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Advice for re-entering clinical rotations

Discussion in 'Physician Scientists' started by lynnier79, Sep 5, 2010.

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  1. lynnier79

    lynnier79

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    Hi,

    Im a current MD/PhD student finishing up my research. My defense date is in November, and I'll be starting my rotations in January with Medicine, then Surgery, then Family, then OB/Gyn.

    Ive been out of clinical medicine for a while, and was curious if anyone has any suggestions on things to read/do/look at before going back. I had sort of re-listened to some of the Goljan lectures i used for Step 1, but I think they are sort of esoteric for what i need now.

    Of course, I know that I'll still be an idiot for a while, but everyone else on my rotation will have been in clerkships for 6 months already, and Im hoping to not totally be a sore thumb.

    Any suggestions would be appreciated.
  2. nothingman

    nothingman We're getting there.

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    Congratulations on wrapping up with the toughest part of the program!

    That said, you will probably find the first few months back in clinics challenging (as does almost everyone) - and there are two things that make me a bit concerned in your situation:

    1) You're coming back off-cycle and will be graded against classmates who've been at it for 6 months and for whom expectations are higher. It would probably help to mention to your teams (but not dwell on this point) that this is your first clerkship back from the PhD, etc. etc. just so they adjust their expectations accordingly. Unfortunately, residency matches for almost all specialties are getting more competitive even for MD-PhDs, so it really helps to do well in 3rd year.

    2) You're starting in medicine, which at many programs is the toughest clerkship. At the start, worry less about the book knowledge (which you will pick up), but it's more being able to function on the floors, knowing the workflow, knowing what to look for on prerounds, knowing how to present patients with a plan, etc. etc. that might be difficult to begin with.

    Alas, the book knowledge catches up with you at the end for the SHELF exam which I thought was the hardest of all the core clerkships - here don't read textbooks but read review books and question books (see other SDN threads for which ones to use. Textbooks are basically useless for clerkships unless as reference for something you totally don't know)

    My advice with all this - after your defense, make book-studying priority #2 until the clerkship. Make priority #1 having some way of getting to know how the floors work. Ask your IM clerkship director if you can hang out with a medicine floor team for a few weeks before the holidays in some semi-structured but non-graded way (our MD-PhD program actually offers this routinely to all returning students and it's been a huge help). If this is possible, pretend this is your clerkship, take it seriously, and go all out to get up the learning curve. Also, talk to other students who've gone ahead of you to see what they did to smooth the transition.

    If this is not possible - see if one of your MD-PhD mentors is on service at a time you can shadow. Especially if they're responsible for a service, get to know the residents and see if they can let you function as a floor med student.

    Option 3 - shadow someone in outpatient. Helps with exam/assessment + plan skills, but a bit less useful for floors.

    Good luck and PM me if you have any questions.
  3. Neuronix

    Neuronix Super Corgi Away! Administrator SDN Senior Moderator SDN Advisor

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    Wow, that schedule is painful. Any way to change it? Put OB/GYN up front if possible. OB/GYN is esoteric knowledge nobody else will know anyways and they aren't real thorough with the medicine parts of medicine you will be weak on. Put surgery after that if possible. I think that OB/GYN rotation really helps you get back into the swing of things. Surgery could easily build on it. Coming back on medicine might be harsh, depending on your team. Some people will cut you slack for being a returning PhD, but most of my supervisors cut me little to no slack on this and my grades/sanity suffered quite a bit when I was on clerkships.

    DO NOT review step 1 material. It's a waste of your time. If anything, start working on shelf exam prep material for your first rotation. I had med rotation in 2005 so I don't recall what books in particular, but I'm thinking along the lines of MKSAP, Blueprints Medicine, etc... Do not read the medicine textbooks. They are too low yield and too detailed for now. How much to focus on this depends on how important the shelf is for grading at your school. But in general your priorities for now should be: prepare good presentations on your patients, prepare topic presentations, study for shelf. I also had a hard time remembering the history and physical and doing it quickly. Oddly, the best resource for me was actually Step 2 CS review, as those materials provide a concise how-to guide on how to be a third year medical student. Check out First Aid Step 2 CS, as it gives the essential components of H&P, notes, and then a lot of example scenarios with differentials and plans. This is what you're really expected to know on clerkships! Don't worry about lack of trivia knowledge. You'll get caught up on that nonsense no matter what you do.

