Getting ready for intern year

[sebsvenmdc]

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What is the best way to develop clinical competence before intern year? I'm a MS4. I feel like a lot of my MS3 year was wasted clinically because of trying to get studying done for shelves. I know this is my fault - I feel like I sacrificed clinical learning for theoretical learning. What can I do as a MS4 to try to close in on lost MS3 learning opportunities...

-Take as many medicine clerkships as possible.
-Read Washington Manual for Med. Therapeutics
-Improve on Clinical skills using FA-Step 2 CS
-Improve on Physical Exam
-Work hard on administrative aspects (transfer orders, admission orders, etc - how to get hospital stuff done) this year

Anything - resource-wise or strategy - that I'm missing? I'm planning to do a TY or prelim IM. Thanks for the help!

 

[turquoiseblue]

Those sound good.

In addition, I think that true resident knowledge of managing a patient stems more from USMLE step 3, so you may want to study out of those review books too. Also sub-internships could help you get the true picture of being a resident. Not to mention asking your senior residents to let you try things out on real patients like writing admission or transfer orders and having them critique you.

 

[anon-y-mouse]

What is the best way to develop clinical competence before intern year? I'm a MS4. I feel like a lot of my MS3 year was wasted clinically because of trying to get studying done for shelves. I know this is my fault - I feel like I sacrificed clinical learning for theoretical learning. What can I do as a MS4 to try to close in on lost MS3 learning opportunities...

-Take as many medicine clerkships as possible.
-Read Washington Manual for Med. Therapeutics
-Improve on Clinical skills using FA-Step 2 CS
-Improve on Physical Exam
-Work hard on administrative aspects (transfer orders, admission orders, etc - how to get hospital stuff done) this year

Anything - resource-wise or strategy - that I'm missing? I'm planning to do a TY or prelim IM. Thanks for the help!

I don't think learning any administrative aspects will help you, as every hospital will be different. You will become up to speed at that in your first week of intern year. If anything, I would ask to start on an inpatient month when they ask for your requests after matching. It is really not that hard, and plus you will perfect your physical exam skills in residency. I would focus on learning how to do things properly, by observing and practicing as much as you can... by learning why the maneuvers you do work, the mechanisms, the physiology, and learning how to look up information / the latest on, say, GI bleeds, ACS, CHF, asthma, the bread+butter stuff. When you get to intern year, your resident should sit down with you after every patient and run the plan with you quickly. You will get used to what you have to do and what your diagnostic workup would have to be. Now I know what people mean when they say they study only a few days for Step 3, because you will quickly become adept at managing situations. My advice to you is to do as few medicine rotations as necessary, and just focus on crazy/awesome stuff you have available at your med school, like foreign electives, pathology, pain management, derm, forensic psych, high risk OB clinic, etc. Now is your time to broaden your horizons and learn for the sake of learning!

 

[doctorFred]

What is the best way to develop clinical competence before intern year? I'm a MS4. I feel like a lot of my MS3 year was wasted clinically because of trying to get studying done for shelves. I know this is my fault - I feel like I sacrificed clinical learning for theoretical learning. What can I do as a MS4 to try to close in on lost MS3 learning opportunities...

-Take as many medicine clerkships as possible.
-Read Washington Manual for Med. Therapeutics
-Improve on Clinical skills using FA-Step 2 CS
-Improve on Physical Exam
-Work hard on administrative aspects (transfer orders, admission orders, etc - how to get hospital stuff done) this year

Anything - resource-wise or strategy - that I'm missing? I'm planning to do a TY or prelim IM. Thanks for the help!

this doesn't directly answer your question, but honestly, your priority fourth year (after the match) should be enjoying yourself and spending time with your classmates, many of whom you won't see again. as was mentioned before, you'll be surprised how much you'll pick up just by being there as you start intern year.

the next couple of years are long. take a good 6 months and recharge those batteries.

