Clinical Guide The Nerd's Guide to Pre-Rounding Table of Contents Part 4. Gear Down: White Coats, Stethoscopes, and Other Fashion Accessories So, what do you need to bring to the clinics and wards? Section 4 of this Clinical Guide covers what to bring on the first day. But for more detail… I break gear down into three general categories: Clothes Tools Books Clothes Whither the white coat? You can expect to wear the white coat on inpatient services - i.e. surgery and medicine. Most "outpatient" rotations - family, peds, psych, ob/gyn - will not require you to wear a white coat, but you should have an ID badge or name tag displayed at all times. The inpatient portions of these rotations generally also won’t require you to wear a white coat, but I think it’s prudent to wear one the first day, rather than presume you don’t need one. Make sure your coat is not too small - it should be loose, comfortable, easy to get in/out of. A practical advantage of the white coat is its pockets - perfect for carrying crucial books and other necessities. Scrubs vs. regular clothes: On inpatient services, especially on call, your superiors will usually be wearing scrubs. It’s often convenient to change into scrubs early in the day - especially if later you’ll be going to the OR. Thus, on such rotations, you may not spend much time in "regular" clothes, and while it’s important to look nice, it’s not necessary to invest in an extensive, pricey work wardrobe. Still, if you’re not in scrubs, you should dress professionally - meaning, wear something you’d wear to a friend’s church/temple wedding (except for the shoes, ladies). A personal plug: I tend not to dress in scrubs unless I’m going into the OR or on-call and doing messy procedures. While scrubs are practical, they can start looking sloppy - especially after 24 hours. Patients deserve professional treatment, which means dressing nicely when it’s not impractical. Dressing nicely shows a disciplined exterior, which hopefully reflects/encourages a disciplined interior. Part of looking smart, is looking smart. This also goes for outpatient services. Dress as you would for a formal occasion. Shoes: There are two schools of thought. Some invest $100 in a good pair of shoes; others go cheap, or don’t bother with buying special shoes at all. I’m normally a cheapskate, but I belong to the first group. I think it’s wise to invest in a comfortable pair of shoes—you’ll be wearing them constantly. In my class, many went with clogs, purchased at On the Run on Ninth Avenue with a 10% student discount. (If you’re going that route, go NOW—the clogs go fast this time of year.) One student said she found it painful to spend that much money on shoes, but she has never regretted her decision. In fact, she now finds it painful to wear any shoes besides her clogs! (We will not digress into a discussion of "clog addiction" at this time.) For men, I recommend Ecco brand. They’re expensive as hell, but look great, and they’re like walking on air. Despite long hours on my feet, I’ve never once been distracted by foot pain. Other students bought inexpensive loafer-type shoes. One student bought no new shoes, and wore her tennis shoes on surgery and other dress shoes for other rotations. To my knowledge, shoe purchases have had no bearing on evaluations.[3] Tools The Black Bag. You’ll need something in which to carry your tools and books. Some people make do putting everything in their white coat pockets. I advise a bag: A fanny pack or side-bag will do. Now, what to put in it? You may be surprised to learn that medical students often act as the "caddy" of the team—which means, your residents and attending often will not have their tools and expect to borrow yours. Every medical student should always carry: Stethoscope[4] Pen light Reflex hammer - although in a pinch, the edge of your scope’s diaphragm will work 2-3 spare black ink pens - your superiors will often steal yours! Alcohol wipes - for wiping your scope’s bell, between patients. Bugs are transmitted by dirty tools. If you’re going to wash your hands, wash your scope. On inpatient rotations, it’s also convenient to have: Surgical shears Tape – "Micropore" paper tape is the most versatile, other types may be too strong or sticky for human skin. You can "borrow" from the supply room. For the slightly nerdy: Small tape measure –giving exact measurements of lesions/locations looks smart Hemocult guaiac[5] test developer –because you can never find it when you need it Snell test vision card –if you want to test CN2, esp. on inpatient services (small) travel alarm clock—more reliable for waking up on call nights than the wimpy alarm function on your pager; recommended Usually not needed Tuning fork – might be good to have in locker for new admits if neuro issues are at play Other neuro exam tools – as above Oto-opthalmoscope –store in your (LOCKED!) locker during inpatient rotations, since most rooms don’t have them; outpatient clinics usually have one Spare bandages ("Four by Fours," "Two by Fours"—no, they’re not lumber) –You can get these from a supply room before rounds, if needed. Needed only for international rotations to the Congo: Blood pressure cuff/sphygmomanometer. By the way: LABEL YOUR TOOLS. There’s not that much variety, and people’s gear can get mixed up. Also, attendings will borrow your stuff, walk off with it, and then not remember which med student they took it from. Books We’ll cover other texts below, but there are a few little reference books you will want to keep on your person. Every medical student should always carry: Tarascon Pocket Pharmacopoeia – I used it 20 times a day. A peripheral brain – described below. For the slightly nerdy: The Sanford Guide to Antimicrobial Therapy –used maybe once a week or the Handbook of Antimicrobial Therapy, from the UCSF Department of Pharmaceutical Services Note that the latter volume is a set of treatment guidelines for specific disease entities, produced by UCSF personnel with our particular patients, microbes, and resistance profiles in mind. This is a nifty little book that no one told me about, and I would up stumbling onto it during third year. You might ask about this book during orientation, or call the Department of Pharmaceutical Services at the main campus (476-1028) and see if you can get a copy. Other useful references (not necessarily needed on your person all the time): Housestaff Handbook, UCSF Department of Medicine. Again, this is a great little book that you will have to request. Even then, it may be tough to get a copy. Some campuses routinely hand out this book to their clerks at the start of the medicine rotation—so, you should at least get a copy at that time. If you don’t, ask for one. The book contains everything it takes to function as an intern--phone numbers of all the main campuses, how to write orders, basic approaches to common problems (acid/base, cards, pulm, hem/onc, etc.) Some of my peers treat it like gold. ECG Interpretation Cribsheets, by G. Thomas Evans Jr., M.D. Tom Evans is the Jedi Master of ECG reading. He teaches a weekend "ECG boot camp" in February for all interested fourth-years, and his regular elective is wildly popular. This little reference is useful BUT not really appropriate for the novice. However, the Appendix A of this section contains a basic approach to ECG that will help you get started. Once you get the hang of it, the Evans book can be quite helpful. Usually not needed on your person: Ferri’s or Washington Manual, or "baby" Harrison’s, etc. They’re just too darn big, and you don’t usually need them at a moment’s notice. They are helpful to keep in a locker for study and reference. If you find something in them you’d like to have on your person, xerox it and slap it in your peripheral brain. [3] I have heard from admission committee members, however, that shoe selection HAS been raised in discussing prospective applicants to our medical school. Don't you find that flabbergasting? [Back] [4] You may consider attaching a stopwatch to the end of your scope, or at least keeping one handy. I don't know about you, but I have a hard time estimating a minute, or even ten seconds, when counting a heart rate. If an attending asks you to check the pulse, having watch handy makes estimating the heart rate during auscultation much easier. [Back] [5] Pronounced "GWEYE-ack".[Back]