How depressed are you supposed to get on MS3 surgery?

[Serous Demilune]

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Does the information you learn on surgery, psych, obgyn translate if you KNOW you wanted to be an internist, for example? I know it's a **** attitude, but is there utility in being the best surgical med student if you won't use 99% of that knowledge again?

Sure, internists see patients with tons of comorbidities that involve nearly every field. Most of these diseases are multisystemic and require lots of different treatments.

 

[SouthernSurgeon]

Does the information you learn on surgery, psych, obgyn translate if you KNOW you wanted to be an internist, for example? I know it's a **** attitude, but is there utility in being the best surgical med student if you won't use 99% of that knowledge again?

There is a LOT to be learned for the future internist on surgery, psych, and OB.

surgery - the pathology overlaps a ton with internal medicine, you're just seeing a different part of the management (e.g. - internists manage Crohn's and UC - but you don't get to see the emergent colectomy for bleeding or the j-pouch).

psych - patients don't check their psych issues at the door when they get admitted for medical problems

OB/gyn - internists deal with a lot of women's health

To say you won't use "99%" of the knowledge again is ridiculous. And that's just the pure knowledge content; to say nothing of learning how other specialties roll and how to interact with others clinically.

 

[SouthernSurgeon]

I don't understand, why would you want to "do ****"? I thought the point of rotations was to get out of them with a good score on the shelf exam while learning the least amount possible?

I really want to get fired up and yell at you over this post...but I just can't muster the strength. I don't understand how someone can be so freaking clueless and completely lack genuine intellectual curiosity/engagement to the degree you do.

 

[circulus vitios]

Wow, you're going to be a pretty useless internist if you don't plan to use 99% of what you learn on surgery, psych, and OB. If your patients are pregnant, you just plan to treat their medical condition, pregnancy be damned? To think you won't see psych patients is extremely naive. And as for surgery, whether you do inpatient or outpatient IM, you need to have a good grasp of the indications for the most common surgical procedures. How else will you know whether or not to refer your patient to a surgeon/consult surgery?

If it's important, won't it be reinforced in residency?

 

[DermViser]

Does the information you learn on surgery, psych, obgyn translate if you KNOW you wanted to be an internist, for example? I know it's a **** attitude, but is there utility in being the best surgical med student if you won't use 99% of that knowledge again?

If you think as a General Internist, that you will not have to deal with patients that fit into the OB-Gyn, Psych, Surgery categories then you are greatly mistaken. Patients don't come into the ER with differentiated medical problems with labels saying which service they need to go to.

For example on Surgery, a med student going into IM needs to know when a problem is a medical problem and when in fact, it's a surgical problem. This will help him when he's calling a consult to the Surgery resident as an intern, to evaluate a patient with acute abdomen.

 

[DermViser]

If it's important, won't it be reinforced in residency?

Your residency is not going to spoonfeed you.

The MS-3 clerkships all interconnect in some way: Psych--IM--Surgery--OB-Gyn (Peds is separate as they are usually in children's hospitals). Notice that even specialties like Urology, Ortho, Plastics, ENT, etc. all have you do General Surgery years.

Even some of the more ancillary residencies: Rad Onc, Derm, Anethesia, Radiology, Pathology, have some connection with MS-3 specialties, although not as great depending on the specialty, in question.

 

[Mass Effect]

If it's important, won't it be reinforced in residency?

Residency is not a repeat of your core rotations. If you're putting all your pregnant patients on Bactrim for UTIs because you didn't do an OB rotation in residency or if you're putting a depressed patient who's on an MAOi on linezolid because you didn't do another psych rotation, you're in trouble.

 

[circulus vitios]

Your residency is not going to spoonfeed you.

The MS-3 clerkships all interconnect in some way: Psych--IM--Surgery--OB-Gyn (Peds is separate as they are usually in children's hospitals). Notice that even specialties like Urology, Ortho, Plastics, ENT, etc. all have you do General Surgery years.

Even some of the more ancillary residencies: Rad Onc, Derm, Anethesia, Radiology, Pathology, have some connection with MS-3 specialties, although not as great depending on the specialty, in question.

