There's something to be said about UB not having a "university based hospital" system. While some may think this is a weakness, I see it as a way to develop unfailing resiliency in being able to adapt to any hospital situation. We have Buffalo General, Children's, Millard Fillmore Gates, Millard Fillmore Suburban, ECMC, the VA, Sisters, and Mercy…plus the rural family medicine hospitals and the family medicine community clinics around the city. Being forced to rotate through multiple health care settings…look at it as a way to practice thrifty parking, time management, and most importantly to handle different medical mantras and patient populations.
1.) BGH primary care outpatient clinic - starts at 9am. Arrive 10 minutes early and park on side streets to avoid paying for parking. Warm hat, gloves, jacket, and practical walking shoes should do the trick; don't whine because walking will help you work off whatever fast food you're buying in the cafeteria for lunch today. In the clinic (Building D1), you'll be working with the Urgent Care patients. Attendings will change every day, morning and afternoon so it's your luck to be paired up with an attending that fits your personality and presentation style. Again, another challenge to be able to adapt to the whims and preferences of your attendings. (For example, never fail to check the BP yourself on the patient when presenting to Dr. Gallagher.) Many patients are looking for medication refills, but some may surprise you with some interesting findings. Before seeing a patient, make sure that the clinic room has sufficient supplies (BP cuff, disposable otoscope earpieces, etc) Other attendings you may see: Drs. Frieary, Ceylony, Machineni, Sundquist, O'Neill.
-an overall good experience for me although I wish there were more patients for me to see. When there are 2 medical students in the clinic, I usually only see one patient in the morning and one in the afternoon. Sometimes Dr. Gallagher will choose to send the students to GI or Coumadin clinic if there are no patients, and this is usually better than sitting downstairs doing nothing, so that is appreciated. Preceptors were attentive to the students and asked good questions.
2.) MFG - starts around 8:30am. Arrive 10 minutes early and park on Linwood to avoid paying for parking. Warm hat, gloves, jacket, and practical walking shoes. Head to the 1st floor outpatient clinic just past the gift shop on the right. This clinic has a better color scheme than BGH (no neon wall paint) but runs pretty much the same way as BGH. Some days of the week there will be OB/GYN and other specialty clinics, but you will stick to Medicine visits. You may have Dr. Kolade as your preceptor, and he will give you the freedom to write directly in the official patient record (wow what trust!) and will cosign your note. He will also try to convince you that "paperwork is fun" and it is up to you to decide the truth. (But honestly, get used to paperwork and lots of writing in medicine in general.) Lots of independence in this clinic.
-overall good experience as I was ALWAYS busy (nonstop!) at this clinic. Dr. Kolade is very patient and obviously enjoys teaching medical students. He works through the cases slowly (to the disgruntlement of more than a few patients, unfortunately) which is ideal for the learning medical student. He encourages diagnoses and questions and will go great lengths to answer them, even assigning articles to read.
3.) DENT - starts around 8:30am. Arrive 5 minutes early and park directly in the parking lot — for free. This clinic is on the 6th floor and you should brush up on your endocrine skills beforehand (HPA axis, diabetes, etc) because this is an endocrine clinic. The clinic runs on EMR so hopefully you are computer savvy enough to figure out how to make the quick switch from papers to clicking away at electronic tabs on the screen. Don't worry — you won't be expected to be entering any information into these laptops. You see the patient, present, and watch your preceptor work the magic. Remember to take the blood pressure, get a thorough list of medications, and don't forget the neurologic tests too.
-overall good experience. This is the one clinic that has EMR, an excellent way for students to get an introductory grasp of higher end technology and medicine. Dr. Ryan explains his patients medical conditions very well and knows his patients as well as he does his endocrine. Because he is a specialist I learned how to better tailor my medical interview and physical to suit the visit.
4.) 85 High - is the renal clinic. This clinic is on the 2nd floor, and is directly across the street from BGH when you walk out of the main entrance. Be amazed at the small size of the clinic and the impressive efficiency of how it runs. Dr. Sridhar is the master of time management and is as meticulous and precise as you could ask for. Don't expect to be interviewing any patients on your own; this is more of a shadowing experience with plenty of time to ask questions in between patients (before/after he does his dictations). If you've a tendency to be disorganized in your medical ways, take notes on how this clinic is run. Look forward to Dr. Sridhar's lecture on RTA — it is fabulous.
-While I did not get to see any patients on my own, shadowing Dr. Sridhar allowed me to see many unusual renal cases I would have not seen in D1. In between patients he welcomes questions (and expects you to have many) as an opportunity to help students be wary of subtle renal complications.
5.) GI clinic - Drs. Corasanti and Miqdadi are the endoscopy kings and you are to watch and gawk only. Great experiences and it will make you want to go and practice Halo or any other 3-D video game. Eye-hand dexterity in a 3-dimensional space. Awesome.
-An excellent opportunity to see endoscopy although attending this clinic more than once a week is probably excessive for the student not considering GI for a career. I shadowed Dr. Miqdadi and he was very amiable and willing to briefly explain his procedures in between patients although usually he was too busy to spare more than a few minutes. One of my classmates expresses frustration in having to attend the GI clinic more than once per week and I would probably echo his frustration that seeing 7-8 endoscopies per week may not be as linearly educational as the scheduling may suggest.
6.) Allergy & Immunology clinic - Dr. Ambrus will answer all your questions and more. Great explanations. He knows more about autoimmune diseases than anyone you will meet…probably because he's seen just about everything. Expect to see many cases of SLE and scleroderma and you will learn to recognize the clinical symptoms of these diseases. Sure, they look like the pictures you've seen in lecture, but to see them in person is awesome.
-Again with the specialty clinics I saw cases that I would never see in D1. Every student should attend these clinics (or as many as possible) because I really believe that the best way to learn medicine is to see it all in the clinic. Dr. Ambrus, like Dr. Ryan, knows his patients well and remembers their PMH usually without consulting his notes. He is a great teacher and mentor.
7.) Coumadin clinic - One time at this clinic is sufficient. It is a good way to see outpatient care for coumadin treatment and followup but gets repetitive after a few hours.
The great thing about all these specialty clinics is that you can separate your experiences into chapters by subject. All different ailments in each clinic. Guaranteed variety in outpatient rotation. It's like how Dr. Hard talked about "packing suitcases" of organ systems in gross anatomy. You go to endo clinic and "fill" your endo suitcase, then pack it away. Go to GI and pack up your GI suitcase and pack it away. Etcetera. The transport back and forth can be a pain, but take these pitches and at least one will put you on base to lead off a great inning of outpatient medicine.
