I need some advice!

[kokoclose]

Hello, I am a PGY 2 IM resident . I am struggling somewhat on the floors in medical knowledge. I feels like i know stuff but can't apply in the right situations, and this is compounded by my timidity, and my Iack of confidence in what i know. I have received a lot of feedback to do lots of MKSAP questions, which I am doing and has been helpful. Presently, I am putting myself on a set schedule to review notes q3 days. I take a blank sheet of paper and write down what i know, and re-review whatever I missed. I believe my problem is retaining and retrieval. You see, I am a visual learner, in medical school resources like picmonics and such got me through my classes but unfortunately, i have no such resources in residency. My question is for other visual learners , are there any resources out there to reduce the load of constantly reading and listening to lectures? Honestly I find myself drifting in morning report, by the end of the day the mental fatigue is at an all time high, but show me a pic , video, drawing, and it says with me forever.. I even tried to draw my notes out but art is not my forte as well I am at my wits end, ideally i would like to do hospitalist work but if this does not improve, then , i will have to research other paths! Most or some of you may have been there and/or done that. Any Ideas, suggestions all welcome. Can i get a clinical coach, tutor, mentor? Thank you in advance!

---

Members don't see this ad.

 

[Lccjblu]

Hello, I am a PGY 2 IM resident . I am struggling somewhat on the floors in medical knowledge. I feels like i know stuff but can't apply in the right situations, and this is compounded by my timidity, and my Iack of confidence in what i know. I have received a lot of feedback to do lots of MKSAP questions, which I am doing and has been helpful. Presently, I am putting myself on a set schedule to review notes q3 days. I take a blank sheet of paper and write down what i know, and re-review whatever I missed. I believe my problem is retaining and retrieval. You see, I am a visual learner, in medical school resources like picmonics and such got me through my classes but unfortunately, i have no such resources in residency. My question is for other visual learners , are there any resources out there to reduce the load of constantly reading and listening to lectures? Honestly I find myself drifting in morning report, by the end of the day the mental fatigue is at an all time high, but show me a pic , video, drawing, and it says with me forever.. I even tried to draw my notes out but art is not my forte as well I am at my wits end, ideally i would like to do hospitalist work but if this does not improve, then , i will have to research other paths! Most or some of you may have been there and/or done that. Any Ideas, suggestions all welcome. Can i get a clinical coach, tutor, mentor? Thank you in advance!

This is hard to answer without knowing where you are struggling the most. As a 2nd year Resident about a third of the way through your year, you should be managing most general Medicine issues comfortably. It’s all about pattern recognition for things like COPD, PNA, mood-moderate HF exacerbation, decompensated cirrhosis, AKI, DM/DKA, etc. these entities should constitute about 60-80% of your gen Med patients. The other diagnostic mysteries I would at least have a general idea about how to initiate work up and rule out common/easy things on the differential. As someone who is aspiring to be a hospitalist, the bar is set pretty low in terms of management of things beyond general Medicine.

Where do you see yourself struggling the most?

 

[DrMetal]

Most of medicine, as we learn it, is memorization. We really don't learn things from a 'first principles' approach (the way they do in say math or physics). I used to have a physics professor that could lecture quantum off the top of his head. You don't see many physicians with the analogous capability.

Ours is a work based on speedy recall (correlates to brute memorization). That's why your mnemonics helped in med school. They can help in residency too. What do you treat an MS or ILD exacerbation with a 1G of solumedrol up front, but the COPD exac only requires 125 mg IV up front (maybe even less). What makes MS or ILD such a bigger beast, to require a much higher dose of steroids? I don't know! I should look it up. Having that kind of mechanistic ('first principle') knowledge is a very powerful thing, but unfortunately we don't have the time to get this deep into everything. So just have to memorize the dosing for the situation. Somehow, make a good mnemonic to remember MS ~ 1G , COPD exac ~125mg.

A good book (and a very quick read) on how we use our memories: "Moonwalking with Einstein", Amazon product It helped me get through med school and really changed the way I think.

 

[kokoclose]

Most of medicine, as we learn it, is memorization. We really don't learn things from a 'first principles' approach (the way they do in say math or physics). I used to have a physics professor that could lecture quantum off the top of his head. You don't see many physicians with the analogous capability.

Ours is a work based on speedy recall (correlates to brute memorization). That's why your mnemonics helped in med school. They can help in residency too. What do you treat an MS or ILD exacerbation with a 1G of solumedrol up front, but the COPD exac only requires 125 mg IV up front (maybe even less). What makes MS or ILD such a bigger beast, to require a much higher dose of steroids? I don't know! I should look it up. Having that kind of mechanistic ('first principle') knowledge is a very powerful thing, but unfortunately we don't have the time to get this deep into everything. So just have to memorize the dosing for the situation. Somehow, make a good mnemonic to remember MS ~ 1G , COPD exac ~125mg.

A good book (and a very quick read) on how we use our memories: "Moonwalking with Einstein", Amazon product It helped me get through med school and really changed the way I think.

 

[Anicetus]

Most of medicine, as we learn it, is memorization. We really don't learn things from a 'first principles' approach (the way they do in say math or physics). I used to have a physics professor that could lecture quantum off the top of his head. You don't see many physicians with the analogous capability.

Ours is a work based on speedy recall (correlates to brute memorization). That's why your mnemonics helped in med school. They can help in residency too. What do you treat an MS or ILD exacerbation with a 1G of solumedrol up front, but the COPD exac only requires 125 mg IV up front (maybe even less). What makes MS or ILD such a bigger beast, to require a much higher dose of steroids? I don't know! I should look it up. Having that kind of mechanistic ('first principle') knowledge is a very powerful thing, but unfortunately we don't have the time to get this deep into everything. So just have to memorize the dosing for the situation. Somehow, make a good mnemonic to remember MS ~ 1G , COPD exac ~125mg.

