If you could go back and redo clerkships, what would you have done differently?

[Spetzler-Martin]

I was hoping to create a mega compilation of insight regarding clerkships. I've noticed time and time again that people generally have a different approach ending an experience compared to when starting an experience. For instance, in pre-clinical years, how one studied initially is likely much different compared to how they studied towards the very end. I personally did a lot of dumb things early on in MS1 that I wish I hadn't done. Therefore, I'm curious how your attitudes and approach to clerkships generally changed and thus what you probably hoped that you knew earlier on in MS3 if that makes sense. Thanks everyone.

---

Members don't see this ad.

 

[Gilakend]

Studied more for the shelf exams. I was almost always happy with my feedback/clerkship comments. Usually what stopped me from getting the next higher grade was my shelf being around average.

 

[Matthew9Thirtyfive]

I wish I would have stopped anki earlier and switched from uworld to amboss quicker. I was so invested in uworld because it was so expensive and everyone else was using it, but it was not representative of my surgery or my psych shelf exams. And I heard a number of people say that as well. I did well on both of them, but I think it was despite uworld, not because of it. I probably would have done better had I switched earlier. I switched in the middle of my fourth rotation and was so happy I did.

Also stopped anki after my first two rotations and wound up with way more free time and an improvement in my shelf scores. The only thing that declined was my ability to answer extremely random pimp questions, which doesn’t matter at all and didn’t affect me in the slightest.

 

[Spetzler-Martin]

I wish I would have stopped anki earlier and switched from uworld to amboss quicker. I was so invested in uworld because it was so expensive and everyone else was using it, but it was not representative of my surgery or my psych shelf exams. And I heard a number of people say that as well. I did well on both of them, but I think it was despite uworld, not because of it. I probably would have done better had I switched earlier. I switched in the middle of my fourth rotation and was so happy I did.

Also stopped anki after my first two rotations and wound up with way more free time and an improvement in my shelf scores. The only thing that declined was my ability to answer extremely random pimp questions, which doesn’t matter at all and didn’t affect me in the slightest.

What did you find better about AMBOSS compared to UWORLD?

 

[Captain_Falcon]

I wish I would have stopped anki earlier and switched from uworld to amboss quicker. I was so invested in uworld because it was so expensive and everyone else was using it, but it was not representative of my surgery or my psych shelf exams. And I heard a number of people say that as well. I did well on both of them, but I think it was despite uworld, not because of it. I probably would have done better had I switched earlier. I switched in the middle of my fourth rotation and was so happy I did.

Also stopped anki after my first two rotations and wound up with way more free time and an improvement in my shelf scores. The only thing that declined was my ability to answer extremely random pimp questions, which doesn’t matter at all and didn’t affect me in the slightest.

Did you use any of the NBME shelf self-assessments while on those clerkships?

I'm a big fan of Amboss, they haven't let me down during Clerkships yet but I've also made it a priority to do all of the NBME assessments too

 

[Matthew9Thirtyfive]

What did you find better about AMBOSS compared to UWORLD?

I thought it was more representative of the types of questions and topics that were on the shelf exams, and I found the answers in the qbank to be short and sweet, but linked to their library which is very extensive. So I had everything right there.

Did you use any of the NBME shelf self-assessments while on those clerkships?

I'm a big fan of Amboss, they haven't let me down during Clerkships yet but I've also made it a priority to do all of the NBME assessments too

I did. I did all the nbme self assessments. Incidentally, I thought they were totally not representative for a few of the shelf exams lol.

 

[Spetzler-Martin]

Studied more for the shelf exams. I was almost always happy with my feedback/clerkship comments. Usually what stopped me from getting the next higher grade was my shelf being around average.

Any advice on finding ways to fit in shelf study time? I start rotations next week with a 6 PM to 6 AM shift on L&D for a week... I'm assuming there's built in downtime but it stills sounds difficult to find sufficient time.

 

[Gilakend]

Any advice on finding ways to fit in shelf study time? I start rotations next week with a 6 PM to 6 AM shift on L&D for a week... I'm assuming there's built in downtime but it stills sounds difficult to find sufficient time.