If our medical education system truly places importance on the information learned during MS3, that's pretty ****ing scary. I mean how many people game MS3 and only concentrate on wrecking the shelfs? How many medical students really try their hardest on psych and OB GYN rotations?

 

[DermViser]

Psychiatrists have patients' lives in their hands. Check out the toxicity, black box warnings, and interactions on some of those psych drugs sometime.



Actually, he never said acutely and I wouldn't have assumed that from his post. Wordead was absolutely correct. It's an absurd assertion that you're not supposed to learn anything third year as people's lives WILL be in your hand -- both acute and non-acute. Makes no difference.



Wow, you're going to be a pretty useless internist if you don't plan to use 99% of what you learn on surgery, psych, and OB. If your patients are pregnant, you just plan to treat their medical condition, pregnancy be damned? To think you won't see psych patients is extremely naive. And as for surgery, whether you do inpatient or outpatient IM, you need to have a good grasp of the indications for the most common surgical procedures. How else will you know whether or not to refer your patient to a surgeon/consult surgery?

I was referring to what Serous Demilune said and assumed differently than you did with respect to what he was referring to, giving him the benefit of the doubt.

Also with respect to seeing pregnant patients, usually they're on the OB-Gyn service and IM sees them as a consult.

 

[Mass Effect]

I was referring to what Serous Demilune said and assumed differently than you did with respect to what he was referring to, giving him the benefit of the doubt.

Also with respect to seeing pregnant patients, usually they're on the OB-Gyn service and IM sees them as a consult.

Not at my hospital, unless they're close to term or the problem is OB/Gyn related. Also, you have to consider that the poster might be doing outpatient IM, in which he'll see many, many pregnant patients, even if he isn't the one taking care of the pregnancy. It's all connected.

 

[DermViser]

If our medical education system truly places importance on the information learned during MS3, that's pretty ******* scary. I mean how many people game MS3 and only concentrate on wrecking the shelfs? How many medical students really try their hardest on psych and OB GYN rotations?

Happens all the time. If you see posts early on when SDN started, that are tons of posts of people who were pissed about their overall clerkship grades, and released the pedal a bit when it came to wrecking clinical evals, and hit it hard on acing the shelf and started getting "Honors". It depends on the school of course, but MS-3 clerkship grades can definitely be gamed well.

 

[DermViser]

Not at my hospital, unless they're close to term or the problem is OB/Gyn related. Also, you have to consider that the poster might be doing outpatient IM, in which he'll see many, many pregnant patients, even if he isn't the one taking care of the pregnancy. It's all connected.

I was referring to inpatient, as that is what most of residency is in IM. But yes, a patient that is not actively in labor who is seeing an IM doc as an outpatient, that is correct. The relatively frequency (many, many) won't be high but there will be some exposure.

Of course, IM, unfortunately, tends to be a major dumping ground for all other specialties.

 

[Mass Effect]

I was referring to inpatient, as that is what most of residency is in IM. But yes, a patient that is not actively in labor who is seeing an IM doc as an outpatient, that is correct. The relatively frequency (many, many) won't be high but there will be some exposure

Even inpatient, he will be treating pregnant women for medical problems. Again, at my hospital, unless the woman is at term or the problem is with the pregnancy, IM is the primary.

 

[DermViser]

Even inpatient, he will be treating pregnant women for medical problems. Again, at my hospital, unless the woman is at term or the problem is with the pregnancy, IM is the primary.

Must be your hospital. If there is any question that the fetus might be in danger (and the threshhold is quite low here), the woman is sent straight to OB-Gyn for monitoring. IM attendings don't want to take the fall for OB-Gyn knowledge and standard of care that they forgot long ago.

 

[DermViser]

I really want to get fired up and yell at you over this post...but I just can't muster the strength. I don't understand how someone can be so freaking clueless and completely lack genuine intellectual curiosity/engagement to the degree you do.

I think he's more seeing things as very black-and-white. MCAT score is indicative of how good of a medical student you will be (it isn't). USMLE score and NBME shelf exam scores are indicative of how good of a resident you will be (they aren't). Very black-and white thinking. Not surprising as that is how the system has been built from the ground up.

