Medical Students on Wards at Virginia Mason

1. MIX IT UP!
Interns sit next to a senior
Seniors sit next to an intern

2. Noon Conference
Laura Saganic
7/19/18

3. © 2016 Virginia Mason Medical Center 3
Objectives
Medical students on our wards teams
• Discuss how interns and senior residents can
work best with medical students
• Define intern vs. resident expectations
• Discuss 3 common scenarios, and identify areas
for improvement

4. © 2016 Virginia Mason Medical Center
Medical students at #VMIMR
• UWSOM IM rotation is 12 weeks; 3rd or 4th yr
students are on the VM wards either 4 or 6
weeks.
• Mon 1-1:30 PM didactic taught by us! Sign up!
• Tues 2-4PM didactics with Dr Grooms and Bucher
• Th AM UW didactics and Th PM is off.
• Students shadow resident/attending during
intern-to-intern group on Fridays.
• Students take off either Sat or Sun.
• Medical Student Teaching Committee
• Dr Bucher, Dr Grooms, Travis, David, Alex and Laura,
Jen Bernstein and Gina Franco (admins)
4

5. © 2016 Virginia Mason Medical Center
Scenarios
Purpose:
1) Optimize our learning environment
2) Brainstorm roles/responsibilities
Attending: Dr. Tina Chang
Senior: Kristen Beck
Interns: Laura Saganic and Alex Ajeto
Medical Student: Joe, MS3, 3rd rotation
Split into mixed groups of 3, select a scribe
5

6. © 2016 Virginia Mason Medical Center
Scenario 1 – first day
It’s Laura’s first day on service. She walks into her
team room at 6:30am and begins to chart round on
all of her patients. The attending arrives at 7 to
receive sign-out and talk about the game plan. Joe,
the medical student who has been on service for 1
week already, introduces himself to Laura just
before sign-out. Laura proclaims, “Oh, we have a
medical student? So are you seeing any of my
patients?”
Identify any problems with this scenario. How
might this have gone better??
6

7. © 2016 Virginia Mason Medical Center
Senior Resident Responsibilities
• Meet the “individual” student
• Identify and set tangible goals for where
they are in their training
• Incorporate new team members
• Review 1-2 of their notes weekly
• Have them prepare a 5 minute teaching
topic for a code day
• Help them identify a noon conference
case to present, refer to the chiefs prn
• Other ideas?
7

8. © 2016 Virginia Mason Medical Center
Intern Responsibilities
• Meet the “individual” student
• Support students as “primary” provider
• Coordinate and communicate frequently
• Model good leadership
• Teach when able
• Practice senioring
• “Pay it forward” (you were a student)
• Other ideas?
8

9. © 2016 Virginia Mason Medical Center
Scenario 2 - admission
Alex receives a new admit and Kristen directs Joe to “pick this
one up.” Alex suggests they head to the ED and he will listen
while Joe “runs the show.” After about 10 minutes of
interviewing, Alex interjects, “Thanks Joe, is it ok if I take it
from here?” Alex then finishes the interview while Joe
watches. Alex performs a focused physical examination and
leaves Joe to perform his full exam and tie up any loose ends.
What are the roles/responsibilities when admitting a patient
with a medical student?
What have you found does or DOES NOT work well when
admitting a patient with a medical student?
9

10. © 2016 Virginia Mason Medical Center
Student patient loads/admissions
• Ask your medical student what level of oversight
they feel comfortable with
• Develop a plan for new admissions together
• Balance autonomy and support best you can
• Target a 1-2 patient “panel” for the first week,
then 2-4 patients daily, depending on their
comfort and patient complexity
• Allow them to break away about 1 hour before
they are scheduled to present their pt on rounds
• Give them ~2 hours to prepare each new patient
admission
10

11. © 2016 Virginia Mason Medical Center
Scenario 3 – acute events
Laura receives a page from the nurse that
one of her patients has worsening
respiratory distress. Joe is also managing
this patient. Laura is concerned about the
patient so she pages RT for possible BiPAP
and rushes to see the patient.
How do you balance patient safety and
student ownership and learning?
11

12. © 2016 Virginia Mason Medical Center
Medical Student Evaluations
12
• P/RIME
• Professionalism – necessary for all levels
• Reporter - pass
• Interpreter – high pass
• Manager/Enhanced Communicator - honors
^^^ Our goal
• Remind nursing/consults to page medical
students first

13. © 2016 Virginia Mason Medical Center
Real life poll
How frequently do you use the current
med student order, and specify that
your medical student is first call on the
patient?
A)All the time
B)Most of the
C)Some of the time
D)None of the time
E) I haven’t hosted a med student yet
13

14. © 2016 Virginia Mason Medical Center
Summary
• Med students are vital members of our care
teams and the physicians of tomorrow
• Help create a strong academic and learning
environment with communication and support
• Work to balance autonomy and support
• Work to balance ownership, efficiency, and pt
safety
• Medical Student Teaching Committee
• Update team roles/responsibilities
• Developing a ‘curriculum’ for med student teaching sessions led
by residents
• Improving the medical student experience
• Join the Med Student Teaching Committee!
14