th. However, on Aug 18th, you may not know your schedule for Block 2 Aug 21st – Sept. 29th. On August 21st you may get your on-call schedule – weeknights and weekdays – for the following six weeks. Thus, you may not have enough time to plan certain things in advance – i.e. buying a plane ticket to meet up with college friends that are getting together, scheduling events, or visiting home to see your family. This can obviously get a little frustrating at times, but is in many ways what you will be encountering in residence on a very small scale.

Orientation

Each Clerkship begins with an Orientation day that is held on the Jefferson campus and will usually last all morning. If you have a rotation in the Philadelphia area, you will usually report to your clerkship affiliate site in the afternoon. If you are going somewhere that is a longer distance, in general you will get the afternoon off to travel to your destination. If you are planning on spending the majority of your time away from campus, you should be aware that you are strongly encouraged if not required to be on the Jefferson campus for the first day of a your rotation for the Clerkship Orientation Day. There are also Interclerkship Days which are all-day events on a variety of topics typically occurring on the first day of a new block.

Grades

In this affiliate book, you will find out what composes your grade for each of the clerkship rotations. Bottom line though, your clerkship grade will boil down to a Shelf grade and a Clinical Grade. Both grades will appear on your transcript separately. Thus, your SHELF score NEVER affects your clinical grade. Shelf exams happen on the Friday at the end of the block except for Internal Medicine, which is administered on the last Thursday of the block.

Time Off Before Rotations

For those rotations that are about an hour away (Reading, Latrobe, Christiana, York) you will sometimes get a "travel day" to return back to the Jefferson campus. Thus, your rotation will end 2 days before your exam. The day before your exam is always a study day for the SHELF.

Shelf Exams Are Put Out Through NBME (the same people as the Boards!)

The best advice to be given regarding these exams is they are EXTREMELY difficult, but passable. They are a nationally administered exam . . . and are "curved!" Each year the clerkship directors dictate the number of correct answers needed to pass his/her clerkship exam (i.e., Surgery, you need to answer 65/100 questions, Medicine, 72/100 – these are completely made up numbers, and just examples!), then your NBME score is converted to a Jefferson Score based on National Means and Norms. When you get your exams for your Shelf, you will get them through a website link. You will get an NBME exam score as well as a Jefferson Score. Just note: it is your Jefferson Score that needs to be >70 to count as a passing exam score.

You will get an email from Dr. Glaser and Mr. Veloski further explaining the conversions between national score and Jefferson Grade. Of note, you must obey the test administrators when they say that you have to stay until all of the Shelf exams are counted at the end. Although this is may be annoying, you’ve got to listen; otherwise, Jefferson may no longer partake in these exams (which would be a huge loss for the 4th year students who essentially use the test day as a study tool for the Step 2 CK).

What is on the Shelf Exams?

You can find out the content breakdown of individual SHELF exams on the NBME website. If you search under "Medical Schools," and then "Subject Examinations." Or you can follow the link:

http://www.nbme.org/programs-services/medical-schools/subject-examinations/clinical-science-disciplines.html

It is suggested that you prepare for the Shelf exams. These exams are an exercise in not only the material in each block, but also in time management. Every Shelf exam in now allotted 2 hours and 45 minutes. While a number of students finish early, most usually need every last minute of that time. There is little time to ponder each question and an understanding of the material that affords quick recognition of certain signs and symptoms is invaluable.

For each clerkship students use different resources to prepare for the Shelf exams. In general most students study a review book like case files or blue prints. In addition, some students choose to do questions either through pre-test books or online through USMLE world. Buying several review and question books can get very expensive so most students tend to buy a few and trade/borrow the rest to keep down costs during their year.

If you do not pass a Shelf exam

Advice from a student where it happened and s/he survived! Remember, it happens . . . take a deep breath and then start to be proactive. The re-take SHELF exams are only given on certain dates throughout the year, because they are National Exams. You are allowed to re-take the exam at any of the future dates but need to pick one date in advance so that the exam can be ordered. You will be excused from your rotation for the morning of the re-take exam and will be taking the exam in a classroom with other students that are also re-taking a SHELF (not necessarily the same subject as you). To determine what dates are available be pro-active and email the Course Administrator – do NOT expect them to email you.

When I went through this process the Course Administrator replied to my email with dates on which I could re-take the exam, an offer to take a practice exam and the suggestion that I should meet with the Course Director to discuss any areas that I felt particularly weak in. If all of these options are not offered to you, ask to see if they are available.