    http://blogs.askdoc-usmle.com/preparing-for-the-usmle-step-2-cs-part-i/ for example, LIQORAAA PAMHUGSFOSS SODATIME is burned into my brain and really helps me move efficiently through patient encounters. Nothingman is right on--get somewhere where you can then go ahead and practice the full H&P before being on rotation. That helps with admit notes. You'll have to pair that down to a focused version for office visits, but it comes with practice.

    Otherwise, look enthusiastic even when you aren't, smile a lot, volunteer a lot. Volunteer to give 5-15 minute topic presentations (aim for one a week or even more, though this is team dependent). I think ~90% of your clerkship evaulations is based on the social aspects of the rotation--i.e. how much people like you. If you're a natural politician it can be easy to succeed, but even the all knowing, all doing House MD would probably fail out of medical school.

    :thumbup: to nothingman's post too.

    Edit: One thing I found really useful but nobody ever talks about is Diagnosaurus. If you walk out of a room and you really don't know what's going on with a patient, just put the main symptoms into Diagnosaurus. When the attending or resident then asks what you think might be going on, at least you have A LIST to work with. That can impress the heck out of them versus you presenting the patient and saying I really don't know what to make of those symptoms. Epocrates is really helpful too.

    Another thing I think I've realized about honoring in medical school is the following philosophy. Try to aim for the next level above you. i.e. Try to pretend to be a sub-I as much as you comfortably can. If you can put in orders for patients, do it. Try to formulate your own plans. Try to take ownership of patients as much as your interns will allow. Get into a good work flow. Take as many patients as you can handle, but aim for four or more.

    Work flow for the sub-I/MS3:
    Get sign out on patients if possible.
    Pre-round on patients. See them all quickly. Jot down notes on each patient as you go from room to room to save time. It's more important to have seen everyone and know what's going on with everyone than to have your notes written unless your team explicitly tells you otherwise.
    Chart check all your patients for new notes/consultations.
    Rounds
    See all the charts late AM, take care of things that need to get taken care of. Get used to calling consultants. It's a bit of a skill that's easy to improve upon and impresses people.
    Lunch/lecture
    See all your patients again in the PM. Take care of things that need to get taken care of. Chart check before you leave.

    I had to figure all this out myself, and I feel like I learned it the hard way. The best way to impress is to know what's going on before your intern. Fill them in. Keep in touch by text message or whatever frequently. Though obviously don't try to outshine your intern--they are in a very insecure position where they are trying to impress the resident/attending as well. Just be on top of everything for your patients and they will notice. Interns love it too when you help lighten their load. As per The House of God "Show me a Best Medical Student who doesn't triple my work and I will kiss their feet." If things run as they should, this load lightening should be repaid to you in teaching time.
    Last edited: Sep 10, 2010
  4. echod

    echod Junior Member

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    Neuronix, these posts are all great info. Maybe you can make it into a sticky?
  5. solitude

    solitude Senior Member

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    ditto to this, thanks Neuronix!
  6. mdpdgirl

    mdpdgirl Senior Member

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    Thanks for all the awesome advice in this thread already, but, now that all the people going back on cycle are getting ready to go back, I was hoping you might let us know if there is anything in the advice posted above that is specific to going back off-cycle?

    Specifically, I am wondering how important it is to get a sense of inpatient work day flow before going back on cycle as all the other medical students will be just as clueless (right?). I have 2.5 weeks before a required review course, but that review course is all out patient and I still have a lot of paperwork to finish plus revisions and I was hoping to get some time off, but I could take a shorter vacation and still get a week or 3-4 days in the hospital if it is really worth it.
  7. Neuronix

    Neuronix Super Corgi Away! Administrator SDN Senior Moderator SDN Advisor

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  8. mdpdgirl

    mdpdgirl Senior Member

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    Thanks for the link to the longer post, there is some good information in there.

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