The Learning Plan, for medical students:
If you are coming to Kenora as part of your 3rd year of medical school to complete your comprehensive clerkship, please complete and return a “Learning Plana” — a list of at least five objective, quantifiable learning goals you hope to achieve during your eight months in Kenora. Return to the SAC, Heidi Stepanik and to please give a copy to your preceptor. We will have you update these at your quarterly assessments. We strongly encourage you to discuss your learning goals with your preceptors at the beginning and regularly during your rotations.
Primary Care Sessions
NOSM guidelines dictate that your primary care sessions (PCS) will make up about 60% of your clerkship year. In the LWHSC, a clinical day qualifies as a PCS when you work with one of the identified primary care preceptors in any location or role that is part of their regular duties. Most often that will mean seeing patients on the wards and in Family Practice clinics, but it also could be assisting in the OR, doing anaesthesia, delivering a baby, attending a call with the coroner, or traveling to a reserve.
- You are required to see a minimum of two (2) patients per half day in a PCS session.
- Any group work (such as VAR) is to be attended in preference to other educational opportunities.
The variety of elements in your schedule makes things appear quite specific on your calendars as far as where to be at what time. It is essential that you regard this with flexibility. Make it your priority to take advantage and attend unique learning opportunities or emergencies whenever they arise. If the opportunity is not with your supervisor at that moment, please respectfully obtain permission from the relevant individual to attend. If the opportunity is outside your usually scheduled hours, recognize that medicine is a 24h job, and that the best preparation you can have is to take advantage of “medical moments” when they are available.
We encourage all students to follow 2-5 inpatients/week during your clerkship year. Rounding on inpatients should occur independently each week day from 0745-0845h. Our expectations are that you will learn to write progress notes, treatment plans and orders directly in the charts. All orders need to be co-signed by your attending. Admission histories and discharge summaries should be dictated. You will learn more by rounding in advance and then presenting and dicussing cases with your preceptor, rather than waiting for them to arrive.
Most patients in our hospital are admitted through the Emergency Department by the ED physician on call. The attending staff is notified by phone and/or email. Our on-call system (see next item) will give you exposure to working through the initial admission and history. Acquisition of an inpatient roster will occur as follows:
- If the patient you admit IS a patient of one of your preceptors-
This is an ideal learning opportunity for you. It is hoped that you will follow and help manage this patient through their hospitalization, and later as an outpatient after discharge from hospital.
- The patient you admit belongs to a preceptor group of a fellow student-
Routine admission protocol is followed and orders are written by the student on call. That evening or the next morning, you “sign-over” the patient you have admitted to your colleague. This will give you practice in safe and efficient transfer of care.
You should try to participate directly in the care of any of your “paneled” patients while in hospital. This may involve assisting in surgery, observing a CT scan, etc. You can schedule “appointments” to attend your inpatient when there are interprofessional providers meeting with them.
We request you attend interdisciplinary ward rounds/discharge planning rounds to discuss your inpatients whenever possible. These occur on Tuesdays from 11AM to noon (2nd floor) and 1 to 2 PM (3rd floor). Please advise your preceptor when you attend.
Grand Rounds / Interesting Cases:
These are scheduled every second and forth Thursday from 8:00 – 9:00 a.m. You will be scheduled to present at these rounds once in the autumn and once in the Winter and are expected to attend all of them. Dr. Kelly MacDonald and Dr. Laurel Snyder will review requirements for the presentations. Case-based presentations in the autumn may be interesting cases you presented in VAR. You may present an interesting case in conjunction with one of your preceptors or as a brief (15 minute?) presentation unto itself. Discuss these details with your preceptor. In the winter term you are asked to present on a topic of clinical interest. Again, you may work collaboratively with your preceptor, or simply give a 15 minute presentation (minimum). Please coordinate and review your presentations with a preceptor prior to presenting at Rounds.
Group Inpatient Rounds:
Scheduled occasionally throughout the year. These will be scheduled with different physicians and will be performed as a group. You will be expected to have one inpatient to present to your colleagues. Preferably the patient is still an inpatient with interesting findings. Usually we will meet in the NOSM room at the hospital across from the Finance Department.
Will take place occasionally throughout the year. Emphasis will be on understanding how to work effectively with the Family Health Team and to participate in team-based care involving some of the Teams programs. There may be a didactic component. (Pilot initiative for 2010-11)
These will occur throughout your placement in Kenora. These assessments could be completed by one of your main preceptors or a preceptor you work with on a more occasional basis (ie. Emerg docs). They will observe you and another Clerk during interactions with patients and assess using the DOCS form. Preceptors that are participating are asked to book 6 to 8 patients to be seen during this time and to notify these patients about the length of their appointment and that it will be student assessment as well as their ongoing care needs. (Pilot initiative for 2010-11)
Lunch and Learns:
Scheduled regularly at the SCFHT- on the third Tuesday of each month from September to June. These will include topics and info sessions presented by a variety of health professionals. You may be asked to contribute, attendance is suggested.
