How can an MS1 best prepare to crush clerkships?

[Dr. Trafalgar Law]

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Current MS1 at school that has unranked P/F pre-clinical (doesn't affect AOA), so I'm not worried about getting top scores on exams at the moment, but we have an advanced curriculum with clinical clerkships being all of M2. Since January I've almost strictly transitioned to doing Pathoma/BnB for whatever organ system I'm on and sticking to a schedule of 100 news daily on my AnKing deck, and neglecting course lectures.

I'm just curious what dividends this method will yield come clerkship time though, since clerkships will be fully graded and will be more important than previously, given P/F Step 1. Will Pathoma/BnB with Anking reinforcement serve well for rotations, or should I be more actively following lectures? I'm also asking this because I've noticed my contributions in PBL small-groups has declined as I have transitioned to studying more 3rd party resources outside of lecture, as the problems we are assigned have a heavier emphasis on lecture material than what I may have been studying with 3rd party resources.

Just wanna make sure I'm not shooting myself in the foot with my current study strategy. What do yall think? And I guess I can add what could I do now to be best ready to do well in clerkships?

 

[Redpancreas]

Current MS1 at school that has unranked P/F pre-clinical (doesn't affect AOA), so I'm not worried about getting top scores on exams at the moment, but we have an advanced curriculum with clinical clerkships being all of M2. Since January I've almost strictly transitioned to doing Pathoma/BnB for whatever organ system I'm on and sticking to a schedule of 100 news daily on my AnKing deck, and neglecting course lectures.

I'm just curious what dividends this method will yield come clerkship time though, since clerkships will be fully graded and will be more important than previously, given P/F Step 1. Will Pathoma/BnB with Anking reinforcement serve well for rotations, or should I be more actively following lectures? I'm also asking this because I've noticed my contributions in PBL small-groups has declined as I have transitioned to studying more 3rd party resources outside of lecture, as the problems we are assigned have a heavier emphasis on lecture material than what I may have been studying with 3rd party resources.

Just wanna make sure I'm not shooting myself in the foot with my current study strategy. What do yall think? And I guess I can add what could I do now to be best ready to do well in clerkships?

I'll bite. Two points:

1.) As the year's go by people keep looking further and further ahead. At the end of the day, med school's med school and there's an established process to it. Your focus should be to excel at every stage. For M1/2, you can opt for the "Pathoma U" education, but it pays to engage in your school's material. The commercial resources are useful adjuncts as they focus on the bigger picture and are easier to grasp hence students gravitate to them instead of their course notes with pixelated images. There's a ton of school lecture material that gets shoved down your throats that's likely relevant to some board exam question in the near future or some NYHA chart that looks pointless now but becomes important come clerkship time.

2.) I understand that clerkships are the big cahuna per your school's assessment policy. Just like you figured that out, you need to figure out how clerkships are graded. There are generally 6 (Internal Med, Gen Surg, Neuro/Pscych, OB/GYN, Family, and Elective). Each one graded is differently at the discretion of the clerkship director. Get your hands on a clerkship syllabi for whatever rotations (ex. IM vs. Gen Surg you're interested in). There will be a percent breakdown on how much the Shelf Exam (NBME Subject Specialty exam) is worth vs. subjective evaluations (likert scores residents/attendings grade you with based on your competency and how much they like you) vs. other things like an OSCE (ex.). Any stuff you pick up now will be useful for the shelf exams that test random details instead of how to treat common things (which you learn in clerkship). Therefore to finally answer your question directly, focusing on your school's curriculum in addition to the commercial resources will pay dividends if your shelf exam is worth a good amount of your clerkship grade. If it's not and evaluations make up the majority, M1/M2 will have little to do with your clerkship grades (although they will deff help for Step 2 CK).

 

[Thesimplelifeofamyloid]

I'll bite. Two points:

1.) As the year's go by people keep looking further and further ahead. At the end of the day, med school's med school and there's an established process to it. Your focus should be to excel at every stage. For M1/2, you can opt for the "Pathoma U" education, but it pays to engage in your school's material. The commercial resources are useful adjuncts as they focus on the bigger picture and are easier to grasp hence students gravitate to them instead of their course notes with pixelated images. There's a ton of school lecture material that gets shoved down your throats that's likely relevant to some board exam question in the near future or some NYHA chart that looks pointless now but becomes important come clerkship time.

