NYP Sub-Internship Shift Log Form

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NYP Sub-Internship Shift Log Form - June

Subinterns: Please complete this form for EACH SHIFT that you work.

Select Your Name *

Shift Date *

YYYY

Attending Name *

If not listed chose Other at the bottom

If the person you worked with is not listed please include here (including Peds faculty but EMS not necessary)

Area *

Additional supervising attending physician or residents (free text)

Procedures Performed

12 lead ECG

ABG

Backboard clearance

Cardiac monitor attachment

Cervical collar clearance

Doppler pulse exam

Foley catheter insertion

IV fluid administration (spike and hang bag, set up line)

Laceration repair

Local anesthesia

Manual bp measurement

Nebulizer administration

Peripheral IV insertion

Rectal exam and stool guaiac

Resuscitation team member

Wound repair

Other:

Anything you did well or feel good about on this shift?

Anything you were disappointed with or frustrated by on this shift?

What are your learning goal(s) for your next shift? (please share this with the attending you work with next shift!)

Other comments on shift, procedures, resuscitations, or other pertinent information

Submit

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