I honestly hated OB with such a passion I would wake up early at like 3:00-3:30 AM or so to study because when I got home I was just absolutely fried and could not study at all. So maybe waking up before your shift could work for you? Additionally, just trying to maximize downtime with cards/questions/reading.

But to be honest for the majority of my clerkships I didn't study at the hospital. There was usually little downtime or always something I could find to do before whatever the next event was. But my week of OB nights was actually one of the few times I got a lot of studying in so hopefully the same is true for you.

 

[Matthew9Thirtyfive]

Any advice on finding ways to fit in shelf study time? I start rotations next week with a 6 PM to 6 AM shift on L&D for a week... I'm assuming there's built in downtime but it stills sounds difficult to find sufficient time.

You just have to dedicate time. You will def have downtime in the hospital, but you will probably have to do some at home too if you have a busy day. Nights are hard so you may not get very much done on nights, but that’s okay. Just adjust your schedule.

 

[Matthew9Thirtyfive]

Did you take COMATs or shelf exams?

Shelf exams. Nbme.

 

[Captain_Falcon]

I did. I did all the nbme self assessments. Incidentally, I thought they were totally not representative for a few of the shelf exams lol.

Most of the NBMEs I've taken have felt harder than the actual Shelf. You agree?

 

[Gilakend]

Most of the NBMEs I've taken have felt harder than the actual Shelf. You agree?

I always felt they were representative. I never left one thinking "wow that was so much harder/different" and I was not the student that always got 90+.

 

[Matthew9Thirtyfive]

Most of the NBMEs I've taken have felt harder than the actual Shelf. You agree.

Yeah I generally did way better on the real thing than the nbme. My IM shelf I hit right in the range of my NBMEs, but it was my last rotation of third year and I was really over it lol. Still did decent though.

 

[Matthew9Thirtyfive]

I always felt they were representative. I never left one thinking "wow that was so much harder/different" and I was not the student that always got 90+.

Really? I felt like several of them were not even close, and I honored every rotation (waiting on IM still, but I did really well on the shelf).

Edit: I still thought they were good practice and would def recommend doing them.

 

[Gilakend]

Really? I felt like several of them were not even close, and I honored every rotation (waiting on IM still, but I did really well on the shelf).

Edit: I still thought they were good practice and would def recommend doing them.

I think that might be the difference. Typically my friends who would get 90+ on every shelf would think they were way harder than the practice ones.

 

[spottedpothos]

Really? I felt like several of them were not even close, and I honored every rotation (waiting on IM still, but I did really well on the shelf).

Edit: I still thought they were good practice and would def recommend doing them.

What do you think were the key ingredients to honoring your rotations?

 

[Ole_Toe]

I wish I would have stopped anki earlier and switched from uworld to amboss quicker. I was so invested in uworld because it was so expensive and everyone else was using it, but it was not representative of my surgery or my psych shelf exams. And I heard a number of people say that as well. I did well on both of them, but I think it was despite uworld, not because of it. I probably would have done better had I switched earlier. I switched in the middle of my fourth rotation and was so happy I did.

Also stopped anki after my first two rotations and wound up with way more free time and an improvement in my shelf scores. The only thing that declined was my ability to answer extremely random pimp questions, which doesn’t matter at all and didn’t affect me in the slightest.

What did you use to learn/study instead of Anki? I’ve seen a lot of your other helpful posts on preclinical threads and I believe you used Anking. Was it hard to give up? Happy to PM if this derails the convo here - just curious. Thanks.

 

[Matthew9Thirtyfive]

What do you think were the key ingredients to honoring your rotations?

Being pleasant to be around, being a helpful part of the team, being prepared for rounds/clinic/OR, and seeming interested and wanting to learn. That’s really all there is to it. For some rotations, the shelf exam was important so making sure I nailed those too, but for others you just had to pass.

Showing you really care about your patients and putting in effort to help out the team go a looooong way toward honors. Like way more important than getting random pimp questions right.

 

[Matthew9Thirtyfive]

What did you use to learn/study instead of Anki? I’ve seen a lot of your other helpful posts on preclinical threads and I believe you used Anking. Was it hard to give up? Happy to PM if this derails the convo here - just curious. Thanks.

