Med Ready

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Medicine

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Medicine

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SEASON 1, EPISODE 3

Before Your First: Vaginal Delivery

Your first vaginal delivery can be exhilarating and nerve-wracking all at once. This episode walks you through the cardinal movements of labor, how to assist with pushing, delivering the baby and placenta, managing bleeding, and what to expect in the immediate postpartum period. Show Outline: Cardinal Movements of Labor – Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion Complete Dilation – Station assessment, labor down vs. push 2nd Stage: Pushing – Offer to help with maternal positioning (holding ankle/leg) Delivery – Downward traction on head, thumbs to nose, anterior shoulder, posterior shoulder, body. Skin to skin. Delayed cord clamping. 3rd Stage: Placenta – Active management, Pitocin, gentle cord traction. Three signs of placental detachment. Bleeding – Atony and uterotonic medications Lacerations – Degree classification and repair Postpartum – Fundal tenderness, lochia, voiding, breastfeeding About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

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23 min
SEASON 1, EPISODE 3

Before Your First Well-Child Check

This episode will prepare you for your first well child visit. In primary care, about half of a pediatrician's time will be spent in well child visits. We will talk about what you need to review before you walk into the patient's room, the elements of the history (diet, sleep, elimination, development, etc.) that you need to ask about in well child visits, tips to approaching the physical exam in children, and anticipatory guidance. Finally, we will provide an example of an oral presentation for a well child visit. About the Speakers: Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA. Host: Jeremy Middleton, MD – Jeremy Middleton, MD is an Associate Professor of Pediatrics and Pediatric Gastroenterologist at UVA Health. He serves as the Pediatrics Clerkship Director and has expertise in children with intestinal failure and aerodigestive disorders. Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine. Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

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15 min
SEASON 1, EPISODE 1

Your Ob/Gyn Survival Guide: Tips and Tricks

Kicking off your Ob/Gyn clerkship and not sure where to start? In this episode, Dr. Doorey walks through the high-yield resources, essential apps, and practical study tips you'll need to hit the ground running on Labor & Delivery and in the OR. Show Outline: Recommended Resources Free Procedure Ready App – Clinical questions to expect in the OR and on the wards YouTube Playlist: bit.ly/pimped-ob Books: Netter's; Obstetrics and Gynecology by Beckmann Apps: UpToDate, Epocrates, GoodRx, LactMed, ASCCP, CDC STI guidelines, ACOG, OB Wheel Tips and Tricks Be proactive – talk to students who just finished the rotation about ways to be helpful and the day-to-day logistics Set expectations early and clarify as needed Be self-sufficient, but ask for help when appropriate Before leaving, ask when to come in, who to pre-round on, and where to meet Ask for feedback once or twice a week Labor and Delivery Basics Gravidity and parity (Gs & Ps) Primips vs. multips Gestational age: preterm vs. term About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

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26 min
SEASON 1, EPISODE 2

Before Your First Day in Newborn Nursery

This episode will prepare you to see well newborn babies in the newborn nursery on day 1. We will talk about the typical newborn stay, the information you need to gather to successfully give oral presentations on your patients, the newborn physical exam, and the tests and procedures commonly performed on all newborns. Nursery orientation: family expectations and goals of the healthcare team, expected length of stay History Maternal History: Gs and Ps Prenatal Care: prenatal labs and ultrasounds Past Medical History & medications Social situation/support Baby History: Gestational Age Delivery type and why, resuscitation efforts and complications Growth parameters The complete newborn exam: head to toe During the newborn stay: Ins and Outs Medications and vaccines Routine screening labs and tests Parental discharge education Discharge criteria and follow up About the Speaker: Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine. Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

