I literally stink at writing SOAP notes. On a primary care related rotation.

[phagocytosis41]

Hi all current MS3 here. I finally realized im not that good at writing soap notes. Its been my 2nd SOAP note and while its 'better' as per a supervisor, I still can't help but compare myself to other students who seem to write great SOAPs. I know it comes from practice but a little discouraged.
I'm trying to study for other exams and I want to put some time aside to write SOAPs. But I am concerned i'll never learn how to write SOAP notes.
I can't compare myself to attendings or even residents since i have little to no experience. Any tips on websites/books to use?

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[BorntobeDO?]

Yes you can compare to residents and attendings. Thats how your note gets better. Try to write your note out and then see how close your differential and plan comes to what the attending actually wants to do. That is the best way to improve a note IMO, and third year is the time to do it.

 

[phagocytosis41]

Yes you can compare to residents and attendings. Thats how your note gets better. Try to write your note out and then see how close your differential and plan comes to what the attending actually wants to do. That is the best way to improve a note IMO, and third year is the time to do it.

and my note sucks. when i compare.

 

[BorntobeDO?]

and my note sucks. when i compare.

Well make it better. Copy all the problems the attendings list and then imagine that if you were the attending what would you need to do next to move this plan forward?

For instance, you check a chem panel and you see a potassium of 3.1. Great now you have something to fix.

1. Hypokalemia
Plan:
1. Kcl 40 meq IV x 2, recheck mag in am (cause low magnesium is a common cause of hypokalemia)

Wait that patient has a history of HTN? Well guess what Johnny that needs to be in the plan now too, maybe you continue home meds, maybe you try something new if its not managed well.
What was the chief complaint? Has it been resolved? If so, say resolved, if not (likely) say what you are going to do next. For instance say you had a pnuemonia, your plan might be to cont antibiotics that was ordered previously (or that is appropriate based on age/presentation). Has the xray cleared? Nope, well then say so and suggest that it will be rechecked in the AM. How about your left shift in your CBC? Has that gotten better? Yes - cont current regimen, if no- consider expanding antimicrobial coverage, r/o fungal pnuemonia etc.

Justify why you are keeping that patient in the hospital.

Anyway, you can do this.

 

[austintr]

Well they should suck by comparison, really. You wouldn't want a physician to have the same level of skill as a 3rd year medical student in pretty much any arena, right?

 

[Gurby]

Hi all current MS3 here. I finally realized im not that good at writing soap notes. Its been my 2nd SOAP note and while its 'better' as per a supervisor, I still can't help but compare myself to other students who seem to write great SOAPs.

Have you only written 2 notes total so far? You should be writing >2 per day...

 

[austintr]

Have you only written 2 notes total so far? You should be writing >2 per day...

This is heavily rotation dependent, IMO. I'm in my 3rd week of family med and have yet to write a single note. My attending wants me seeing every patient and developing assessments and plans and presenting them instead of writing notes. I'm totally down with this, because it just means I'll have to work on notes more in a later rotation while having more experience with the above.

It's a 20+ patient/day practice though, so me writing notes is basically the epitome of wasting time. We barely have 30 minutes combined between patients all day most days.

 

[phagocytosis41]

Have you only written 2 notes total so far? You should be writing >2 per day...

wrong. actually my previous IM rotation we did 0 notes / day, so nope, it depends on the type of rotation your on.

 

[phagocytosis41]

This is heavily rotation dependent, IMO. I'm in my 3rd week of family med and have yet to write a single note. My attending wants me seeing every patient and developing assessments and plans and presenting them instead of writing notes. I'm totally down with this, because it just means I'll have to work on notes more in a later rotation while having more experience with the above.

It's a 20+ patient/day practice though, so me writing notes is basically the epitome of wasting time. We barely have 30 minutes combined between patients all day most days.

yes it depends

 

[phagocytosis41]

Well make it better. Copy all the problems the attendings list and then imagine that if you were the attending what would you need to do next to move this plan forward?

For instance, you check a chem panel and you see a potassium of 3.1. Great now you have something to fix.

1. Hypokalemia
Plan:
1. Kcl 40 meq IV x 2, recheck mag in am (cause low magnesium is a common cause of hypokalemia)

Wait that patient has a history of HTN? Well guess what Johnny that needs to be in the plan now too, maybe you continue home meds, maybe you try something new if its not managed well.
What was the chief complaint? Has it been resolved? If so, say resolved, if not (likely) say what you are going to do next. For instance say you had a pnuemonia, your plan might be to cont antibiotics that was ordered previously (or that is appropriate based on age/presentation). Has the xray cleared? Nope, well then say so and suggest that it will be rechecked in the AM. How about your left shift in your CBC? Has that gotten better? Yes - cont current regimen, if no- consider expanding antimicrobial coverage, r/o fungal pnuemonia etc.

