How well does M1-M2 prepare you for M3?

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Jabbed

Jabbed

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I'm expecting the learning curve to be steep with clinical skills (i.e. H&Ps, plans and assessments, notes), but does the actual pre-clinical knowledge base (not necessarily the study skills/habits) play any significant role in your day-to-day as an M3 and beyond?
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I feel like I'm learning something totally different. Things in textbooks don't look like things in real life. It's helpful to have the early years, but there's so much to learn. Fortunately, we can make our own curriculum by choosing our resources
 
Depends on your school. We have a doctoring course every other week throughout M1/M2 where we learn and execute history taking/physical exam maneuvers on standardized patients. We then type up a SOAP note documenting the encounter, plan, etc. All of this is timed and we have individual faculty mentors that observe us via video recording and provide us with immediate feedback and instruction. We also present the patients to our faculty preceptors like we would our attending. My understanding is that we crush it during rotations as a result. We have OSCEs periodically during the first two years as well.

For example, we are in our Neuromusculoskeletal block right now, so we've learned the physical exam maneuvers related to NMS. Our SP encounter this week will feature someone coming in with hip pain, so we'll have to examine the Hip, L spine, take a comprehensive history, present it, document it, etc.

As to the clinical knowledge, I can't speak much to that as I'm still a first year.😛
 
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Third year is completely different from the pre-clinical years. Most of the information you learn in the pre-clinical years is useless for the practice of clinical medicine. I remember rounding on medicine in July of 3rd year, and being completely overwhelmed by my patient assigned to me with a GI bleed. Somehow memorizing all the layers of the GI tract for anatomy did not help me present a plausible plan to my attending. It's about integrating tidbits you've learned during the pre-clinical years with new, clinically relevant info. Remembering that most GI bleeds are upper vs lower, the mechanism of a PPI, that table comparing the different types of shock...and then integrating with the algorithm of determining where the bleed is coming from, how to call a GI consult, etc...
 
TheLionheart said:
Depends on your school. We have a doctoring course every other week throughout M1/M2 where we learn and execute history taking/physical exam maneuvers on standardized patients. We then type up a SOAP note documenting the encounter, plan, etc. All of this is timed and we have individual faculty mentors that observe us via video recording and provide us with immediate feedback and instruction. We also present the patients to our faculty preceptors like we would our attending. My understanding is that we crush it during rotations as a result. We have OSCEs periodically during the first two years as well.

For example, we are in our Neuromusculoskeletal block right now, so we've learned the physical exam maneuvers related to NMS. Our SP encounter this week will feature someone coming in with hip pain, so we'll have to examine the Hip, L spine, take a comprehensive history, present it, document it, etc.

As to the clinical knowledge, I can't speak much to that as I'm still a first year.😛
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Your school is very good
 
The information is more or less helpful depending on the rotation. If you do well in the first two years and on step 1 you might be better prepared for some of the pimp questions on medicine. OB barely gets taught the first two years so it's pretty much all new and most of what you learned before is useless with the exception of preeclampsia, HELLP, and some tumors you learn in path. Largely, though, OB is its own game.

As far as helping you with the material realities of the hospital, unless your school makes you track down unresponsive people's families and send faxes during the first two years . . . no preparation at all.
 
This is going to be very school dependent. Med school should prepare you for both boards and wards, but a common meme I hear from own own OMSIII and IVs is that they sometimes rotate with MD students from some Big Name schools, and said while students can rattle off every detail about metabolic acidosis, they do not know how to touch or talk to patients. So, as if life, things will vary.

If your school is serious about your Clinical Medicine courses (the doing part of Medicine), you'll be fine.


Jabbed said:
I'm expecting the learning curve to be steep with clinical skills (i.e. H&Ps, plans and assessments, notes), but does the actual pre-clinical knowledge base (not necessarily the study skills/habits) play any significant role in your day-to-day as an M3 and beyond?
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As someone from a bigger name MD school, the above works both ways. I personally think interaction with patients largely varies by the individual, not by the school (although preclinical curriculum can have effects here as well, as some of you have noted).

What I would have to say is that I have found my grades in first and second year did not correlate or predict my grades in third year. There's a lot of subtleties of different curricula that play a role such as grading and time constraints. I have a good friend at a different school that did IM at the same time as me. I worked 75-80 hr weeks on average plus additional quizzes, assignments, etc. He worked anywhere from 35-50 hours a week with very few additional assignments and had lots of study time. At his school their grade was 100% shelf score, at mine shelf was worth less than 30%, with most of our grade coming from clinical evals. So how that transition goes and how predictive preclinical years are of clinical years will depend greatly on your curriculum.

