Tag: KCU

Finding Audition Rotations (Sub-I’s)

Hello hello!

Long time no post. I know. I’m not sorry either, simply because my mental health has swiveled down the drain fourth year. And here I was thinking I was stronger mentally than that.

Oh well. Life is a bitch. And medical school has seriously worn me down.

But, back to what we were talking about!

So, you may or may not have ready my entry “Applying to VSAS”. There are still some good tidbits there. However, I am more aware now of some programs and how they operate than I was when I wrote that during my mid-third year. And to be honest, my school was absolutely no fucking help. Like at all. Basically they told us we needed 3 sub-I’s to graduate and after that they pretty much just got annoyed when I didn’t have my scheduled filled out on time for them to check their boxes and cross their to do list off.

Alright. I need to calm down. It’s like I’m starting to let ya’ll feel the hatred I have… I mean dislike I have for academic policies and their pencil pushers.

Back to why you are here!

What is a sub-I?

A Sub-internship, or sub-I, is the same thing as an audition or acting internship (AI). They all mean the same thing. Basically, it is where a residency program (of your choice) allows fourth year students to be there for a month and basically work as an acting intern. It is where you get to show your skills and learn all sorts of new stuff that will make you feel indefinitely inadequate (as medicine tends to do), and at the same time you are trying to get to know the program and try to get them to give you an interview. Interviews = increased chances at a residency slot.

So long story short, you work you ass off at a residency program and hope it is enough to impress some people into liking you to give you an interview and hopefully a residency spot.

No, you are not guaranteed an interview even if you do an audition. However, you are more likely to be put on a favorable list to get an interview if you do show up in person, take your time at their program, and try your little booty off in front of them. Although some places are just dicks and don’t care that you spent time and money trying to get into their program. C’est la vie.

Moving on.

How to find sub-I’s?

So, I promise this isn’t a shameless plug. But seriously all the links are in that VSAS post and I’m too fucking lazy to repeat it. Finding a list of residences through ACGME is one way. I do recommend this so you can at least see which programs are not doing well and are at risk of being pulled from being a residency or are on watch. You don’t particularly want to go to a residency if they are at risk of being pulled by the ACGME. But I digress.

Secondly, get you a FREIDA account. It gives you access to several different residencies and information on each. If they aren’t able to get you that information, it will at least give you the bare minimum and the site’s website so you can explore on your own. I’m talking how many spots they give, salaries, scores for boards and if you need both or not as a DO, childcare access, vacation days, how many DO, MD, and IMG’s they take, where they are located, average hours a week you work; all that fun stuff. They also give you the program director (PD) and their program coordinator/assistant’s information. YOU WANT THIS.

So, you do your research. By both specialty and location or just specialty. There are a lot of programs for some specialties, so you may need time for this. I’m a dumbass and always fly by the seat of my pants and it has definitely bit me in the ass more than once during fourth year BECAUSE I DIDN’T RESEARCH. But also, I’m a firm believer in the universe will put me where I need to be. I may or may not have leaned on that ideology too much. Oh well.

DO YOUR RESEARCH. FIND YOU THOSE PROGRAMS.

How to GET those sub-I’s?

Okay, so now you did your research like a good little medical student and you have programs you want to reach out to. Because most of ya’ll are super prepared and not at all like me. I will commend you for your work younglings.

Get that coordinator’s information off of FREIDA. Sometimes they have information on the ACGME list, but either way, contact the coordinator. NOT THE PD. The PD is the big guns. Contacting the PD directly could immediately make you lose your chance. They are busy, and usually have large egos (as one does accumulate if you are in charge of an entire residency program). So don’t head to the PD first.

Email the coordinator and ask about openings/auditions/sub-I’s/AI whatever term you want. Tell them you are interested in their program and would like to set something up for your fourth year. If they aren’t the ones you need to contact they will put you in contact with the right person. The following will be their response:
– Absolutely, here are the months open OR what month/dates are you available?
– Absolutely! We use VSAS, and recommend applying on there when it opens on XYZ date.
– No.
– We are not taking students for the next year yet. Please contact me/us at XYZ date to revisit this.

Now, DON’T LOSE THEIR INFO. Keep it. You want the names and emails and program of the person you spoke to and their responses. If you are able to start setting up auditions early in the year (so mid- third year, in January or February) fan-fucking-tastic! I’m proud of you. I was stupid and didn’t do this early. Not like my board scores would be helpful anyways.

