One ESSENTIAL CLINICAL SKILLS
One ESSENTIAL CLINICAL SKILLS
INTRODUCTION
In this section, you will find some of the basic skills required to be a clinical clerk or intern. Your role as a medical student will transition from preclinical to clinical years. As a student, your primary goal is to gain an understanding of normal human physiology and pathology, while your clerkship experience will require you to act as an information gatherer (in the form of a patient history and physical examination) and then as an interpreter, using your evolving knowledge of disease and treatment. At this juncture, a refresher on the basic skills will be useful to ensure your performance and value in the context of your clinical team.
In an OSCE or clinical scenario, you may be asked to interpret basic clinical laboratory tests or radiographic images to demonstrate your skill as a diagnostician. The following pages discuss those skills in further detail. Regardless of the test, do not forget the clinical context in which these tests are being interpreted. Carefully read the clinical vignette provided with the case and use it to corroborate your interpretation of the test. That is, do not let the pressure of limited time in the OSCE allow you to forget that there is an individual behind the numbers reported.
This section also contains information on the basic written clinical communication skills: prescriptions, progress notes, and orders. These written forms of medical communication are essential to the work that physicians do. On the wards, a clearly written and concise progress note will give your colleagues, residents, staff, consultants, and interdisciplinary team members the ability to follow a patient's progress during a hospital stay or over the course of multiple clinic visits. It will also give you the ability to track and quickly recall the details of a patient you are following. Having a systematic approach to constructing clearly written prescriptions and orders will ensure that the care of your patients is carried out and medication errors are reduced.
On the ward, in clinic, and in examination settings, medical students often are asked to provide an oral summary of a patient interaction. When a resident or staff physician asks you to present a case, organization is key to delivering a useful synopsis. Before beginning the presentation, take a few seconds to think about what it is that you want to convey. Consider your message. Implicitly painting a picture of the pertinent positives and negatives will help your audience understand the patient's presentation and help narrow the differential diagnosis. It also will demonstrate that you have paid careful attention to the possible differential. A clinical presentation does not need to include every last detail about the patient-it should simply provide sufficient information to make a decision on the current clinical presentation. As an analogy, think of your clinical presentation as an iceberg, of which only thirty percent is above the water's surface with the vast majority hidden below. Similarly, you should present only the key findings, while keeping in your own mental reserve the remaining seventy percent of detail in the event you are asked. Practicing your own oral presentation style and taking into account the type of feedback and questions that are asked are essential to building your confidence and skill. At the end of your presentation, be ready to discuss your differential diagnosis and steps that can be taken in the investigation, management, and disposition of the patient.
We hope that you find these essential clinical skills useful as you begin your clinical placements and prepare for OSCEs.
ADMISSION and DAILY ORDERS
ADMISSION and DAILY ORDERS
Orders (DAD-DAVID)
Note: Be sure to flag the patient's chart once orders are written. Any stat, important, or nuanced orders should be communicated to nursing colleagues.