M3 Rotations - Things to know/expect to learn

[Achilles1164]

Hey all,

Rising upperclassmen medical student here trying to prepare for the upcoming year of rotations. These will include your general rotations:

1. Internal Medicine
2. Family Medicine
3. General Surgery
4. Ob/Gyn
5. Pediatrics
6. Psychiatry

With that in mind, I heard this is a helpful community to ask how to prepare. What I am specifically interested in knowing are specifics.

Example --> ObGyn - Do attendings expect certain things in every presentation such as Gravida/Para status of the mother, how many weeks pregnant, etc.
Beyond presentations, are there specific scores or HY points to know such as APGAR score or different types of abortions, etc.
Finally, for example, how in General Surgery and Emergency Shears are good to have, are there tools specific to each rotation that I should keep in mind/get?

I guess overall what I am interested in knowing is for each of the above rotations:

1. How do you present? Are there specifics to keep in mind like "The Three Minute Presentation" for EM, etc
2. Are there specifics scores SUPER HIGH YIELD to know like HEART score or CURB 65 in the ED?
3. Are there specifics calculations or skills to expect to be pimped on/asked about?
4. Are there currently any all-encompassing resources available to students to use?
5. Any specific tools I should get other than shears and a penlight?

THANK YOU ALL SO MUCH. I have heard great things about the helpful and detailed community that is on SDN and I look forward to being a part of it and being better for it.

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[mistafab]

I would say to not worry about the nitty gritty about each rotation - those you will learn on the job. Just master the basics and you will be on the road to honors.

The basics:
1. show up on time
2. be helpful
3. actually read/study
4. discuss interesting topics for the sake of further learning (real questions, not to look good)
5. be an excellent clinician
6. be a true professional
7. don't be a dick, ever
8. don't you dare pull out your damn phone, EVER
9. if the team does well, you do well, so help people do well
10. Absolutely crush the shelves, you have no choice if you want to do well
11. STAY ENGAGED, Don't talk about stuff not related to the job when residents or attendings are doing stuff
12. People are listening to you, whether you notice them or not (related to number 11).
13. Don't complain about a rotation ever, at all, ever ever ever. You are within earshot of people who chose that for their life's work... Grow a few brain cells and realize this please (related to #11 and #12)

Do all that and people will go to bat for you. That will get you great subjective evals. The rest will be up to your shelf score.

Best of luck.

 

[efle]

Honestly the #1 biggest way you can help yourself is asking people who already rotated on that specialty about the evaluators. Giving 110% effort is entirely wasted if you then ask a 3-bomber for an eval. Same thing with SPs, if they're a significant part of your grade, then hearing about what each case is about through the grapevine is a big advantage compared to the people that are going into it with no idea what to expect. For quality of life in general, whenever you get to pick from several options for where to spend elective weeks, find out from other people where the chill sites/services are that will dismiss you at a reasonable time so you can study for the shelf.

It's good to try your best and all that, but understanding the system (and dumb luck for assigned evaluators) start to be just as big of factors.

 

[Lawpy]

Giving 110% effort is entirely wasted if you then ask a 3-bomber for an eval.

"Outstanding student. Nothing to improve on! 3/5"

 

[seeinghowitgoes]

Now as a resident, I can say medical students who are positive and actually try to find ways to help the team in addition to doing their learning are the ones that we love. All the specific scores and things you’ll pickup quickly on the job and are less important to know walking into the rotation.

You’ll learn just by reading about your patients and spending time honing your communication style by being with them. Being helpful means offering to make calls to PCPs to do med recs and setup follow-ups and other tasks that aren’t “fun” or medical-knowledge related but are completely necessary to getting patient’s good care. Note it’s not scut work (like getting the team coffee).

Stay engaged and take tasks that help move a patient’s care forward even if it isn’t “fun” and you will be highly thought of even if you answer every question on rounds wrong.

 

[efle]

you will be highly thought of even if you answer every question on rounds wrong.