Students have a hard time understanding that evaluation of competency of a medical student during MS-3 is multidimensional. That's why there are schools that not only do NBME shelf + clinical evals, but also have you do an OSCE, turn in patient logs and procedure logs, turn in a patient H&P for grading, etc. I think of it as seeing a specimen under different powers on a microscope. Too frequently, esp. on SDN, students perseverate on the multiple choice examinations as an all-encompassing biomarker for medical student competence, when they really aren't.

 

[SouthernSurgeon]

I think he's more seeing things as very black-and-white. MCAT score is indicative of how good of a medical student you will be (it isn't). USMLE score and NBME shelf exam scores are indicative of how good of a resident you will be (they aren't). Very black-and white thinking. Not surprising as that is how the system has been built from the ground up.

Students have a hard time understanding that evaluation of competency of a medical student during MS-3 is multidimensional. That's why there are schools that not only do NBME shelf + clinical evals, but also have you do an OSCE, turn in patient logs and procedure logs, turn in a patient H&P for grading, etc. I think of it as seeing a specimen under different powers on a microscope. Too frequently, esp. on SDN, students perseverate on the multiple choice examinations as an all-encompassing biomarker for medical student competence, when they really aren't.

My issue was his use of the word "goal". The goal of third year is to learn as much clinical medicine as you can. Grades are a pragmatic goal but they are not the reason we do this.

 

[DermViser]

My issue was his use of the word "goal". The goal of third year is to learn as much clinical medicine as you can. Grades are a pragmatic goal but they are not the reason we do this.

Well, naturally as a resident you can say that (I agree). Unfortunately, MS-3s look at things through a "Me! Me! Me!" prism so the goal is to get "Honors" on that transcript even though it doesn't mean **** (i.e. asking the clerkship coordinator to place you with an attending who happens to be an easy grader, being placed at a clerkship site in which you don't do much and get loads of time to study for the shelf, telling the attending/resident that you wish to go into their specialty when you don't, etc.) for the purposes of the match. That "H" means everything to an MS-3.

It isn't until internship year, that the "Oh ****! What have I done?", from gaming the system, comes to pass, when the buck starts with you.

 

[SouthernSurgeon]

Well, naturally as a resident you can say that (I agree). Unfortunately, MS-3s look at things through a "Me! Me! Me!" prism so the goal is to get "Honors" on that transcript even though it doesn't mean **** (i.e. asking the clerkship coordinator to place you with an attending who happens to be an easy grader, being placed at a clerkship site in which you don't do much and get loads of time to study for the shelf, telling the attending/resident that you wish to go into their specialty when you don't, etc.) for the purposes of the match. That "H" means everything to an MS-3.

It isn't until internship year, that the "Oh ****! What have I done?", from gaming the system, comes to pass, when the buck starts with you.

Right...but ark went so far as to say he thought the goal was to learn as little as possible.

The vast majority of students I've worked with, gunnerish tendencies or lazy tendencies or what have you, are at least intellectually curious at the heart of it all. Ark is seemingly completely missing that and it always surprises me a little when he expresses it

 

[Arkangeloid]

Will respond to southernIM later, but I had a question. My research prof is making me get up early to go to see something called a "grand round." wtf is that and what am I supposed to do?

 

[DermViser]

Right...but ark went so far as to say he thought the goal was to learn as little as possible.

The vast majority of students I've worked with, gunnerish tendencies or lazy tendencies or what have you, are at least intellectually curious at the heart of it all. Ark is seemingly completely missing that and it always surprises me a little when he expresses it

I agree. Ideally, you should at least be interested intellectually in the material. Although sometimes, sleep deprivation/hunger etc. can mess with that a little.

It runs the gamut between gunning for a non-MS-3 clerkship residency (to where amassing Honors is critical) vs. the lazy ("I'm not going into your specialty so I could care less"). At some point during medical school, the "I just want to get thru this and over with" mode of thinking sets in for some.

 

[DermViser]

Will respond to southernIM later, but I had a question. My research prof is making me get up early to go to seething called a "grand round." wtf is that and what am I supposed to do?

http://en.wikipedia.org/wiki/Grand_rounds

Probably just wants you to attend, from an educational perspective, to learn something as part of your education. Spoiler alert: It's not going to be on Step 1, but it will contribute to your education in some way.

