How to Thrive During M3?

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seanth

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15+ Year Member
A lot of us M1s and M2s have heard about how the grades from the preclinical years aren't hugely important. (Of course you do want to get the material down well) But I was wondering if the older students/residents had any advice as to any steps that we can take early in medical school to help us succeed during all-important third year.

Thanks!
 
seanth said:
A lot of us M1s and M2s have heard about how the grades from the preclinical years aren't hugely important. (Of course you do want to get the material down well) But I was wondering if the older students/residents had any advice as to any steps that we can take early in medical school to help us succeed during all-important third year.

Thanks!
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I'm sure you'll get many responses, I'll just throw in some things that I think are helpful to keep in mind.

Remember you're a student and your prime objective is to learn. Instead of nodding off during morning report grab a cup of coffee and pay attention. Any opportunity to learn from a formal lecture is valuable and will translate into a better shelf exam. Now that being said, you must also be responsible about studying. Cramming is difficult during rotations, study a little each night if that works for you. Don't spread yourself too thin, just find one good review book and one good question book. 4th yr students can recommend specifics.

Your responsibility on the ward is suprisingly small as a clerk. Your job is to BE ON TIME, dress appropriately, and not complain. Other than that, you may follow a patient or two, no big deal really. It always looks good to know a thing or two about your patient and the most interesting patients on the ward. Find a review source you find useful, I used uptodate, and familiarize yourself with their illness. If someone asks you to look something up always do it, and prepare a 2 minute talk or whatnot. Avoid being a fly-on-the wall- try to answer 1 or 2 of the attendings questions on rounds or ask an intelligent question. But don't monopolize all the time.

If you're not sure what your ward responsibilities are for the rotation don't afraid to ask the attending, resident or whoever is evaluating you, what you should be doing. I've seen friends get bad clinical evals simply because they were not clear what their job on the team was. My last word of advice is to be kind and respectful to the nursing staff- their job is infinitely more important than a students' and when your a subI you'll need them on your side.
 
Ask your residents what they like students to do in terms of tasks, then look for additional things that are within your power to handle (e.g. - you might write discharge orders or prescriptions and leave your resident the task of signing them. That will eliminate some of their drudgery doing paperwork, plus give you practice getting such things right before you become an intern).

Make lists of patient labs, consults, path reports, etc. to follow up on, and bring them to your team's attention. Also follow trends in daily CBC's and electrolytes for things that need tending to (a K+ of 3.6 is still within normal, but if it was 4.0 yesterday morning you might want to give that person 40 mEq's of KPhos before it gets lower tomorrow). Little things like this are what help show you "know" your patient, more than what their disease is and how to treat it.

Keep an inpatient list, and use it to track room numbers, admission dates, hospital day #, post-op day #, antibiotics day #, current meds, problem lists, pertinent lab results (path, culture results) and significant events. You can do this all on an excel sheet easily. Sites like medfools.com also have scutsheets you can use for each patient that can be used over many days to track labs.

On your inpatient list, make daily task lists for each person. I've seen lots of people do these and make check boxes by the tasks (checking something off is rather empowering!). Residents usually do this for their own tasks, but your tasks may be different than theirs in that it's more scut based. It could be "F/u blood cx", or "update med list" or whatever tasks are in your hands. You can also make a learning point a task, such as "look up chemo regimen for metastatic colon cancer". This keeps you organized.

Know what to keep in your pockets. Tongue depressors on peds, scissors on surgery, always some pharm source, a Maxwell's. If your institution's department's don't do this, a card with important numbers to the various labs, nurses stations, and resident's pager numbers you work with.

Keep a powerbar or two handy, as well as some dollar bills. You'll be glad you have a dense snack to munch or change to grab a coffee or Coke on those quick 5 minutes you have occasionally.

Hope that's some good stuff to start.
 
seanth said:
A lot of us M1s and M2s have heard about how the grades from the preclinical years aren't hugely important. (Of course you do want to get the material down well) But I was wondering if the older students/residents had any advice as to any steps that we can take early in medical school to help us succeed during all-important third year.
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* Don't ever complain.

* Don't ever make excuses.

* Don't ever be late.

