Invaluable advice to incoming 3rd year

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The Angriest Bird

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If you had received some advice from those already in clinical rotations what do you wish they had told you?

Do you have anything in mind that's like "man, I definitely learned this the hard way because nobody told me!"

What would be Words-of-Wisdom you want to pass on to future 3rd years? You can either post something specific to a rotation or the clinical world in general.

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I learned this in the middle of my first rotation (Surgery): your experience, both personal and grade-wise, will be much improved if you don't worry about the grade. That's not to say don't do your best, but this mindset helps when you get yelled at to let it roll off your back and also helps you be yourself (which most residents actually like) instead of a no-personality stiff.
 
Learn to keep a pleasant, neutral look on your face at all times. Try to appear eager, even if you'd rather go home. Be easy to get along with. Be five minutes early. See your patients before the residents. Read a little every day.

Those things will get you through most rotations just fine.
 
Learn to keep a pleasant, neutral look on your face at all times. Try to appear eager, even if you'd rather go home. Be easy to get along with. Be five minutes early. See your patients before the residents. Read a little every day.

Those things will get you through most rotations just fine.


Amen.
 
This is from my own personal experience: Learn how to present a patient before showing up for your first day of third year! I know at this point you don't have much practice, but just get the basic format down: Mr. B is a 54 year old white male with a past medical history of blah, blah, blah who presented with blah, blah, blah. ROS is positive for....... ROS is negative for ........

If I had done so, I would have avoided getting yelled at repeatedly by my hot-tempered surgery attending my first two weeks of third year!
 
learn to eavesdrop. i was so frustrated early on because they'd expect me to know all these things about my patients that there was no way I could know as the communication and decision making was often going on at a level above my head between senior residents and attendings. Nobody is gonna be like oh we better inform the med student we decided her patient should be discharged tomorrow...then you look stupid on rounds when the resident has to correct your outdated info. So now if I see anyone who looks remotely like they are talking about my patient I butt into the conversation or hover.
 
Another thing I wanted to add is to go to your clerkship director if you're having a difficult time with a resident. I don't mean go anytime you get yelled at or whatnot, but if you're having a bad experience because of your resident don't hesitate to go to the rotation director. As I've been told a few times this year, they can't do anything about it if you don't say anything, and they really do help you when they can.
 
Have a template handy for notes/orders/etc! I know Maxwell's has them in it, First aid for the Wards does, and for surgery i have a book "150 biggest mistakes and how to avoid them" which also has templates for them...
 
Have a template handy for notes/orders/etc! I know Maxwell's has them in it, First aid for the Wards does, and for surgery i have a book "150 biggest mistakes and how to avoid them" which also has templates for them...
Has anyone used the ones on medfools? Or other premade, nice ones that I can just print out? Some company manufactures them...whattup doc or something

It's been bumped up to 250 mistakes for the new edition, and a book called How to be an Excellent Med Student seems to have templates too.
 
Has anyone used the ones on medfools? Or other premade, nice ones that I can just print out? Some company manufactures them...whattup doc or something

Medfools templates got me through most of my rotations. I think OB-Gyn was the only clerkship where I used anything other than medfools and Maxwell's.
 
Medfools templates got me through most of my rotations. I think OB-Gyn was the only clerkship where I used anything other than medfools and Maxwell's.

What did you use for OB?
 
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What did you use for OB?

We had a one page sheet (which I have long since lost) that had templates for post-partum notes, L&D notes, and H&Ps specific to OB. It was heaven on earth.
 
If you had received some advice from those already in clinical rotations what do you wish they had told you?

Do you have anything in mind that's like "man, I definitely learned this the hard way because nobody told me!"

What would be Words-of-Wisdom you want to pass on to future 3rd years? You can either post something specific to a rotation or the clinical world in general.

Words of Wisdom off the top of my head:
(1) never pass a bathroom -- you may not get another chance.
(2) keep the team in your peripheral vision when you are fetching charts during rounds -- they won't wait for you and it looks lame having to page someone once they ditch you.
(3) wear comfortable shoes that you can stand in for hours.
(4) use the shoe covers, particularly in OBGYN or any surgery procedure that involves irrigation.
(5) Always approach a patient from the side -- they will cough, sneeze or puke on anyone directly in front of them. This goes double for peds.
(6) toddlers don't tolerate ear exams well. Make sure you or the mom has them immobilized.
(7) you won't die if you go without sleep, but you might fall asleep if you go without sleep. So always lean against something whenever possible.
(8) There absolutely is such a thing as a stupid question. Don't let anyone tell you otherwise. And they will try.
(9) At some point during your clerkship you will work for someone who won't like you, no matter what you do. Just roll with it.
 
If I had done so, I would have avoided getting yelled at repeatedly by my hot-tempered surgery attending my first two weeks of third year!

I think this is meant to occur in third year though. You learn from your mistakes. And boy will you make mistakes. Every third year totally sux during their first rotation. You don't know squat and most people expect you to have learned what you need to know elsewhere (on the street perhaps?). So you learn fast or get chewed out. It's part of the experience.
 
