3rd year is killing me

[watchergub]

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On surgery right now (1st rotations) and just came back fom a day that started at 4:30 and ended at about 7 pm. I stay up until about 1 every night trying to study for the OR, review my patient's charts so that my notes aren't horrible, etc. But I still feel like I don't know what I'm doing and am an idiot. I don't know how to write a proper plan (how to manage hypernatremia, when to pull a foley, etc). I sort of just guess at these things while I frantically try to look up what the indications are for everything in UpToDate... And today, despite all my studying, I still could only answer about 1/2 the questions I got in the OR right.

I am just wondering if anyone has any tips. What scares me is that I literally do not know how to work any harder. Like maybe I just can't ever catch up to where I feel like I should be and maybe I didn't work hard enough first and second years? Not to mention I barely seem to have time to study for the shelf or step 2. All I know is that I am scared that I won't ever learn how to manage patients properly, I'm scared I'm stupid, and I don't know how to make 3rd year better so that I can survive it, get to residency, and then keep this pace up without killing patients or myself*.

*Figuratively.

 

[Kaustikos]

First thing: get surgical recall. 99% of questions come from there. And it's short enough to read before cases. It also has bullet points about what you're talking about.
Second,
You just started third year. You're supposed to suck (sorry, it's true). You didn't learn protocols on this.
Step Up to medicine has a really nice review on electrolytes.
Also, don't take pimping so personally. Getting half right is better than nothing. There's also the annoyance of "guess what I'm thinking"
You shouldn't be studying so late every day for surgery. You're only getting 3 hours of sleep and it's going to take its toll on you very quick.
Relax. You'll get the hang of it. You're not suppose to know how to take care of a patient as a third year.

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[Psai]

Answering 1/2 of questions is pretty good bro, especially at the beginning
Pimping is to teach you, not to make you look stupid
Try not to study too much afterwards, just sleep a lot. You only really need to do pestana and uworld

Don't worry about step 2 yet

We all look stupid. I thought I was a god coming into third year because I did well on step 1 and I was surprised to find out that I knew pretty much nothing

 

[Moko]

I am just wondering if anyone has any tips. What scares me is that I literally do not know how to work any harder. Like maybe I just can't ever catch up to where I feel like I should be and maybe I didn't work hard enough first and second years?

A large part of starting third year is coming to terms that you really don't know a whole lot and that you cannot gain all of this knowledge overnight or even over a year. It's an incredibly common and natural feeling to have. I've gone through this process as has almost everyone I've talked to.
My tip would be to use this as motivation to continue working hard as you have been, and to be forgiving of yourself when you make 'mistakes'. The sooner you accept this, the happier you'll be (honestly!). Having realistic expectations is key here: if we were supposed to know how to manage patients when starting third year, there wouldn't be medical school or residency! Do keep working hard, be okay with making mistakes, and take time for your own mental and physical well-being. As long as you are making progress every week, you're on the right track. We're all in a marathon, not a sprint 🙂.

 

[DubVille]

Agree with all of the above. To me 3rd year was the worst year by far. I'd rather do 2 intern years, than have to repeat 3rd year.

 

[sinombre]

Agree with all of the above. To me 3rd year was the worst year by far. I'd rather do 2 intern years, than have to repeat 3rd year.

Just out of curiosity, why was intern year better for you than 3rd year?

 

[Dave89]

Pimping really need not be stressful. Unless my rotation was different from most others', I can tell you that the majority of surgeons with whom you work are completely irrelevant to your final grade (and for good reason). If you don't know the answer, just say so, shrug your shoulders, and listen to whatever the attending has to say.

As far as plans go... just have a rudimentary, vague outline of interventions and therapies. It sounds more impressive (or less unimpressive) if you present these by either system or problem. E.g., "for Neuro/pain, we will continue Roxi until the patient is ready to transition to non-opiate analgesics."