How good you are with people is huge in your 3rd year transition too. Some of the more awkward 250+ step students start getting outshined by people that can just hold a normal conversation.
 
skipdivided said:
As someone from a bigger name MD school, the above works both ways. I personally think interaction with patients largely varies by the individual, not by the school (although preclinical curriculum can have effects here as well, as some of you have noted).

What I would have to say is that I have found my grades in first and second year did not correlate or predict my grades in third year. There's a lot of subtleties of different curricula that play a role such as grading and time constraints. I have a good friend at a different school that did IM at the same time as me. I worked 75-80 hr weeks on average plus additional quizzes, assignments, etc. He worked anywhere from 35-50 hours a week with very few additional assignments and had lots of study time. At his school their grade was 100% shelf score, at mine shelf was worth less than 30%, with most of our grade coming from clinical evals. So how that transition goes and how predictive preclinical years are of clinical years will depend greatly on your curriculum.

How good you are with people is huge in your 3rd year transition too. Some of the more awkward 250+ step students start getting outshined by people that can just hold a normal conversation.
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Their rotations are 100% shelf scores??? Is that for every rotation? That's crazy, I've never heard of that...
 
Goro said:
MD students from some Big Name schools, and said while students can rattle off every detail about metabolic acidosis, they do not know how to touch or talk to patients.
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I'm fine with talking to patients... I can't talk to anyone who isn't a med student, doctor, professor, research related, or out side of medical field anymore.

I'm sitting with my friend from college. I didn't know how to initiate small talk past the "Tell me about how things are going..." followed by "oh that sounds stressful, how are you coping?" or "oh you have a stomach ache? I'm sorry to hear that. Have you been taking NSAIDs? Is it better or worse with eating?"

:O
 
First and second year prepare you for 3rd year about as well as a Master's Degree in Accounting prepares you to work as a supermarket cashier. You understand that inventory is going down, cash is going up, the effect on shareholder equity and the income statement. Tax is added to the bill but does not contribute to revenue. Making change is a trivial exercise. But why does every single other ****ing person know that the PLU code for bananas is 4011 except you? Why the **** didn't they teach you the common PLU codes? And what in God's name do you do when you run out of singles? AHHH!!! I'm out of singles!
 
Psai said:
Your school is very good
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I've had a similar experience to this. it's pretty great, and believe it or not some students complain about it because it "takes away from our study time" for other classes, which is just ABSURD. this is why I came to medical school.

but yeah at this point I can do a basic "complete" medical history and physical exam, though of course as a first year I have no context for many of these maneuvers yet lol. none the less I have gained a bunch of clinical skills in the first few months and have a preceptor physician I go to in order to practice these things and see real patients. it's been great
 
DoctorLacrosse said:
I've had a similar experience to this. it's pretty great, and believe it or not some students complain about it because it "takes away from our study time" for other classes, which is just ABSURD. this is why I came to medical school.

but yeah at this point I can do a basic "complete" medical history and physical exam, though of course as a first year I have no context for many of these maneuvers yet lol. none the less I have gained a bunch of clinical skills in the first few months and have a preceptor physician I go to in order to practice these things and see real patients. it's been great
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I am in exactly the same situation
 
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I followed the advice given to me by upperclassmen and took time second year to prepare on presenting, soap and H&P. It seemed like a good idea as I went into family medicine more comfortably. I wasn't perfect but at least I was familiar with it.

Sent from my 0PJA2 using Tapatalk
 
Hopefully your physical exam and basic interviewing are decent by ms3.

The rest of everything... emr's, ddx, presentation skills, "swallowing problems, let's call speech" (speech? But they can talk just fine.) ...Yeah, not so much help from ms1/ms2.
 
When I was a scribe on the ER, I got a chance to call three consults: one to neph for hyperkalemia in ESRD, and two to GI, both choleithiasis stuff for ERCP. Those two were fun because the GI on call was my personal GI who helped manage my UC.
 
What about the medical knowledge learned / gained from M1-M2? How helpful is that for third year / shelfs?
 
