how to prepare for medicine sub-i?

[MyNameIsAlex]

hey.... i did my medicine core rotation a year ago, so i don't remember much, havent studied for step 2 yet either.... but i have a medicine SUB-I scheduled very soon.....can anyone give an advice on how to prepare and what to expect?

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[OveractiveBrain]

Being a Sub-I is very much like being a medical student, except with a little more patient load. If you are not prepared, I wouldn't worry about it too much. They wont expect much of you.

If you are prepared, then you can get as much responsibility as an intern. That was exciting.

By now, you should have developed a method for figuring out differentials, be competent in your physical exam, and know the basic starting points for management. You will be looked at to answer the questions the medical students cannot, know a bit more than they do, and be able to manage more patients than the med students. If med students handle 1, you handle 2. If they handle 2, you handle 3.

To prepare, you should have been paying attention to all your other rotations. The fact you haven't studied anything was definitely a poor decision. But if you are a fourth year, all you have to do is pass, since it will not impact your matching prospects.

Of course, the bottom line will be that every Sub-I is dependent on the attending, the program, and the hospital. You should probably skim through Crush (because its easy to get through), or review your notes.

 

[MyNameIsAlex]

ive done well compared to other students in my rotations....

my question is, i dont have that much time to review all of harrisons. crush is one of the worst books ive read unfortunately, too superficial for anything.

my question is this, if i were to review the most encountered cases, would reviewing cards/nephro/gi be sufficient on a general IM floor?

 

[myhandsarecold]

my fourth year told me to just read Pocket Medicine and the ICU Book.

 

[McGillGrad]

1. Realize that the differential and PLAN are your most important duties.

2. Know everything about your patients, which means reading all of their notes and doing a FULL history and physical, even if it has already been done.

3. You have to know the bread & butter cases and their presentations cold before you start. You've already had a full IM rotation, so there is no excuse for blanking on ACS, chest infection or CVA protocols.

4. Just read through Step up to Medicine or do a bunch of Pretest medicine questions. better yet, do the MKSAP questions. They are quick and bread and butter.

 

[ANCAdoc]

A general refresher of common medical diseases should suffice. Read up on COPD, treatment of PNA, CHF, inpatient management of DM, etc. Read up on prevention of contrast induced nephropathy, as some of the patients you see will be high risk.

I'd recommend going to the Annals of Internal Medicine - they publish a series called "In the clinic", and review many of these bread and butter topics.

During the rotation, perform good H&P's and have a plan. It doesn't have to be perfect, because we know it won't be. To have a wrong plan is better than no plan in my book. Give succinct yet thorough presentations to the attending.

Staff really do like it if you go beyond this and show evidence of outside learning. For that patient you are treating with PNA - go to the IDSA guidelines and review treatment guidelines, and share it with the team during rounds. Part of going through training is not only learning, but teaching.

 

[nlax30]

All good advice above. I'd also suggest maybe getting a review book like Step Up to Medicine, seems like a lot of students like that one.

Just be thorough and try to act like you don't have an intern coming behind you, which you may not have if the program has their sub-i report straight to the senior resident. And really I'm referring to things like talking with the case manager re: discharge planning/social issues, discharge paperwork, arranging outpt followup, etc... things that you may or may not have gotten much exposure to during your 3rd year IM months.