* Don't ever lie.

These rules will take you through third year pretty well.
 
How to thrive in 3rd year: befriend the ladies who work in the cafeteria, they are your access to better food.
 
seanth said:
A lot of us M1s and M2s have heard about how the grades from the preclinical years aren't hugely important. (Of course you do want to get the material down well) But I was wondering if the older students/residents had any advice as to any steps that we can take early in medical school to help us succeed during all-important third year.
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Don't be a freakin' weirdo/psycho. Seriously, if you've got a decent head on your shoulders, you WILL make it through m3. It doesn't matter how stupid you feel, if you can carry a civil conversation, have some humility, and behave like a civilized human being, you will do fine third year.

Some students in our school were big fans of trumpeting the old chestnut "lots of people who do well first two years fall on their face third year." And, of course, it didn't happen. But myself, and the majority of our med school easily predicted who would struggle third year based on the people who displayed the bad habits of laziness, haughtiness, and poor interpersonal skills during the first two years.
 
PeepshowJohnny said:
Don't be a freakin' weirdo/psycho. Seriously, if you've got a decent head on your shoulders, you WILL make it through m3. It doesn't matter how stupid you feel, if you can carry a civil conversation, have some humility, and behave like a civilized human being, you will do fine third year.

Some students in our school were big fans of trumpeting the old chestnut "lots of people who do well first two years fall on their face third year." And, of course, it didn't happen. But myself, and the majority of our med school easily predicted who would struggle third year based on the people who displayed the bad habits of laziness, haughtiness, and poor interpersonal skills during the first two years.
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I definitely agree with this. To succeed in MS3, be a good person. Don't be a prick to your classmates, pull your weight, get along with the residents, and you'll be fine. If those are problems for you, you won't do well in third year.
 
How to thrive during 3rd year? Oh hell, no. Your job is to survive it!

Here's how you do it, and enjoy it along the way: 1. Find something you absolutely LOVE doing. 2. Find opportunities to do it. 3. Do it. 4. If anyone gives you hell about doing it, you can either tell them to suck it, or you can relate it back to continuity of patient care and learning experience - and how can anyone dealing with a student argue with continuity of patient care and a learning experience for a student accumulating 40-60K worth of debt a year?

You end up being motivated, learning because you're motivated, helping people out because you're motivated, and doing things you want to be doing instead of sitting around with your thumb up your ass waiting for your resident to page you to go waste your time doing something from which you don't get anything educationally or motivationally.

And hence, you win.
 
smq123 said:
* Don't ever complain.

* Don't ever make excuses.

* Don't ever be late.

* Don't ever lie.

These rules will take you through third year pretty well.
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That first one you really need to keep an eye on, because its a little subtle and can be hard to keep in check. Never EVER whine at the hospital. Not to anybody... not even fellow med students and especially not interns/residents. Everybody gets screwed over every now and then... it happens.

If you absolutely have to vent... hey, thats what SDN is for. 😀

Other rules...

* Don't be lazy.

More importantly * Don't look lazy.

* Don't make the same mistake twice (trying to avoid every mistake is pretty much impossible... most residents realize that M3's will screw up just about everything the first time)
 
Terpskins99 said:
* Don't make the same mistake twice (trying to avoid every mistake is pretty much impossible... most residents realize that M3's will screw up just about everything the first time)
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When you make a mistake, appologize once to anyone from your team who was around for it, knows about it, etc. That means that if you are in the OR and you accidently touch something non-sterile, say in a clear voice, "I'm sorry" then do whatever they tell you to do. If you are rounds, and you mis-state a lab value and someone calls you on it, say "I'm sorry" and move on after they heap abuse on you.

A common problem I see (and used to have) is either (a) not appologizing when you screw up, or (b) appologising over and over. The former makes you look uninterested or uncaring, the latter makes you look like a dork.

One time, clear voice so everyone can hear you, and move on when appropriate.
 
Be very confident, but not cocky. In medical world, being confident is respected more than being correct.

Give the appearance whenever possible that you know what you are doing.

If you don't know what you are doing, appear very eager to learn and thank the person afterward for teaching you something.