A good book (and a very quick read) on how we use our memories: "Moonwalking with Einstein", Amazon product It helped me get through med school and really changed the way I think.

This makes me feel like I chose the wrong career since I suck at brute memorization compared to the “first principles” approach, which is how I have been TRYING to do medicine.

 

[DrMetal]

This makes me feel like I chose the wrong career since I suck at brute memorization compared to the “first principles” approach, which is how I have been TRYING to do medicine.

It's not necessarily the case that you chose the wrong career. Your career choice is more a reflection of your personality traits than anything else.

The problem resides with our style of education in medicine. We insist on learning a large volume of items but not learning any particular item in great detail (jack of all trades, master of none). And we're always studying for the next test (shelfs, USMLE, ITE, Boards, etc), which just requires hard memorization. There's no way around this, you just have to accept it and do it.

Perhaps when we're all done with our training, with no more formal tests to take, we can study things in a more 'first principles' approach. I've had more than a few attendings recount that their real education took place in their first 5 years as an attending, when they have the time to really sit down and study a disease process from the bottom-up, not having to worry about what's on the "next test".

 

[kokoclose]

This is hard to answer without knowing where you are struggling the most. As a 2nd year Resident about a third of the way through your year, you should be managing most general Medicine issues comfortably. It’s all about pattern recognition for things like COPD, PNA, mood-moderate HF exacerbation, decompensated cirrhosis, AKI, DM/DKA, etc. these entities should constitute about 60-80% of your gen Med patients. The other diagnostic mysteries I would at least have a general idea about how to initiate work up and rule out common/easy things on the differential. As someone who is aspiring to be a hospitalist, the bar is set pretty low in terms of management of things beyond general Medicine.

Where do you see yourself struggling the most?

Thank you for replying. Yes I can handle the common issues as stated above . I just fumble a bit when the becomes complicated or is not straight forward. Like a GI bleed who needs resuscitation but EF is 25% or a full blown septic patient thats volume overloaded, or an ICU patient who is hepatic encephalopathic but with sepsis. When i say fumble , i have to think about it for a bit, but it seem everyone around me just effortlessly knows what to do. I have juniors under me, when they ask oh what do we do now i will like too be like bam bam bam instead of wait let me process this . Practice they say makes perfect. we will see. Thank you!

 

[kokoclose]

Yes and this is my method of studying, i love to figure out the whys and pathological processes the pathophysiology behind disease processes as much as i can. Most time it takes a bit of time but i remember and apply it better. Sad to say i am horrible at brute memorization but such is life, and i have done that through med school, and many shelfs, and usmle. I just feel that as i enter the working force, i should start having a refined knowledge of the field, like you attendings who leisurely and effortlessly discuss academic papers at length without missing a beat! Thank you for your insight !

 

[Rocher]

Yes and this is my method of studying, i love to figure out the whys and pathological processes the pathophysiology behind disease processes as much as i can. Most time it takes a bit of time but i remember and apply it better. Sad to say i am horrible at brute memorization but such is life, and i have done that through med school, and many shelfs, and usmle. I just feel that as i enter the working force, i should start having a refined knowledge of the field, like you attendings who leisurely and effortlessly discuss academic papers at length without missing a beat! Thank you for your insight !

I am also terrible at memorizing things and forget things very quickly if I don’t use them or have a fundamental understanding of things. I chose a physiology-based sub specialty partly because of this and it’s been a lot better. I was never one of those people who could keep random facts in my head.

I’m sure with more experience you’ll have seen the same thing so many times that it’ll stick.

 

[GastriqueGraffin]

Stop doing a bunch of random questions and start reading about your patients. Start with basics like summary points on UTD. Then maybe do questions pertinent to the types of patients you currently have. Don’t be afraid to ask questions from your peers, attendings, and consulting services about how and why. Better to look stupid and learn than not learn and continuously make stupid questions. As a fellow I often try to explain to residents on my service as well as the primary teams about why we are recommending what we are and sometimes even the literature behind it because I know many are afraid to ask but in the future will have the exact same problems.

 

[cbrons]

I would not say that what we do is "all about memorization." There is quite a bit of critical thinking involved, especially if you aren't a person who runs lots of tests for everything without thinking things through. Or unless you are a person who blindly follows algorithms without tailoring things appropriately for the situation.

I wouldn't study MKSAP as a way of improving your clinical practice. Better to read on the topics (or watch videos/listen to podcasts). The Curbsiders is an excellent example of the latter.

 

[cbrons]

Thank you for replying. Yes I can handle the common issues as stated above . I just fumble a bit when the becomes complicated or is not straight forward. Like a GI bleed who needs resuscitation but EF is 25% or a full blown septic patient thats volume overloaded, or an ICU patient who is hepatic encephalopathic but with sepsis. When i say fumble , i have to think about it for a bit, but it seem everyone around me just effortlessly knows what to do. I have juniors under me, when they ask oh what do we do now i will like too be like bam bam bam instead of wait let me process this . Practice they say makes perfect. we will see. Thank you!

There's the critical thinking aspect. None of that you will learn from studying charts in MedEssentials or from an MKSAP question.

Septic patients who are (total body) volume overloaded are extremely common, and usually we're the ones who overload them... this is why we have vasopressors and shouldn't blindly follow idiotic guidelines telling you to give everyone with sepsis 30cc/kg (or more idiotically, to intubate them so you can further overload them).