+1 to this. Early on in med school I thought pimping was going to be some big thing, where it mattered that you knew stuff

In reality, requesting outside hospital records for your patient will help you a lot more in the eyes of your team than knowing about pathologies

 

[libertyyne]

"Outstanding student. Nothing to improve on! 3/5"

Here is a literal quote from a reviewer
"Performing at the level of an intern" Straight 3's.

Take it to the chin and move on. Part of year three is realizing things are out of your control and may not get perfect evals even if you give 100%.

 

[ace_inhibitor111]

Bro, I’m struggling to even get evals. Out of 16 I’ve sent I only got 6 back. Having med students be responsible for getting their own evals is a terrible system. It’s like half of what you do will never even matter

 

[Sleepingdoc]

Actually learn, most people you will meet are nice.
Do not argue with nurses.. Listen to residents and attendings. Study when you are not doing anything. If a resident brings up something in front of the attending, do not cut him/her off and try to "look good" in front of attending. Do not try to correct someone higher than you infront of a group unless you have a one on one conversation with him/her later and explain your stance (there is a very high chance that you as a medical student are wrong). They are always watching. Do not talk down about other staff. They are very important and the one's doing the actual work, so respect their time and their effort to teach you.

 

[Ho0v-man]

Here is a literal quote from a reviewer
"Performing at the level of an intern" Straight 3's.

Take it to the chin and move on. Part of year three is realizing things are out of your control and may not get perfect evals even if you give 100%.

Lol I’ve had the same experience. I stunk up one of my rotations and got a wonderful eval.

Never missed a pharm question on the entire rotation “areas to improve: pharmacology” bc he always puts that.

Third year is mostly just showing up and being asked why you don’t already know things that you’re there to learn in the first place. Everyone’s been nice and gets it bc they were there too. But it’s just a cluster****

 

[deleted645092]

Honestly it all depends on the attending. At the bare minimum you want to be able to do a quick and efficient HPI. For the most part (again can be attending-specific and sometimes case/specialty-specific) this means leave out all the bull$h!t you were told is important in OSCEs; Leave it to chief complaint/ reason for visit, how long it’s been going on, have they had this issue before and if they were treated, what was done and how long ago was it, associated symptoms, medical/ surgical history. That’s really gonna be the core of your presentations. The more nuanced stuff for presentations is going to be deciding when things like social history, family history, and random issues that might affect care like whether or not the patient can make it to appointments are going to actually matter. Not that you shouldn’t know them. You should find these things out but keep them in your back pocket in case the attending actually needs that information.

Core information that you can base presentations around for each specialty:

EM: Is the patient acutely ill, do they need to be hospitalized, and are they actively trying to die.

Surgery: Do they actually need surgery? What medical management has been attempted so far? For the actual surgeries, know the overall steps and relevant anatomy. Also practice knot tying and suturing at home. On my surgery rotations the less they had to teach me the basics, the more likely they were to let me be more involved, like 1st assisting.

Family: Know how to listen to patients and know outpatient treatment algorithms.

OB/GYN: Can’t give too much input because OB/GYN was my last rotation and I mostly shadowed anyways. But knowing the patients pregnancy and medical history and any medication changes can be helpful. Basically knowing the differences between low and high-risk pregnancies.

IM: Probably the hardest. Knowing when to escalate vs. de-escalate care is a big thing. Basically present well and come up with a reasonable plan for the most pressing issue at first. Then later on you can try and change plans around based around their other medical problems once you get more complicated patients.

Psych: Knowing what medication to use based on side-effect profiles was heavily emphasized on my psych rotation.

As for supplies, the only thing I carried on me were my Pocket Medicine guide and stethoscope. Pretty much everything else was available on-site.