Other suggestions (for general peace of mind) are to set up a meeting with:

  • Dr. Glaser (215) 955-0704, Karen.Glaser@jefferson.edu to discuss study techniques
  • Dean of Student Affairs (215) 503-6988 to discuss what not passing the original SHELF means in terms of your Dean's letter, residency application and any other questions you might have
  • Student Handbook online will tell you exact protocols.

As to what happens if you do not pass the re-take Shelf exam, you must contact Dr. Pohl, who noted some portions of the clinical rotation would have to be repeated, along with another re-take of the Shelf.

How to make your 3rd Year Schedule?

In general, different rotations are different in intensity: Surgery and OB/GYN are the busiest, then Medicine, then Peds, then Family, then Psychiatry. Just think about your personality – do you want to be absolutely exhausted from July – Dec and then relax more in the spring? Or, are you the kind of person who wants something intense, something easy, and then something intense again . . . Also, maybe there is a field you are interested in. If so, maybe you want to take it early to make sure it meets your expectations, or maybe you want to take it later to make sure that you are up to speed with being a 3rd year med student. When you make your schedule you will rate WHERE you want to do each clerkships (top 3 picks), AND you will rate WHEN you want to do your clerkships (Blocks 1-8). THEN, you have to pick whether WHERE or WHEN is more important to you. Most people go with WHERE . . . but picking WHEN is perfectly fine!

What happens on a typical 3rd year day?

First of all we recommend "First Aid for the WARDS" to give you info regarding what to expect for each rotation. It summarizes a typical day for EACH clerkship, gives an example SOAP NOTE for each clerkship, says what is expected of you and lists briefly the common diseases for each clerkship. It’s a good thing to read the weekend before/first week of the clerkship to get a better feel of what is expected of you. That said, we’ll try to give you the basics of a third year day.

Ideally, your team likes you to have patients from their beginning of their care with that team. Thus, you will most likely be following patients whom you admit to the service (i.e. do a whole H&P). Many Attendings and Residents don’t like to have you pick up cases in the middle of treatment – it’s not as effective for learning . . . and we agree!

You arrive anywhere between 4:00 a.m. – 9:00 a.m. (depending on the rotation!) and see YOUR patients and write a SOAP Note – that means do a quick interview, physical exam, read any new notes in the chart, write down their labs, and make a plan. Then, at some designated time your team will "ROUND/RUN THE LIST" (this could happen at 6:30 a.m. – 10 a.m. (once again, depending on the rotation). This basically means going over the patients with other members of your team. This may be with:

  • Residents only
  • Residents AND Attendings
  • Psych -- Residents, Attendings, Nurses and social workers.

It may involve sitting around a table OR doing "Walking Rounds" which means going to see every single patient as a team. You will most likely present your patient at this time – which means give a quick intro to the patient, and then basically go over your SOAP Note. The presentations you give vary by clerkship: Surgery = very fast, Medicine = more depth. Don’t worry if your plan isn’t correct; try to think of one anyway. Giving the oral presentation is a skill in itself. Don’t worry; everyone knows that you are learning.

Secondly, the most important thing is that you become a good "Data Gatherer." Learn everything you can about your patients – you spend the most time with them! Also, write down Labs, Vitals, Study Results (MRI, CTs) etc. Depending on the Rotation after "Rounds/Running The List" you may:

  • Head off to the Operating Room
  • See more patients
  • Follow up on plans that you just discussed with your team at Rounds
  • To lecture . . . etc.

Remember these are the very BASICS of a Third Year Day.

How about Thanksgiving and the Friday following?

Last year the course directors decided unanimously to give Thanksgiving and the following Friday off. This policy is expected to continue next year, but remember some students will be required to work over the following Saturday and Sunday so do not buy tickets/make plans without knowing your call schedule.

PELS and Requirements Update

In accordance with both accreditation and Jefferson Medical College policies, our clinical experiences are monitored to insure certain skills and experiences are acquired during our clinical rotations. To do this Jefferson uses PELS, a web-based program. During third year, you will be required to keep a record of your patient encounters and procedures through PELS and obtain mid- and end-of-rotation sign-offs by supervising physicians. Each rotation organizes PELS slightly differently and has unique requirements, which will be detailed to you at the beginning of each block.

For people with smartphones, PELS is currently compatible with most operating systems and there is no need to buy a particular type. Keep in mind that you can always fill it out online as well. We highly recommend that you enter your PELS data as you go. Sitting at the end of the clerkship with scraps of paper with patient names and ages and trying to remember the details is not only inaccurate, but also REALLY time consuming. Just punch in your PELS throughout the day, it will make your life easier!

Timing of STEP 2 CK

Doing well on your 3rd year clinical rotations will help you immensely on taking your Step 2 Clinical Knowledge. Most people take CK between June (right after 3rd year) and December (because Jefferson requires you to take it by the end of the calendar year of your 4th year).