 

[turquoiseblue]

I would say just spend only a small amount of your time (maybe a month or less) on learning to be an intern, because you'll have to do that anyways as an intern, and they often give you a month to a few months grace period of understanding that you just started. when i was a resident in IM everyone was so slow for the first few months when they started, stayed till late hours, (which has changed..you're not allowed to stay that long anymore) and it was like that in prelim surgery as well...we didn't know what was going on at first but eventually got the hang of that particular hospital.....every PGY1 in your class will be new like you and in your boat, so you don't have a lot to worry about. Usually your senior residents and attendings will help you through...It's all just a learning process....

 

[deleted50541]

I'm with everyone on taking some time to relax during fourth year. But if you can, do one or two ICU rotations, preferably a surgical or closed ICU with competent and knowledgeable critical care attendings. Learn to manage critically ill patients and everything else will seem like cake in comparison. I did three months of ICU as an MS4, and those 12 weeks were worth more alone than the remainder of my clinical experience as a med student.

 

[sebsvenmdc]

Thanks for the advice, guys! I would try to chill a bit during 4th year, but honestly, I'm not comfortable/confident at all with my clinical abilities yet (and it doesn't help that I've heard some negative garbage about interns not coping or possibly getting the axe...not many stories, but a few is enough to be pretty intimidating!)...so I'll probably try to work pretty hard to make sure that I get as competent as possible pre-intern year. 140K of debt and a ton of sacrifice = too much to risk at this stage of the game! My step 1 and shelves are great, it's just been daunting discovering that I'm not ahead of the curve clinically...at best, I'm probably/hopefully normal.

I am currently signed up for 2 months of critical care: 1 in a medicine unit, another doing anesthesia ICU, does that count? I will look into loading up more ICU time in the year, maybe 1 or 2 more. It might have to be Jan, but that's interview season! 🙄

 

[Law2Doc]

What is the best way to develop clinical competence before intern year?

You will not be clinically competent at the start of your intern year. You will not know what you are doing and will end up chasing your tail for a few weeks to months, regardless of what you will do. My suggestion: (1) do rotations that emphasize procedures. Having a working familiarity with a handful of basic procedures, including very basic things like putting in IVs, putting in foleys, suturing, will all come in handy. For this reason sticking an ED rotation into your fourth year electives might be useful. (2) Sign up for challenging sub-I's. This gets your head into the game in terms of "ownership" of patients. I get that people want to kick back and relax during 4th year, but if the program makes you do a sub-I or two, you should at least do one with some value. (3) Review Bates, so you know the various physical exam "moves". Folks tend to forget a lot of this by the start of intern year and you definitely will use it in a lot of fields. I would lose the CS FA book the moment you pass that test -- it's not particularly practical. Learn how to examine patients on actual patients, not actors taught to respond to certain cues.

 

[sebsvenmdc]

You will not be clinically competent at the start of your intern year. You will not know what you are doing and will end up chasing your tail for a few weeks to months, regardless of what you will do. My suggestion: (1) do rotations that emphasize procedures. Having a working familiarity with a handful of basic procedures, including very basic things like putting in IVs, putting in foleys, suturing, will all come in handy. For this reason sticking an ED rotation into your fourth year electives might be useful. (2) Sign up for challenging sub-I's. This gets your head into the game in terms of "ownership" of patients. I get that people want to kick back and relax during 4th year, but if the program makes you do a sub-I or two, you should at least do one with some value. (3) Review Bates, so you know the various physical exam "moves". Folks tend to forget a lot of this by the start of intern year and you definitely will use it in a lot of fields. I would lose the CS FA book the moment you pass that test -- it's not particularly practical. Learn how to examine patients on actual patients, not actors taught to respond to certain cues.

Thanks, Law2Doc. I'm definitely doing 1 sub-I. May see if I can sign up for an additional one ore do an extra month of ICU. Will hit Bates in addition to DeGowins. It's clear that I can't get rid of a drastic transition between ms4-intern...just want to do what I can - ahead of time - to make the transition successful.

 

[cartoondoc]

Don't worry about getting fired! Everyone is kind of clueless when they start intern year. As long as you don't do anything grossly negligent, I don't think there's any chance of something like that. After all, you are basically slave labor... why would they give that up?

You will probably learn more during your first month of internship than you will in anything you do this year.