I used cheesy lightyear in preclerkship and it was critical. For clerkship it just sucked up time I could have been doing other things. I used different resources for different rotations. For surgery, I mostly used pestana and surgical recall. For psych I just memorized the dsm 5. For peds, I used online med ed. For OB I used the ACOG app and creogs over coffee. For IM I used step up to medicine, and for FM I used a mix of things from other rotations.

 

[Ho0v-man]

I would have focused less on boards and clinical grades and been less afraid to look stupid. I hate the culture of medical education as it basically encourages being safe and faking confidence so you can get that coveted Honors.

If you look like you don’t know something and put yourself out there to learn you'll look less impressive than the other students who also don’t know this stuff but have their chests puffed out anyway.

Of course it’s easy to say that after I’ve graduated/matched. But because of the need to look good on paper for ERAS, I might not do anything different even knowing what I know now.

 

[Matthew9Thirtyfive]

I would have focused less on boards and clinical grades and been less afraid to look stupid. I hate the culture of medical education as it basically encourages being safe and faking confidence so you can get that coveted Honors.

If you look like you don’t know something and put yourself out there to learn you'll look less impressive than the other students who also don’t know this stuff but have their chests puffed out anyway.

Of course it’s easy to say that after I’ve graduated/matched. But because of the need to look good on paper for ERAS, I might not do anything different even knowing what I know now.

My school isn’t like that for the most part. Trying to answer but getting things wrong looks better than not trying, as it looks like you’re putting yourself out there and trying to learn. So at least it’s not like that everywhere.

 

[Spetzler-Martin]

I would have focused less on boards and clinical grades and been less afraid to look stupid. I hate the culture of medical education as it basically encourages being safe and faking confidence so you can get that coveted Honors.

If you look like you don’t know something and put yourself out there to learn you'll look less impressive than the other students who also don’t know this stuff but have their chests puffed out anyway.

Of course it’s easy to say that after I’ve graduated/matched. But because of the need to look good on paper for ERAS, I might not do anything different even knowing what I know now.

Glad my school has P/F clerkships. It makes the process more about learning. Unfortunately, I believe there's fewer than 5 schools in the country that have P/F 3rd year.

 

[spottedpothos]

Being pleasant to be around, being a helpful part of the team, being prepared for rounds/clinic/OR, and seeming interested and wanting to learn. That’s really all there is to it. For some rotations, the shelf exam was important so making sure I nailed those too, but for others you just had to pass.

Showing you really care about your patients and putting in effort to help out the team go a looooong way toward honors. Like way more important than getting random pimp questions right.

Thank you so much! I appreciate your wisdom on SDN.

 

[Lawpy]

Glad my school has P/F clerkships. It makes the process more about learning. Unfortunately, I believe there's fewer than 5 schools in the country that have P/F 3rd year.

Pretty sure they are all top schools that can go P/F with little to no downsides

 

[Dantes]

-Get along better with malignant residents and attendings. Got along fine with >90% of people naturally, but I didn't make an effort to see the good in some, er...interesting personalities
-Focus more on the shelf often and early, no matter how tired you get. Never really knocked a shelf out of the park and felt like that was at least more in my control, but still let that slip. Did practice NBMEs but not enough UWorld throughout the year
-Set expectations day 1. The good attendings/residents already have this planned, but sometimes you need to do it

 

[Matthew9Thirtyfive]

Oh and I’m just going to say this here because it seems to get ignored a lot on this site. Your shelf exam may not matter at all for your grade other than just passing, or it may be a compensatory or non-compensatory component. Of my third year rotations, I literally had all 3 scenarios including a rotation where all you had to do was pass the shelf and after that your grade did not matter at all for honors. Please read your individual rotation grading policies. If your rotation does not take your shelf grade into account for honors, sinking a lot of time into studying for it is taking time away you could be looking up stuff for your patients or just enjoying extra free time.

 

[TelemarketingEnigma]

If your school makes you do a bunch of random busy work for clerkship (aquifer cases, etc), really try to get that done EARLY so you aren’t cramming them all in at the end around the shelf

 

[ChocolateChipCookiez]

I'm just an M1 so pardon the interjection, but does anyone know if shelf exam performance can be correlated to NBME subject exams during preclinicals?

