Getting back to GME after GMO time?

[ahowardmd]

I am applying for a PGY-2 GME slot this year (specifically Army IM) and by July 1st I will have been out of the hospital in GMO land for 3 years. My skills with MSK medicine are very sharp, but I’m feeling unprepared to practice inpatient medicine. Any tips on how to prepare for ward medicine over the next several months from people that have taken a long break like that?

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[MilMD01]

I wouldn't worry too much about it. As long as you can present patients effectively, are hard working, and easy to work with you won't have a problem.

You'll learn the rest as you go by reading about your patients as you see them.

 

[Ziehl-Neelsen]

I wouldn't worry too much about it.

I would.

I'm not an internist, but my specialty ends up with a lot of residents coming back to GME after GMO interludes. They are almost without exception weaker than their classmates who came straight from medical school when it comes to academic medicine. They are particularly weak on non-MSK anatomy (what are the afferent vascular sources that supply blood to the liver), physiology (how could this patient's hypokalemia be related to the citrate bolus she received during her GI bleed resuscitation), and quizzable medical minutiae (what is the defining mutation of chronic myeloid leukemia) which is expected because this is the sort of knowledge is reinforced during medical school and not as a GMO. Many of them also have a seriously hard time readjusting to the time requirements of residency. The GMO day ends at 1630 and and the next day's schedule consists of an 0530 squadron death run, meetings, and a hail and farewell in the afternoon. A resident's day "ends" at 1630 too, but tomorrow you're going to have to round on that patient with antiphospholipid antibody syndrome and if you don't know more than you did today, I'm gonna let you know that you didn't meet my expectations. Add a spouse and a family that weren't there when you had similar time requirements as a medical student, and you can see how difficult it can become. Of the couple previous GMO residents I've had who were total failures, half were people who should have probably never been admitted to medical school and residency was where they eventually flamed out, but the other half could never get readjusted to the time requirements and fell progressively behind leading to eventual dismissal or board failure.

I usually have a talk with the previous GMOs the first time we work together where I tell them that I respect their previous service as GMOs. They were put in a difficult positions doing an important job overseeing the health of their units with minimal training and did the best they could which, in and of itself, buys them respect from me as their attending. I frankly explain that they will likely be behind their classmates straight from medical school with regard to medical "fund of knowledge". This will probably require that they work harder and put in more hours than their classmates to catch up. I explain that they will probably get shown up by their classmates during group teaching sessions and that they should use those slights to their pride as fuel to go home, do more reading/preparation and hold their own the next time. I explain that previous GMOs have a lot to offer the program because they generally have the maturity, wisdom, and equanimity that comes from being an independent provider and their classmates do not. They also have a knowledge of how the military really works that is incredibly valuable to their classmates. I explain that I give a pass for fund of knowledge issues to former GMOs for the first year. After that year, if you aren't cutting it, I'll recommend you for remediation or probation just like anybody else.

My recommendation to you is to go back to second year of medical school and do the things that worked for you then. Podcast lectures, Step-1 Q-banks, Robbins, medical school syllabi, whatever. You want your knowledge to be comparable to the residents coming out of medical school, and for that you need to go back to medical school.

 

[ArmyTiger]

Read now about medicine diagnoses. It's easy to forget relevant disease processes when everything you see in clinic is boring colds and msk injuries. The rest comes back quickly.

Sent from my Pixel XL using Tapatalk

 

[DrMetal]

I am applying for a PGY-2 GME slot this year (specifically Army IM) and by July 1st I will have been out of the hospital in GMO land for 3 years. My skills with MSK medicine are very sharp, but I’m feeling unprepared to practice inpatient medicine. Any tips on how to prepare for ward medicine over the next several months from people that have taken a long break like that?

Get yourself MKSAP 18. Start reading, augment it with uptodate, current guidelines, etc. There's a lot you haven't considered in a while as a GMO, probably b/c you haven't encountered it, so there's plenty to learn. Most important advice: work hard, be humble, and lose your GMO swagger (some return from the fleet with unsubstantiated overconfidence....this pisses off the senior attending!)

 

[ahowardmd]

I would.