The key to third year is leaving any sense of competence at the door. Be completely emotionally detached when you receive criticism, and you'll do just fine. But be eager to learn for learning's sake. This will shine through your inevitable incompetence and get you far better evals than sycophancy will.

 

[Moko]

Just out of curiosity, why was intern year better for you than 3rd year?

Power and respect?

 

[DubVille]

Just out of curiosity, why was intern year better for you than 3rd year?

1) You are getting paid, instead of paying to be there.
2) Although you still do scut, you really have a purpose.
3) After a few months you aren't a total idiot and can make some decisions on your own.
4) My intern year was very non-malignant and at a community hospital. We got free food for each meal. When calling consults the PP docs were happy for the business. As a student (in an academic hospital) the fellows/residents were never happy to get more work.
5) You stay on the same service for more than a few weeks, so you actually start to know stuff. 3rd year you were never comfortable and constantly switching to a new service.

I actually considered switching to medicine at some point in intern year. Thrilled I didn't as residency has continued to get better each year and I wouldn't be as happy as an internist.

 

[mcloaf]

Am I the only person who thinks that studying 6hrs per day in addition to your hospital time and only sleeping like 3 hrs a night is ****ing nuts? Pretty sure I wouldn't be functioning either if that were my usual schedule.

 

[Stagg737]

Am I the only person who thinks that studying 6hrs per day in addition to your hospital time and only sleeping like 3 hrs a night is ****ing nuts? Pretty sure I wouldn't be functioning either if that were my usual schedule.

I can't function well if I get less than 5 hours of sleep a few days in a row. Studying 6 hours sounds like a lot but not outrageous. 3 hours of sleep regularly sounds like grounds to avoid that field at all costs (at least for me).

 

[mcloaf]

I can't function well if I get less than 5 hours of sleep a few days in a row. Studying 6 hours sounds like a lot but not outrageous. 3 hours of sleep regularly sounds like grounds to avoid that field at all costs (at least for me).

6 hours a day during M1/M2 is fine, 6 hours a day when you're in the hospital all day is another thing entirely. I find 1-2 hours on workdays is about all I can fit in without making serious sacrifices re: sleep, grabbing some time with the SO, and fitness.

Everyone has different needs and goals, but reading OPs schedule it seems like he's setting himself up for failure.

 

[mimelim]

Am I the only person who thinks that studying 6hrs per day in addition to your hospital time and only sleeping like 3 hrs a night is ****ing nuts? Pretty sure I wouldn't be functioning either if that were my usual schedule.

Or they are exaggerating the numbers like a lot of students do. Or they are incredibly inefficient with their time both at the hospital and at home studying. Or their school/rotation actually sucks.

 

[Donald Juan]

I imagine surgery could be tough to start out on. In addition to the general nervousness of third year and starting in a new environment, you're having to learn general medicine things like presenting and writing notes on top of the worst hours you'll have in third year and while trying to learn as much about surgery as possible.

It will be tough for me to give you specific advice because I can't say what your program really does. You need to be efficient with your time though. Try and study or look up patients during the day. Too many med students spend hours a day standing behind a resident watching them type notes and put in orders. Go find another computer and look up on your patients then or start looking up about tomorrow's surgery so you don't have to spent 5 hours doing it when you get home. Have uworld and pestanas on your phone so you can whip it out when you've got 10 minutes of downtime. Get out of the mindset that you can only study or learn things when you have a 4 hour block of free time. And for forming plans for patients, almost all surg post op patients follow a similar course, your program may even have a sheet somewhere that has guidelines for expected post op course. Ask the intern or PGY2 if you're really unsure about what you're doing with a patient; you might annoy people a little early on, but it's the only way you'll improve and eventually be worth a damn.

 

[Kaustikos]

Or they are exaggerating the numbers like a lot of students do. Or they are incredibly inefficient with their time both at the hospital and at home studying. Or their school/rotation actually sucks.