 

[Matthew9Thirtyfive]

I'm just an M1 so pardon the interjection, but does anyone know if shelf exam performance can be correlated to NBME subject exams during preclinicals?

Only in that if you are generally a good test taker you will probably continue to be a good test taker. Some of the shelf exams are significantly more difficult than preclerkship nbme exams.

 

[deleted1100659]

I would have volunteered more for more procedures, more patient care stuff, etc. I had the fear of failure thing going on 3rd year for future, where I was nervous about screwing up/how I looked. The lesson learned was that screwing up is often how you learn, and thats why you have attendings.

Each doctor you work with, identify their strength, and how you can incorporate that strength into your own style.

 

[calivianya]

The only thing I'd change about third year would be my rotation site.

I feel like I did the best I could do with what I was given. I showed up on time, was enthusiastic even when I disliked the rotation, and scored high on all of my COMAT exams. I just ended up at a bad site, which hurt me, and strongly disliking the area your rotation site is in is a major quality of life issue when you're going to have to live there for at least a year. Obviously this is not applicable to most people here since probably a lot of you are at places with lots of residency programs and/or somewhat close to your school, but not having a backup at all because your clinical site doesn't have a residency program in your specialty of interest sucks. And being separated from all the classmates. friends, and family you've ever known by nearly 1000 miles, several state lines, and even a different time zone also sucks. Not to mention the costs associated with a major interstate move.

If you have multiple sites and your school allows you to bribe classmates to switch, this isn't the time to cheap out like I did. I turned my nose up at this behavior, but in hindsight, I should have bitten the bullet, dissolved my leftover 401k, and paid someone off so I could have had their spot.

 

[TheaterOfTheme]

Tbh, this advice will vary significantly between personality types. I have no major regrets. I tried hard on the rotations that mattered for my specialty and IM. Otherwise, I dipped as soon as a possible always. UWorld and Anki for shelves, mostly did average, but repeated UWorld for Step 2 and got >255. Don’t get me wrong, I studied a lot, but I tried to limit it to working hours/weekends before. Just enjoy yourself as much as possible. Med school, in my mind, is far too long for the actual value you get out of it. It’s an archaic system. You learn the actual job in residency.

A few words of advice though, get as honest feedback as you can from residents. Attendings rarely offer practical feedback for how to perform on Sub-I rotations etc. Some Med students struggle way more interpersonally than I thought was possible—learn to take hints/know your place in the treatment team. Be humble. If you want to impress, offer to do more. Otherwise, just try to be chill.

 

[Spetzler-Martin]

Med school, in my mind, is far too long for the actual value you get out of it. It’s an archaic system. You learn the actual job in residency.

Glad I'm not the only one who feels this way.

 

[psyspy]

Being pleasant to be around, being a helpful part of the team, being prepared for rounds/clinic/OR, and seeming interested and wanting to learn. That’s really all there is to it. For some rotations, the shelf exam was important so making sure I nailed those too, but for others you just had to pass.

Showing you really care about your patients and putting in effort to help out the team go a looooong way toward honors. Like way more important than getting random pimp questions right.

Completely disagree. Plenty of us do all of the above and can't consistently hit a pan honor eval. And the pimp questions do seem to matter a lot because in the eyes of many attendings, that shows that you're in the "manager/interpreter" stage. Also plenty of attendings just don't want to give honor evals no matter what. The highest you can possibly earn is a 4/5 or 3/4 or whatever your school does.

OP read this advice as well, because you'll hear "just be a helpful member of the team" as advice from many people but that's not really enough to get the highest marks if you want them

 

[psyspy]

Tbh, this advice will vary significantly between personality types. I have no major regrets. I tried hard on the rotations that mattered for my specialty and IM. Otherwise, I dipped as soon as a possible always. UWorld and Anki for shelves, mostly did average, but repeated UWorld for Step 2 and got >255. Don’t get me wrong, I studied a lot, but I tried to limit it to working hours/weekends before. Just enjoy yourself as much as possible. Med school, in my mind, is far too long for the actual value you get out of it. It’s an archaic system. You learn the actual job in residency.

