Is clinical year something you can prepare for?

[Monkeymaniac]

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I hear from people that even the books that talk about what to expect during the clinical years are merely introductory and that you learn most of the things that you need to survive the clerkship during the first some months.

But for those of you who've finished the 3rd or 4th year, what would you say you would have done differently during the time between the summer after the 1st year and the beginning of the 3rd year (e.g. work on interpersonal skills, patient presentation, focus on 2nd year pre-clinical courses (patho, derm, etc.)) that would have prepared you better in the ward and for shelf exams? I'd greatly apprecaite your comments.

 

[dr zaius]

The best advice, in my opinion, is to pay attention and try to learn as much as you can during MS1-2. Knowing MS1-2 pathophysiology and presenting symptoms of diseases as well as pharmacology really help you to go far during third year. Doing well in the early years really does help prepare you for third year no matter what anyone says. Everyone's not going to have sarcoidosis like they did in pathology, but you will get pimped on it. A good base of medical knowledge is what is expected of you. You get this from the first 2 years.

Don't blow off your clinical skills course. Hone your physical exam early. Try to get a flow down so you can focus on what you're seeing/hearing instead of what you will do next, are you on the correct side, etc. You're not going to be able to pick up on every pertinent physical exam finding in the beginning- you've more than likely been practicing on standardized patients so you haven't really seen much true pathology and that's fine. You will get better with time and exposure. Going into third year with a good, methodical physical exam routine will really help you out.

If you're socially inept try to fix that. Go to parties and talk to random people. Stop being awkward and quoting Nietzsche every 3 seconds.

Third year is different for a number of reasons. One that stood out to me is that the clinical vignette is no longer fully given to you. You have to seek it out by doing a history and physical exam. By knowing pathophys you will be able to ask the right questions, and with a good physical exam you can really look for those pertinent findings. It's very different from the standard multiple choice question.

For shelf exams read early (don't put off cracking case files or whatever until the last week of the rotation), and read up on every one of your patients' diseases. Know presenting symptoms, management, and complications.

Anyway, these are just my opinions on reflection of third year. It's probably incoherent because I'm sleep deprived, cramming some last bit info for my surgery oral exam tomorrow followed by shelf on Friday...and then the bliss that is 4th year.

 

[Monkeymaniac]

The best advice, in my opinion, is to pay attention and try to learn as much as you can during MS1-2. Knowing MS1-2 pathophysiology and presenting symptoms of diseases as well as pharmacology really help you to go far during third year. Doing well in the early years really does help prepare you for third year no matter what anyone says. Everyone's not going to have sarcoidosis like they did in pathology, but you will get pimped on it. A good base of medical knowledge is what is expected of you. You get this from the first 2 years.

Don't blow off your clinical skills course. Hone your physical exam early. Try to get a flow down so you can focus on what you're seeing/hearing instead of what you will do next, are you on the correct side, etc. You're not going to be able to pick up on every pertinent physical exam finding in the beginning- you've more than likely been practicing on standardized patients so you haven't really seen much true pathology and that's fine. You will get better with time and exposure. Going into third year with a good, methodical physical exam routine will really help you out.

If you're socially inept try to fix that. Go to parties and talk to random people. Stop being awkward and quoting Nietzsche every 3 seconds.

Third year is different for a number of reasons. One that stood out to me is that the clinical vignette is no longer fully given to you. You have to seek it out by doing a history and physical exam. By knowing pathophys you will be able to ask the right questions, and with a good physical exam you can really look for those pertinent findings. It's very different from the standard multiple choice question.

For shelf exams read early (don't put off cracking case files or whatever until the last week of the rotation), and read up on every one of your patients' diseases. Know presenting symptoms, management, and complications.

Anyway, these are just my opinions on reflection of third year. It's probably incoherent because I'm sleep deprived, cramming some last bit info for my surgery oral exam tomorrow followed by shelf on Friday...and then the bliss that is 4th year.

Thanks for all your comments, I really do appreciate it!

 

[Anastomoses]

The best advice, in my opinion, is to pay attention and try to learn as much as you can during MS1-2. Knowing MS1-2 pathophysiology and presenting symptoms of diseases as well as pharmacology really help you to go far during third year. Doing well in the early years really does help prepare you for third year no matter what anyone says. Everyone's not going to have sarcoidosis like they did in pathology, but you will get pimped on it. A good base of medical knowledge is what is expected of you. You get this from the first 2 years.