My only suggestions would be to review general admission orders for whatever service you start on. My first rotation was the first time I'd ever worked in a hospital and the first time an intern handed me an order sheet and told me to start writing the orders, I had no idea what to write! I wished I had thought to review that before my first day. Secondly, pay close attention to everything said during rounds. Often everything moves fast or is really busy and no one thinks about the little med student. But, you can pick up a lot of useful information just by eaves dropping. Last, don't ask many questions during rounds. It slows everything down. Just make a mental note to ask the attending or a senior later. It gets really frustrating when there's one gunner on the service asking question after question.
 
Questions are a double edged sword--I worry if I don't ask enough they'll give me beef for being uninterested and aloof. On the other hand I don't want to cause disturbance when things are busy. I guess I'll have to get a sense of the right times to ask and when not to. I'd probably be ok with never asking questions but I know I'll have to force some now and then to avoid beef.
 
This is especially true if anyone on the team is post call. They will look at you with daggers if you prolong the agony of rounds and keep them from their beds. It's just bad form.

One or two good questions are okay. It is important for the attending to know that you are alert and interested. But, I've been on with students who ask several questions per patient and you can tell they are just kissing a$$. Everyone knows what they are up to and it gets really annoying when you're in the 5th hour of rounding.
 
1. Get good at pretending you're listening to the discussion of every patient during rounds (not just your patients) and really really try to never be late (even if a few minutes), as it's really incredible the stuff they remember during evaluations.
2. Do lots of questions for the shelf-exam (I found a year long subscription to USMLEWORLD= 400$ to be incredibly helpful) and schedule your rotations so you have time to study (avoid doing all brutal services, make the second half of your rotation easier so you have time to study before the shelf, etc...). A classic mistake I saw a lot of my friends make was killing themselves on the wards to get honors/good evaluations and not leaving enough time to study for the shelf (which often accounts for up to 50% your final grade). Be efficient with your time and use it in a way that is going to be most effective for your overall performance.
3. When you admit a patient in the ER make sure you at least look at the w/u and treatment of their chief complaint/diagnosis in pocket medicine or UPTODATE BEFORE TALKING TO YOUR RESIDENT (it takes like five minutes). These resources will pretty much write the plan for you the majority of the time and really make you look like you know what you're doing.
4. Try to make an assessment and plan for all patients (even if you really don't have a clue what's going on) and make sure to present it. A lot of the time the resident/attending may cut you off before getting to your A/P and then you might see on your evaluation "needs to work on developing plan" and you'll be like WTF! Learn to streamline your presentations or non-confrontationally ask if u can present your plan, as residents/attendings love to see that you're thinking (even if you're wrong).
5. As much as it's a pride swallowing thing to do, if you are struggling with oral presentations (especially early on) make an effort to listen the all star student on your service who walks on water and incorporate elements of their presentations into your own (at least until you develop a effective style of your own).
6. MOST IMPORTANT: It's a shame that 3rd year grades are some of the most important grades you receive in medical school and are also some of the most subjective. If you want to do well, you're going to have to treat it like a game (as lame and soul crushing as that is). From my experience, the single most important thing you can do to ensure a good evaluation is speak to your friends/classmates and fourth years before your rotation about what attendings/residents give good evaluations and which attendings are known for screwing people over (i.e. some attendings give everyone honors, some will give you a good grade if u work your butt off, and some will screw you over no matter how good you are). Next, talk to your clerkship coordinator and request to work with certain attending app 2-4 weeks before beginning of rotation. At least at my school, clerkship coordinators have a lot of power and can really hook u up if you're nice.
Ok, that's ridiculously long. I'm spent. GL
 
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This is especially true if anyone on the team is post call. They will look at you with daggers if you prolong the agony of rounds and keep them from their beds. It's just bad form.

On one rotation, I was prewarned by the residents to never ask the attending a question. And to not stand to close to said attending as well. Essentially this meant I was standing 8 feet away and couldn't hear what was being said about the patient. Once or twice I forgot myself and asked a couple of questions (this particular attending loved to teach) and in his eval he made a nice comment about how I actively participated instead of just standing there like most med students.

Poor med students. Stuck between a rock (not ticking off residents while still impressing attendings) and a hard place (evals).
 
to study for the shelf (which often accounts for up to 50% your final grade).

Agree with most of what you've said, but the percentage sounds too high for most schools I'm familiar with. The shelf exams are more frequently only a quarter to a third of your grade. Still important, but hardly half. I think a lot of us would love to have such objectively graded rotations, rather than the 75% subjective fiascos that abound.
 
Agree with most of what you've said, but the percentage sounds too high for most schools I'm familiar with. The shelf exams are more frequently only a quarter to a third of your grade. Still important, but hardly half. I think a lot of us would love to have such objectively graded rotations, rather than the 75% subjective fiascos that abound.

