Bronxcare Family Medicine Elective
Week 1: Inpatient - 16th Floor (6a-6p)
Week 2: Off
Week 3: Inpatient - 16th Floor (6a-6p)
Week 4: Outpatient - Locations vary (8a-3:30/5p)
Week 5: Outpatient (8a-3:30/5p)
Week 6: Outpatient. (8a - 3:30/5p)
This schedule can vary and your "off" week can be at different times during your schedule.
ALWAYS business casual. Although we were never given an orientation packet on what to wear during your elective here at BronxCare FM most of the residents wore business casual. When we started the first day of inpatient most of the students wore scrubs and quickly realized we were the only ones in scrubs. There was no clarification throughout the rotation but the residents do wear business casual.
DAY 1: ORIENTATION
First day of Orientation, you will be completely lost unless you have this because you wont really be told what to do by the onsite coordinator during FM rotation. You will go Employee Health Services across the street of the hospital (green awning). Make sure to bring your vaccination records because Bronx Leb DOES NOT USE Complio. They rely on their own titers. You will likely wait a fairly long time to get your blood drawn for titers. You will also take a urine drug test at this time. After Employee Health, hopefully you have gotten an email from the coordinator who will tell you where orientation is and where to go. This is usually located at the Fulton Clinic. You will take a shuttle which leaves every hour mark from 7am-5pm behind the hospital . You cant miss this shuttle it has big green writing on the side that says Bronx Leb Hospital. Let the bus driver know you are a medical student going to get your clearance. Once you get to Fulton, you will enter through the back of the hospital then follow instructions to where your orientation is. If you didn’t get any instructions, go to the 4th floor of Fulton BronxCare and look for Chaka’s office (Coordinator for Family Medicine) who can direct you further. She will likely give you a sign in sheet and one evaluation form. After you are done with orientation you will cross the street to get your ID badge. This clinic is maybe a block away. When you get to this location, the ID badge may take you a long time to get. Many students starts the rotation the same time and this can take hours. After this time, most students head home and start the rotation the following day. Do as instructed by your email (if you receive one).
You will show up to the 16th floor of the hospital at 6am and immediately start rounding with the attending and residents. If you show up even 5 minutes late you will walk in during rounding. I would try to show up at least 5 minutes early for this rotation just to make sure I wasn’t walking in while they were rounding. Most of the residents and attendings will ignore you if you walk in during rounding, but try to get there on time. We would round on all patients and discuss the event that occurred overnight on the 16th and 17th floor. After rounding, you will be assigned a resident. Most of the residents will give 1-3 patients to follow. Then you will round with your resident to each patient. The patients you are assigned you will present to the attending when you round a few hours later. At 9am, there are social rounds. In the Bronx, there are a lot of social issues that occur with each patient including housing for patients who are homeless or need to be placed in long term care, unable to afford medications, unable to walk needing a cane or walker, ect. You will present some of this information to the social working. After social rounds, you will walk around with the attending and your resident to present the patient you were assigned. After you are done presenting, the resident will most likely make you write a progress note on the patient’s you were assigned. This can vary depending on your resident. This usually is just a short description of their course in the hospital today and what the plan is for the rest of their time during admission. At this time you could be asked to assist in procedures or do venipuncture. After this you will either go to student teaching, Tuesday and Friday from 3:30-4:30 or Grand Rounds Thursday at 4:30 or 5:30.
You will be placed at either Fulton Clinic, OGDEN, or Wellness Center. Wellness Center and Fulton Clinic have shuttle buses at the hospital that can take you to the site. OGDEN you will have to find transportation - Uber, bus, or walk 30 minutes from the hospital. A lot of students will Uber to and from the OGDEN clinic but there are buses you can take that might cost less money. I was placed in the Fulton clinic. Start time with the residents is usually around 9am. Take the 8am shuttle from the hospital and be ready to find a resident to work with for the day. You will then shadow a resident for the day. In this clinic, you will do much more shadowing than presenting or actually interviewing a patient but this depends on the resident you pick. If you are not Spanish speaking, make sure to work with a resident that is only english speaking and doesn’t know Spanish. Some days, you will only work with residents that are Spanish speaking and listen to conversations you don’t understand all day... Those days are long, exhausting and frustrating. We tried to get switched back to inpatient or change clinics on days like these but the coordinator for AUC seemed very unreachable and unhelpful. The three weeks of inpatient were mostly shadowing the physician from 9a-5p.