Justify why you are keeping that patient in the hospital.

Anyway, you can do this.

that helps but that really doesnt address my issue. hence why your still a medical student.

 

[Gurby]

wrong. actually my previous IM rotation we did 0 notes / day, so nope, it depends on the type of rotation your on.

Well there's your answer then... You can't expect to be good at it after doing it twice. After you've done >100 of them you'll start to feel like you're getting the hang of it.

 

[jurassicpark]

It's really all about practice practice practice. You can't compare yourself to the your attendings note, nor even your resident's note. You're a brand-spanking new Ms3 student. Look at everyone's note and see what is missing from yours. Remember to address all the pertinent problems as you can and come up with a plan for them. Doesn't necessarily have to be right, as long as you make a justified and intelligent effort at it, that what your senior and attending are for, to tell you how to fix it.

 

[BorntobeDO?]

that helps but that really doesnt address my issue. hence why your still a medical student.

What is your issue then? Do you not know how to do a subjective? Write an HPI? You have trouble writing a physical exam in Objective? Including appropriate labs. I didn't include these in the earlier post because they should be obvious.

As for the second comment, I would agree that I am a medical student. A medical student who has already been on audition rotations writing 5 notes a day that was told they where at the level of a 2nd year resident and excellent. A medical student who was writing notes on upto 15 patients a day on his inpatient IM rotation and got a great letter for the effort. But go ahead. Bite the hand that feeds you. You surely don't need my help. If you are so wise, why didn't you just do it right in the first place? Maybe if you figured that out your notes wouldn't suck.

Edit: I am done with this one. My goodwill has been abused.

 

[phagocytosis41]

What is your issue then? Do you not know how to do a subjective? Write an HPI? You have trouble writing a physical exam in Objective? Including appropriate labs. I didn't include these in the earlier post because they should be obvious.

As for the second comment, I would agree that I am a medical student. A medical student who has already been on audition rotations writing 5 notes a day that was told they where at the level of a 2nd year resident and excellent. A medical student who was writing notes on upto 15 patients a day on his inpatient IM rotation and got a great letter for the effort. But go ahead. Bite the hand that feeds you. You surely don't need my help or why would you post such a thing?

If you are so wise, why didn't you just do it right in the first place? Maybe if you figured that out your notes wouldn't suck.

calm the hell down. you are a medical student aren't you? that still stands though. didn't mean to take a swipe at your ego, yes your the best med student.. happy?
and fyi, i never said i was so wise, my notes suck hence why im posting here.

 

[Espressso]

calm the hell down. you are a medical student aren't you? that still stands though. didn't mean to take a swipe at your ego, yes your the best med student.. happy?
and fyi, i never said i was so wise, my notes suck hence why im posting here.

What exactly is the issue? Your original post says you suck at writing soap notes. Is there any particular part you feel like you suck at? The above poster assumed it was the A/P which is a fair assumption as that is the trickiest part of the soap note. Yes, he's just a medical student but we should always be open to advice and tips, from all levels.

Maybe if you don't mind, be a little more specific with your issue with your soap notes and we can better help?

 

[phagocytosis41]

What exactly is the issue? Your original post says you suck at writing soap notes. Is there any particular part you feel like you suck at? The above poster assumed it was the A/P which is a fair assumption as that is the trickiest part of the soap note. Yes, he's just a medical student but we should always be open to advice and tips, from all levels.

Maybe if you don't mind, be a little more specific with your issue with your soap notes and we can better help?

like when i read EMR, i see there are 2-3 different diagnoses. When I put one, literally the first sentence i read to my attending, my attending stops me. I'm just reading what was written on the admission records.
Also, when I try to write the HPI and the assessment/plan, I literally can't write anything correct or anything that my attending is happy about. Its sort of frustrating. I feel like im put in a position where i'm expected to know what to do. I feel there is a lot of know how to this. Something just isn't clicking.

I'm someone that doesn't learn by 'being thrown into the water and expected to swim.' I need very detailed structure on how to write SOAP notes, else it will just be meaningless SOAP note exercises. Maybe i just have to find like hundreds of patient information somewhere and 'correct SOAP notes' answers sort of like math questions, and have my SOAP note the 'closest' to the desirable one. If you know what i mean.

