3rd year

[jbod34]

Am I the only one who feels like I don't know anything? I just finished my 1st month of Internal medicine and I'm now in my 2nd week of the 2nd month. I am getting frustrated mainly cause I don't know what is really expected of me. I think I'm kinda at a disadvantage in some respects cause I'm not at a teaching hospital but its nice cause I'm not competing with anyone either. Anyways I try to look up conditions that I see throughout the day but I in no way feel competent. Is this normal?

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[nerfherder]

You're not supposed to know everything! Just show up (on time preferably), be enthusiastic, learn how to do a good H&P, read up on your patients for rounds, learn how to do a good presentation and see if internal medicine is something that you want to go into. As far as the shelf exam, use MKSAP. Even "teaching" hospital rotations don't expose you to half the things on the exam.

 

[Gumshoe]

I understand completely. People not being up front on what to do because they have their own stuff going on (residents/interns and their stress for beginning), and attitudes because you aren't picking stuff up. The protocol of IM is amazing. I never thought it would be like this. Go get this lab, round for 3 hours, talk about what to do next, discharge someone, call for appointment here,

F that

 

[phllystyl]

jbod, 99.9% of your classmates are feeling just like you do now. Hell, I felt like that all the way through my first 4 blocks. Slowly, you will get your clinical balance though and things will start to click. I agree with nerfherder...

The best things to do right now are:

1) focus on learning to write good notes. Medicine has some of the longest notes, so it should be good practice at really getting thorough

2) H+Ps. you won't get good at this over a rotation, or even 4, but you can really get started during block 1

3) The oral presentation is such a must as you get further into 3rd year. Just knowing the proper organization and being able to syntheisze that information and present in a succint and orderly fashion regularly really is the goal of the first part of 3rd year. Once you get that down, the year really chills out and gives you can start working on the real task, which is taking everything from 2nd year and reorganizing it so that it is arranged in DDx format. Fret not.. you have the next >1.5 years to figure that out

4) Start thinking about plans. Pt comes in with SOB, PMHSF COPD... what would you do initially? Would you add azithro to the regimen and why? See what your residents do for your patietns or theirs, and if you dont understand why, ask.

Be a sponge with regards to material. Read about your patients. But I think 1,2,3 are the most important that will help you throughout the enxt year, and they all interact with each other... writing better soap notes makes you abetter presenter... knowing how to present can guide you in your interview as you anticipate what kind of info you will need to know when you present... and then all of this...

but most importantly.... breathe deep and realize everyone is on this boat with you And when sh1t starts to click, it feels awesome.

 

[chicamedica]

Am I the only one who feels like I don't know anything? I just finished my 1st month of Internal medicine and I'm now in my 2nd week of the 2nd month. I am getting frustrated mainly cause I don't know what is really expected of me. I think I'm kinda at a disadvantage in some respects cause I'm not at a teaching hospital but its nice cause I'm not competing with anyone either. Anyways I try to look up conditions that I see throughout the day but I in no way feel competent. Is this normal?

I'm a MS4 and i STILL feel that way.

 

[Gumshoe]

I'm a MS4 and i STILL feel that way.

It is all about time. These attendings have just gone through enough examples of all this stuff that they finally know it. You can tell that some that are looked at as OK in their field are as much a joke as you think they are. They've just paid their dues. They've memorized the algorithms. As you've probably heard before, you don't have to be smart to be a doc ...

(which I don't totally like because all these people are smart ... but it's not like they are any smarter than you by any means, that's what I'm saying)

Now go round for 3 hours, fine sir

 

[irish79]

I too am on my 2nd week of my IM rotation and I am feeling the SAME way. It is amazing how inept I am (how could I forget so much?)! It is such a change from the first 2 years, where they pretty much gave us all the needed information (classic) in our test questions and all we have to do is figure out the disease. It is hard to figure out what tests to order, what labs to check, etc. My one saving grace has been the interns. I think they remember (more so than the residents) what it is like to be a 3rd year, and are always willing to help me and give me hints.

It takes me such a long time to do an H&P and even to round and do progress notes each morning. I have decided that the majority of IM is doing paper work and balancing electrolytes. It is also amazing how the residents do SO many tests (everyone seems to get a CBC, ABG, CAT scan, etc.) and seem to put everyone on Levoquin or Lasix! Oh yeah, and is anyone else having to look up every drug they talk about in your pharmacopia because they use the trade name? If you don’t have it, I have found Maxwell’s Guide to be quite helpful! Nonetheless, it is so much better to be in the hospital than in lecture. Good luck!

 

[DOtobe]

I'm a MS4 and i STILL feel that way.

I'm an intern and I feel that way! At no point in our careers will we feel like we know everything.

And nerfherder, nice sig. I think that's my new favorite movie. "I caught you a delicious bass."

