Hey person2004,
I will attempt to answer your question, but it's kind of hard to remember early July, because I have made such strides in just the last 11 months.
I started my 3rd year on the internal medicine rotation at University Hospital (where the medicine service is located at Charity) on July 1. As you can imagine, things are crazy in July because everyone is new. The interns had just graduated from med school and the resident had never been a resident before. It was quite an experience. I think, after having Dr. Wiese as a teacher during second year in the longitudinal Clinical Diagnosis class, I was fairly competent in my physical exam skills and, even better, I had a good appreciation for why certain things were necessary (meaning, I wasn't just going through the motions). Remember, though, that a big part of 3rd year is developing those skills. So, to say I was "fairly competent" may not sound impressive to you, but believe me, people are impressed by even that during those early days, and you will gain so much during 3rd year that you shouldn't walk in thinking you're anything more that pretty good anyway.
As far as ordering labs, the interns are just getting their first real shot at doing this stuff too, so you're not alone in figuring out what to order and what's important. At this point in my education, I would say that I am very good at ordering labs, but in July I didn't have the greatest grasp beyond the basic stuff. Really, in July you're kind of walking around in a haze, just trying not to piss off the nurses and trying to stay out of the way of people doing seemingly important things. As you go on, you figure out your place and things get much more clear.
You also asked about developing a differential. Dr. Wiese does a great job getting you thinking in those terms early in med school. I walked into 3rd year feeling like this was a strength for me. One thing that has changed for me over the year, though, is that now I think more about horses and less about zebras. Either way, thinking through clinical problems is one of the best skills for new 3rd year to have, especially early in the year. In July, the new docs are doing more of the "doing" and the early 3rd years are doing a lot of the "thinking."
To move on to you question about 2nd year, I feel like we get a lot of patient exposure early in med school. Starting first year, we see patients and write up H&Ps so that we get the experience of listening and thinking through problems. We are given the opportunity to hang out in Charity's ER anytime we want so that we can work through a patient's case from the second he walks in the door. We also have a standardized patient program that is one of the oldest in the country and these guys are really good. We start out learning all our physical exam techniques on them, and then we go into the hospital with our preceptors and work with real patients. I was lucky enough to get matched with the chair of the medicine department, and I learned so much about presenting patients and getting pimped. It was amazing.
So, to wrap this up, I felt like I walked into 3rd year knowing what I needed to know to do well, and I'm walking out having learned and gained so much from the many patients and attendings I have worked with at Charity, Tulane, the VA, and Ochsner.
PM me if you have any other questions!