I think probably a good half of our third year clerkships are graded with the shelf (or sometimes departmental) exam comprising 50% of the grade. Helps equalize things a little bit for the folks who are dedicated to reading during rotations.
 
Agree with most of what you've said, but the percentage sounds too high for most schools I'm familiar with. The shelf exams are more frequently only a quarter to a third of your grade. Still important, but hardly half. I think a lot of us would love to have such objectively graded rotations, rather than the 75% subjective fiascos that abound.

I dunno I think for purposes of internship being effective on the ward is more important than how much you know as tested by a shelf exam which is why the "subjective" part i.e. your managerial, organizational, and people skills count for more. I think it's possible to have a very mediocre knowledge base and still manage a ward properly as long as you have good judgement and know when to look something up or defer to your seniors. I know people who do well on their exams but are complete disasters in terms of presenting cases or doing their work efficiently and residencies should have some way to identify these people as they would really be a liability.
 
yeah..ditto what was said about just being yourself.

i know its real hard to forget about the grade, but let me tell you what...i made close to (not quite, but almost) honors ALL year, with one honors in between, of just maintaining an interested/neutral(when bored) aura about me.

that, and be kind/ respectful/ show team spirit... offer to get the rez a coffee if youre going to Starbucks, or food if youre going to the cafeteria (DUH).

seriously, i know most of you have no clue whats its like to be part of a professional team, but every little bit counts.

and believe me, sometimes someone offering to get you a latte is just sweet music to your ears....

wouldn't you want someone to offer it to you?
 
I dunno I think for purposes of internship being effective on the ward is more important than how much you know as tested by a shelf exam which is why the "subjective" part i.e. your managerial, organizational, and people skills count for more. I think it's possible to have a very mediocre knowledge base and still manage a ward properly as long as you have good judgement and know when to look something up or defer to your seniors. I know people who do well on their exams but are complete disasters in terms of presenting cases or doing their work efficiently and residencies should have some way to identify these people as they would really be a liability.

I agree with you in principle, but everyone has an attending or two that doesn't really give you a fair shake, and probably shouldn't be given subjective control over your lot. You can be quite good in terms of management, organization and people skills according to the half a dozen other attendings you worked with, and yet theres always one dude/tte looking for something different, and your grade in that rotation is at the mercy of atypical personalities far too often. So yeah, in those situations having more weight on objective standards would be nice. 50% still requires you to do well at the wards but gives you some semblance of control over your grade. 25% means the whacko evaluating you might be the only game in town, and his expectations may just be off kilter.
 
My #1 piece of advice is to know that anyone, anywhere, even the people you hate most, can end up being your senior resident or even your attending in the future, or the anesthesiologist or the surgeon on the other side of the blue drape, particularly if you stay in state for residency. If you stay in the same city, even if you cross town, you will see the same people for the rest of your career. Be nice to everyone, even the residents who treat you like crap, or it will come back to bite you in the ass.

Corollary: the residents you hate most in other programs will be close friends with or will be married to other residents in your own residency program, or even worse your attendings. Medicine is a very small community. Do not make enemies, and do not badmouth someone even if you think they are the biggest butthead on the planet.
 
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My #1 piece of advice is to know that anyone, anywhere, even the people you hate most, can end up being your senior resident or even your attending in the future, or the anesthesiologist or the surgeon on the other side of the blue drape, particularly if you stay in state for residency. If you stay in the same city, even if you cross town, you will see the same people for the rest of your career. Be nice to everyone, even the residents who treat you like crap, or it will come back to bite you in the ass.

Corollary: the residents you hate most will be close friends with or will be married to other residents in your residency program, or even worse your attendings. Medicine is a very small community. Do not make enemies, and do not badmouth someone even if you think they are the biggest butthead on the planet.

And it will come back to bite you in your ass even faster on your evaluations at the end of the clerkship.
 
I would also add that for this reason, do not give in to the temptation to get your revenge on someone by writing them a really crappy eval at the end of the rotation. It will not make any real difference, and it will only do you harm in the long run.

This does not apply if you have a resident or attending who is outright guilty of sexual harassment, overt racism, homophobia or other serious abuse of power.
 
I would also add that for this reason, do not give in to the temptation to get your revenge on someone by writing them a really crappy eval at the end of the rotation. It will not make any real difference, and it will only do you harm in the long run.

Weren't the evals by students at your school confidential?

At our school the person being evaluated only gets the comments in aggregate at the end of the year. As long as you don't put in specific comments that would lead back to you there is no way they can trace it (although they can always assume i suppose).

Anyways, I agree about it not making any real difference as our evaluations count for absolutely nothing.
 
Weren't the evals by students at your school confidential?

Although they were supposed to be, at least one student was personally cited for a "lack of professionalism" based on a confidential computerized eval. Do not take anything for granted.

Part #3 of my advice: assume that anything you say is being overheard by the person you are talking about. That includes nurses, residents, attendings, patients, and their families. They all have a way of materializing behind you without you ever realizing it. It is bad, bad news when this happens.
 
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