A few words of advice though, get as honest feedback as you can from residents. Attendings rarely offer practical feedback for how to perform on Sub-I rotations etc. Some Med students struggle way more interpersonally than I thought was possible—learn to take hints/know your place in the treatment team. Be humble. If you want to impress, offer to do more. Otherwise, just try to be chill.

No you have to play the game too. It may be an archaic system but at this point saying something like that is like "water is wet." You don't want to end up with a residency undesirable to you, and a nontrivial portion of your classmates will have this happen to them unless you're at a top school. Residency is also arguably far too long for the actual value you get out of it.

Also "offer to do more" is another bogus strategy. I think in 2022 all these gimmicks are just way too obvious to everyone. Best thing to do is be as close to absolutely perfect with the presentations and pimp questions as you can...and M3's will find that that's way easier said than done. Every thing you do wrong is ammunition for them to use against you in your eval. Offering to take on more scut work or offering more of your time isn't a favor that has to be or will necessarily be returned...and in majority of cases it won't be returned at all. If you have to resort to that, don't waste your time. Just take your "L" as it were of getting high pass instead of honors and go review material for the shelf/step 2 instead.

 

[Lawpy]

ITT: clinical grading is heavily rotation and school dependent, with some schools/rotations having great grading and great attendings and others being completely garbage

 

[psyspy]

ITT: clinical grading is heavily rotation and school dependent, with some schools/rotations having great grading and great attendings and others being completely garbage

It's garbage in many schools but I still think people should do whatever it reasonably takes to do the best they can in them. There's still step 2 at the end of it....

 

[SpoiledMilk]

During my 2nd clerkship of the year, neurology, I now regret not speaking with the clerkship director about being assigned another attending for outpatient clinic. It was the 2nd half of the month long clerkship and I was initially excited to work exclusively with an attending because I had a huge interest in neurology and did not want to share the attention with classmates.

I did everything I could to show interest in the specialty, was appreciative of the nurses and staff, and practiced quality patient care, etc. However, this neurologist who was objectively a good clinician with their patients turned out to be an apathetic instructor. I had to remind them to allow me in on the telehealth with patients, they would not let me follow them around, would not let me do any procedures or write HPIs, failed to let me know which clinic to be at on days they were not in the regular clinics, would not allow to me to do any neurological examinations, and failed to learn my name (they introduced me incorrectly to patients countless time, which prompted me to correctly say my name, and on the final evaluation, got me name wrong also). In essence, I was their shadow for the clerkship.

At the end of the clerkship, during feedback, I wrote to the program director about the experience to contest the "blah" evaluation. The PD told me to send the feedback to the attending and CC them. I reluctantly did as told, against my better judgement. On par with the course, the attending did not reply to my email. When the attending "redid" my evaluation, nothing changed, and they still had my name incorrect on the re-evaluation.

I thought it was just me and that the attending did not "take" to me. However, later in the year during neurosurgery clerkship, a 5th year neurology fellow confirmed for me that this particular attending was like that with all the residents. Nothing changes...

 

[Spetzler-Martin]

Completely disagree. Plenty of us do all of the above and can't consistently hit a pan honor eval. And the pimp questions do seem to matter a lot because in the eyes of many attendings, that shows that you're in the "manager/interpreter" stage. Also plenty of attendings just don't want to give honor evals no matter what. The highest you can possibly earn is a 4/5 or 3/4 or whatever your school does.

OP read this advice as well, because you'll hear "just be a helpful member of the team" as advice from many people but that's not really enough to get the highest marks if you want them

I have P/F clerkships at my school so I don't need to worry about getting high marks. Haha. I honestly stopped caring about getting pimp questions wrong since starting my rotation especially since we also get to choose who writes our evals here. I simply pick the people who are the nicest and I know who clearly like me best.

 

[Spetzler-Martin]

During my 2nd clerkship of the year, neurology, I now regret not speaking with the clerkship director about being assigned another attending for outpatient clinic. It was the 2nd half of the month long clerkship and I was initially excited to work exclusively with an attending because I had a huge interest in neurology and did not want to share the attention with classmates.