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20 min
SEASON 1, EPISODE 23

Developmental Milestones for Children

In today’s episode, we are talking about normal child development. We will talk about why this is important and how you will be evaluating children’s development. We will go over major milestones in the 4 developmental domains: movement/physical development – or gross and fine motor, language/communication, cognitive, and social/emotional. We will go over some common cases. Finally, we will briefly discuss what you should do if you suspect developmental delay. Why it is important to learn about developmental delay. Why it is important to learn about development Developmental surveillance versus developmental screening versus diagnosis of developmental issues Developmental domains/categories: Expressive language Receptive language Gross motor: this is how you use all of your big muscles Fine motor: hand/eye coordination Social/emotional: how children interact with others and show emotion. Language/Communication: how children express their needs and share what they are thinking, as well as understand what is said to them. Hearing is important for language/communication development. Cognitive: how children learn new things and solve problems Movement/Physical Development: how children use their bodies. Learning milestones Learn the schedule for well child visits Watch children at different ages to see what they can do. Gross motor milestones: 1 year goal is to be able to walk independently. Fine motor milestones: 1 year goal is to be able to put food into one’s mouth Language and communication milestones: 1 year goal is to be able to say a few words Social and emotional milestones: 1 year goal is to recognize that people are individuals that they can interact withOK, so those are some of the major milestones. Now, let’s go through a few common case scenarios that have some specific teaching points. Cases What if there is developmental delay Resources/Links: CDC’s Developmental Milestones: https://www.cdc.gov/ncbddd/actearly/milestones/index.html Ages and Stages developmental screening tool: https://agesandstages.com/products-pricing/asq3/ Modified Checklist for Autism in Toddlers (MCHAT): https://www.mchatscreen.com/ Links: https://www.cdc.gov/ncbddd/actearly/milestones/index.html https://agesandstages.com/products-pricing/asq3/ https://www.mchatscreen.com/ About the Speaker: Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA. Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

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31 min
SEASON 1, EPISODE 6

Before Your First Adolescent Well Visit

The goal of the adolescent well visit is to empower the adolescent in starting to take ownership of their health with the support of their parent/caregiver and their health provider. There are thus specific ways in which the adolescent well visit differs from well visits for younger children. We will discuss how you can approach these visits, how to handle patient confidentiality, and how to ask those sensitive questions. Before visit: Review normal psychosocial development of adolescence Review sexual maturity rating (SMR) (previously referred to as Tanner Staging) of adolescence Review past medical history, medications, vaccines, labs, prior concerns from previous visits, and their last well visit if available. Vital signs (including BP), height weight, BMI. Any screening questionnaires (e.g., PHQ-9A) During visit: Introduce yourself; ask how they would like to be addressed Review structure of visit, including genital exam and interviewing adolescent alone; importance of confidentiality Direct questions to adolescent as much as possible Concerns from adolescent/parent or from prior visits that require follow up or updates Psychosocial screening: HEADSS (home, education/employment, activities, drugs, sexuality, suicide/depression/self-image, and safety) or SSHADESS (strength, school, home, activities, drugs/substance use, emotions/eating/depression, sexuality, and safety). NOTE: Some of this will be done during confidential interview. Nutrition: number of meals/snacks, dairy intake Sleep: nighttime and naps Screen time: duration, type(s) Dental: frequency of brushing, last seen by dentist Menstrual history: Age of menarche, frequency, length of periods, heaviness of flow, symptoms associated with menses Review medications, allergies, growth chart, vaccines Confidential interview: any additional questions or concerns; Home, Drugs and substance use; Emotions, eating, and depression; Sexuality; Safety Physical exam Head to toe Discuss acne Need chaperone for breast and genital exam Preparation for oral presentation About the Speaker: Host: Serwa Ertl, MD – Serwa Ertl, MD is an Assistant Professor of Pediatrics specializing in Adolescent Medicine at UVA Health. She completed her residency at Connecticut Children's Medical Center and fellowship in adolescent medicine at Children's National Medical Center. Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

