Doing a TY year

[ABCXRT]

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I'm doing a relatively laid back TY next year. The common complaint faculty have about residents doing a TY program is weak clinical skills their PGY2 year. Any idea exactly which clinical skills they're referring to? Anyone hear specific examples? Obviously I don't want to be clinically weak (this is in regards to rad onc. I don't feel like I need to be an expert in tertiary syphilis or genetic diseases with three hyphenated names to make a 30+ differential diagnosis for a heart murmur), so if I know specifically what skills are most lacking in TY residents I will try to work on them.

Also, more generally, what do people feel are the best electives to take your TY year? Med onc? radiology? interventional radiology? I have 6 months of electives, so I could use some advice in choosing.

 

[herbalgarden]

I'm doing a relatively laid back TY next year. The common complaint faculty have about residents doing a TY program is weak clinical skills their PGY2 year. Any idea exactly which clinical skills they're referring to? Anyone hear specific examples? Obviously I don't want to be clinically weak (this is in regards to rad onc. I don't feel like I need to be an expert in tertiary syphilis or genetic diseases with three hyphenated names to make a 30+ differential diagnosis for a heart murmur), so if I know specifically what skills are most lacking in TY residents I will try to work on them.

Also, more generally, what do people feel are the best electives to take your TY year? Med onc? radiology? interventional radiology? I have 6 months of electives, so I could use some advice in choosing.

Hi ABCXRT, I think there was a pretty good discussion about this.
http://forums.studentdoctor.net/showthread.php?t=231695

hope that helps.

herbalgarden

 

[ABCXRT]

Thanks herbalgarden. I'm actually curious if there are specific areas the advocates for a prelim feel were most important. Also suggestions for useful electives that TY people were really glad they did.

 

[Gfunk6]

I did a prelim medicine year not a TY, but I can tell you areas which I felt I could have used more experience on.

Surgery (particulary surgical anatomy and operative approaches) -- neurosurgery and otolaryngology operations would have been particularly enlightening

Radiology (image-based anatomy is critical in our speciality)

Medical Oncology (learning about some of the logistics of chemo is important since many of our patients are on concurrent chemoXRT)

 

[ABCXRT]

Thanks! I wouldn't have thought of doing neurosurgery or ENT, but it makes sense.

 

[deleted4401]

Yeah, ENT would be extremely helpful. Not just OR, but clinic, too - get some practice with the scope, and learn from the Head/Neck specialists. They are very cerebral compared to other surgeons and I think have a solid understanding of onc. Difficult anatomy and I think seeing some resections/neck dissections may be helpful.

Maybe surg-onc, seeing an LAR with TME would have been helpful anatomically. Also, whipple/esophagectomy could be helpful to see. NSG would be interesting, but I'm not sure how much it would help you understand CNS tumors any better. Maybe med-onc, but I'm not too sure how helpful it would be. GU, might be helpful, if you got to see more than a prostatectomy.

Radiologists at two or three institutions that I've been at weren't super excited to have off-service residents. Their own residents are so damn busy and don't really teach much, either. Path might be better, those guys are always so nice and helpful.

I think gen med is of key importance. This week we had an interesting scenario. 47 yo man with hx of DM, HTN on tx for GBM after GTR with concurrent RT/temodar. 2 weeks in, very nauseous. Initially, we blamed on Temodar (very common side effect), had him talk to the neuro-onc. The neuro-onc and PA gave specific instructions on how to take Temodar (not on empty stomach, etc.) Continued to feel like crap, nausea, vomiting, fatigue. Neuro-onc blamed the patient for being non-compliant. Our nurse finally checks a blood sugar - the highest I've ever seen - 1649! With steroids/stress and maybe Temodar interaction the guy was going into hyperosmotic non-ketotic state and was admitted.

So ... guess you should build up skills to be able to think like a doctor first, not just an oncologist

S

 

[Cancerdancer]

Thoughts from the crowd on value of rotations in nuclear medicine or a hospice rotation (relative to others that have been mentioned)? Thx