2.) I understand that clerkships are the big cahuna per your school's assessment policy. Just like you figured that out, you need to figure out how clerkships are graded. There are generally 6 (Internal Med, Gen Surg, Neuro/Pscych, OB/GYN, Family, and Elective). Each one graded is differently at the discretion of the clerkship director. Get your hands on a clerkship syllabi for whatever rotations (ex. IM vs. Gen Surg you're interested in). There will be a percent breakdown on how much the Shelf Exam (NBME Subject Specialty exam) is worth vs. subjective evaluations (likert scores residents/attendings grade you with based on your competency and how much they like you) vs. other things like an OSCE (ex.). Any stuff you pick up now will be useful for the shelf exams that test random details instead of how to treat common things (which you learn in clerkship). Therefore to finally answer your question directly, focusing on your school's curriculum in addition to the commercial resources will pay dividends if your shelf exam is worth a good amount of your clerkship grade. If it's not and evaluations make up the majority, M1/M2 will have little to do with your clerkship grades (although they will deff help for Step 2 CK).

Fixed this

 

[Matthew9Thirtyfive]

Current MS1 at school that has unranked P/F pre-clinical (doesn't affect AOA), so I'm not worried about getting top scores on exams at the moment, but we have an advanced curriculum with clinical clerkships being all of M2. Since January I've almost strictly transitioned to doing Pathoma/BnB for whatever organ system I'm on and sticking to a schedule of 100 news daily on my AnKing deck, and neglecting course lectures.

I'm just curious what dividends this method will yield come clerkship time though, since clerkships will be fully graded and will be more important than previously, given P/F Step 1. Will Pathoma/BnB with Anking reinforcement serve well for rotations, or should I be more actively following lectures? I'm also asking this because I've noticed my contributions in PBL small-groups has declined as I have transitioned to studying more 3rd party resources outside of lecture, as the problems we are assigned have a heavier emphasis on lecture material than what I may have been studying with 3rd party resources.

Just wanna make sure I'm not shooting myself in the foot with my current study strategy. What do yall think? And I guess I can add what could I do now to be best ready to do well in clerkships?

So, you almost definitely don’t need your school’s lectures. I used my school’s for one block, and that was because I heard from prior classes that they were excellent. For every other block, I used BnB, Rx, and sketchy. Plus anki obviously.

For the PBL thing, it depends on how useful the sessions are. My school had regular PBL style clinical reasoning sessions throughout preclinicals, and they were great. I probably got more out of those for rotations than anything else. If yours aren’t very helpful, then just do what you need to do to get through them.

 

[Gilakend]

You'll be ahead knowledge-wise, the only thing that might be lacking is that your school lectures will likely have more clinical pearls (because you are starting clinical next year) compared to AnKing which is largely more detailed and sciencey. However, the likelihood you'd remember all of those is unlikely, and prepping with OME or some other resource can easily catch you up.

Someone else on here made their own thread about how to do well in clerkships and it is 100% true: Likability > Usefulness > Knowledge, the number 1 most important thing you can do to perform well on clerkships is just being a personable and nice person to be around and help out where you can.

 

[Lost in Translation]

All good advice so far, I'll chime in with how I expect my med students to excel:

I don't really like how the onus is placed on the student to be proactive and involved in what's going on day-to-day. Sometimes the intern doesn't even know, so how can you expect the student to know? I feel like as residents we need to be better in actively including the student in the day-to-day, including the boring stuff like making the list and returning floor pages. Especially on surgical services, it's nice to be in the OR all day as a student but you don't necessarily learn much about that particular specialty unless you see the medical management outside of the OR.

So, as a med student on clerkships, the best thing you can do to stand out is just flat out ask your intern to walk you through a typical day with them. If at all possible (which, if you're on a surgical service, can be difficult at times especially if the clerkship director doesn't want you doing that) I would highly recommend shadowing the intern for the first day so you can see what it is they do and identify areas you can help out in the coming weeks.

For example, ask to hold the pager for a day. I disagree with the general idea (or what was the idea at my training institutions) that med students can learn nothing from returning "nonsense" pages from the floor. Those pages only become nonsense when you're at a point in your training where the question being asked is elementary and you can arrive at the answer in a snap. To a student, there's no such thing as a nonsense page because they're not at a point in their training where they can instantly solve the simplest floor management problem. So when you hold the pager and have to be the one to talk to the nurse, you're already training up your clinical acumen (and of course if it's a question you don't think you can arrive to the answer to on your own, the intern is always a desk or text away).

