guidance for 3rd year

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Hi

For those of you who are further along in their medical training, what advice would you give us as beginning 3rd year medstudents? What do you know now that you wished you had known when you began your 3rd year? Your experience & feedback would be greatly appreciated.

 

[PimplePopperMD]

You'll hear this again and again, so here goes:

1. Know your patients. This means their whole history of present illness AS WELL AS past medical history, social history, etc. AND it means their labs every day, the path results, their last echo, etc. It's not important to have it memorized, but it needs to be handy.

Often, the third year student knows the patient the best, because they have the most time to spend. Thus, the info that the third year has can often make a difference in treatment, etc.

2. READ about your patients. This is the best way to learn. If your patient has four medical problems, but only came in with cellulitis, this is your opportunity to learn about all four disease processes. What med is the patient on at home to care for the disease? Does the disease have anything to do with the current chief complaint? etc...

3. Be a hard worker. Should go without saying. If you are done with your work but your team is still getting killed, make sure that you offer to help.

4. Know why you're there. Don't get abused. Don't fetch coffee daily. Etc.

5. Have fun! If you are miserable, it's contagious. If you're having fun, that's contagious too.

best of luck!! you're coming into the fun stuff. this is why you went to med school, not to memorize krebs!

 

[Flipchick]

As someone who just finished 3rd year, here's a couple of tips:

1. Be yourself. Nothing is worse than being seen as "trying too hard". Many attendings and senior residents have had lots of experience with med students, and they know when a med student is faking their enthusiasm, their concern or their attitude. This doesn't mean that you shouldn't be enthusiastic, concerned, or have a good attitude--you just shouldn't fake it.

2. Don't make other med students look bad. NOBODY, especially attendings and senior residents, likes to see this.

Good luck to everyone, and have fun! (I know, hard to imagine when you have to get up at 4 in the morning)

 

[Tazmaniac]

I wish I'd introduced myself to the nursing staff prior to beginning a rotation.

Near the end of the 3rd year, I started saying Hi and introducing myself to the nurses for my patients even if I didn't need anything at the time. For whatever reason, things just got done more quickly and more efficiently.

-Todd MSIV

 

[njbmd]

Originally posted by Tazmaniac
I wish I'd introduced myself to the nursing staff prior to beginning a rotation.

Near the end of the 3rd year, I started saying Hi and introducing myself to the nurses for my patients even if I didn't need anything at the time. For whatever reason, things just got done more quickly and more efficiently.

-Todd MSIV

Hi there,
Even better than introducing yourself to nurses is to go up after rounds and give them the plan for the day. Not only will your plans get carried out but the nurses will appreciate the information and you taking the time to keep them in the loop.

njbmd😎

 

[RuralMedicine]

Originally posted by njbmd
Hi there,
Even better than introducing yourself to nurses is to go up after rounds and give them the plan for the day. Not only will your plans get carried out but the nurses will appreciate the information and you taking the time to keep them in the loop.

njbmd😎

I definitely agree! It also gives an opportunity to clarify if things are confusing which prevents mistakes and can save you pages throughout the day.

 

[Asher]

Buy a few extra white coats. You never know when yours will get stained from coffee or when the buttons will fall off.

Be friendly to everyone. When you hit the nurses station at 5 a.m. in the morning, say good morning to the nurses that are there. Don't be an arrogant student who treats other health care workers as servants.

Get to know the social worker/case manager that works with your team. The ones I know do an incredible job with patient placement.

Carry a few pieces of candy in your pocket. You never know when your blood sugar will drop since you missed lunch. Plus, some teams I worked with loved when we took turns bringing "treats" for rounds.

Don't buy into the idea that the third year is a big competition. It is normal to want to do well and to get good grades. But you are doing a disservice to yourself and your classmates by gunning. Your classmates are your future colleagues -- don't you want your fellow future doctors to be as well-trained as possible.

Find out the system at your school for reporting medical student abuse/unethical behavior. Don't put up with abusive behavior or sexual harrassment. Just because "it is the way it has always been," doesn't make it right or mean that it should always be that way.

Don't blow off rotations that aren't related to a field that you plan to go into. It may the only opportunity you will have to be exposed to that speciality and your patients deserve the best care possible even if you aren't a future surgeon. Plus, hospitals are small gossipy places. If you act like a brat on a rotation or mistreat staff, it will get around and can cause people to have a negative impression of you before they even start to work with you.

If you absolutely hate a speciality, make an extra effort to find one thing in each day's work that you can get very interested in.