Always think of the next step. In patient care. During rounds. For scut work for the day. This is hard to do, but really helps the residents and makes you look forward-thinking, organized and very motivated.

Come prepared, with the right equipment, dressed properly for the particular rotation/clinical environment. On surgery, wear your stethoscope in your pocket, not around your neck, and carry a pen-light, sterile swabs, 4x4, 2x2, scissors, suture removal kit, gloves, and be prepared to hand them to the resident at the appropriate time during rounds.

Be nice and respectful to people, even people who piss you off. This includes all staff, nurses, patients, other med students, your team members, etc. Don't be a gunner; help your fellow classmates.

Ask the resident your first day if you can pick up 1-2 patients. This will make you look like you take initiative and are eager to learn and help the team. Pre-round on them and give an organized and succinct presentation in SOAP format. Try to get through the subjective and objective parts fairly rapidly (don't waste time stuttering), so that you can focus on your stab at the assessment and plan. Even if you are completely wrong about the A/P, it is better to do it and say it confidently. The residents will usually kindly correct you, but they will respect the fact that you are thinking ahead, that you care about the patients, and that you were confident.

Although the subjective evaluation process will no doubt contribute to you becoming more jaded, try to limit this effect and realize that the most important thing is to learn. The more you worry about evals, the more they tend to bite you!

If focused on learning, helping and being respectful, you will do fine.

Hope this helps! 🙂
 
Thank you to all of those who have posted advice! There's a bunch of useful stuff here.

To those who have posted critical comments, I am not a psycho/prick, but I would like to know how I and others can best prepare for what's ahead.

I was also wondering if there were steps that we could take during the first two years to help us perform out best during M3? (perhaps reading medical journals (NEJM) on a weekly basis) While at a free clinic, an attending mentioned that for top students, it's important to be able to integrate information and form a diagnosis and plan. Are there ways we can work developing on these skills as M1s/M2s?
 
seanth said:
To those who have posted critical comments, I am not a psycho/prick, but I would like to know how I and others can best prepare for what's ahead.
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(Sigh). Better reading comprehension skills will help you in third year AND on Step 1. 🙄

If you read carefully, no one called you a psycho OR a prick. They're just succinctly stating the best advice for how to survive third year - try to be a normal, friendly, outgoing person. Don't be weird, don't be idiotic, and don't intentionally screw your classmates over. If you accidentally screw your classmates over, then apologize profusely ASAP.

Again, in case you didn't get it the first time - no one called you a psycho, and no one called you a prick.
 
seanth said:
I was also wondering if there were steps that we could take during the first two years to help us perform out best during M3? (perhaps reading medical journals (NEJM) on a weekly basis) While at a free clinic, an attending mentioned that for top students, it's important to be able to integrate information and form a diagnosis and plan. Are there ways we can work developing on these skills as M1s/M2s?
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For top 4th year students, this seems to be key.

For top 3rd year students, thinking ahead, being prepared, and being a decent person who can make the residents laugh (even if they're cranky and post-call) seem to be much more important. Being useful is the best thing that a third year can be. DON'T BE DEAD WEIGHT.

Reading the NEJM now won't help much - you won't remember it on the floors next year. And I guarantee that you won't remember it when some 6' 3" attending is staring down at you with furrowed eyebrows.
 
smq123 said:
And I guarantee that you won't remember it when some 6' 3" attending is staring down at you with furrowed eyebrows.
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I swear I've yet to work with a doctor over 5'10"

I'm not even that tall and rounds for me feels like freakin' Gullivers Travels as I'm with a team of Lilliputian residents and attending.
 
PeepshowJohnny said:
I swear I've yet to work with a doctor over 5'10"

I'm not even that tall and rounds for me feels like freakin' Gullivers Travels as I'm with a team of Lilliputian residents and attending.
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Consider yourself very lucky. My surgery attending was a pretty tall guy (probably around 6' 2" or so), so I always had to stand on a step stool when I was scrubbed in.