Another thing I try to get my students to do that is relevant to clinical learning is running the list. Typically you run the the list twice a day: once after rounds in the morning and then again in the afternoon before PM sign out. The AM running of the list is where you make sure orders are put in and consults are called and the night/afternoon running of the list is where you see if what you wanted done that day was actually done. I like when students participate in the running of the list for two reasons: it shows me if they were paying attention on rounds (I'm happy if they can give me all the consults and orders for their 2-3 patients that they carry, ecstatic if they can do that for every patient on the list) and it shows that the student is trying to assume more responsibility, especially if they're writing down stuff for every patient. Running the list is also the perfect time to do some on-the-fly learning, especially if you don't know why a consult is being called or why an order is being put in for X test or Y therapy. Honestly, list running is where you'll learn the bulk of your clinical knowledge.

One more tip before this becomes a novel: if you're on a service that's not terribly busy or you're not in the OR that day, it would help the intern out immensely if you periodically rounded on the patients on your own (one of my most favorite chiefs said that his workflow as an intern was: AM rounds --> consults --> orders --> notes --> mid-morning nurse rounds --> lunch/finish notes --> early PM nurse rounds --> +/- PM chief rounds). I don't think you need to round that often, but a mid-morning round would be beneficial. I don't mean see every patient again, but just walk by their room and talk to their nurse to make sure the orders put in were executed, make sure the consulting team that was called earlier has stopped by (or not), and get an idea from the nurses how the patient is doing. Medicine is a 24/7 enterprise and things are always happening. Often, the intern doesn't have the time to go talk to every nurse so if the student does it and reports back with any major information they'll be contributing a lot to the team.

There's more but to me those three are the most important things a med student can do for the team and that actually teach the student something about being a resident and not a sponge.

 

[quickjab1212]

Strong foundation of knowledge will help you in obvious ways during rotations (shelf, pimp questions). More importantly it will build confidence (better rapport with the team and attendings) and allow you to focus on other things that will hopefully bump of your eval scores. You can grab coffee with your resident instead of needing extra time on uptodate building a differential for your patient’s hypokalemia.

 

[quickjab1212]

All good advice so far, I'll chime in with how I expect my med students to excel:

I don't really like how the onus is placed on the student to be proactive and involved in what's going on day-to-day. Sometimes the intern doesn't even know, so how can you expect the student to know? I feel like as residents we need to be better in actively including the student in the day-to-day, including the boring stuff like making the list and returning floor pages. Especially on surgical services, it's nice to be in the OR all day as a student but you don't necessarily learn much about that particular specialty unless you see the medical management outside of the OR.

So, as a med student on clerkships, the best thing you can do to stand out is just flat out ask your intern to walk you through a typical day with them. If at all possible (which, if you're on a surgical service, can be difficult at times especially if the clerkship director doesn't want you doing that) I would highly recommend shadowing the intern for the first day so you can see what it is they do and identify areas you can help out in the coming weeks.

For example, ask to hold the pager for a day. I disagree with the general idea (or what was the idea at my training institutions) that med students can learn nothing from returning "nonsense" pages from the floor. Those pages only become nonsense when you're at a point in your training where the question being asked is elementary and you can arrive at the answer in a snap. To a student, there's no such thing as a nonsense page because they're not at a point in their training where they can instantly solve the simplest floor management problem. So when you hold the pager and have to be the one to talk to the nurse, you're already training up your clinical acumen (and of course if it's a question you don't think you can arrive to the answer to on your own, the intern is always a desk or text away).

Another thing I try to get my students to do that is relevant to clinical learning is running the list. Typically you run the the list twice a day: once after rounds in the morning and then again in the afternoon before PM sign out. The AM running of the list is where you make sure orders are put in and consults are called and the night/afternoon running of the list is where you see if what you wanted done that day was actually done. I like when students participate in the running of the list for two reasons: it shows me if they were paying attention on rounds (I'm happy if they can give me all the consults and orders for their 2-3 patients that they carry, ecstatic if they can do that for every patient on the list) and it shows that the student is trying to assume more responsibility, especially if they're writing down stuff for every patient. Running the list is also the perfect time to do some on-the-fly learning, especially if you don't know why a consult is being called or why an order is being put in for X test or Y therapy. Honestly, list running is where you'll learn the bulk of your clinical knowledge.

One more tip before this becomes a novel: if you're on a service that's not terribly busy or you're not in the OR that day, it would help the intern out immensely if you periodically rounded on the patients on your own (one of my most favorite chiefs said that his workflow as an intern was: AM rounds --> consults --> orders --> notes --> mid-morning nurse rounds --> lunch/finish notes --> early PM nurse rounds --> +/- PM chief rounds). I don't think you need to round that often, but a mid-morning round would be beneficial. I don't mean see every patient again, but just walk by their room and talk to their nurse to make sure the orders put in were executed, make sure the consulting team that was called earlier has stopped by (or not), and get an idea from the nurses how the patient is doing. Medicine is a 24/7 enterprise and things are always happening. Often, the intern doesn't have the time to go talk to every nurse so if the student does it and reports back with any major information they'll be contributing a lot to the team.