 

[DermViser]

My issue was his use of the word "goal". The goal of third year is to learn as much clinical medicine as you can. Grades are a pragmatic goal but they are not the reason we do this.

Oh you surgeons and your ridiculously high expectations for medical students. (joking)

 

[Arkangeloid]

Right...but ark went so far as to say he thought the goal was to learn as little as possible.

The vast majority of students I've worked with, gunnerish tendencies or lazy tendencies or what have you, are at least intellectually curious at the heart of it all. Ark is seemingly completely missing that and it always surprises me a little when he expresses it

I think I was intellectually curious until MS-1 drove it out of me with its focus on rote memorizing sheer amounts of crap. Coming from an undergraduate background where I was encouraged to read, write, explore, synthesize, and express myself, med school's focus on stuffing "high yield" topics into my head was anathema.

I mean, I got over it, but that doesn't mean I enjoy this stuff.


Who knows though, maybe I'll find a specialty I like.

 

[xffan624]

I think I was intellectually curious until MS-1 drove it out of me with its focus on rote memorizing sheer amounts of crap. Coming from an undergraduate background where I was encouraged to read, write, explore, synthesize, and express myself, med school's focus on stuffing "high yield" topics into my head was anathema.

I mean, I got over it, but that doesn't mean I enjoy this stuff.


Who knows though, maybe I'll find a specialty I like.

If you approach your rotations with the attitude of doing well on shelfs and doing as little as possible, then it's unlikely you'll find anything you like. Maybe it's the curriculum and true P/F environment I'm in, but I'm still happy and intellectually curious even towards things that are not in my planned specialty path. I also didn't choose to go to medical school to bring honor to my family, attract a good mate, and procreate.

 

[DermViser]

I think I was intellectually curious until MS-1 drove it out of me with its focus on rote memorizing sheer amounts of crap. Coming from an undergraduate background where I was encouraged to read, write, explore, synthesize, and express myself, med school's focus on stuffing "high yield" topics into my head was anathema.

I mean, I got over it, but that doesn't mean I enjoy this stuff. Who knows though, maybe I'll find a specialty I like.

Medical school education and the way it's structured is not Medicine. When you professionalize any field, there are a lot of hoops that you have to jump thru. Schooling has never been equivalent to real practice of the field in any occupation.

What makes the studying semi-bearable is that information is supposed to be interesting (although not all parts equally) and will be used when you least expect it. As a student, you don't have enough gravitas to decide what's "high-yield" and what's rote minutiae for your medical education. For example, for an ENT doc - Head and Neck anatomy is very important. You may not appreciate it, but the point is to appreciate why doctors in certain fields would need to know that information.

The job of your medical school is not to solely prepare you for a standardized multiple choice exam. If you want that - go to a Carribean school that builds it's education around that. Letting an exam or block get you down bc you expected medical school to be the key to happiness, your golden ticket to riches, and would be running through daisies is more a need to recalibrate your own expectations to real life. This would have happened to you regardless of the field you chose. Medicine is not going to fill any void or unhappiness that you had prior to entering medicine. It's not going to substitute for other things.

 

[Kaustikos]

I don't understand, why would you want to "do ****"? I thought the point of rotations was to get out of them with a good score on the shelf exam while learning the least amount possible?

I don't learn from my shelf exams, honestly. They honestly make me lazier in the hospital because I'm like "where's the pathomnemonic or clue?" Just kidding, but not really. I'm not looking to get honors on these exams because these exams don't translate well for me in the hospital/patient care. It's ultimately more important to know guidelines/procedures/treatments/protocols during third year. I do study for shelf exams - on my own time. But that only takes you so far when you're involved in patient care. Doing great on shelf exams, for me, involves more about cramming all information and ultimately forgetting it like I did for MS1/MS2. I learned that it's better to be comfortable with the knowledge and applying it.

Plus - most people who get AOA in my class are going for fields with the least amount of work/work hours and not about patient care. That's not me.