Don't blow off your clinical skills course. Hone your physical exam early. Try to get a flow down so you can focus on what you're seeing/hearing instead of what you will do next, are you on the correct side, etc. You're not going to be able to pick up on every pertinent physical exam finding in the beginning- you've more than likely been practicing on standardized patients so you haven't really seen much true pathology and that's fine. You will get better with time and exposure. Going into third year with a good, methodical physical exam routine will really help you out.

If you're socially inept try to fix that. Go to parties and talk to random people. Stop being awkward and quoting Nietzsche every 3 seconds.

Third year is different for a number of reasons. One that stood out to me is that the clinical vignette is no longer fully given to you. You have to seek it out by doing a history and physical exam. By knowing pathophys you will be able to ask the right questions, and with a good physical exam you can really look for those pertinent findings. It's very different from the standard multiple choice question.

For shelf exams read early (don't put off cracking case files or whatever until the last week of the rotation), and read up on every one of your patients' diseases. Know presenting symptoms, management, and complications.

Anyway, these are just my opinions on reflection of third year. It's probably incoherent because I'm sleep deprived, cramming some last bit info for my surgery oral exam tomorrow followed by shelf on Friday...and then the bliss that is 4th year.

Excellent. Esp the bit about the clinical vignette no longer being given to you. Oh, yeah.

 

[evilbooyaa]

The best advice, in my opinion, is to pay attention and try to learn as much as you can during MS1-2. Knowing MS1-2 pathophysiology and presenting symptoms of diseases as well as pharmacology really help you to go far during third year. Doing well in the early years really does help prepare you for third year no matter what anyone says. Everyone's not going to have sarcoidosis like they did in pathology, but you will get pimped on it. A good base of medical knowledge is what is expected of you. You get this from the first 2 years.

Don't blow off your clinical skills course. Hone your physical exam early. Try to get a flow down so you can focus on what you're seeing/hearing instead of what you will do next, are you on the correct side, etc. You're not going to be able to pick up on every pertinent physical exam finding in the beginning- you've more than likely been practicing on standardized patients so you haven't really seen much true pathology and that's fine. You will get better with time and exposure. Going into third year with a good, methodical physical exam routine will really help you out.

If you're socially inept try to fix that. Go to parties and talk to random people. Stop being awkward and quoting Nietzsche every 3 seconds.

Third year is different for a number of reasons. One that stood out to me is that the clinical vignette is no longer fully given to you. You have to seek it out by doing a history and physical exam. By knowing pathophys you will be able to ask the right questions, and with a good physical exam you can really look for those pertinent findings. It's very different from the standard multiple choice question.

For shelf exams read early (don't put off cracking case files or whatever until the last week of the rotation), and read up on every one of your patients' diseases. Know presenting symptoms, management, and complications.

Anyway, these are just my opinions on reflection of third year. It's probably incoherent because I'm sleep deprived, cramming some last bit info for my surgery oral exam tomorrow followed by shelf on Friday...and then the bliss that is 4th year.

Agree with all the above. A good basis of MS2 knowlede, along with looking up basic guidelines for whatever rotation you're on such as:
1) On IM? Look up JNC-8 for HTN, CHADS2 for AFib, Childs-Pugh and/or MELD score for Liver failure, Staging CKD, etc. Know the NYC criteria for heart failure. Look up what order diabetic medications are supposed to be prescribed in (forget the name of that guideline) Ask residents what their hospital's regimen in Abx for CAP vs HAP vs HCAP is, as many hospitals will differ slightly in their normal regimen.

2) On OB/GYN? Learn on your own how to read a rhythm strip. Know how to differentiate between Trich/BV/Candida using your nose, a microscope slide, and a history.

3) On Psych? Understand that each attending's preference for meds is slightly different, and the main thing to understand is to try the patient on something new (so you have to look back and see EVERYTHING they've ever been prescribed for their psych illness).

 

[mvenus929]

Honestly? I took some time to shadow. It's easy to get caught up in the stress of studying for the next exam (especially as Step 1 looms over your shoulder), or focusing on making sure you ask every question you can to the standardized patients that sometimes it's just good to sit and watch someone else do it.

I did a volunteer thing in the summer of M1 where I got to do HPIs on patients. I didn't know most of the pathologies yet (I hadn't done cardio, pulm, renal, endocrine, reproductive, or heme/onc yet), but it was good just trying to practice the flow of history taking, and the horror of my first couple presentations really made them easier to do once I got to third year (course, I'm still not very good at doing them on the fly).