One of the OB/gyn attendings is 6' 4", so I ended up having to stand on TWO step stools when we did a c-section. I felt a little unsteady on that many stools. At least I was better off than the resident, who was on THREE step stools! :laugh:
 
smq123 said:
One of the OB/gyn attendings is 6' 4", so I ended up having to stand on TWO step stools when we did a c-section. I felt a little unsteady on that many stools. At least I was better off than the resident, who was on THREE step stools! :laugh:
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I'm 6'0". In med school, one of my attendings was 4'10".

Try throwing a sub-dermal stitch bent over 90deg at the waist. 😀
 
Sorry if I misinterpreted/over-analyzed some of the negative comments. I apologize.

Thanks for all the replies.
 
Tired said:
I'm 6'0". In med school, one of my attendings was 4'10".

Try throwing a sub-dermal stitch bent over 90deg at the waist. 😀
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Didn't have that problem (fortunately!), but when working with the surgery attending, the circulating nurse insisted that I needed TWO step stools. I told her that one would be fine, but she insisted ... and you know that there's no arguing with the circulating nurse. 😉

As soon as I stepped onto those two stools, I promptly contaminated the light handles with my head. I TOLD her that I only needed one stepstool!

seanth said:
To those who have posted critical comments, I am not a psycho/prick, but I would like to know how I and others can best prepare for what's ahead.
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Do you really want to know how you "can best prepare for what's ahead?" Don't read so much into everything, and don't be so sensitive.

If you mistakenly thought that people on here were calling you a psycho and a prick, wait until you hit your rotations - and the residents are calling you a psycho and a prick in plain, unmistakeable language. Seriously, I have had residents "jokingly" ask me if I was always this stupid, or if today was just an aberration. I have had attendings and residents call med students "a waste of space" - even though I was right there in front of them. I have had attendings who, after 3 weeks, STILL didn't know my name. (They differentiated the med students by physical characteristics - "Tall med student" vs. "Asian med student" vs. "Short caucasian med student") In order to thrive in third year - to answer your original question - you need to have a fairly tough emotional skin.
 
IUSM said:
My school will never get a dime out of me. That leaves twice as much to my undergrad school.
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Amen to this!

If the powers that be were to eliminate 3rd year of med school, I'd bet alumni donations would at least triple! 😉
 
Vader said:
Amen to this!

If the powers that be were to eliminate 3rd year of med school, I'd bet alumni donations would at least triple! 😉
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No, they'd go through the floor -- because you would be incompetent to practice medicine.
 
smq123 said:
Consider yourself very lucky. My surgery attending was a pretty tall guy (probably around 6' 2" or so), so I always had to stand on a step stool when I was scrubbed in.

One of the OB/gyn attendings is 6' 4", so I ended up having to stand on TWO step stools when we did a c-section. I felt a little unsteady on that many stools. At least I was better off than the resident, who was on THREE step stools! :laugh:
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:laugh: I would much rather be on step stools than hunched over every day. At 6' 3'' i wish my attendings were at least 6'0''.

Here's my 3 secrets to the thriving during third year. Work hard and don't let the BS get to you personally, but above all enjoy the time off you get. Honest to god it makes such a difference. Before Christmas break I was cranky, tired and miserable. Over the last week I didn't so much as open a book. I just played, and visited family. I feel infinitely better. I'm ready for the next six months. :hardy:
 
I worry about the "short man syndrome" stigma considering I am 6'0 and female. I have experienced many men who are shorter feeling intimidated by my height. In my family I am the shortest one so it feels odd to me to be considered "amazon like". Is height really an issue on the wards?
 
I'm not sure how much of an issue hieght is during the rotations as opposed to having intelligent, pertinent and non-oppurtunistic comments once in a while! but I gotta say, being a 6' 2" guy myself, I definitely would like a taller lady collegue around in my rotations😉
 
Anka said:
No, they'd go through the floor -- because you would be incompetent to practice medicine.
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That's true. Perhaps I should have suggested just eliminating grades rather than 3rd year completely.

In my case that probably would have eventually enabled me to feel good about donating some cash to my school. As the system at my school stands, however, I cannot in good conscience financially support a highly subjective system that does not reward hard work and dedication to patient care, or that gives equal reward to those who work their behinds off versus those who just squeak by with a pass, or that fires our Dean for no apparent reason!
 
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