 

[austintr]

like when i read EMR, i see there are 2-3 different diagnoses. When I put one, literally the first sentence i read to my attending, my attending stops me. I'm just reading what was written on the admission records.
Also, when I try to write the HPI and the assessment/plan, I literally can't write anything correct or anything that my attending is happy about. Its sort of frustrating. I feel like im put in a position where i'm expected to know what to do. I feel there is a lot of know how to this. Something just isn't clicking.

I'm someone that doesn't learn by 'being thrown into the water and expected to swim.' I need very detailed structure on how to write SOAP notes, else it will just be meaningless SOAP note exercises. Maybe i just have to find like hundreds of patient information somewhere and 'correct SOAP notes' answers sort of like math questions, and have my SOAP note the 'closest' to the desirable one. If you know what i mean.

It sounds like you would benefit by watching some videos on the subject. Less onlinemeded and more "how to present/how to write notes" videos. There are quite a few on YouTube, and I saw a series of 3 that was great by some internal medicine guy at Stanford. Just look around.

You'll probably get more benefit by working on this on your own outside of rotations because it sounds like the rotation style of learning isn't working great for you in this case.

A lot of people learn better by doing things wrong and remembering those mistakes, so they do better on rotations generally. If you don't learn well that way, you'll have to fix whatever the main issues are outside of clinical time.

 

[phagocytosis41]

It sounds like you would benefit by watching some videos on the subject. Less onlinemeded and more "how to present/how to write notes" videos. There are quite a few on YouTube, and I saw a series of 3 that was great by some internal medicine guy at Stanford. Just look around.

You'll probably get more benefit by working on this on your own outside of rotations because it sounds like the rotation style of learning isn't working great for you in this case.

A lot of people learn better by doing things wrong and remembering those mistakes, so they do better on rotations generally. If you don't learn well that way, you'll have to fix whatever the main issues are outside of clinical time.

yes that is what i thought. just the problem is that i'm focused on my shelves and step 2 that i don't have a ton of time to watch those note writing videos, but i guess i should start if i'm not making progress on SOAP note writing on rotations.
And I agree with you, the rotation style of learning isn't for me. Nor really anything that was in my medical school curriculum so far lol. The curricula in the 1st 2 year sort of suffocated me and rotations so far aren't really that different. I need to learn my own way, sadly that isn't always possible as we know med schools always impose their will in a way.

 

[austintr]

yes that is what i thought. just the problem is that i'm focused on my shelves and step 2 that i don't have a ton of time to watch those note writing videos, but i guess i should start if i'm not making progress on SOAP note writing on rotations.
And I agree with you, the rotation style of learning isn't for me. Nor really anything that was in my medical school curriculum so far lol. The curricula in the 1st 2 year sort of suffocated me and rotations so far aren't really that different. I need to learn my own way, sadly that isn't always possible as we know med schools always impose their will in a way.

I understand, and it sucks that we have to worry about shelves and step 2 now. But I think the first part of 3rd year is a great time to learn how to be comfortable talking to patients and how to get a good history and perform a solid physical exam. This should be the "fun" part of med school, but that's probably largely dependent on your preceptor. If they're a real douchecanoe, you're not gonna feel competent at all. If they're good, you feel good.

If you're looking things up throughout the day and working on diagnoses, assessments and plans, you should do fine on shelves (even though we don't really know what to expect for primary care shelves).

I think what you're going through is just growing pains. Try and find bright spots and remember the things you do well during rotations and try to repeat that success and build off of it. The stuff you do wrong, you should note and try not to dwell on it. You'll be good.

 

[NotYou20]

like when i read EMR, i see there are 2-3 different diagnoses. When I put one, literally the first sentence i read to my attending, my attending stops me. I'm just reading what was written on the admission records.
Also, when I try to write the HPI and the assessment/plan, I literally can't write anything correct or anything that my attending is happy about. Its sort of frustrating. I feel like im put in a position where i'm expected to know what to do. I feel there is a lot of know how to this. Something just isn't clicking.

I'm someone that doesn't learn by 'being thrown into the water and expected to swim.' I need very detailed structure on how to write SOAP notes, else it will just be meaningless SOAP note exercises. Maybe i just have to find like hundreds of patient information somewhere and 'correct SOAP notes' answers sort of like math questions, and have my SOAP note the 'closest' to the desirable one. If you know what i mean.