I suggest making a document of some sort for this. I think I reached out to 30 programs this way. Because I did it later (like April or May or something) a lot of their responses were no or that they used VSAS and then denied me on there. Some I was able to start the process with and then once they saw my application materials outright rejected me.

THE AUDACITY. How could they? JK. Yea it stung but I’ll just talk about it in therapy or whatever.

Overall, I ended up with 2 out of my 3 sub-I’s this way. It is work, but since VSAS isn’t open that early (or at least they be slacking since COVID hit and they all use it as an excuse to not work) you can at least get your feet wet this way.

Again, save your responses and information in a document. You don’t need to enter your rotations yet for your school, but you will want to make sure you know your dates and where you will be going if you are able to secure a sub-I early.

Otherwise, you can use clinician nexus or whatever that program is and VSAS when programs open up to apply and try to find other sub-I’s. Most big academic institutions use VSAS. I find them stuffy but it was worth a shot. If you are able to secure the amount of sub-Is you want via email early then even better. You don’t even have to deal with VSAS. See that post for how to do that shit.

Google Doc For tracking. This is BASIC. I know. But if you want somewhere to start this is what I used. Please copy it to your drive and then you can edit your own version. NO I will not give you edit access to this one. Plus once you’ve copied it you can re-arrange it for how you like.

KCU students: How to enter your shit into e-value

  • Login to the portal and go to the e-value link.
  • Open e-value and and click zee schedules tab
  • You should find the link at the bottom of the small page titled “manage schedule requests”. Click that bitch.
  • The only thing you need to do, is under the first drop down (curriculum) change it to 4th year/student use.
  • Under clerkship is where you will add the elective. I.e. if it is a surgical elective versus a sub-I. It is actually pretty easy to navigate this. I know, I’m surprised too. Normally everything is unnecessarily difficult. Find your clerkship.
  • Then put your dates.
  • Next, put your site. There are A LOT. But it goes by state abbreviation and then alphabetically within the state.
  • Then put your preceptor name. I usually put UNKNOWN if it was for a sub-I and then filled out a form for unknown preceptor later. If it is at your home institution you should know who your preceptor is.
  • And then submit. It will need to be approved, but that is it. If you need to add a comment you can, but you don’t need to.

FOR FLEX TIME

  • Same as above, except for site you will put FLEX. It is there, I promise. It is under “F” alphabetically and just titled flex time.
  • For site, I just put my campus (i.e. Kansas City University-Joplin Campus)
  • For preceptor you put in FLEX, no preceptor. All you have to do is just put in flex and search and it will pop up.
  • You are welcome to put in why you are requesting flex in the comments but honestly, they don’t need to know.
  • You should be able to use 2 weeks of straight flex time (weekends don’t count as flex time) if you need to. But no more can be coupled. I used it like this to give myself more time for boards at the beginning of the year. Most students actually use it for traveling between sub-I’s/rotations, and also for holiday time around Christmas/New Year’s, etc.

FOR ONLINE ROTATIONS

I mean, I did this plenty of times since I had senioritis so bad fourth year. But you don’t have to use online rotations. It also helped give me a “rotation” in between actual in-person rotations since no one’s schedule lines up perfectly with yours. It is a pain in the ass to schedule shit in fourth year because everyone is on their own fucking timeline. But I digress. Plus, you can do it at home in your PJ’s.

  • CLMD 412 is the online course code
  • site is online course. It is under the O’s and squished between the states.
  • preceptor is online course. You will need to upload the certificate of completion when you are done with the course.

ALSO…

Your schedule requests will show up at the bottom of this screen. All of them that are either pending or accepted. You can look at things here too, especially if you forget how to enter flex/online course and you did one already. It also helps so you can see if you have any schedule gaps that you didn’t note on your own.

This is how it looks when you’ve filled out schedule requests.

Anywho, hope this was helpful. Tell your friends if you think it was, I could use the views boost. Toodles!

HPI Template: General/Well exam

Yo. What’s up?

I’ve honestly wanted to do a more specific post like this because it is highly searched, but I’ve also been dreading doing it.

Simply put: writing an HPI is hard. It is usually hard to find a template as everyone has their own style. Some are longer, more eloquently put and flow great. Some are short and choppy in style. It really all depends on your preferences, your provider’s preferences, and sometimes the specialty.

So, I’m going to attempt to do a general template for you. Again, most of this you just have to PRACTICE. It really is the only way to get good at HPI’s.

