SAMS 5485
Small Animal
Internal Medicine
3.9 Credit Hours
Course Description and Objectives
This
clinical rotation focuses on internal medical problems of dogs and cats. The animals seen will be primarily referrals
from veterinarians practicing outside the university, but some cases will be
transferred in-house from surgery and local practice service. Each student will spend 3 weeks on the
Medicine II service, which focuses on small animal internal medicine and cardiology.
The
objective of this block is to develop problem-solving skills in small animal internal
medicine and cardiology. This is done
through daily discussions in rounds and keeping problem-oriented medical
records that will be evaluated daily.
This rotation is designed to help you make the transition from student
to doctor and to assist you in dealing with internal medicine problems if you
choose to enter a private practice that sees small animal patients. Even if you do not enter clinical practice,
this block will assist you in developing general problem-solving skills that
can be applied across species and disciplines.
Our Expectations
You will
assume a responsible role in the management of the patients you see, some of which will be critically
ill. After taking a history and performing
a physical examination, you will be expected to formulate your own R/O lists,
and diagnostic and therapeutic plans in writing prior to approaching the
clinician (unless the case is critical) and to carry the plans out once
approved by the supervising clinician on the case. You will be sure to search for the results of your plan each day
(e.g. laboratory reports, radiographs, ultrasound, surgery, etc.) so that you
can include these in your SOAP and your plan for the following day. You will strive to manage your cases as
efficiently as possible (for example, you will remember not to feed animals
that are scheduled for sedation or radiographic studies, or blood tests that
require fasting). You will be present
for patient discharges and will be well-prepared with instructions and
medications ready at the time the client is expected. You will not schedule patient discharges during your receiving or
rounds times.
You will
arrive early enough in the mornings to examine and care for all your patients prior to 8:00 am on weekdays and 9:00 am
on weekends. You should plan 30 minutes
per ICU case and 15 minutes per ward case.
Your ICU orders will be completed prior to 8:00 am every day. Your treatments will be completed by 9:00 am
on weekends, at which time clinicians will review each case and distribute new emergency cases. Weekend emergency receiving will be assigned
and you will pick up new emergency cases on a rotating basis.
You will be a
"team player"
by working well with the nurses, caretakers, and your classmates. You will help your classmates as needed,
knowing that many procedures require more than one person. You will keep the number of cases assigned
to you up to date on the dry-erase board in the medicine ward so that the case
distribution will be as equitable as possible.
If you know you have the fewest cases, you will volunteer to take the
next emergency case.
You will be
professional in appearance
with clean, clinically appropriate smocks, slacks or skirts (no jeans), and
shoes. You will strive to keep the hospital professional in appearance by
cleaning up after yourself and your patients in the ward, examination rooms,
conference room and exercise areas.
Your patients will be well cared for and will go home clean and groomed.
You will be
on time for receiving
your cases and will be willing to take emergency cases any time on this block.
You
will be sure your patients have identification collars and that their cages
are appropriately labeled
with a completely filled out cage card.
You will SOAP
each inpatient's record each day. SOAPs and TPRs are due by 8:00 am on
weekdays and 9:00 am on weekends. Each
active problem will be SOAPed. Problems
that are clearly related can be combined (for example, increased BUN and
increased creatinine do not have to be SOAPed separately, but can be combined
as azotemia). In most cases you will
begin with a large number of problems and gradually see which ones can be
combined so that you will work down to one or two major problems. Remember that problems can be historical,
physical, or laboratory in origin. Stay
focused on your patient as you SOAP.
Read textbooks for assistance in assessments, but do not copy
information (such as long rule out lists) from textbooks. The content of your record should be applicable
to your specific case. Be sure
to include a diagnostic and therapeutic plan for each problem for each
day. Tests and treatments you are doing
should be boxed and checked off when done.
Tests you may want to do should be listed but not boxed. When administering drugs, be sure to include
the dose (mg/kg and total dosage), route, and frequency of administration.
You
will contact in-patient clients once daily or as instructed by your supervising clinician. You will be prepared to convey general updating
information, such as which diagnostic or therapeutic procedures were completed
that day or how the patient is doing.
You maintain good communication with your supervising clinician
regarding information conveyed to clients.
You will record a summary of all client communications in the patient’s
medical record.
You
will prepare for didactic rounds and participate in the discussions. Didactic rounds will be daily
from 8:00 am to 9:00 am.
You will be
prepared to present your patients during case rounds in an organized and time-efficient
manner. When you have a case, you will
bring the record, radiographs and any other pertinent information. On the first day of presentation, give the
signalment, chief complaint of the owner, summary of the history, pertinent
physical examination findings and any pertinent diagnostic test results. Summarize the major problem, your major
rule-outs, and your diagnostic and therapeutic plans for that day. On subsequent days, give the signalment,
major problems, and current status of the diagnostic and therapeutic plans.
You will
utilize nursing staff effectively. The medicine ward nurses can perform most
diagnostic tests for you if you communicate the need for these tests with them.
They will perform daytime treatments as long as these are listed on the
treatment sheets hanging on each cage door. Learn to make nurses part of your
animal health care team. Our nurses are
a valuable resource.
Student Evaluation
Evaluation will
be done as written comments in your patient records and verbally as
appropriate. The evaluation form and
the descriptions of each category are in your protocol book. Evaluation is based on subject knowledge,
patient care, the utilization, organization, and content of the
problem-oriented medical record, ability to identify and solve problems,
participation in rounds, organization and clarity of case rounds, efficiency in
carrying out diagnostic and therpeutic plans, ability to relate well to people
even in stressful situations, professional appearance, initiative, enthusiasm,
communication skills, and technical abilities.
A verbal and
written evaluation will be provided after the first 1.5 weeks. A final written evaluation will be completed
on the last day of the block and submitted to the Dean's office. Overall block evaluation is given as
"satisfactory" or "unsatisfactory". In order to receive a
"satisfactory" evaluation, the student must perform passing work in
each of these major areas: knowledge base, record keeping, enthusiasm, and
professional deportment. An
unsatisfactory grade means the block must be repeated.
Attendance
Students cannot
expect to miss any weekdays without making the days up to receive a grade for
the course.
Regarding
weekends, all students having cases are expected to come into the hospital and
take care of their patients. Students
not having cases who are not assigned to pick up emergencies may take the
weekend off with the permission of (and at the discretion of) the supervising
faculty member.
Ethics
Medical
records must never be falsified in any manner.
All information recorded must be accurate. Professional terminology must be used. Once written, no page of a record may be destroyed or discarded.
All pages in the record must be dated and clearly and completely identified as
belonging to a specific patient. All
changes must be initialed and dated.
Information deleted should be marked through with a single line.