You shouldn't be just looking at the admission note and copying their diagnoses. Its fine to agree with them, but come up with those on your own. Nor should you be copying anything from their "admission records." Those ER or admission notes are helpful for getting a rough idea of whats going on. I often looked things up on uptodate before talking to the patient so I walked in the room with a broad differential and distinguishing features between them. Then write your note as an argument as to why you believe they have X. Or why they probably have X but we need to rule out Y first. Present the patient to the team in the same manner.

And jesus step 2 isn't for another 10 months. You do not need to be studying for it now. Especially if you're struggling with a fundamental clinical skill.

 

[phagocytosis41]

I understand, and it sucks that we have to worry about shelves and step 2 now. But I think the first part of 3rd year is a great time to learn how to be comfortable talking to patients and how to get a good history and perform a solid physical exam. This should be the "fun" part of med school, but that's probably largely dependent on your preceptor. If they're a real douchecanoe, you're not gonna feel competent at all. If they're good, you feel good.

If you're looking things up throughout the day and working on diagnoses, assessments and plans, you should do fine on shelves (even though we don't really know what to expect for primary care shelves).

I think what you're going through is just growing pains. Try and find bright spots and remember the things you do well during rotations and try to repeat that success and build off of it. The stuff you do wrong, you should note and try not to dwell on it. You'll be good.

thank you i really appreciate it 🙂

 

[Ho0v-man]

calm the hell down. you are a medical student aren't you? that still stands though. didn't mean to take a swipe at your ego, yes your the best med student.. happy?
and fyi, i never said i was so wise, my notes suck hence why im posting here.

You might need to work on how you receive criticism.

If it’s any consolation, I suck at soap notes too. Kinda feels like everyone does it a little different and the only consistent thing is that I’m wrong lol.

 

[phagocytosis41]

You might need to work on how you receive criticism.

If it’s any consolation, I suck at soap notes too. Kinda feels like everyone does it a little different and the only consistent thing is that I’m wrong lol.

now i'm being told i don't know how to present a patient. Well that would have been nice if it was at the beginning of my first IM rotation, not now, into my 2nd IM rotation.
Surely this doesn't hurt my confidence and workethic.

 

[Ho0v-man]

now i'm being told i don't know how to present a patient. Well that would have been nice if it was at the beginning of my first IM rotation, not now, into my 2nd IM rotation.
Surely this doesn't hurt my confidence and workethic.

I feel ya. I’m getting the same experience within the same rotation but just different attendings.

 

[phagocytosis41]

I feel ya. I’m getting the same experience within the same rotation but just different attendings.

Its bull ****, look if im not good at something i admit it. And apparently I suck at doing SOAP notes and presentations, fine I'll take that. But telling me when I completed 2 hospital rotations (technically 3 including a non-inpatient one, but i won't count that) that i need to change everything is nonsense. I have been doing EVERYTHING my school tells me. I guess I need to keep listening to my school and what everyone says, especially since listening to my school and doing everything they say got me a board score im disappointed in. I Need to keep listening to what my school and everyone else says, sure.
In terms of doing SOAP notes and rotations, I need time to look at my mistakes, consult with someone and then fix my mistakes. Throwing all this nonsense at me 2 days after the start of a rotation me doesn't help me, its just unnecessary criticism. it stresses me out and just scares me. It wasn't given constructive feedback, I was just told what is wrong... That is the story of my life, hence why I became a late bloomer and took a long ass time to do anything.

 

[AMEHigh]

Its bull ****, look if im not good at something i admit it. And apparently I suck at doing SOAP notes and presentations, fine I'll take that. But telling me when I completed 2 hospital rotations (technically 3 including a non-inpatient one, but i won't count that) that i need to change everything is nonsense.
I need time to look at my mistakes, consult with something and then fix my mistakes. Throwing all this nonsense at me 2 days after the start of a rotation me doesn't help me, its just unnecessary criticism. it stresses me out and just scares me. It wasn't given constructive feedback, I was just told what is wrong... That is the story of my life, hence why I became a late bloomer and took a long ass time to do anything.

I think you need to take a deep breath and look at the big picture.

Different attendings (and residents) are going to have different expectations and styles.

It’s good that they’re giving you feedback at the beginning of the rotation so that you can fix it and move along.

It is still very very early in the year. You are still learning a lot. It is difficult to go from one rotation to another every 4 weeks, but that’s how it is for the next 2 years and often in residency.