I did everything I could to show interest in the specialty, was appreciative of the nurses and staff, and practiced quality patient care, etc. However, this neurologist who was objectively a good clinician with their patients turned out to be an apathetic instructor. I had to remind them to allow me in on the telehealth with patients, they would not let me follow them around, would not let me do any procedures or write HPIs, failed to let me know which clinic to be at on days they were not in the regular clinics, would not allow to me to do any neurological examinations, and failed to learn my name (they introduced me incorrectly to patients countless time, which prompted me to correctly say my name, and on the final evaluation, got me name wrong also). In essence, I was their shadow for the clerkship.

At the end of the clerkship, during feedback, I wrote to the program director about the experience to contest the "blah" evaluation. The PD told me to send the feedback to the attending and CC them. I reluctantly did as told, against my better judgement. On par with the course, the attending did not reply to my email. When the attending "redid" my evaluation, nothing changed, and they still had my name incorrect on the re-evaluation.

I thought it was just me and that the attending did not "take" to me. However, later in the year during neurosurgery clerkship, a 5th year neurology fellow confirmed for me that this particular attending was like that with all the residents. Nothing changes...

When I encounter malignant people like this during my medical training, I try to actively make sure I never become even remotely close to what these people were like. Somewhere along the lines of medical training, some people turn sour. I'm not sure what happens that causes them to become that way (maybe they always were and they finally revealed their true nature once they became attendings). However, I really hope I don't become one of them. Personally, I would never pimp a student. If I do ask questions, I would not penalize them for getting it wrong. We're not human encyclopedias. It's okay to get questions wrong. I'd also not keep a student longer in clinic than needed. Just today, I was on my rotation and I didn't see a patient all day (90% of patients were covid positive and I wasn't allow to see them as a med student). I just sat there for 10 hours despite kindly asking others if they needed help. I'd also make an active effort to teach and get a student as involved as much as possible. Most importantly, I'd try my best to make an experience fun even if a student wasn't interested in my field. Let's see how this idealistic thinking turns out in 15 years though. Perhaps someone on this forum can follow up in 2037.

 

[psyspy]

I have P/F clerkships at my school so I don't need to worry about getting high marks. Haha. I honestly stopped caring about getting pimp questions wrong since starting my rotation especially since we also get to choose who writes our evals here. I simply pick the people who are the nicest and I know who clearly like me best.

Yea if you’re P/F for clerkships huge portion of this becomes a non issue.

But for those of you who aren’t p/f, choosing evaluators doesn’t guarantee anything either. You won’t get overly negative evals but don’t expect pan honors (though you may get it) necessarily just because you both vibed

 

[Dral]

I wish I would have stood up for myself a bit more.

The last day of my IM clerkship, one of the senior residents made me disimpact a bowel on a patient that wasn't even mine. I guess I was too happy to be free from the incessant daily rounding at that point to care in the then and now.

 

[Lawpy]

I wish I would have stood up for myself a bit more.

The last day of my IM clerkship, one of the senior residents made me disimpact a bowel on a patient that wasn't even mine. I guess I was too happy to be free from the incessant daily rounding at that point to care in the then and now.

Wow that resident didn’t like you

 

[Dral]

Yah, I don't know if they were being a jerk or they had to do it and just didn't want to.

Maybe they didn't like me. After that episode, the feeling was mutual for sure.

 

[painballer27]

Study hard and know the material. This starts the first two years but also study for the shelf. I recommend watching shelf review videos before the start of a rotation so that you have a general idea going in. Show up on time and do what you're asked is a given, but knowing the answers to questions when asked really does make a huge difference and attendings will be impressed.

 

[Spetzler-Martin]

Study hard and know the material. This starts the first two years but also study for the shelf. I recommend watching shelf review videos before the start of a rotation so that you have a general idea going in. Show up on time and do what you're asked is a given, but knowing the answers to questions when asked really does make a huge difference and attendings will be impressed.

Getting pimp answers right is overrated. Most attendings that would ask me questions would do so because they were trying to teach rather than quiz me. No one remembers what answers you get right or wrong. Getting every single answer wrong, however, is a different story. Although to be fair, given that my school is P/F, I haven't feared any attending or resident. Still got great evals though.