When asked what you plan to go into, don't lie and say whatever rotation you are on is what you plan to do if it isn't. Most people can see through insincerity.

Hemoccult developer is like gold. Find out where the secret stash of it is.

Always carry more pens than you think you will ever need -- people will borrow them from you and most likely never return them. Also carry an extra copy or two of the list with you so that if an attending or resident loses theirs you can help them out.

Be a good person. Have fun as much as you can.

 

[kcrd]

these are great tips - does anyone have anymore?

 

[bobbyseal]

I just started 3rd year, and I've found one of the things that I need to improve upon is keeping track of the little things. For instance, keeping track of what consults say in their notes, paying attention to what your patient asks during prerounds, remembering plans the resident makes during work rounds, then keeping on top of what the attending wants, and finally, the random things the team wants during the day can be awfully difficult. You need to keep track of all these little things. So, figure out a system of some kind. It's kind of a bummer when your intern says, "Did you forget to order the phos for the patient yesterday after I asked?" It's much better to say, "Excuse me, Dr. so and so, could you please cosign the order for KCl on Mr. Doe?" And your intern replies, "Oh yes, I forgot all about that."

 

[squeek]

Some of this will reiterate "third year gems" already mentioned:

1) NEVER try to one-up your classmates. NEVER answer a question that's been asked of someone else, unless you are asked directly afterward by an attending. NEVER gossip about your classmates, whether it's with residents, attendings, or other classmates. These things will end up making YOU look bad. In contrast, if you are always kind, positive, and willing to help your classmates out, it bodes well for you.

2) This is something you learn with time, but it's important nevertheless: Work hard, but know when to go home. I read on this site several years ago that you should ask once if your help is needed (at the end of the day, of course). If they say "no, go home," then do jus that. This was very good advice. There are times when medical students are, frankly, in the way and irritating for the residents, and getting out of their hair can be a blessing. Besides, you'll need your rest and time to study.

3) Keep very good track of your patients. I made forms for each patient, with room for several days' notes. You should have a list in front of you with each patient's medical history, daily vitals, meds and med changes, imaging results, laboratory data, active issues, disposition planning info, "to do" boxes to check off (so you don't forget to do anything), etc. That way, when the attending grabs you because she can't find the intern, you'll be on your toes, not only with that day's info, but with the past few days' info.

4) Get to know your patients personally--what do they like to do? What is their career? These types of interactions mean a great deal to patients and "humanize" a hospital stay.

5) Always make sure your patients are comfortable. Remind them that if they have pain, they need to ask for pain medicine. Ask if there's anything you can get them--slippers, bed pans, extra pillows, etc. These small things make a great difference in patient comfort

Also, you'll find that many medical things are not adequately explained to your patients. You have lots of time, so make sure they understand what studies have shown (as long as it's okay by the attendings/residents to divulge--you don't want to be the first one telling them they have terminal cancer, because you're not adequately prepared to answer questions), what the plan for the day is, what to expect, what medications they are on and why, etc.

6) Always be around OR let your resident know where they can find you. During down time, I tried to study within close proximity to the floor I was working on, so my residents wouldn't be fuming, "Where is she?!?"

7) This is a lesson taught to me by a very wise medicine tutor: If you have study results (e.g., Echo, radiology, etc) go to the experts to have them teach you about it! Have them review the actual Echo video with you (or go to watch when your patient goes for the study), have them go through the xray with you, go to the lab and look at urine sediment, you get the idea. It takes a bit of tenacity and perserverance on your part, but you learn SOOO much more than if you just read the results. AND, you make acquaintances all throughout the hospital. When asked to go fetch something, you'll know your way around and will be back within minutes!

8) When presenting patients at rounds, have all pertinent data available--including radiology studies (either in film or pulled up on the computer). Also make sure you've reviewed as much as you can about their disease.

9) Always volunteer to do a procedure, or learn one. If in Ob-gyn clinic, volunteer to do every pap smear. Be excited about deliveries, even if it's 3 am. In neuro, beg them to let you do an LP. In surgery, make sure they know you want to suture and make incisions. You'll have a lot more fun, and you'll look like you've got initiative. (BUT, only ask in appropriate situations, as well...use your judgment).

10) Work really hard, and don't EVER complain.

11) Be dependable. Follow-up all of your patient studies. Make sure everything that needs to be done is done. Finish, with excellence, anything asked of you. If you become indispensable, you'll receive a great evaluation. And, you'll get more responsibility, so you learn more.