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24 min
SEASON 1, EPISODE 33

Before Your First Discussion about Infant Formula

In this episode, we will be reviewing what you need to know before your first discussion about infant formula. We will cover the characteristics and types of formulas, why infants might require different types, the correct way to prepare formula and how much infants need, common concerns from parents, indications for changing formulas, and when to transition away from it. Reasons for formula feeding Human milk is first choice for most infants Concern about lactating parent’s milk supply Workplace conditions make it difficult to sustain human milk feeding Parent preference There are few true contraindications to breastfeeding. Galactosemia Maternal HIV infection that has not achieved an undetectable viral load Maternal phencyclidine (also known as PCP) or cocaine use Active Herpes Simplex virus lesion Active tuberculosis Types of formula: 3 characteristics Caloric density: calories per ounce. Standard term formula is 20 calories/oz. Infants born preterm or have growth failure may need 22-27 calories/oz. Carbohydrate source: Lactose (galactose + glucose) or non-lactose Protein type: Cow-milk based formula proteins are whey and casein. Hydrolyzed formulas: proteins are broken down into smaller protein “chunks” or into individual amino acids, which are hypoallergenic and easily digestible. Other formulas utilize different sources of protein, including soy protein and goat’s milk. Special formulas for infants with specific metabolic conditions: eg. phenylketonuria, maple syrup urine disease, homocystinuria. Forms of formula Powder: most common and least expensive. Usually, 1 scoop of formula powder is mixed with 2 oz water. Liquid concentrate: mixed 1:1 with water. Ready to feed: no mixing required, but most expensive. Be sure that the formula is being mixed correctly! Incorrect formula mixing can result in growth failure or electrolyte abnormalities. How much formula should be given? A good rule of thumb is that infants require between 120-150 calories/kilogram per day. Common myths about formula Lactose intolerance. True congenital lactase deficiency is rare disorder and, in infants, it will usually present with very severe diarrhea. What adults experience as lactose intolerance occurs later in childhood. Developmental lactase deficiency can occur in premature infants, but lasts for a short time after birth and the majority are still able to consume lactose-containing formulas. Infants can develop a temporary, self-resolving lactase deficiency after suffering from a gastroenteritis Increased spit ups (often at around 4 months of age): Generally not a sign of formula intolerance. Gassiness and stomach discomfort after feeding: Normal and usually not a reason to switch formulas. Medical reasons to switch formula type Galactosemia: most often diagnosed after abnormal newborn metabolic screen. Milk protein allergy: usually presents with blood in stool from allergic proctocolitis. Rarely, more severe milk protein allergies can present as hives or even anaphylaxis. Metabolic disorders Usually stop infant formula at 1 year of age and switch to cow’s milk, usually whole milk. Do not switch to cow’s milk before 1 year of age because of solute load on kidneys. Resources/Links: https://www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/default.aspx

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12 min
SEASON 1, EPISODE 1

Your Pediatrics Survival Guide - Tips and Tricks

Pediatrics is different from any other rotation that you will do. Children are not just small adults. There is a huge range of ages and developmental stages. This episode will provide you with some general tips and tricks for all clerkships in general and the Pediatrics clerkship specifically, and essential resources that will help you to succeed in your clerkship. Essential Resources Podcasts: Clerkship Ready-Pediatrics Charting Pediatrics - Weekly podcast with lots of bread-and-butter pediatrics discussed. Pediatrics on Call - The most recent research and the newest policy updates from the American Academy of Pediatrics. Books: Red Book (also an app for AAP members) - the definitive source for pediatric infectious diseases. Harriet Lane Handbook (also an app) - has drug doses, commonly used charts, and algorithms. Websites: Peditools for bilirubin Uptodate CDC website is a great source for vaccine guidelines Apps: PedsScripts App: specifically to work on illness scripts General Tips and Tricks: Be Proactive Know what the expectations are. Become familiar with the electronic medical record system. Be Self-sufficient, but ask for help when appropriate. Know when you should come in to round, who to pre-round on, and where to meet. Pair up with an intern to pre-round. Ask for feedback. Pediatric-specific Tips and Tricks: Pediatrics is different from any other rotation. Huge range of ages and developmental stages. At every age, children act differently - and you need to adjust appropriately. If you can, get as much of the history from the child, but you will likely need to supplement that with history from the parent or guardian. When you do your physical exam on younger children, have to adjust the order of exam Vital signs change with age. Look up or ask about what is a normal vital sign in the age you are seeing. Check weight, length/height and/or head circumference and report both percentiles and trends. If an infant has been born prematurely, correct growth and development for gestational age. Fluids and medication are dosed per kilogram. Family-centered rounds are a unique, important part of pediatrics. The goal is to get both the team and family up to date on the patient’s diagnosis and overall course, and to formulate a plan for the day together with the family. Brief summary and plan outside of the patient room. Invite family to participate. Conversational language with no medical jargon. Be concise and clear. About the Speakers: Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA. Host: Jeremy Middleton, MD – Jeremy Middleton, MD is an Associate Professor of Pediatrics and Pediatric Gastroenterologist at UVA Health. He serves as the Pediatrics Clerkship Director and has expertise in children with intestinal failure and aerodigestive disorders. Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine. Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their c...