I'm not an internist, but my specialty ends up with a lot of residents coming back to GME after GMO interludes. They are almost without exception weaker than their classmates who came straight from medical school when it comes to academic medicine. They are particularly weak on non-MSK anatomy (what are the afferent vascular sources that supply blood to the liver), physiology (how could this patient's hypokalemia be related to the citrate bolus she received during her GI bleed resuscitation), and quizzable medical minutiae (what is the defining mutation of chronic myeloid leukemia) which is expected because this is the sort of knowledge is reinforced during medical school and not as a GMO. Many of them also have a seriously hard time readjusting to the time requirements of residency. The GMO day ends at 1630 and and the next day's schedule consists of an 0530 squadron death run, meetings, and a hail and farewell in the afternoon. A resident's day "ends" at 1630 too, but tomorrow you're going to have to round on that patient with antiphospholipid antibody syndrome and if you don't know more than you did today, I'm gonna let you know that you didn't meet my expectations. Add a spouse and a family that weren't there when you had similar time requirements as a medical student, and you can see how difficult it can become. Of the couple previous GMO residents I've had who were total failures, half were people who should have probably never been admitted to medical school and residency was where they eventually flamed out, but the other half could never get readjusted to the time requirements and fell progressively behind leading to eventual dismissal or board failure.

I usually have a talk with the previous GMOs the first time we work together where I tell them that I respect their previous service as GMOs. They were put in a difficult positions doing an important job overseeing the health of their units with minimal training and did the best they could which, in and of itself, buys them respect from me as their attending. I frankly explain that they will likely be behind their classmates straight from medical school with regard to medical "fund of knowledge". This will probably require that they work harder and put in more hours than their classmates to catch up. I explain that they will probably get shown up by their classmates during group teaching sessions and that they should use those slights to their pride as fuel to go home, do more reading/preparation and hold their own the next time. I explain that previous GMOs have a lot to offer the program because they generally have the maturity, wisdom, and equanimity that comes from being an independent provider and their classmates do not. They also have a knowledge of how the military really works that is incredibly valuable to their classmates. I explain that I give a pass for fund of knowledge issues to former GMOs for the first year. After that year, if you aren't cutting it, I'll recommend you for remediation or probation just like anybody else.

My recommendation to you is to go back to second year of medical school and do the things that worked for you then. Podcast lectures, Step-1 Q-banks, Robbins, medical school syllabi, whatever. You want your knowledge to be comparable to the residents coming out of medical school, and for that you need to go back to medical school.

Your candor is greatly appreciated. I know it’s not going to be easy going back, but I’m hoping I can get ahead of it by starting to study now.

Get yourself MKSAP 18. Start reading, augment it with uptodate, current guidelines, etc. There's a lot you haven't considered in a while as a GMO, probably b/c you haven't encountered it, so there's plenty to learn. Most important advice: work hard, be humble, and lose your GMO swagger (some return from the fleet with unsubstantiated overconfidence....this pisses off the senior attending!)

I think I’ll get MKSAP 18 as you suggested and try to study at least a couple hours every day. Is it worth getting the whole package (which is $989), or would the print books be enough fodder for study? Also is there a big enough difference between MKSAP 17 and MKSAP 18 to justify the price differential?

 

[DrMetal]

Your candor is greatly appreciated. I know it’s not going to be easy going back, but I’m hoping I can get ahead of it by starting to study now.

I think I’ll get MKSAP 18 as you suggested and try to study at least a couple hours every day. Is it worth getting the whole package (which is $989), or would the print books be enough fodder for study? Also is there a big enough difference between MKSAP 17 and MKSAP 18 to justify the price differential?

If you become a member of ACP (and I advise you do, you'll get discounts on meetings and such, it's worth it), you can get a pretty substantial discount on MKSAP. As far a print vs. digital: I'd recommend definitely getting the digital (which you can access from many devices) at the very least. If you're going to buy the print because you like having hard copies, then I'd recommend getting the combo package. As far as MKSAP 17 vs 18: no I don't think there's a huge difference. If you already having '17, I would use that for now. Consider buying '19 when it comes out. They say each version is good for the Boards for 2-3 years out, but who knows. I'd also recommend Uworld at some point, their qbank is very good.

Just work hard, be humble, you'll do fine. And don't take anything personally, you'll get critiqued on all sorts of things (some of it good feedback, some of it silly). Just take the jabs and move forward, most things are not worth fighting about....it's Medicine, we love being douchey about all sorts of things.