How do you LEARN during third year?

[swoopyswoop]

Maybe this is a silly question, but I'm about to start third year and I've noticed that the recommendations for each rotation are question books essentially. I know textbooks aren't popular among med students, but how do you learn the material of the rotation so that you can actually use the questions? Do you just look up patients you see that day on uptodate? All the rotations "recommend" officially a gigantic textbook for each field, but is there another option? Or do you really just answer questions and learn thru the explanations?

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[VisionaryTics]

Maybe this is a silly question, but I'm about to start third year and I've noticed that the recommendations for each rotation are question books essentially. I know textbooks aren't popular among med students, but how do you learn the material of the rotation so that you can actually use the questions? Do you just look up patients you see that day on uptodate? All the rotations "recommend" officially a gigantic textbook for each field, but is there another option? Or do you really just answer questions and learn thru the explanations?

Just like M1/M2 year, each rotation generally has a mix of textbooks (including ones written for med students), review books, and question books. People generally read some of these and do UWorld for Step 2 throughout the year to prepare for the NBME shelf exams. People also usually read up on their patients in UTD or a textbook.

You can read in the shelf exam threads which resources people used.

 

[wanderer]

What the last response said. UTD is good for looking smart on rounds (maybe) but way too inefficient for testing purposes. Every block has a good q book, a good review book and uworld. the combo of those 3 will enable you to hit 95%ile assuming you have the other skills necessary to do well on exams.

 

[swoopyswoop]

Hm, I couldn't find any mention of review texts in the Family Medicine thread.

 

[redpanda]

1. Read about your patients (UptoDate, Harrison's, Cecil's, or whatever)
2. Review book in whatever clerkship you're in (Step Up to Medicine, NMS Surgery, etc.)
3. UWorld

About family medicine, the NMBE shelf is basically...everything. I'd suggest Step Up to Medicine, some peds review text, and maybe an OB/GYN review text?

 

[futuredoctor10]

1) How do you learn the material of the rotation so that you can actually use the questions?
There are different review books for each rotation, as mentioned above. Books which cover the content for the shelf exam include: Blueprints, CaseFiles, Step Up to Medicine (IM), Pestana or NMS Casebook (Surgery), or First Aid. You will have to take a look at these different series and decide which one best suits your learning style (do not need all of them)

2) Do you just look up patients you see that day on uptodate? All the rotations "recommend" officially a gigantic textbook for each field, but is there another option?
As a general rule, I found using UptoDate to review the details of diagnoses that my patients had to be helpful. I would say avoid gigantic textbooks as they are too detailed for the purposes of the shelf exam.

3) Or do you really just answer questions and learn thru the explanations?
Once you complete a reading textbook review source (see Q1), then do questions. This can be a book like Pre-Test or QBank such as UWorld.

 

[JoshSt]

At home: UWorld, UWorld, and these videos -- www.onlinemeded.org -- if you must read, Master the Boards Step 2‎

On rotation: Ask your attending/residents why, pray for a good teaching attending, Uptodate for your patients

 

[swoopyswoop]

thank you guys! this makes it seem a lot more manageable.

if i have step up to medicine, should i still get master the boards: step 2?

 

[futuredoctor10]

Oh yes I forgot about the Online MedEd videos, those were awesome! I only discovered them around Step 2 studying time and used them as a overview before studying each topic. It helped me get several UWorld questions right that I don't think I would have otherwise.

With regards to the textbook, I think you can either use Master the Boards or First Aid (for Step 2) and yes Step Up to Medicine is great for IM, albeit very detailed.

 

[bwmd]

1. Uptodate for patients. Pocket medicine is also good if you somehow do not have ready access to uptodate or the internet. I would never ever read an actual textbook. Time/value ratio is generally not worth it at this stage of the game.
2. These books for each rotation/shelf exam. The only all encompassing review book I could possibly slog through was Crush Step 2 (terse and incomplete but very fast/readable). SUTM is quite good though.
3. USMLEWorld. Relevant questions for each rotation. Reset and re-do for Step 2 CK. IMHO, you really can learn essentially everything you really need for exams by doing questions (if you take time to savor the explanations).

 

[sazerac]

A recurring theme I see in this thread is to "learn by reviewing". Unlike our pre-clinical years, there is no base set of lectures or base textbook - we just start with nothing and "review" material we've never seen before. Sure we will utterly bomb the first few blocks, but eventually we will get the hang of it by reading the answer explanations and recognizing patterns.

Am I understanding this correctly? (I start MS-3 in a couple weeks - I'm so clueless right now)

 

[Armadillos]

A recurring theme I see in this thread is to "learn by reviewing". Unlike our pre-clinical years, there is no base set of lectures or base textbook - we just start with nothing and "review" material we've never seen before. Sure we will utterly bomb the first few blocks, but eventually we will get the hang of it by reading the answer explanations and recognizing patterns.