12) Memorize the location of every vending machine in the hospital, and always have at least a dollar or two in change in your coat pocket. You'll be grateful for this on surgery and ob-gyn. AND, don't eat chips. Buy peanuts or something that will stick with you. Also, I bought granola bars and stuffed them in my coat pockets for hunger emergencies. In spite of this, I lost 5 pounds on 6 weeks of Ob-Gyn, and I'm not that big to begin with!

13) Use the stairs instead of the elevator. It's faster, and you'll get some exercise during those days you simply can't muster the energy to work out once you get home.

14) Read, read, read, read, read, read, read......

Good luck! 🙂

 

[squeek]

Some of this will reiterate "third year gems" already mentioned:

1) NEVER try to one-up your classmates. NEVER answer a question that's been asked of someone else, unless you are asked directly afterward by an attending. NEVER gossip about your classmates, whether it's with residents, attendings, or other classmates. These things will end up making YOU look bad. In contrast, if you are always kind, positive, and willing to help your classmates out, it bodes well for you.

2) This is something you learn with time, but it's important nevertheless: Work hard, but know when to go home. I read on this site several years ago that you should ask once if your help is needed (at the end of the day, of course). If they say "no, go home," then do jus that. This was very good advice. There are times when medical students are, frankly, in the way and irritating for the residents, and getting out of their hair can be a blessing. Besides, you'll need your rest and time to study.

3) Keep very good track of your patients. I made forms for each patient, with room for several days' notes. You should have a list in front of you with each patient's medical history, daily vitals, meds and med changes, imaging results, laboratory data, active issues, disposition planning info, "to do" boxes to check off (so you don't forget to do anything), etc. That way, when the attending grabs you because she can't find the intern, you'll be on your toes, not only with that day's info, but with the past few days' info.

4) Get to know your patients personally--what do they like to do? What is their career? These types of interactions mean a great deal to patients and "humanize" a hospital stay.

5) Always make sure your patients are comfortable. Remind them that if they have pain, they need to ask for pain medicine. Ask if there's anything you can get them--slippers, bed pans, extra pillows, etc. These small things make a great difference in patient comfort

Also, you'll find that many medical things are not adequately explained to your patients. You have lots of time, so make sure they understand what studies have shown (as long as it's okay by the attendings/residents to divulge--you don't want to be the first one telling them they have terminal cancer, because you're not adequately prepared to answer questions), what the plan for the day is, what to expect, what medications they are on and why, etc.

6) Always be around OR let your resident know where they can find you. During down time, I tried to study within close proximity to the floor I was working on, so my residents wouldn't be fuming, "Where is she?!?"

7) This is a lesson taught to me by a very wise medicine tutor: If you have study results (e.g., Echo, radiology, etc) go to the experts to have them teach you about it! Have them review the actual Echo video with you (or go to watch when your patient goes for the study), have them go through the xray with you, go to the lab and look at urine sediment, you get the idea. It takes a bit of tenacity and perserverance on your part, but you learn SOOO much more than if you just read the results. AND, you make acquaintances all throughout the hospital. When asked to go fetch something, you'll know your way around and will be back within minutes!

8) When presenting patients at rounds, have all pertinent data available--including radiology studies (either in film or pulled up on the computer). Also make sure you've reviewed as much as you can about their disease.

9) Always volunteer to do a procedure, or learn one. If in Ob-gyn clinic, volunteer to do every pap smear. Be excited about deliveries, even if it's 3 am. In neuro, beg them to let you do an LP. In surgery, make sure they know you want to suture and make incisions. You'll have a lot more fun, and you'll look like you've got initiative. (BUT, only ask in appropriate situations, as well...use your judgment).

10) Work really hard, and don't EVER complain.

11) Be dependable. Follow-up all of your patient studies. Make sure everything that needs to be done is done. Finish, with excellence, anything asked of you. If you become indispensable, you'll receive a great evaluation. And, you'll get more responsibility, so you learn more.

12) Memorize the location of every vending machine in the hospital, and always have at least a dollar or two in change in your coat pocket. You'll be grateful for this on surgery and ob-gyn. AND, don't eat chips. Buy peanuts or something that will stick with you. Also, I bought granola bars and stuffed them in my coat pockets for hunger emergencies. In spite of this, I lost 5 pounds on 6 weeks of Ob-Gyn, and I'm not that big to begin with!

13) Use the stairs instead of the elevator. It's faster, and you'll get some exercise during those days you simply can't muster the energy to work out once you get home.

14) Read, read, read, read, read, read, read......

Good luck! 🙂