During your clerkship year you will be on call in the Emergency and OBS Department.
Emergency Department (ED) On Call:
- Monday to Friday: will generally rotate 1 and 6 – shifts are 5:00 pm to 11:00 pm
- Weekend- Saturday & Sunday: will generally rotate 1 and 6- fulfill 15 hours over the weekend
There will be additional exposure to the ED through day shifts during the first few months of your placement, as well as if a preceptor in your group works in the ED.
Please concentrate your effort in the emergency department on complex cases requiring admission. Please keep a personal log of your admitted patients / problems for quarterly review. You may do this by logging the case Dx and case ID on your google calendar.
OBS Department On Call:
- Monday to Friday: be in contact with preceptors in your group that do OBS for exposure during the week (i.e. when your preceptor gets called in you go too)
- Weekend- Friday to Sunday: will generally rotate 1 and 6- check in at the OBS floor by late afternoon on Friday of your call weekend to have your presence on the ward known that you are on call
There are a number of family medicine preceptors who also provide obstetrics care, as well as 2 midwives. We’ve done our best to match each learner with one preceptor in their group who does obstetrics, and schedule everyone SES sessions with the midwives. This means that you will see some prenatal care in the office, and be called when your preceptor’s patient presents to the Maternity floor for assessment during the week. Obstetrics exposure is always coveted. We will do our best to make sure you are always included, but please appreciate that there are some cases where patients may opt out of student involvement, and there are times when nurses and preceptors are so rushed or tired that you may get missed. On weekends, there will be a clerk on call for Friday – Sunday. When you are on call for obstetrics, you are on call for assessments and labours, not just deliveries. You will learn much more and patients and preceptors will be more comfortable with letting you be “hands on” if you’ve been involved all along the way. On your call weekends, check in with the nurses on maternity in late afternoon on Friday to see what’s in the works, and remind them to call you when things get busy.
You should be able to attend approximately 5 to 15 deliveries during your time in Kenora (note that our hospital delivers about 250 babies per year). If you have any questions or concerns about obstetrics involvement, please direct them to Dr. Shannon Wiebe and/or your preceptor. We’ve done our best to balance the teaching groups so that everyone gets some obstetrics exposure.
Always clarify with the attending doctor/midwife that it is okay for you to be involved on a case-by-case basis and don’t take it personally if you are given a “rain-check”.
The On-Call Schedule will be posted in the ER and Maternity Department with your contact information.
Surgical Assist Call:
Other call responsibilities include being on call Monday to Thursday for Surgical Assist. This will follow the “surgical assist” call schedule that is published on “DocRoster”. When one of your preceptors is on call for surgery assisting, you are on call. It is anticipated that weekend call will involve the student in the ED also being on call to the Operating Room.
If you are unavailable to the OR, or the case going to the OR after hours is one that the student in ER admitted, then the student in the ED may be called to assist.
When doing surgical assisting, take the opportunity to be involved in the anaesthesia induction and recovery of the surgical patient.
Each of you will have a two week “burst” rotation with the surgeons. During this burst you will spend time with the surgeons for most of your scheduled clinical time, and be available for surgical call. Surgical Bursts will occur in the second half of your CCC year (between January and April)
Other Clinical Sessions
Pinecrest Home (Kenora Home for the Aged)
Dr. Maxine Carlise is the home director, and a number of local family docs provide care there. Specific geriatric sessions may be arranged with Dr. Carlisle or Dr. Sawatzky
WNHAC (Waasegiizhig Nanaandawe’Iyewigamig Health Access Centre)
At least two – three students will be paired with a Nurse Practitioner (Jennifer Roberts, Barb Pernsky, or Leeann Desrochers) who provides outreach care to local First Nations Reserve Communities. You will attend the same community monthly throughout the year. You may also have sessions at the KAHAC satellite Clinic with Dr. Laurel Snyder or Dr. Sandra Sas. It is our hope that you will become familiar with a cadre of patients on the reserve you visit over the year. If one of your core preceptors does regular reserve visits you may not be placed with an NP for this experience.
Specialty Enhancement Sessions
You must complete 60 SES (30 physician based, 20 Health Care Professional based, 10 Community based) sessions throughout the year. A majority of these will be scheduled through your SAC. Please notify her of any areas of interest so that the proper sessions can be booked. SES sessions can be reserve visits; time with visiting specialists, community organization, Family Health Team sessions etc. These sessions will also include the mandatory Grand Rounds, Tuesday mornings with Clinical Topics and Group Rounds, as well as the IPE Friday afternoons. Questions? See Heidi.