If you’re struggling that much to learn and improve is there anyone at your school that you can talk to? Otherwise, what you’re going through does sound pretty typical and I don’t think you should take it personal, just take the feedback (even if it’s crappy feedback) and try to incorporate it in the best you can.

 

[phagocytosis41]

I think you need to take a deep breath and look at the big picture.

Different attendings (and residents) are going to have different expectations and styles.

It’s good that they’re giving you feedback at the beginning of the rotation so that you can fix it and move along.

It is still very very early in the year. You are still learning a lot. It is difficult to go from one rotation to another every 4 weeks, but that’s how it is for the next 2 years and often in residency.

If you’re struggling that much to learn and improve is there anyone at your school that you can talk to? Otherwise, what you’re going through does sound pretty typical and I don’t think you should take it personal, just take the feedback (even if it’s crappy feedback) and try to incorporate it in the best you can.

i'm literally trying hard looking at the big picture, looking at the entire med record. Asking the clinical/nursing staff about patient information when i can't get it.
Despite trying hard i feel very discouraged.
All I get is 'you are all over the place.' Thats great, four months into my MS3 year, thanks. Instead of giving me time to fix up.

 

[Espressso]

i'm literally trying hard looking at the big picture, looking at the entire med record. Asking the clinical/nursing staff about patient information when i can't get it.
Despite trying hard i feel very discouraged.
All I get is 'you are all over the place.' Thats great, four months into my MS3 year, thanks. Instead of giving me time to fix up.

Dude. You honestly could use some work on the whole... taking criticism thing. Your comments in this thread are slightly alarming. He/she says you're all over the place. Okay so what? Fix it. Ask how to improve it. Four months into third year, so what? You're new at this. What do you expect?

Third year is a roller coaster. Ride the damn ride. Each preceptor and resident and attending will have different styles and you have to carefully wade those waters each day. Instead of flipping out when an attending is saying your presentation is all over the place, have you tried asking him/her how they would prefer you to present? Or how you can improve? A good piece of advice is that for every first day with a new attending/rotation, ask them straight up how to they prefer you present, what there expectations are, how do they like the soap notes written. Get an idea on day one, that will help you get a good starting point.

Understand that even four months into MS3, you're still a newborn clinician. We are literally the bottom of the clinical totom poll. We're close to nothing. Our job is to be open to all advice, criticism, and mean spirited critiques. And take all of them together and slowly fix and polish your clinical tool box. Stop whining. Not many students start third year and just crush it all the time. You're there to learn. And if you're going

The goal is to improve each day. It doesn't have to be crazy, and it often won't. But you should just try to improve with something each and every single day. Medicine is hard dude. It's not supposed to be some walk in the park. And at the end, you're going to have patients to care for who's lives are in your hands. Do you want these attendings to be nice and cuddly with you? Come on. Stay positive. Stay late after the clinic day, ask the preceptors how you can be improving. Smile a lot. Say thank you often. A better, positive attitude will help you more than any soap note template you find online.

 

[Neopolymath]

I'm going to be stern because everyone else has been kind and it obviously didn't work.

Calm down. Stop whining. Be thankful for the criticism you have received early as it will pay off in the long run. From your previous posts about didactic, you seem like a problem student with the "my house is on fire" mentality at all times. You really need to reflect on this theme. It will prevent you from succeeding and crush your mental health. You cannot survive 3rd year this way. No one wants you to fail because of that. You need to understand that you are there to learn from all these people and it's your job to change. It's your job to adapt and learn from various styles. That is what makes you come out the other side as a 4th year that can be molded into a useful resident. It doesn't matter how you think you learn. Clearly, nothing is working for you so perhaps it's time for self-reflection as you are the common denominator. Best of luck and take care of yourself.

 

[SurgeDO]

Have you considered going into surgery?

S: Pt. came to ER complaining of this problem
O: alive, following commands, RRR, MAEx4
A: 37 year old with problem
P: surgery or no surgery...if no surgery, sign off. Sometimes I add a little zest: “remainder of care per medicine team.”

SurgeDO, pager#

 

[Ho0v-man]

Have you considered going into surgery?

S: Pt. came to ER complaining of this problem
O: alive, following commands, RRR, MAEx4
A: 37 year old with problem
P: surgery or no surgery...if no surgery, sign off. Sometimes I add a little zest: “remainder of care per medicine team.”

SurgeDO, pager#

Since I’ve started I’ve realized writing ortho notes must be amazing.