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10 min
SEASON 1, EPISODE 9

Before You Examine A Pediatric Patient - Physical Exam Tips & Tricks

Today, we will be reviewing what you need to know to examine your pediatric patients. Examining children is a bit of an art form and is often unfamiliar to clerkship students who may have a varied degree of experience being around children, may never have worked with children and may not have been exposed to pediatric patients in the pre-clinical years. In this episode, we discuss tips and tricks to get the exam you need on your pediatric patient with as little crying as possible. How to examine a baby/infant How to examine a toddler/preschool aged child Focused information on the ear exam/otoscopy How to examine a school aged child/teen Engaging older children in your exam Focused information on the genitourinary exam Presenting your physical exam during oral presentation Resources/Links: Bates' Guide to Physical Examination and History Taking by Lynn Bickley (your pediatric clinics will generally have a copy) https://batesvisualguide.com Links: https://batesvisualguide.com/ https://batesvisualguide.com About the Speaker: Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine. Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

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14 min
SEASON 1, EPISODE 4

Before Your First: Postmenopausal Bleeding Evaluation

Join this episode to learn about postmenopausal bleeding (PMB) — the incidence, the etiologies, and the diagnostic approach to a patient presenting with uterine bleeding after menopause. A special focus is placed on endometrial hyperplasia and endometrial malignancy, including associated risk factors and the use of transvaginal ultrasound and endometrial sampling in the evaluation. Critical evaluation of PMB is important as the leading concern is cancer until proven otherwise in this patient population. Keywords: Postmenopausal bleeding, Transvaginal ultrasound, Endometrial hyperplasia, Endometrial malignancy/cancer, Endometrial sampling Topics Covered: Overview of PMB – Definition, incidence (5% of office GYN visits, 4–11% of menopausal patients), and why the leading concern is endometrial cancer until proven otherwise. Etiologies Polyp (~35%) – Localized overgrowths stimulated by estrogen; mostly benign but higher concern for malignancy/hyperplasia in PMB patients. Atrophy (~30%) – Low estrogen leads to endometrial/vaginal atrophy, micro-erosions, and spotting. Uterine Fibroid (~5%) – Less common postmenopausally; if a PMB patient has fibroids, still assume endometrial pathology. Endometrial Carcinoma (6–14%) – Most common gynecologic cancer in the U.S. Type I (estrogen-driven, favorable prognosis) vs. Type II (high-grade, aggressive). Endometrial Hyperplasia (with and without atypia) – May coexist with or progress to carcinoma in 30–50% of cases. Other causes – Proliferative/secretory endometrium, medications (HRT, anticoagulants, tamoxifen, SSRIs), post-radiation, infection, and non-uterine sources. Risk Factors for Malignancy – Increasing age, obesity, unopposed estrogen, tamoxifen, early menarche, late menopause, nulliparity, PCOS, Type 2 DM, Lynch syndrome, Cowden syndrome, and family history. Diagnostic Approach History and physical exam Transvaginal ultrasound (TVUS) – Endometrial thickness measurement; normal 4 mm in postmenopausal women; sensitivity 94–97%. Endometrial sampling – In-office EMB vs. OR-based hysteroscopy with D&C, including benefits, risks, and how to choose. Follow-Up and When to Refer – Management by pathology result, when to proceed to HSC D&C, and indications for Gyn Oncology referral. Resources: UpToDate: Approach to the Patient with Postmenopausal Uterine Bleeding ACOG Committee Opinion: The Role of Transvaginal Ultrasound in Evaluating the Endometrium of Women with Postmenopausal Bleeding ACOG Clinical Consensus: Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia APGO Topic #54: Endometrial Hyperplasia and Carcinoma ASCCP Cervical Cancer Screening Guidelines About the Speakers: Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency. Guest Speaker: Emily Stock, MD – Chief...

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22 min

Med Ready aims to advance clinical medical education by developing accessible resources for medical students and clinical educators. Our projects include the Pimped app, Procedure Ready: Ob/Gyn (a top 10 medical student podcast), and our new podcast, Clerkship Ready: Pediatrics.

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