Am I understanding this correctly? (I start MS-3 in a couple weeks - I'm so clueless right now)

Thats the point of the first 2 years or medschool...

Also most rotations will have lectures and assign/suggest some readings

 

[VisionaryTics]

A recurring theme I see in this thread is to "learn by reviewing". Unlike our pre-clinical years, there is no base set of lectures or base textbook - we just start with nothing and "review" material we've never seen before. Sure we will utterly bomb the first few blocks, but eventually we will get the hang of it by reading the answer explanations and recognizing patterns.

Am I understanding this correctly? (I start MS-3 in a couple weeks - I'm so clueless right now)

No, you shouldn't expect to bomb exams until the winter.

1. Your school usually provides lectures. They may not be all-inclusive, but they're something
2. There are books for each rotation that are pretty thorough for the level of understanding required for an M3: Step Up to Medicine or Cecil's Essentials, Blueprints OB/GYN, NMS Surgery (the textbook), etc. They definitely take some dedication to getting through, but you can do it. Most students use review books and do just fine.

The usual formula is Text/Review book + UWorld Step 2 + another question source (because Step 2 is really only thorough for medicine).

 

[futuredoctor10]

The usual formula is Text/Review book + UWorld Step 2 + another question source (because Step 2 is really only thorough for medicine).

Agreed

 

[DermViser]

No, you shouldn't expect to bomb exams until the winter.

1. Your school usually provides lectures. They may not be all-inclusive, but they're something
2. There are books for each rotation that are pretty thorough for the level of understanding required for an M3: Step Up to Medicine or Cecil's Essentials, Blueprints OB/GYN, NMS Surgery (the textbook), etc. They definitely take some dedication to getting through, but you can do it. Most students use review books and do just fine.

The usual formula is Text/Review book + UWorld Step 2 + another question source (because Step 2 is really only thorough for medicine).

I'm surprised people use USMLEWorld Step 2, when the shelf exam questions can be quite detail specific (since it's only 1 subject). I guess people don't use Case Files and Pretest anymore.

 

[futuredoctor10]

I'm surprised people use USMLEWorld Step 2, when the shelf exam questions can be quite detail specific (since it's only 1 subject). I guess people don't use Case Files and Pretest anymore.

Just using UWorld Step 2CK can be dangerous, in my opinion, on shelf exams with smaller representation in the QBank like Peds or Surgery. For such rotations, I think people still use those additional texts like Pre-Test, Blueprints or Case Files.

 

[DermViser]

Just using UWorld Step 2CK can be dangerous, in my opinion, on shelf exams with smaller representation in the QBank like Peds or Surgery. For such rotations, I think people still use those additional texts like Pre-Test, Blueprints or Case Files.

LOL - Blueprints! Some books in that series were a joke. i.e. Surgery.

 

[Nasrudin]

I think the hardest thing to learn as a new clerk is who to serve and when and to what extent.

Each clerkship in each school has a different set of priorities for what you must learn to do well. So the question of how to learn medicine is a different question than how to learn what will help your performance in a clerkship.

If the shelf is the better part of your grade then you have to cut short those unnecessarily long bromantic evenings with your intern doing discharge summaries.

 

[futuredoctor10]

LOL - Blueprints! Some books in that series were a joke. i.e. Surgery.

Thought Blueprints was pretty good for Peds and OB/GYN. Did not use for Surgery. I used it for Psych and it was a good overview, but FA Psych was better.

 

[DermViser]

Thought Blueprints was pretty good for Peds and OB/GYN. Did not use for Surgery. I used it for Psych and it was a good overview, but FA Psych was better.

Yes, those are probably the only 2 clerkships it's good for. What kills me is that each new edition of Blueprints is exactly the same as the previous edition with no changes or additions.

 

[@JackShephard]

I'm surprised people use USMLEWorld Step 2, when the shelf exam questions can be quite detail specific (since it's only 1 subject). I guess people don't use Case Files and Pretest anymore.

Sure, but for medicine there are around 1200 questions. That's a solid base for both medicine and surgery.

 

[DermViser]

Sure, but for medicine there are around 1200 questions. That's a solid base for both medicine and surgery.

Yeah, but that leaves out Psych, Peds, OB-Gyn, Family Med, and Neuro (assuming your school makes you take the shelf for the last 2).

 

[@JackShephard]

Yeah, but that leaves out Psych, Peds, OB-Gyn, Family Med, and Neuro (assuming your school makes you take the shelf for the last 2).

I agree that it leaves out a lot.

If you have command of all the Uworld medicine and surgery though, you should be able to pick up other stuff rather quickly. But sure, for each of those other areas you may need to get a little more help.