What is a well exam?

Ah. So glad you asked.

A well exam is usually a yearly exam for your checkups. Can be called annual exam, well exam, general medical exam, etc. Typically when you are a pediatric patient, you have many well exams in a year. For example, you will be seen at 1 week post-life, then like 1 month, 2 months, 4 months, 6 months, etc. Once you reach about the age of 2 or 3 you start seeing a pediatrician yearly. After that (especially as an adult), you should really have a comprehensive medical exam with your doctor once a year.

Now, if you have chronic conditions, you are likely going to have to see your doctor more regularly. But they can at least count one of those visits as a yearly exam which is less of a cost to your insurance.

Additionally, most adults’ jobs will give discounts if you go to your yearly exam to show you are trying to stay healthy. I don’t know why some jobs seem to care about this, but they do.

Okay back to the template

By now you should know what a SOAP note template looks like. If not, go check out my other scribe series posts. It’s all in there. If you have, I’m going to skip all the additional stuff and just focus on the HPI.

Super basic, no flare:

{First name, last name} is a {age} y/o {sex} presenting with a cc of {location if applicable} {chief complaint} which started {onset}. Symptom is described as {character/quality}, last for {duration}, and is described as a {0-10/10, severity} on the pain scale. It. {does/doesn’t} radiate to {location}, and is noted mostly at {timing}. {List of aggravating symptoms} exacerbate/aggravate {cc}. While {list of alleviating symptoms} improve {cc}. Associated symptoms include {List of associating symptoms}. {List negative associated symptoms}. There are no other concerns/complaints at this time.

It looks like this:

Mr. {Judge X} is a {55} y/o {M} presenting with a cc of {RLQ} {abdominal pain} onset {15 hours ago}. Initially, pain was around his umbilicus, but has now settled to his RLQ. It is described as {sharp}, and at first was {waxing and waning} but is now {constant}. Pain is currently rated an {8/10}. It {does not} radiate. {Hitting bumps on the car ride over} aggravated his pain. He has tried {Tylenol, Motrin, and Pepto-Bismol} without relief. Associated symptoms include {nausea, vomiting x1, low grade fever of 100.4’F at home, and chills}. {No reported hematemesis, diarrhea, hematochezia, chest pain}, DIB, or other symptoms.

Template when there are multiple complaints

So. As much as life would be really easy if there was only one complaint that someone came in with, people don’t just do that. A lot of times, they have several chronic diseases that are managed. Other times they wait a very long time before being seen, and then come in with several complaints that they would like addressed. These templates need to be a bit more broken down.

Basic, multiple complaint template:

{First name, last name} is a {age} y/o {sex} presenting for a generalized well examination.

{His/Her} first concern, {main complaint}. They first noted {his/her} {complaint} {onset}. Symptom is described as {character/quality}, last for {duration}, and is described as a {0-10/10, severity} on the pain scale. It. {does/doesn’t} radiate to {location}, and is noted mostly at {timing}. {List of aggravating symptoms} exacerbate/aggravate {cc}. While {list of alleviating symptoms} improve {cc}. Associated symptoms include {List of associating symptoms JUST FOR THIS COMPLAINT}. {List negative associated symptoms JUST FOR THIS COMPLAINT}.

You only want to add negative and associated symptoms that correlate with that complaint. This may not be a long list. That is okay.

You can then add as many similar paragraphs to additional complaints.

In regards to {his/her} {chronic condition}, they have been doing {well, poor}. They have been {compliant/non-compliant} with their medications, which include {list their medications and doses}. They have tried/incorporated {lifestyle changes} with good measure. Their last {objective finding related to this disease/condition}. {List associated symptoms if any}. {List negative associated symptoms if any}.

You can then add several similar paragraphs if they have multiple chronic conditions.

For example:

{Miss Sanchez} is a {32 y/o} {F} presenting today for a generalized well examination.

In regards to {her} {diabetes}, she has been doing {fairly well} per her reports. She has been {compliant} with her metformin and glipizide on her current regimen. She has tried to {cut out sodas and limits her caffeine intake to 1-2 coffees a day}. She additionally tries to walk around the block after work and on her lunch break. However, she has not made progress with much other changes to her lifestyle. She does not often check her sugars at home. Her last {hgb A1C was 8.0}. Today, her hgb A1C is {7.9}. She denies any {paresthesias, weight gain, eye changes, or urinary complaints}. She has not gone for her annual eye exam yet.