Tuesday and Friday 3:30-4:30p
Teaching was determined every week by the coordinator. All teaching is located usually on the ground floor at Fulton. An email was usually sent out about the specific topics for teaching. They expect that you read an article prior to teaching and come prepared. Every teaching session is different depending on who is giving the lecture.
Grand Rounds - Thursday 4:30-5:30 or 5:30-6:30
Honestly, Grand Rounds was very informative and usually interesting lectures. You go to the building directly behind the hospital for Grand Rounds. Almost all rotations Grand Rounds are located in this building. An official email will be sent out a few days before Grand Rounds explaining topics and what will be discussed. Some of the clinics are done at 3:30 on Thursdays and therefore it seems hard to wait around for Grand Rounds for 2 hours. Since there is not many waiting areas, no cafeteria seating, most of us tried to stay in the clinic as late as possible to study during this time.
YAY, NO SHELF EXAM FOR THIS ROTATION!
Overall review of this rotation has somewhat mixed feelings. Inpatient experience was incredible. Although the hours were long, I received a lot of exposure on patients admitted to the floor. I was able to follow 2-3 patients daily and write notes about their progress. Most of the attendings taught the medical students like residents and pimped many of the students daily which really helped my overall experience. One of the attendings walked around with me to each room and taught me the thought process in assessment, plan, and differential along with possible treatment. I was able to assist in procedures and do venipuncture.
Outpatient was a completely different story. It was completely unorganized with the medical students. Students were expected to shadow. Most of the attendings would have the residents present their patients and would occasional teach afterwards. Most of the attendings were warm and pleasant and wanted to help and teach but since there are many patients coming in and out of the clinic there wasn’t as much opportunity for teaching. Medical students did not present patients most days. The only time the medical student was really spoken to was when the resident didn’t know an answer to a question (which honestly, most of the time we didn’t know the answer either). The downside to this rotation is you did not interview the patient, preform physical examinations, present to the attending, or write progress notes. The other problem with this inpatient clinic is many of the physicians speak Spanish. If you do not know Spanish and are placed with a Spanish speaking provider you will not understand the conversation your patient is having with your provider. 50% of my time in clinic consisted on me starring at a patient and provider speaking a language I did not know. The resident would give me a short summary of the visit when we were walking back for him/her to present to the attending (sometimes).
The coordinator of the FM rotation at Bronx Lebanon isn’t very helpful during your entire rotation (inpatient or outpatient). When you get an orientation email about FM - there is a very short summary of your schedule and times. Other than that, there was no welcome packet, no summary of what to expect on this rotation, and no summary of what to wear during inpatient or outpatient. I emailed her 2 times throughout my rotation at the Bronx FM and did not get one response from my emails. The first email I had food poisoning and could not come into work - no response. The second email my dad had been placed in the hospital after being found unresponsive (he is okay now) - still no response. I honestly didn’t even know if it was okay to miss two days until my colleagues had said we can have 2 sick days every rotation (honestly I didn’t get much clarification on this from the handbook or the core site - this was our pediatric policy though). The amount of communication in this rotation from this coordinator was minimal to zero. We tried going to her office to ask a few questions about the rotation/dates only to be yelled at and sent back down to the clinic. One of the students was placed in a Geriatric clinic with one physician (that turned out she was away on vacation) for a 2 week elective.... The coordinator placed her in a different rotation for a week only to tell her the rotation wasn’t going to count. She had spent $1,000’s of dollars on the rotation, hotel stay, and food. It was her last 2 weeks of electives of medical school and wasn’t able to graduate on time. This coordinator is really not going to help you if you need it so just beware of that at the beginning of this rotation.
HOW TO SUCCEED:
The best thing to do during this rotation is make sure you find a resident that is willing to teach you during inpatient and outpatient and you will have a positive experience. Most of the inpatient and outpatient residents are incredible. They are willing to teach you and help you throughout your time rotating with them. Show up on time to inpatient at 6a to make sure you get the resident you want to work with. Be willing to change floors if your residents need help (sometimes they need help on the 11th floor which really gives you the medical students lots of opportunities to work along side the resident/attending). Always volunteer to assist in procedures. Ask for feedback on progress notes and intake notes for your resident. Ask for feedback from your attending you are working with that day on how you can improve. Overall, avoid the coordinator, inpatient is what you make of it and outpatient just deal with it til its over - not much you can do but watch and observe.