 

[Freddie Mercury]

I hear the surgery shelf has a lot of IM stuff on it... surgery is my first rotation, should I plan on doing the UWorld IM questions in addition to the surgery ones?

 

[Armadillos]

I hear the surgery shelf has a lot of IM stuff on it... surgery is my first rotation, should I plan on doing the UWorld IM questions in addition to the surgery ones?

Just read pestana, do Uworld surgery and rely on your StepI knowledge, I had it first and it was probably my easiest shelf to study for. (Except for psych which is super predictable). Only thing that made it hard was I was so sleep deprived I don't think my brain could even form memories, so I think I honored it mostly from old stepI knowledge and reading pestana on the one rested up weekend I had.

 

[Kaustikos]

I hear the surgery shelf has a lot of IM stuff on it... surgery is my first rotation, should I plan on doing the UWorld IM questions in addition to the surgery ones?

Do Uworld Surgery, Pestana and then do IM but I'd recommend sticking to Cards/Pulm/GI for IM. The Pestana questions give a good basis/foundation, but it is by no means a reflection of the exam.

Just read pestana, do Uworld surgery and rely on your StepI knowledge, I had it first and it was probably my easiest shelf to study for. (Except for psych which is super predictable). Only thing that made it hard was I was so sleep deprived I don't think my brain could even form memories, so I think I honored it mostly from old stepI knowledge and reading pestana on the one rested up weekend I had.

You'll have to clarify that statement. I'm not saying you're wrong but it's a far cry to say the surgery shelf is a walk in the park. Especially for your first exam. I don't think any of the shelf exams aside from Psych/Neuro or OB/GYN are exams you would want to take first.

On that statement - did anyone else have an Anesthesia shelf exam like I did? Because if you want easy; there you go.

 

[Armadillos]

You'll have to clarify that statement. I'm not saying you're wrong but it's a far cry to say the surgery shelf is a walk in the park. Especially for your first exam.

I just thought the combo of pestana + Uworld surgery was really good for the actual surgery related questions on the test. Then there is the aspect of the surgery shelf that is so totally off the wall that I don't think you could really ever successfully guess what to prepare for, so taking it just after StepI is the optimal time to get that stuff right. I think I would have done worse on it if I took it later in the year.

Also the "next best step" questions in surgery shelf are way easier and more common sense than other shelves, ie. getting large bore IVs when someone BP is 50/30, taking the ruptured AAA to the OR, compartment syndrome fasciotomy, rigid trauma abdomen to the OR, etc.

 

[Kaustikos]

I just thought the combo of pestana + Uworld surgery was really good for the actual surgery related questions on the test. Then there is the aspect of the surgery shelf that is so totally off the wall that I don't think you could really ever successfully guess what to prepare for, so taking it just after StepI is the optimal time to get that stuff right. I think I would have done worse on it if I took it later in the year.

Also the "next best step" questions in surgery shelf are way easier and more common sense than other shelves, ie. getting large bore IVs when someone BP is 50/30, taking the ruptured AAA to the OR, compartment syndrome fasciotomy, rigid trauma abdomen to the OR, etc.

Agreed. Actually, I know what you mean now because there was A LOT of step 1 material on there so I can see your point. Also - next best step on surgery shelf = never surgery

 

[operaman]

I just finished M3 with across the board honors and my formula was pretty similar to those already posted here:

1) UWorld Step 2 CK
2) Pre-test for every rotation + some other similar source like Lange. I found the combo of 2 sources very helpful for covering the breadth of minutiae on shelf exams. I used pre-test every time not necessarily because it was the best, but because I found a bug in the iphone app which enabled me to get them all for free each rotation.
3) Didactics on each rotation were generally good and covered important exam topics
4) Additional readings as needed and usually covering highly important topics for that rotation. For example, you know medicine will ask you about CAD, DM, etc., so I would read on topics like that so there was no way they could ask me a question I couldn't answer.

More than anything else though, I found that learning from patients was most helpful, especially for figuring out the "next step in management" sort of questions. Of course, this also breeds confusion since the next step on the exam and the next step in real life are not often the same. Even so, this is the exception rather than the rule. I would encourage you to stretch yourself to pick up as many patients with as many different conditions as possible. Most conditions have a fairly predictable way of presenting and this is usually how they present on the shelf, so the more you see in real life, the better prepared you are. For every patient you see, come up with your own assessment and plan and then figure out why the ultimate plan is the same or different - great way to get a feel for next steps and tests to order. I was lucky that the residents on my first rotation (surg) forced me to do this and I just kept doing it throughout the year. Yes, I felt stupid a lot for coming up with a bad plan, but I got better.

Third year is a lot of fun, so enjoy it! That said, I'm still REALLY glad to be starting 4th year