 

[Ho0v-man]

Its bull ****, look if im not good at something i admit it. And apparently I suck at doing SOAP notes and presentations, fine I'll take that. But telling me when I completed 2 hospital rotations (technically 3 including a non-inpatient one, but i won't count that) that i need to change everything is nonsense. I have been doing EVERYTHING my school tells me. I guess I need to keep listening to my school and what everyone says, especially since listening to my school and doing everything they say got me a board score im disappointed in. I Need to keep listening to what my school and everyone else says, sure.
In terms of doing SOAP notes and rotations, I need time to look at my mistakes, consult with someone and then fix my mistakes. Throwing all this nonsense at me 2 days after the start of a rotation me doesn't help me, its just unnecessary criticism. it stresses me out and just scares me. It wasn't given constructive feedback, I was just told what is wrong... That is the story of my life, hence why I became a late bloomer and took a long ass time to do anything.

Sooo...I’m not sure if this post is like against me of agreeing with me or what.

 

[libertyyne]

Hi all current MS3 here. I finally realized im not that good at writing soap notes. Its been my 2nd SOAP note and while its 'better' as per a supervisor, I still can't help but compare myself to other students who seem to write great SOAPs. I know it comes from practice but a little discouraged.
I'm trying to study for other exams and I want to put some time aside to write SOAPs. But I am concerned i'll never learn how to write SOAP notes.
I can't compare myself to attendings or even residents since i have little to no experience. Any tips on websites/books to use?

yo. It is one of the easiet things you can do .
Step 1. Find the smartest / best resident.
Step 2. literally Copy Note format.
Step 3. Fill in information with your patient into format.
Step 4. Profit ?

If you are bad at generating plans you should read up todate about the condtion and just spitball confidently. Be sure to have a reason for every action you are doing. Usually I like breaking down by listeing a problem and then the assessment and plan for that problem.

 

[phagocytosis41]

yo. It is one of the easiet things you can do .
Step 1. Find the smartest / best resident.
Step 2. literally Copy Note format.
Step 3. Fill in information with your patient into format.
Step 4. Profit ?

If you are bad at generating plans you should read up todate about the condtion and just spitball confidently. Be sure to have a reason for every action you are doing. Usually I like breaking down by listeing a problem and then the assessment and plan for that problem.

Someone (authority figure) literally said 'up to date' was wrong. So kinda confused since everyone I been around in my first couple months said it was something I had to use all the time. ....

 

[phagocytosis41]

Sooo...I’m not sure if this post is like against me of agreeing with me or what.

it was agreeing... kinda venting too lol

 

[phagocytosis41]

I'm going to be stern because everyone else has been kind and it obviously didn't work.

Calm down. Stop whining. Be thankful for the criticism you have received early as it will pay off in the long run. From your previous posts about didactic, you seem like a problem student with the "my house is on fire" mentality at all times. You really need to reflect on this theme. It will prevent you from succeeding and crush your mental health. You cannot survive 3rd year this way. No one wants you to fail because of that. You need to understand that you are there to learn from all these people and it's your job to change. It's your job to adapt and learn from various styles. That is what makes you come out the other side as a 4th year that can be molded into a useful resident. It doesn't matter how you think you learn. Clearly, nothing is working for you so perhaps it's time for self-reflection as you are the common denominator. Best of luck and take care of yourself.

"'My house is on fire' mentally at all time" You are not qualified to even say that to me, your just a medical student so sorry. Not only that you know nothing about me, so quit with the terrible responses and analyses you are giving, they are just laughable. And you are wrong that is not my mentally. 'Clearly, nothing is working for you,' yes things are working for me NOW, so you are wrong. Dead wrong I should say. Also, I never said i'm perfect, BUT i'd rather listen to someone with less un-constructive criticism and pointing the finger than someone who has no life and has to look up someone else's posts. Seriously getting a life, but i doubt you even have one. Almost everyone else gave better advice than you, so a little bit of advice, quit snooping around other peoples posts and learn how to actually respond in a constructive and nice way. I've already reported you, btw.
Please do not message or give any other further advice to me.

 

[phagocytosis41]

Dude. You honestly could use some work on the whole... taking criticism thing. Your comments in this thread are slightly alarming. He/she says you're all over the place. Okay so what? Fix it. Ask how to improve it. Four months into third year, so what? You're new at this. What do you expect?

