Introduction to clinical years

By: Joba Bernard Joma Erica

Content

1. How‘s life in clinical years2. Integrated Block3. Junior Clerkship4. Case clerking5. Book Recommendations6. Q&A

1. How’s life in clinical years

• Life= WCS + bedsides + clerk case + tutorials/teaching clinics

• V. different from pre-clinical years takes time and effort to adapt

• Tiring year but fruitful and amazing• So don’t be overstressed and enjoy!

2. Integrated Block• IB = WCS (for formative) + PE teaching sessions (for future practical

use in block ABC) + Projects/moliu assignments e.g. TB clerkship, TCM essay

• Formative = MCQ + EMQ - marks not counted so no worries - just study the wcs well will do (good to study

the wcs in IB some useful when enter block/ wont be covered again later on)

2. Integrated Block• PE - Main focus in IB - Should take time to study PE well (clin skills

notes + macleod/talley + browse) - Practice PE well at home & during Clerkship - Use it when entering blocks

• Human sexuality course - will also be examined in formative (little) - one interesting session that worth attending

3. Junior Clerkship

• JC = Block A + B + C (each 2 months) CCT/exam at the end of each rotation• Group 1-6 = A B C Group 7-12 = B C A Group 13-18 = C A B (congratulations)

3. Junior Clerkship

• Block A = MEDICINE - CHURest, but most fruitful + meaningful - (Clerk case + study + chau book) x infinity - Main focus = 1. Respiratory 2. Cardiology 3. Gastrointestinal 4. Neurology 5. Others less examined

So study the first 4 well!!! Clerk more cases

3. Junior Clerkship

• Block A = MEDICINE - Study materials: WCS + Red Book +/- Davidson… - Clerk case is important! ∵= sources of clinical sense, experience,

knowledge and PE skills

But no need rush to clerk case in IB as case clerking would be much more fruitful when gather more knowledge after entering blocks and there’s lots of chances

3. Junior Clerkship• Block A = MEDICINELessons1. Bedside (Long case)2. Interactive tutorial (Chau book in small group)3. Teaching clinic (Chau book in large group)4. Data interpretation (Chau book in large group again…)5. Clinical Skills (Go to GH and TWH, learn physical signs)6. Case clerking, report writing and case checking (every

weekend, homework, depends on different rotation, total no. case report needed to be done is different)

All fruitful!!

3. Junior Clerkship• Block A = MEDICINECCT: Short caseperform PE, no running commentarypresent findings to examinerQ&A sessionMaybe another patient (system)Exam on Mon (2 systems) + Thurs (2 systems

examed systems will not be examined)Time is countedMalignant examiners(E.g: Prof. Kwong, etc)

3. Junior Clerkship

• Block B = SURGERY - Content: General Surg e.g EGI/CRS/HBP/uro/… + ENT + Ortho + TCM

- Bedside: be prepared to wait/ hv session cancelled

- Clerk case is also useful

3. Junior Clerkship• Block B = SURGERY - General Surgery = Upper GI, Lower GI, HB, Vascular,

Urology, Breast, endocrine surgery, lumps and bumps, Head and neck/ Plastic surgery

(neurosurgery), (Pediatric surgery)not examined

- Orthopedics and traumatology= Osteosarcoma, Septic arthritis and TB spondylitis

just need to know these 3 =v=“ just to recite answers for exam which repeat year

after yearreally 100% repeat answers

3. Junior Clerkship

• Block B = SURGERY -Focus = disease presentation + PE Investigations in year 4 Operation details not required -PE: needs running commentary

3. Junior Clerkship• Block B = SURGERYLessons1. Bedsides (Call surgeon before history taking)2. Revisit bedside (usu. wont go)3. Teaching Clinic (much more benign)4. PBL (Q&A session)5. Interactive tutorial (grp presentation ==)6. Emergency surgery (attach to a doctor in A5)7. Ambulatory surgery (Lipoma and different short surgery, good)8. ENT teachings (well organized, not commonly appear in long case,

summative?) 9. One lesson on community medicine screening10.Orthopedics and traumatology teachings11.Traditional Chinese medicine @@

3. Junior Clerkship

• Block B = SURGERY - Most surgeons are nice (but still can kill) - Assessment = Long case (take place in QMH/TWH: know 1 week before)

about 30 mins history taking ( only you and patient ask diagnosis Immediately, please)

present to examinerPE Q&A session

3. Junior Clerkship

• Block C = Multi-disciplinary A&E, O&G, Pediatrics, Community medicine,

Microbiology, Clinical oncology, Chemical Pathology, Family medicine, ophthalmology, Diagnostic radiology

3. Junior Clerkship

• Block C = Multi-disciplinary - not much case clerking can be done - CCT: OSCA in CSL Live: Ophthalm, Fammed, A&E (New) Others dead Paedi: got a video, watch and ans abt

physical signs observed

3. Junior Clerkship• Block C = Multi-disciplinary - A&E (Lectures and clinical skills important because useful

and name of maneuver, learn how to perform those ‘PE’ during CSL sessions as it will be examined)