Procedures and Scores: Not necessary to know cold going in. On surgical rotations if you know the procedures and surgeries scheduled in advance it’s always good to watch videos on them and Google common pimp questions just in case. But you’ve never encountered 95% of the procedures or scores that you’re going to come across so nobody expects you to be able to get them right the first time. But consistent improvement in procedural tasks and researching scores and being able to calculate them in advance before presenting in the future are going to go a long way. Basically learn everything you can from the first time you encounter a pathology so you have a basic plan to go off and improve upon the next time you see it.

And don’t be a dick.

 

[Epilepsy365]

Learn not to gaf and just focus on learning.

 

[deleted978973]

I would say to not worry about the nitty gritty about each rotation - those you will learn on the job. Just master the basics and you will be on the road to honors.

The basics:
1. show up on time
2. be helpful
3. actually read/study
4. discuss interesting topics for the sake of further learning (real questions, not to look good)
5. be an excellent clinician
6. be a true professional
7. don't be a dick, ever
8. don't you dare pull out your damn phone, EVER
9. if the team does well, you do well, so help people do well
10. Absolutely crush the shelves, you have no choice if you want to do well
11. STAY ENGAGED, Don't talk about stuff not related to the job when residents or attendings are doing stuff
12. People are listening to you, whether you notice them or not (related to number 11).
13. Don't complain about a rotation ever, at all, ever ever ever. You are within earshot of people who chose that for their life's work... Grow a few brain cells and realize this please (related to #11 and #12)

Do all that and people will go to bat for you. That will get you great subjective evals. The rest will be up to your shelf score.

Best of luck.

how do i excellent clinician

 

[mistafab]

Numbers 1-13.
Also, number 14. Display common sense.

how do i excellent clinician

 

[tennessee2244]

Numbers 1-13.
Also, number 14. Display common sense.

Just be a normal human. Most of the people on this forum dont know what that means. Acting normal in a sea of wacko psyched up kids goes a long ways.

 

[tennessee2244]

Just be a normal human. Most of the people on this forum dont know what that means. Acting normal in a sea of wacko psyched up kids goes a long ways.

And you can pull out your phone it's not a goddamn prison camp in North Korea.

 

[efle]

And you can pull out your phone it's not a goddamn prison camp in North Korea.

Haha I literally got told off for checking my email on my phone by a surgery resident last week. And no it wasnt on rounds or something, they just had a rule that med students shouldn't be seen on their phones

 

[Ho0v-man]

And you can pull out your phone it's not a goddamn prison camp in North Korea.

I ask at the beginning of the rotation if it’s okay if I study flash cards on my phone in my downtime. So far so good.

 

[7331poas]

I ask at the beginning of the rotation if it’s okay if I study flash cards on my phone in my downtime. So far so good.

wait till you get your eval

 

[Ho0v-man]

wait till you get your eval

I’ve gotten two glowing ones so far. One of which praised me for how much I study.

 

[Dr. Doctor MD]

Third year is mostly just showing up and being asked why you don’t already know things that you’re there to learn in the first place.

This quote is absolutely amazing and 100% accurate

 

[mistafab]

Learn from the best or join the rest.

And you can pull out your phone it's not a goddamn prison camp in North Korea.

 

[MedScat]

And you can pull out your phone it's not a goddamn prison camp in North Korea.

I think what @mistafab was getting at is that...you never know who's watching. What if someone who doesn't know you're doing flashcards sees you sitting on your phone. You want to paint yourself in the best light possible even if its not to those who may be directly evaluating you. I'm only a second year now but even when I'm in the hospital and I see 3rd years on their phone I think it looks slightly unprofessional. I mean, who gives a damn what I think but it may not only be me....

 

[Chibucks15]

I think what @mistafab was getting at is that...you never know who's watching. What if someone who doesn't know you're doing flashcards sees you sitting on your phone. You want to paint yourself in the best light possible even if its not to those who may be directly evaluating you. I'm only a second year now but even when I'm in the hospital and I see 3rd years on their phone I think it looks slightly unprofessional. I mean, who gives a damn what I think but it may not only be me....