Obviously the material you learn from M1/M2 has some bearing on your ability to learn in M3, but the pre-clinical and clinical experiences are really two different beasts. During the pre-clinical years, you take in a lot of book knowledge and you know a lot about a lot but it's unlikely that when you go out to the wards that you'll have the faintest idea of how to manage a patient and do the day-to-day work of being a doctor.

Prior to getting out on the wards, I think you should do everything you can to prepare yourself to take a competent history and doing a quality, complete physical exam. Beyond that, you should learn as much as you can but understand that your "book knowledge" and what is actually done in real life is likely to be different. That's ok, though, because that's the entire point of having an apprenticeship model for medical training. You'll pick up the important bits as you go through your rotations in addition to your own reading/learning, and by the end of it you'll be pretty surprised at how much you've learned.
 
TheLionheart said:
Depends on your school. We have a doctoring course every other week throughout M1/M2 where we learn and execute history taking/physical exam maneuvers on standardized patients. We then type up a SOAP note documenting the encounter, plan, etc. All of this is timed and we have individual faculty mentors that observe us via video recording and provide us with immediate feedback and instruction. We also present the patients to our faculty preceptors like we would our attending. My understanding is that we crush it during rotations as a result. We have OSCEs periodically during the first two years as well.

For example, we are in our Neuromusculoskeletal block right now, so we've learned the physical exam maneuvers related to NMS. Our SP encounter this week will feature someone coming in with hip pain, so we'll have to examine the Hip, L spine, take a comprehensive history, present it, document it, etc.

As to the clinical knowledge, I can't speak much to that as I'm still a first year.😛
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We had all that too at my school, and the transition to third year was still terrible and we all sucked.
 
Honestly, my PhD and my years in a sorority prepared me better for MS3 than my pre-clinical years.

Pre-clinical education can help you arrive at a differential diagnosis and come up with a treatment plan if you really understand all those facts you've been stuffing into your brain...but in my experience most of your grade as an MS3/4 is based on how you interact with people and how clearly you communicate. Those are things you usually pick up from other facets of life.
 
mymembernames said:
What about the medical knowledge learned / gained from M1-M2? How helpful is that for third year / shelfs?
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As others have alluded to, the medical knowledge from M1-M2 is huge for shelves (not just the medicine one), but won't help you too terribly much eval-wise unless you get attendings/residents that actually assess your knowledge. Unfortunately it does seem like most of your clinical evals are based more on how happy your resident is the day they fill out your form than how much you know or have learned during the rotation.

However, if we step away from the myopic view of grades being the only thing that matter, then that M1-M2 foundation of medical knowledge is fundamental to how much you get out of third year. If you are struggling to reteach yourself all the basic fundamental pathology of diseases that you've already learned, you are going to have a harder time picking up all the new clinical applications of that knowledge third year. If you don't know the basic presentation of the different types of gallbladder pathologies and how to diagnose them (M1-2 material), then you have to learn that + how to work up and treat them as a third year, while someone who had a better foundation from M1-2 can go more in depth into learning the management of the disease (which is in my opinion, what separates third year material from the preclinical material). Now, on top of all that, you are learning to function in a hospital, see patients, take h and ps, see consults, round, preround, function in an operating room, see patients in a clinic, write notes... and it can easily get overwhelming and very difficult to learn extra material you missed that you should have picked up from preclinicals.

I took the time to write this out because it seems like a common theme on SDN is the idea that preclinicals don't matter, its all about step 1, why are the first 2 years so useless, I'll just coast then buckle down for step 1 etc. And I think in all the focus about residency applications, step 1, etc that the true purpose of the first two years gets taught in the shuffle. It is to learn basic medical physiology/pathology/pharmacology, and is incredibly important not only for third year but for the rest of your career as a physician. Take it seriously and learn the material as well as you can. You will never regret that.
 
M1/M2 and how well you did on step 1 seem to correlate well with shelf performance and overall performance at my school, probably because it is basically a reflection of work ethic. I have yet to meet the awkward 250+ who just falls apart in social situations or the <220 who just shows up and rocks the socks off of 3rd year. Most of the people I know who test well are also very nice people -- sure, some are more on the introverted side, but overall they continue to honor 3rd year. All the clerkships at my school are weighted about 70% clinical and 30% shelf for grading (with some variation in each clerkship) but the shelf still seems to be quite influential on your overall grade. This is probably because, unless you have a preceptor only rotation (like FM), most of the clerkships have so many residents and attendings evaluating a student that we all seem to just average out around a 4/5. Unless you do something really bad or really impressive, you're grade will probably be determined by the shelf. Anyone who tells you that step 1 and the first two years are just a bunch of minutiae you'll never need again is a liar. They will help a great deal with shelf exams and it sure is nice to be hoping to be pimped rather than dreading it. I agree, however, that it does not really help with practical patient management and I still feel like an idiot all the time in that realm.
 