  • Typically, when you take CK depends on how you did on Step 1 AND when you’ve got time to study. If you are very happy with your Step 1 score, then you have no rush to take Step 2 CK. However, if you are not very satisfied with Step 1 score, you typically want to take Step 2 CK early so that your score can go on your residency application and so that you can show residency programs that you are capable of doing well on a Board exam.
  • When planning to study for Step 2 CK, typical time allotted for studying is: 2 weeks of studying if all of time is dedicated to studying; 4 weeks of studying if on a light 4th year clerkship.
  • Lastly, it has been shown that the earlier you take Step 2, the better you will do (obviously not always correct, but in general is true).

Review Resources for STEP 2 CK

There are numerous resources available to help you prepare for Step 2 CK. They are mainly split into two categories: 1) General information review and 2) Sample multiple-choice questions. In general most students do some general information review, but all students do multiple-choice questions. Here are examples of the most used resources in each category: 1) General information review: First Aid and CRUSH Step 2. 2) Sample multiple-choice questions: Kaplan Review (on-line), USMLE-World (cheaper than Kaplan but equivalent), and Kaplan’s USMLE Step 2 CK QBook. The AOA website on JEFFLINE also has helpful information about this exam.

Review Resources for STEP 2 CS

The Step 2 Clinical Skills exam is somewhat of a hassle for all med students. The exam is a long full day of seeing standardized patients, doing H&Ps, and writing up SOAP notes. The cost of the exam is over $1000!

Many 4th years suggest you take the exam right after your 3rd year because it is when you are most used to seeing all types of patients and doing complete H&Ps and write-ups. Also, you will have just completed your 3rd year OSCE with the Clinical Skills Center - the OSCE is essentially a mock Step 2 CS. However, if you decide to wait until mid-way through your 4th year you may have forgotten how to work up something as common as "chest pain." Therefore, if you can, take it early. If not, no worries.

The exam is not difficult. Review the material given out by the Clinical Skills Center. If you still are worried about the exam, there are a variety of review books out there that go through the sort of patients you will encounter on your CS exam. Please visit the AOA website on JEFFLINE for more information.

Days Off Policy

In the past, there has been some variability in students’ understanding about what sort of absence is excused during our clinical rotations. In order to clarify, please read the Q&A below.

Whom do I ask about being granted an excused absence?

The JMC policy states that students must get approval by the Clerkship Director in order to be excused from a rotation. The CLERKSHIP DIRECTOR ULTIMATELY DECIDES whether or not a student is excused.

When should I contact the clerkship director to request an excused absence?

Requests for absences should be made as far in advance as possible. The student is also responsible for contacting the clerkship site and clerkship director promptly should an unintended absence occurs.

What is an acceptable reason to ask for an excused absence?

  • Personal Illness (students should go to Student/Employee Health to be evaluated in addition to contacting the clerkship director)
  • Sudden death or serious illness in the family (students should contact their student dean in addition to contacting the clerkship director)
  • Educational conferences (are often permitted, especially if a student is presenting, but the clerkship director should be contacted BEFORE registering for the conference or booking flights)
  • Religious observances (are traditionally allowed if course coordinator AND team members notified prior to the absence. Please give team members and coordinators much advanced notice, as these absences are usually known well in advance)

This is by no means an exhaustive list, but rather some basic guidelines. As stated above, the final decision rests with the clerkship director.

Does my team need to be notified of my absence if I am excused by my clerkship director?

YES! Remember to always ask permission from and notify your team about any absences. Additionally, keep in mind the nature of the rotation as some may be more amenable and flexible to taking time off.

Will I have to make up missed time for an excused absence?

Students should expect that time missed for excused absences may need to be made up at the discretion of the clerkship director.

Are students allowed "vacation time" during a rotation?

Students are NOT ALLOWED VACATION TIME during a rotation.

What about excused absences to be on the Jefferson campus for scheduling, Dean appointments, etc?

Clerkship directors appreciate that especially during the second half of 3rd year and during 4th year students may need to be on campus during "business hours" to prepare for 4th year and residency. Often this includes visiting student health, meeting with your dean and/or registering for classes. While this is permitted every attempt should be made to schedule these errands between rotations or at least limit time taken away from the rotation.

What is the policy for requesting time off for Interviews during 4th year?

Students are allowed to request from the department 3 days of absence for a 6-week rotation, 2 days per 4 week rotation, and 1 day per 2 week rotation (please refer to JMC Handbook pg 27). In addition, the department may decide that this time must be made up. Therefore, ALL ABSENCES MUST BE APPROVED by the department.


Last revised: 02/11


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