Things to think about per complaint:
  1. Diabetes: medication compliance, diet/exercise changes, weight gain/loss, Hemoglobin A1c results (more reliable than glucose levels on a BMP), any new symptoms they are having. The three big things with diabetes is diabetic retinopathy, nephropathy, and peripheral neuropathy. Or eyes, kidneys, and tips of the extremities. They should be seen every 3 months for glucose checks, should be checking their sugars at home, should have an annual eye exam, and should have their urine monitored for protein and glucose at least yearly. Additionally, a diabetic foot exam should be performed once a year (some providers like to do it twice a year).
  2. Hypertension: medication compliance, monitoring blood pressures at home, diet/exercise changes. Losing 10% of your body weight can actually resolve or improve a lot of chronic diseases (including improving diabetes and hypertension). Other things to think about include hyperlipidemia, so a yearly lipid panel check should be done as well. Overall, most of this discussion will be medication compliance and lifestyle changes.
  3. Thyroid checks: The main blood test ordered is TSH, but you will also see FT3/4 also sent. Most of the patients you will see will already be on medication, and this is simply checking to make sure the medication dosage doesn’t need to be changed. As a scribe, you won’t really need to be doing much else with this information. But if the patient is being newly diagnosed, then a high TSH indicates hypothyroidism, and a low TSH indicates hyperthyroidism. Usually follow up tests such as a thyroid ultrasound would also be ordered to confirm that there isn’t anything else occurring, so add this information in if your provider likes that information in their HPI. Otherwise, the medication dosage and frequency is important along with any possible symptoms the patient is having.
  4. Chronic lung complaints: Common things to add include when the last PFT was (lung function testing), last CXR, if they are on inhalers, what they are, dosage, etc; how often they are using rescue inhalers, the type of work they do, if they are exposed to smokers, if they are a smoker, things like that. Worsening symptoms include sputum production, increased coughing, and dyspnea. These patients can tend to have COPD exacerbations more frequently as the disease progresses or isn’t well controlled, and they tend to get pneumonia very easily.
  5. Well Woman exam: The main thing here is when was her last exam, any prior positive HPV testing (and what it showed, such as ASCUS vs low vs high dysplasia), and if those resulted in any procedures previously. Last mammogram or ultrasound or MRI (depending on age), last menstrual period, previous pregnancies (included as GPA, or gravid, para, and abortions), age when her menstrual cycle started, if she is in menopause/when did that occur.
  6. Vaccinations: These are mostly age specific. In a pediatric population, there are many more vaccinations to keep track of. In the elderly, there are a few that are important. Otherwise, you will usually see tetanus as a big one being asked in the ED regardless of the age. You basically want to know what vaccination and when/how long ago they had it.
  7. Additional cancer screenings: There are a lot. For example, gynecologic screenings, breast screenings, colon cancer screenings, lung cancer screenings… you get my point. Each has a specific set of questions and age requirements. Usually your doctor will be the one to ask, you just need to put if they have or haven’t. If they have, what age the screening was done/how long ago and what the results were.
General Information for the plan

Yes, well exams tend to take a while simply because you need to have a thorough examination. And if you are just writing the note, it means more things for you to click/type out. However, not every well exam you do will be daunting. And neither will the note. Typically most people don’t have several complaints and are just there to get yearly bloodwork and a pat on the back. However, you will have people with a list of complaints/concerns and then you have a massive HPI and usually a larger plan.

But well exams aren’t just the large HPI’s. The plan is also important. General health information gets relayed here along with information for each complaint. Several of the complaints listed in the above section go over areas that need to be counseled on. You may end up discussing a lot of this or majority of this information. When one of your providers frequently has a spiel about something, I suggesting making a “dot phrase” or quick phrase. That way, you can just pull it into the note and you don’t have to re-type it all the time.

Additional things:

  • Counseling on diet and exercise.
  • Exercise prescriptions
  • RICE instructions
  • how to measure your blood pressure
  • low salt diet
  • screenings
  • home safety
  • General discussion about labwork/imaging
  • general discussion about what to return for/call/go to the emergency department for

Again, depending on the encounter will depend on what is brought up. Once you see a few you will start to get the hang of it. As a scribe, if you can’t pick up well and run with it you won’t make it very far. As a medical student, PA student, or nursing student, you should have enough background to trigger this knowledge to help you run with it. That is what you are being trained to do after all!

Anywho, good luck and cheers!