The preclinical years have very little in common with the clinical years, apart from the fact that good performance on all those multiple choice tests generally predicts fairly well performance on shelf exams, in-house quizzes (if present), etc. Answering a question with the (most correct) answer right in front of you as one of the options is quite different from thinking of a coherent plan or presenting a surgery patient in 45 seconds while the chief resident glares at you.

And while I don't snoop around WRT my classmates' grades (clinical or preclinical), I am unaware of anyone who rocked M1/M2 and found themselves getting Low Passes (or even Passes) on clinical evals. For the most part, residents are reluctant to give anything below a HP, and it ought not to be all that difficult to play the game around attendings you see an hour or so a day.
 
Hangry said:
As others have alluded to, the medical knowledge from M1-M2 is huge for shelves (not just the medicine one), but won't help you too terribly much eval-wise unless you get attendings/residents that actually assess your knowledge. Unfortunately it does seem like most of your clinical evals are based more on how happy your resident is the day they fill out your form than how much you know or have learned during the rotation.
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I can't speak for all residents, obviously, but when I do evaluate med students (rarely) my gestalt impression is based on, in this order:

- Your ability to know as much as you possibly can about your patients
- Your ability to succinctly present patients on rounds
- Your ability to take in feedback and implement it immediately
- Your interest in learning (I don't expect you to be falsely enthusiastic, but I do expect you to be willing to learn - even if you're not going to be a psychiatrist, neurologist, etc.)
- Your willingness to help the team when asked - on a busy rotation medical students are actually extremely helpful even if you feel like you aren't and you can be a huge asset to your busy interns and residents
- Your personality and how you "gel" with the team

I "pimp" med students but I don't really care whether they get the answers right or wrong and it doesn't change what I think about a student unless they're completely lacking basic knowledge (taking a history, doing a physical). My goal in pimping is to see where your knowledge base is and provide you with useful tidbits that you'll hopefully remember as a (whatever specialist). You have a shelf that will assess your knowledge in greater detail than I could. When I work with med students, I'm more interested in how you well you work and how much you're able to absorb over the rotation. How much I like you is literally the last thing that I care about. I've worked with students that I don't find particularly personable or that I don't get along with all that well but they were still outstanding students because they were invested in their education, they helped out the team, and they were able to accept feedback and incorporate it into their practice.
 
lmn said:
Their rotations are 100% shelf scores??? Is that for every rotation? That's crazy, I've never heard of that...
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My school is actually the same way, which I find a little frustrating. The school also doesn't have a single hospital for M3/M4, so I assume it's our schools way of standardizing grades for everyone.
 
Stagg737 said:
My school is actually the same way, which I find a little frustrating. The school also doesn't have a single hospital for M3/M4, so I assume it's our schools way of standardizing grades for everyone.
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I'm pretty sure that's the norm rather than the exception, but most places (as far as I know) still don't make the rotation 100% shelf scores. That would be a strange justification by your school for that grading scheme.
 
Hangry said:
I'm pretty sure that's the norm rather than the exception, but most places (as far as I know) still don't make the rotation 100% shelf scores. That would be a strange justification by your school for that grading scheme.
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All of our rotations had convoluted grading schemes but for all practical purposes the primary determinant was your shelf scores. Even though the shelf score nominally contributed no more than a third to your final grade (with most rotations less than that), most everyone did well clinically. I suppose it's possible that a student did extremely poorly on clinical evaluations which kept them from getting honors despite acing the shelf but I never heard of it.
 
Jabbed said:
I'm expecting the learning curve to be steep with clinical skills (i.e. H&Ps, plans and assessments, notes), but does the actual pre-clinical knowledge base (not necessarily the study skills/habits) play any significant role in your day-to-day as an M3 and beyond?
Click to expand...
Really depends on the school.
For my school it did not prepare you at all.
Most of my class couldn't give a presentation that made sense halfway through 3rd year. Most cant do basic physical exam stuff.

Should be something the LCME should clamp down on, forcing schools to teach relevant and useful things, but instead they are worried about Diversity seminars and other things of 0 importance.
 
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