 

[bla_3x]

I too am on my 2nd week of my IM rotation and I am feeling the SAME way. It is amazing how inept I am (how could I forget so much?)! It is such a change from the first 2 years, where they pretty much gave us all the needed information (classic) in our test questions and all we have to do is figure out the disease. It is hard to figure out what tests to order, what labs to check, etc. My one saving grace has been the interns. I think they remember (more so than the residents) what it is like to be a 3rd year, and are always willing to help me and give me hints.

It takes me such a long time to do an H&P and even to round and do progress notes each morning. I have decided that the majority of IM is doing paper work and balancing electrolytes. It is also amazing how the residents do SO many tests (everyone seems to get a CBC, ABG, CAT scan, etc.) and seem to put everyone on Levoquin or Lasix! Oh yeah, and is anyone else having to look up every drug they talk about in your pharmacopia because they use the trade name? If you don’t have it, I have found Maxwell’s Guide to be quite helpful! Nonetheless, it is so much better to be in the hospital than in lecture. Good luck!

The drug trade name thing is a $%#@. I am just on a family/OM rotation and am amazed. The nurses and docs through around these trade names so $#@$ fast it is hard to make a note to even look up the drug!
I cannot wait until I start me IM ward rotation. Although hard, it will be refreshing to see more than LBP and follow ups

 

[blue2000]

About the drug names...

It's kind of a great scam by the drug companies...make a drug with a really complicated name, and then make the patented name simpler. Which do you think people are going to use? Furosemide or Lasix -- and that isn't the best example out there. You'll get used to it. A lot of third year is getting your feet wet, and the whole synthesis of information thing people talked about is really the focus.

The other thing you should be learning is to ask yourself -- "how sick is this patient?" Practice assessing this - even if you are surrounded by your intern or resident who are doing the work and you're just observing. The best thing you can teach yourself before you start internship is to assess how sick someone is, so you can make decisions about how quickly to work something up, when to call your upper, when to call the unit, etc. Obviously, third year isn't about practicing these skills, but you should be thinking about those issues as they come up. And if you have questions, after the flurry is over, ask the resident, intern or fellow you were working with about what exactly was the data that made them order the bolus, call the unit, call anesthesia, etc. It'll help you in the long run.

 

[jbod34]

Thanks guys I actually feel a lot better!!!!

 

[carrigallen]

About the drug names...

It's kind of a great scam by the drug companies...make a drug with a really complicated name, and then make the patented name simpler. Which do you think people are going to use? Furosemide or Lasix -- and that isn't the best example out there.

The best examples are the monoclonal antibodies, ie:

Ibritumomab tiuxetan (Zevalin)
Bortezomib (Velcade)
Denileukin diftitox (Ontak)
Gemtuzumab ozogamicin (Mylotarg)

You would think they would have stricter rules for generic drug names..ie limit them to less than 3 syllables. I guess commercialism takes precedence over patient safety..

 

[Espion]

The best examples are the monoclonal antibodies, ie:

Ibritumomab tiuxetan (Zevalin)
Bortezomib (Velcade)
Denileukin diftitox (Ontak)
Gemtuzumab ozogamicin (Mylotarg)

You would think they would have stricter rules for generic drug names..ie limit them to less than 3 syllables. I guess commercialism takes precedence over patient safety..

Those all sound like MONSTERS FROM OUTER SPACE! I am MYLOTARG, FEAR ME!

 

[MISTERshortcoat]

The beginning of 3rd year is probably one of the most frustrating times I've ever experienced. Not only are you the low-man (or woman) on the totem pole, but you can encounter very malignant superiors at the same time. The first few rotations are all about learning how to gather data at your particular institution, and how quickly you can assimilate that information into an assessment. Plans come later, so don't even worry about it. Sure, take a jab here and there, but what will help you in the end is the speed at which you can obtain raw information about your patients. In my experience, attendings will always appreciate the data more than your assessment, since no matter what your plan is, they must make up their own minds independently.

 

[mdqueen]

I'm having a hard time on gyn too. Just when I got used tof OB, when I had to switch to the gyn service. Another barrier is that I don't speak spanish and most patients at the hospital do = less people I can triage/workup especially if there are no translators around. Earlier this week my presentation was so bad and disorganized, that the team basically turned it into a teaching session on how to give a presentation. I wanted to just disappear, but I had to remind myself that I'm just learning. I have improved alot this week and hope to get better. Stay encouraged and know that you are not the only one going through this.

 

[GenSurg]

Third year is a tough year. It's different than what most med students have done before. The best advice I can give is to be enthusiastic about learning and talk to the residents.

Even if you hate the specialty or rotation, there is something to learn from it. Be enthusiastic and ask questions. If you can be interested, you will learn and the residents/staff will take more interest in you.

If you don't know what is expected of you, talk to the residents. They work with a lot of medical students. Ask them to review your daily notes and to review how you are doing. Ask for suggestions for how you can do better.

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