 

[Kaustikos]

I think I was intellectually curious until MS-1 drove it out of me with its focus on rote memorizing sheer amounts of crap. Coming from an undergraduate background where I was encouraged to read, write, explore, synthesize, and express myself, med school's focus on stuffing "high yield" topics into my head was anathema.

I mean, I got over it, but that doesn't mean I enjoy this stuff.


Who knows though, maybe I'll find a specialty I like.

Okay...
MS1/MS2 =/= MS3/MS4. You're learning as much information as possible for one exam. Then you start third year and learn how you apply the knowledge. There is a point to those first two years and it's making you comfortable enough with diseases that you don't have an issue taking it to the next level - Assessment and Plan.

 

[DermViser]

I don't learn from my shelf exams, honestly. They honestly make me lazier in the hospital because I'm like "where's the pathomnemonic or clue?" Just kidding, but not really. I'm not looking to get honors on these exams because these exams don't translate well for me in the hospital/patient care. It's ultimately more important to know guidelines/procedures/treatments/protocols during third year. I do study for shelf exams - on my own time. But that only takes you so far when you're involved in patient care. Doing great on shelf exams, for me, involves more about cramming all information and ultimately forgetting it like I did for MS1/MS2. I learned that it's better to be comfortable with the knowledge and applying it.

Plus - most people who get AOA in my class are going for fields with the least amount of work/work hours and not about patient care. That's not me.

The shelf exams are not meant to reproduce things in your clerkship. They are a standardization tool for clerkships, when much of your assessment is subjective. It contributes to the whole picture. The same way USMLE scores are not your entire application.

Also your last sentence is more a medical student generation shift more than anything else. I think this more has to do with certain specialties having more regulatory BS than others.

 

[DermViser]

Okay...
MS1/MS2 =/= MS3/MS4. You're learning as much information as possible for one exam. Then you start third year and learn how you apply the knowledge. There is a point to those first two years and it's making you comfortable enough with diseases that you don't have an issue taking it to the next level - Assessment and Plan.

I agree. Basic sciences is more the minimum information you need to have. For example, if you don't understand Crohn's Disease/Ulcerative colitis -- then you'll have a harder time, when it comes to clinical guidelines, connecting it to assessment and plan, etc.

 

[Kahreek]

I agree. Basic sciences is more the minimum information you need to have. For example, if you don't understand Crohn's Disease/Ulcerative colitis -- then you'll have a harder time, when it comes to clinical guidelines, connecting it to assessment and plan, etc.

but dermviser, no one understands inflammatory bowel diseases.

 

[DermViser]

but dermviser, no one understands inflammatory bowel diseases.

I'm saying our understanding of the pathology of those disease as we know of them now. There is no disease that we understand fully in and out, case closed. That's why there is constant research.

 

[username456789]

Plus - most people who get AOA in my class are going for fields with the least amount of work/work hours and not about patient care. That's not me.

lolwut

 

[DermViser]

lolwut

Feel the love.

 

[neusu]

Absolutely. For instance, one of the most important things an internist can learn is who to consult when, and why.

Knowing how other specialties function (not to mention the obvious crossover between medicine and nearly every other field) is vital to an internal medicine physician's training and practice.

They should teach this to the EM guys.

 

[DermViser]

They should teach this to the EM guys.

It wouldn't matter bc when someone needs to be admitted they don't actually care WHO takes them. As long as they take them before they get off shift.

 

[Psai]

It wouldn't matter bc when someone needs to be admitted they don't actually care WHO takes them. As long as they take them before they get off shift.

Let's not throw stones, they have a difficult job to do and have to deal with a lot of bs from many different sides.

 

[DermViser]

Let's not throw stones, they have a difficult job to do and have to deal with a lot of bs from many different sides.

I didn't say their job isn't difficult. It is. That being said, when they make the decision to admit a patient, they don't care who they admit to, as long as someone picks the patient up. That's not false.

 

[Dave89]

Easy to **** on people from the depths of anonymity, hard to stick your neck out there in an attempt to be helpful. Whatever makes you feel better about yourself, bud.

I found your video very informative and helpful when applying/preparing to apply.