Third year is a roller coaster. Ride the damn ride. Each preceptor and resident and attending will have different styles and you have to carefully wade those waters each day. Instead of flipping out when an attending is saying your presentation is all over the place, have you tried asking him/her how they would prefer you to present? Or how you can improve? A good piece of advice is that for every first day with a new attending/rotation, ask them straight up how to they prefer you present, what there expectations are, how do they like the soap notes written. Get an idea on day one, that will help you get a good starting point.

Understand that even four months into MS3, you're still a newborn clinician. We are literally the bottom of the clinical totom poll. We're close to nothing. Our job is to be open to all advice, criticism, and mean spirited critiques. And take all of them together and slowly fix and polish your clinical tool box. Stop whining. Not many students start third year and just crush it all the time. You're there to learn. And if you're going

The goal is to improve each day. It doesn't have to be crazy, and it often won't. But you should just try to improve with something each and every single day. Medicine is hard dude. It's not supposed to be some walk in the park. And at the end, you're going to have patients to care for who's lives are in your hands. Do you want these attendings to be nice and cuddly with you? Come on. Stay positive. Stay late after the clinic day, ask the preceptors how you can be improving. Smile a lot. Say thank you often. A better, positive attitude will help you more than any soap note template you find online.

I agree with you totally and I am working on improving myself, i appreciate that you were nicer than Neopolymath. Maybe he should take advice from you on how to respond better to others who need help.
I agree I was whining, but believe me it wasn't without reason.
Again, thank you.

 

[phagocytosis41]

yo. It is one of the easiet things you can do .
Step 1. Find the smartest / best resident.
Step 2. literally Copy Note format.
Step 3. Fill in information with your patient into format.
Step 4. Profit ?

If you are bad at generating plans you should read up todate about the condtion and just spitball confidently. Be sure to have a reason for every action you are doing. Usually I like breaking down by listeing a problem and then the assessment and plan for that problem.

great advice! Others can learn more about how to respond to others and give better advice from you.
thank you.

 

[phagocytosis41]

yo. It is one of the easiet things you can do .
Step 1. Find the smartest / best resident.
Step 2. literally Copy Note format.
Step 3. Fill in information with your patient into format.
Step 4. Profit ?

If you are bad at generating plans you should read up todate about the condtion and just spitball confidently. Be sure to have a reason for every action you are doing. Usually I like breaking down by listeing a problem and then the assessment and plan for that problem.

thank you for the great advice! Others can learn more about how to give advice better from you.
Thanks again.

 

[Neopolymath]

"'My house is on fire' mentally at all time" You are not qualified to even say that to me, your just a medical student so sorry. Not only that you know nothing about me, so quit with the terrible responses and analyses you are giving, they are just laughable. And you are wrong that is not my mentally. 'Clearly, nothing is working for you,' yes things are working for me NOW, so you are wrong. Dead wrong I should say. Also, I never said i'm perfect, BUT i'd rather listen to someone with less un-constructive criticism and pointing the finger than someone who has no life and has to look up someone else's posts. Seriously getting a life, but i doubt you even have one. Almost everyone else gave better advice than you, so a little bit of advice, quit snooping around other peoples posts and learn how to actually respond in a constructive and nice way. I've already reported you, btw.
Please do not message or give any other further advice to me.

Ha. I did not "snoop" on your posts. Your posts are public and you posted in the comlex thread numerous times. I think you should consider re-reading your posts in this thread. You seem really upset and when experienced posters attempted to help you (BorntobeDO?), you sent a lot of mixed messages. Why would you make a thread about this topic if nothing was wrong? It seems like you have a mindset issue, which others have also noted. It was just some friendly advice so it doesn't get worse. It's clear something is wrong, hence the thread. You can call it "un-constructive" criticism if you like, but what I said is good advice and important for keeping your sanity this year. I can't imagine how you would act if someone said something actually mean to you. It's also kind of ironic how vitriolic your response was given your disdain for me telling you to get it together so you don't fail.

Good luck. I mean it.

 

[nwmedapplicant]

Well make it better. Copy all the problems the attendings list and then imagine that if you were the attending what would you need to do next to move this plan forward?

For instance, you check a chem panel and you see a potassium of 3.1. Great now you have something to fix.