- Chemical Pathology (hypo-/hyper-Na = exam focus, remember the diagnostic pathway)

- Clinical oncology (1 lecture + Q&A, 1 OPD, 1 bedside, medicine and surgery revisit/introduction)

- Community medicine (3 seminars and HAP)

3. Junior Clerkship• Block C = Multi-disciplinary - Diagnostic radiology (Several lectures, gd)

- Family medicine (go to Ap Lei Chau GOPC, attach GP)

- Microbiology (bedside + teaching clinic) - O&G (One week, PBL, case clerking for later presentation,

organized, good preparation is needed)

- Ophthalmology - Pediatrics (Physical examination, lecture, Q&A, bedside on

CVS, RS, NS, MSS & GI, good teaching)

4. Case Clerking

• Don’t just focus on signs, learn to take a good history from patients

• Be good to the patients, plz don’t clerk larn cases

• Joyea said golden case clerk time = EARLY morning ie. 7-7:15am arrive

4. Case Clerking• Block A = MEDICINE

B1- Admission ward (female)A2- Admission ward (male)B2- Admission ward (female)E3- Male GI+ HBS+ general wardB6- respiratory (male, female)D6- Male hematology+ general wardE6- Female (and male) endocrinology wardB7- Male and female neurology wardK19- Male and female cardiology ward

4. Case Clerking• Block B = SURGERYA3- Male HBSB3- Female HBSA5- Colorectal surgeryB5- Admission wardA7- Neurosurgery ward

K14- Vascular surgeryK 15- Paedi surgery (seldom go)K 16- endocrine, head and neck/ plastic surgeryK 17- Urology and Upper GIK 18- Transplant ward

5. Bedside Tips

• Scars - Collar neck scar - Midline laparotomy scar - Kocher scar - Gridline scar - Pfannenstiel scar

• 1 - Kocher's Incision Biliary surgery eg. Cholecystectomy Hepatic surgery (may also require a larger transverse incision for wider access: eg. Liver Transplant)

• 2 - Upper Midline laparotomy Nissens fundoplication observe: associated with Gastrostomy tube? Upper GI surgery 2a - Lower / Long Midline Laparotomy Scars Any major abdominal surgery

• 3 - Transverse Upper Abdominal Incision Repair of congenital diaphragmatic hernia Splenic surgery

• 4 - Ramstedt's Pyloromyotomy Scar Ramstedt's Pyloromyotomy Scar - treatment of Pyloric Stenosis

• 5 - Grid-Iron Incisions at McBurney's Poiint Appendicectomy A non-inflamed appendix should always be removed once this scar has been made so that clinicians are not mislead in the future. Called the 'Grid-Iron' incision due to the way the muscle layers are divided at operation. McBurney's Point: the junction of the distal third and proximal two thirds of the line between the umbilicus and the anterior superior iliac crest.

• 6 - Umbilical / Sub-umbilical Scars Hernia repairs Gastroschisis repair Exomphalos

• 7 - Point incision marks Laparoscopy port sites Drain sites Also consider abdominal wound sites for Ventriculo-Peritoneal shunts

• 8 - Inguinal Incisions Inguinal hernia repairs Vascular access scars• 9 - Lateral Thoracolumbar Incision Renal Surgery - eg.

Nephrectomy• 10 - 'Hockey-Stick' scar Examine for orthotopic renal transplant

5. Bedside Tips• Lines, Tubes and Drains• - Central venous line -peripheral inserted central catheter - Nasal cannula - IV fluid/antibiotics - IV access - Nasogastric tube - Foeley’s catheter - Chest drain

5. Bedside Tips

• Drug chart (Oral, Parenteral)• Temperature chart• I/O chart• Nursing station• Patient record• X-ray/CT/MRI/PETs/

6. Books Recommendation

• Medicine

切 !Medicine

PE (Medicine)

Neurological Examination Made EasyM 616.80475 F965 n

Problem-Based Medical Case Management(紅書 )

250 Cases in Clinical MedicineFebruary 26, 2012

Oxford Handbook in Clinical Medicine(黃巴士 )

Some professors hate it!

Personally think not useful

Neurology in practice (HKU)

Hvnt read before

But heard that it’s a difficult book

Neurology and neurosurgery illustrated

Clinical Respiratory Medicine (HKU)M 616.2 C64  

CLINICALRESPIRATORY MEDICINE

Third Edition

Edited by

James CM HoBing LamMary SM IpWK Lam

Division of Respiratory MedicineDepartment of MedicineThe University of Hong KongHong Kong 2007

Integrated Systemic Nephrology (HKU)

M 616.61 C45  

CXR and ECG (good, read before enter block A)

• Surgery

May read essential surg/ “UCH surgical notes” in year 3 if got time

• UCH Surgical Notes (in goddisc)

Browse's Introduction to the Symptoms & Signs of Surgical Disease

Clinical Cases and OSCEs in SurgeryM 617.0076 R165 c64 

Surgical finals: Passing the Clinical M 617.075 K9  

• ENT

ENT

• OG

• Paedi

• Orthopaedics

7. Q&A