There's more but to me those three are the most important things a med student can do for the team and that actually teach the student something about being a resident and not a sponge.

This is really helpful!

 

[Qwerty122]

There's a lot of great advice on improving the relationship between the med student and the resident/attending. But I'm curious to get some opinions on how we as med students should act towards other med students rotating with them. Is it just every student kind of does their own thing? Do you stick together throughout the day? Of course you don't want to be a gunner, no one wins from that, but is it your duty to relay everything you learned/have to do to other med students so they can also help out? Or is that unnecessary?

 

[RunsOnCaffeine]

There's a lot of great advice on improving the relationship between the med student and the resident/attending. But I'm curious to get some opinions on how we as med students should act towards other med students rotating with them. Is it just every student kind of does their own thing? Do you stick together throughout the day? Of course you don't want to be a gunner, no one wins from that, but is it your duty to relay everything you learned/have to do to other med students so they can also help out? Or is that unnecessary?

I was super nice to other med students - treated them like my colleagues rather than my competition. Especially during 4th year auditions/clerkships, you never know who you are going to be working with, and I had the mentality of competing against myself rather than other med studs. Residents/staff notice when a med student is out to get someone else and notice when someone is the type of person everyone wants to work with during residency. If I was on a team with other med students, I tried to go hang with them outside of work. Made great friends that way.

That said, you are responsible for yourself and your knowledge, not the other medical students. I policed myself on where I was supposed to be each day and read all the time to prep for cases, clinic and rounds. I had no problem helping students with questions or with their patients, but it definitely isn't your duty to relay everything you learn daily - just isn't practical. That said, if you resident says "be here at 0500 and tell your fellow med studs" and you don't tell anyone so they all look bad by not showing up on time, I would never want to work with you ever.

I think one thing I get asked about a lot is "do you answer questions which another student got asked?". Never answer a question asked to another student, unless you get asked by the resident/attending afterwards. If the student gets it wrong, and they pass the question on to you, that is your time to shine, but if you cut another student off when it wasn't your question, you just come across as a gunner. Now, some people have different thoughts on if a question gets asked to a resident and then passed along to a med student (I hated being in this position). I personally choose to feign knowing the answer so my resident wouldn't look bad UNLESS the attending had already discussed the answer with me previously on the rotation, and then I would phrase it "Ah, I think we discussed it earlier Dr. Blank, then the answer" .

If you are a great medical student, and you are working hard, being nice to everyone, and improving your knowledge, you will stand out without stepping on others.

 

[Matthew9Thirtyfive]

I personally choose to feign knowing the answer so my resident wouldn't look bad UNLESS the attending had already discussed the answer with me previously on the rotation, and then I would phrase it "Ah, I think we discussed it earlier Dr. Blank, then the answer" .

I’m guessing you mean feigning not knowing the answer. But yes, this is what I do too. This has only happened to me like twice so far, and I just said I didn’t know lol. Not about to show up a resident.

 

[Matthew9Thirtyfive]

There's a lot of great advice on improving the relationship between the med student and the resident/attending. But I'm curious to get some opinions on how we as med students should act towards other med students rotating with them. Is it just every student kind of does their own thing? Do you stick together throughout the day? Of course you don't want to be a gunner, no one wins from that, but is it your duty to relay everything you learned/have to do to other med students so they can also help out? Or is that unnecessary?

Depends. Mostly you’re all just doing your own thing. You each have patients you’re carrying, so you’re taking care of the stuff for your patients. There are def times when you’ll be doing stuff together, like rounds and ****, but for the most part you’ll be working in the same area but independently. At least that’s how it’s been for me.

As for how to act toward them, I’m not sure why this even needs to be said, but you act professionally toward everyone. We are all part of a team. Help everyone out. If I finished my clinic for the day, I asked my fellow med studs if I could help them with anything. If I happened to have free time and had rounded on my own patients but they were swamped, sometimes I’d check on theirs and then let them know what was going on so they could have all the info to update the team. Just be a team player.

 

[RunsOnCaffeine]

I’m guessing you mean feigning not knowing the answer. But yes, this is what I do too. This has only happened to me like twice so far, and I just said I didn’t know lol. Not about to show up a resident.

Yes, that's the phrasing I meant