I could not study more than 2 hours daily on rotations. Partly due to exhaustion but also because I wasn't studying for an exam. 2 hours review was usually enough to get by the next day. Even surgery.

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[watchergub]

Am I the only person who thinks that studying 6hrs per day in addition to your hospital time and only sleeping like 3 hrs a night is ****ing nuts? Pretty sure I wouldn't be functioning either if that were my usual schedule.

Didn't mean to imply I'm studying 6 hrs a night. Probably more like 4 when getting home, dinner, shower, packing up for the next day, etc are all taken into account.

I do think I need to work on my efficiency. I feel like my days are wasted because I'm pointlessly tailing residents who more often than not barely speak to me, or am standing in the OR holding body parts or placing sutures at a snail's pace. Then I get home and I'm so tired it takes me forever to get though any reading I wanted to do. Plus I maybe spend too long prepping for the next day's pimping? I hate feeling like people think I'm stupid so I've been sacrificing shelf studying for that. But at the same time, I have to pass the shelf, so I think I need to calm down a little about the feelings of inadequacy that the OR brings out in me and just learn to live with it (as some of you said).

I'm going to sign up for UWorld today and try to do questions during OR downtime. I'm worried about failing the shelf since I hear it's medicine heavy? And I haven't had that yet. But nothing to do but keep on grinding I guess.

Thanks for the advice. I am going to get to bed earlier tonight and just accept that I might not know as much in the OR tomorrow.

 

[Psai]

Didn't mean to imply I'm studying 6 hrs a night. Probably more like 4 when getting home, dinner, shower, packing up for the next day, etc are all taken into account.

I do think I need to work on my efficiency. I feel like my days are wasted because I'm pointlessly tailing residents who more often than not barely speak to me, or am standing in the OR holding body parts or placing sutures at a snail's pace. Then I get home and I'm so tired it takes me forever to get though any reading I wanted to do. Plus I maybe spend too long prepping for the next day's pimping? I hate feeling like people think I'm stupid so I've been sacrificing shelf studying for that. But at the same time, I have to pass the shelf, so I think I need to calm down a little about the feelings of inadequacy that the OR brings out in me and just learn to live with it (as some of you said).

I'm going to sign up for UWorld today and try to do questions during OR downtime. I'm worried about failing the shelf since I hear it's medicine heavy? And I haven't had that yet. But nothing to do but keep on grinding I guess.

Thanks for the advice. I am going to get to bed earlier tonight and just accept that I might not know as much in the OR tomorrow.

Sounds like surgery clerkship. Third year sucks and the worst is surgery and ob.

 

[Kaustikos]

Didn't mean to imply I'm studying 6 hrs a night. Probably more like 4 when getting home, dinner, shower, packing up for the next day, etc are all taken into account.

I do think I need to work on my efficiency. I feel like my days are wasted because I'm pointlessly tailing residents who more often than not barely speak to me, or am standing in the OR holding body parts or placing sutures at a snail's pace. Then I get home and I'm so tired it takes me forever to get though any reading I wanted to do. Plus I maybe spend too long prepping for the next day's pimping? I hate feeling like people think I'm stupid so I've been sacrificing shelf studying for that. But at the same time, I have to pass the shelf, so I think I need to calm down a little about the feelings of inadequacy that the OR brings out in me and just learn to live with it (as some of you said).

I'm going to sign up for UWorld today and try to do questions during OR downtime. I'm worried about failing the shelf since I hear it's medicine heavy? And I haven't had that yet. But nothing to do but keep on grinding I guess.

Thanks for the advice. I am going to get to bed earlier tonight and just accept that I might not know as much in the OR tomorrow.

It's not specifically the OR or surgery. Walking into third year sucks in general. Medicine, surgery, etc. You are walking into something you haven't experienced.
Relax. Grab a drink.

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[pd1112]

Start by getting more sleep. Everything else should be secondary if you're truly only getting 3 hrs/night.