1. Hypokalemia
Plan:
1. Kcl 40 meq IV x 2, recheck mag in am (cause low magnesium is a common cause of hypokalemia)

Wait that patient has a history of HTN? Well guess what Johnny that needs to be in the plan now too, maybe you continue home meds, maybe you try something new if its not managed well.
What was the chief complaint? Has it been resolved? If so, say resolved, if not (likely) say what you are going to do next. For instance say you had a pnuemonia, your plan might be to cont antibiotics that was ordered previously (or that is appropriate based on age/presentation). Has the xray cleared? Nope, well then say so and suggest that it will be rechecked in the AM. How about your left shift in your CBC? Has that gotten better? Yes - cont current regimen, if no- consider expanding antimicrobial coverage, r/o fungal pnuemonia etc.

Justify why you are keeping that patient in the hospital.

Anyway, you can do this.

This! Only way to make it second nature is to practice. Trust me - it will be second nature in due time. Try not to get frustrated - you will have lots and lots of practice. In medicine, we always strive to get better with the knowledge that it will be through learning and practice - and this doesnt happen overnight. Don't be so hard on yourself. After you've written 250 it will be easy, after you've written 1500 - it will be second nature and you will be thinking of the additional 10 you have yet to write 😛

Example above is good but we all have our own twists:
1. Hypokalemia
-etiology: likely renal wasting/diuresis
plan: effervescent potassium 40 mEq PO X2, recheck K, check mag, on telemetry, continue to monitor

 

[nwmedapplicant]

Someone (authority figure) literally said 'up to date' was wrong. So kinda confused since everyone I been around in my first couple months said it was something I had to use all the time. ....

While sure every reference can be inaccurate or invalidated by newer research etc; However, UpToDate is a cornerstone of the latest applications and recommendations of research within the last year. Textbooks are often 5+ years behind for reference.

 

[NonTrad16]

I’m also “just a medical student”, and only a 3rd year (!), but I’ll say it’s 100% not worth fighting someone above you if they don’t seem open to hear your conflicting evidence. If they were interested in your opinion, they’d ask and listen, or at least be receptive when you bring it up. If they don't/aren’t, then for whatever reason (the patient is complicated in a way you’re not understanding, the higher up is stressed, etc) it’s not worth pushing.

Otherwise, I’d second (third? fourth?) the above and recommend: 1) being less hard on yourself; 2) accept that no matter what you do, more than likely your attending/resident will recommend something different; 3) keep trying despite the endlessly changing and conflicting recommendations; and 4) understand that a lot of 3rd year is subjective evaluation, so just do your best and take feedback as well as you can (ie don’t spend 45 seconds apologizing for a 5 second critique, take it, use it as best you can, and move forward).

 

[hungrydoc710]

This entire thread you are coming across as weak and all over the place to be honest.
If your attendings are stepping on your toes a bit, it's bc they sense this brittle attitude.

Multiple people gave you advice and you snarked back at them. I'd be fed up with you too.

Someone gave you advice and your response was "wow everyone should give advice like you"
Lol are you kidding me.

Good luck with the rest of rotations + residency.

 

[hallowmann]

I'm going to comment because apparently being a resident will mean something:

One of the greatest skills you learn in med school is adaptability to various styles and expectations. Sure, it helps to recognize what needs to be in a note, what overall format you should be presenting in, figuring out which details are important to mention, recognizing truly why someone is being admitted (and ultimately what will need to happen to make them ready to discharge, transfer, be med ready for a procedure, etc), and what is important when formulating a good plan. That said, you're a med student, you won't be as good as someone further ahead than you, and that shouldn't be a surprise.

So all of that helps, but even more important than that is being able to adjust to the expectations and styles of your residents, attending, and/or team. Med school and a lot of residency is a lot of back and forth in different rotations, on different services, and with different attendings, sometimes every week, and honestly sometimes even more frequent than that. The people that struggle, can't adjust. You need to be able to. If one attending tells you the most important thing in your presentation is X and another tells you its Y, you need to be able to present with X to the first attending and Y to the second even if they are opposites.

Its frustrating and painful, especially in the beginning, and you'll feel like nothing you do is right, but that's the way it is. There is an art to medicine, and often times there is not only one "right" way to handle a situation. Your job in residency is to find your way, your practice style. Medicine is not just about algorithms (even if some of it is). If that's all you do, then you might as well have gone to NP or PA school.

I will say that we've all been through this, but its important not to get held up on this. You need to be able to adapt. You need to be able to take criticism and implement changes in how you do things, even if its only for attending A and you do something completely different for attending B.

You'll all get there, just take it in stride. Good luck.

 

[I'd Rather Be Camping]

You literally stink at it? Literally? If that’s the case, I’d suggest a shower and deodorant.