At my hospital, everyone communicates with their cell phones and attendings even take direct calls on them. I think it’s just how everything works now doesn’t seem like anyone views it as unprofessional unles you’re obviously just scrolling Instagram or something

 

[NickNaylor]

As someone who now supervises trainees, here are my thoughts. Keep in mind that this is for psychiatry.

As far as knowledge base goes, I am going to assume that you know nothing. If you do actually know some stuff, great, but not knowing things is not going to hurt you. Pre-clinical teaching in psychiatry is generally bad and useless. I frequently "pimp," but the goal of pimping is for me to understand what you do and do not know and teach accordingly, not as a "test" to tell me how "good" of a medical student you are.

These are the things that I care about most when it comes to grading medical students:

1) Are you receptive and responsive to feedback? This is quite possibly the most important thing, and if you fail to incorporate feedback into your clerkship experience you will get a bad grade irrespective of your performance otherwise because this is such a critical thing to do as a young clinician. If you keep making the same mistakes or doing the same things despite being provided feedback about what to do differently, that's a bad prognostic sign.

2) You need to at least appear interested in what's going on. I don't care if you're not interested in psychiatry - I fully understand that it is very unlikely that you will go into psychiatry. That doesn't mean that you get to "check out" and not care. If you decide to go that route, fine, but you will be graded accordingly. Participate in interviewing patients, figure out how psychiatry might be applicable to your field of interest (hint: it will be, even if you're a surgeon) and ask questions accordingly, and at least put forth an effort. Make me believe that even if you don't find psychiatry interesting and don't like the work that you understand that you can take away something useful from the experience.

3) Be interested in and own your patients. Do you just copy what the resident writes in his/her notes? Or are you willing to go out on a limb to actually do some thinking in your notes, even if you're wrong? Do you take the initiative and figure out what needs to be done and what would be helpful for the patient? Do you ask questions about why XYZ is being done or why the diagnosis is ABC and not DEF? Great, that tells me that you're actually thinking about what's going on and are trying to understand what's happening. Again, it is less important to me that you get the "correct" answer and far more important to me that you're engaging in the process and trying to think through diagnostic and management problems, even if you do so incorrectly.

4) Are you easy to work with? Do you add to, rather than subtract from, to the work the team needs to do? No, this is not the same as "liking" you. There are plenty of medical students that I don't care for personally but are still incredibly helpful to the team. Hint: if you're demanding a ton of attention from the resident and/or attending, you likely aren't doing it right. Obviously the resident/attending is responsible for teaching and supervising you and that takes time, but if you can't do anything without having your hand held the entire way, you are likely not being useful to the team. I'm not saying that you need to be a cowboy and just YOLO your entire clerkship - that also won't fare well. But if someone has to supervise you administering a MOCA after teaching you how to do it a couple of times, for example, you are adding to the work of the team rather than being helpful.

I tend to de-emphasize "fund of knowledge" when it comes to grading because 1) that's what the shelf is for and 2) there isn't that much "core" psychiatry knowledge that, in my opinion, all physicians needs to be familiar with. Instead, I tend to focus more on how you work with the team, how you work with your patients, and how you are progressing as a soon-to-be professional. Those things are much more important to me because they are critical to your long-term success. The knowledge will come with time - or not, depending on the field that you ultimately go into.

 

[sharkbyte]

I think the stuff with the phone is more so just common sense. It's obviously fine to use your phone during breaks like lunch or clear downtime when nothing is going on. Otherwise just use your phone as little as possible and especially not on rounds or during teaching or w/e unless you're looking something up.

 

[ARK1234]

I agree with all of the above. Great pearls of wisdom.

Also, it just might be me, but for surgery rotations, very important to know where the nearest bathrooms are and the quickest way to get to the cafeteria/lounge. Cz the best advice I heard was "sit while you can, eat while you can, and go to the bathroom while you can." Boy, was I thankful to the resident for sharing that with me...