Deanis

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Hi.

I'm just wondering if there were any particular hands-on skills that any M3's or M4's would have found useful heading into some of the more hands-on rotations (EM, surgery,...). I'm not looking for intense practice, just more something I could do occasionally in my spare time when I'm bored. I've done this a bit with suturing and knot tying, but i'm wondering if there is anything else for which I can practice the basics.

Thanks.
 

ohboy

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Hi.

I'm just wondering if there were any particular hands-on skills that any M3's or M4's would have found useful heading into some of the more hands-on rotations (EM, surgery,...). I'm not looking for intense practice, just more something I could do occasionally in my spare time when I'm bored. I've done this a bit with suturing and knot tying, but i'm wondering if there is anything else for which I can practice the basics.

Thanks.
I don't think so. If you have a clinical skills lab you could always practice intubating on dummies. Most of the skills 3rd year tend to require an actual person to practice on. The best "clinical skill" to work on would be writing SOAP format notes. If you have that down pat you will look like a rockstar on rounds and consults.
 
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Hi.

I'm just wondering if there were any particular hands-on skills that any M3's or M4's would have found useful heading into some of the more hands-on rotations (EM, surgery,...). I'm not looking for intense practice, just more something I could do occasionally in my spare time when I'm bored. I've done this a bit with suturing and knot tying, but i'm wondering if there is anything else for which I can practice the basics.

Thanks.
History-taking and presentation skills trump knowledge, and knowledge trumps skills. This hierarchy of med student abilities goes for any rotation... even surgery.
 

Jwax

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Learning how to parallel park has been my biggest skill set from this year (we are allowed to park in limited spots right next to the hospital in 3rd/4th year... learning how to parallel park means a 7 min walk vs 15-20).

I think the most important skill to learn in 3rd year is how to be useful to your team. This is always a challenge as many residents are too OCD to let you do anything for them and they don't know how to tell you what to do to be helpful. Not really something you can practice, so just realize you will be on the same boat as everyone starting out in 3rd year. Improving quickly will be the biggest accomplishment to get ahead of your peers, if that's what you're going for.
 

Deanis

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Alright. Thanks a lot guys. I'm trying to work on both my history taking and presenting skills, but find it difficult to be concise. I'm sure the key is practice, but any advice to streamline the process?

Thanks again.
 

Vonsmack

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Alright. Thanks a lot guys. I'm trying to work on both my history taking and presenting skills, but find it difficult to be concise. I'm sure the key is practice, but any advice to streamline the process?

Thanks again.
Practice a lot. You will get better over time, everyone does.
 

MSmentor018

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History-taking and presentation skills trump knowledge, and knowledge trumps skills. This hierarchy of med student abilities goes for any rotation... even surgery.
:thumbup: it's good to have H+P, knowledge and skills but eventually 1 will lead to the other. go to the SAEM website, they have a med student area with a fantastic article on the 3 minute presentation. I know that can be a little short on say, medicine rounds, but for surgery and EM it worked great.
 

RxnMan

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Hi.

I'm just wondering if there were any particular hands-on skills that any M3's or M4's would have found useful heading into some of the more hands-on rotations (EM, surgery,...). I'm not looking for intense practice, just more something I could do occasionally in my spare time when I'm bored. I've done this a bit with suturing and knot tying, but i'm wondering if there is anything else for which I can practice the basics.

Thanks.
1) Growing a thick skin
2) Learning how to study effectively in short 5-15 minute bursts
3) How to look busy when you're not.
4) Take a quick history and exam and summarize it into a good 2 min presentation
5) How to operate on little sleep or food
 

Substance

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Third year is less about learning medicine and more about learning politics. Here's what's valuable:


1. Learning how to stand up for yourself. There are more kunts in health-care than in basically any other field. You're gonna need to learn how to command respect.
2. Learning how to pretend to see the JVP.
3. Learning how to say no to unreasonable requests. This is probably the most important skill. If you accept too much on your plate, you'll never get it done, and you'll look foolish.
4. Learning how to network and shmooze.
5. Realizing that inpatient medicine sucks and the real money and lifestyle are in the NPC (not-patient-care) specialties, as outlined in House of God more than 30 years ago.
6. Learning how to prioritize your own needs. If you need to study, stay away from where the work is and do your thing. If they need you, they'll page you.
7. Learning that once you're finished work to turn your pager off and remove the battery so they cannot turn it on remotely.
8. Learning that people, when given even a smidgen of power, will make it known to everyone else and will be unreasonable about it. Prepare to be berated by everyone from the fat scrub nurse to the ward desk clerk(who barely has a GED) just because you're the "student" and they are "above" you. Then see point number 1 in my list.
 

McGillGrad

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Wow, sounds like you were treated very badly during your life. I feel bad for you.




Third year is less about learning medicine and more about learning politics. Here's what's valuable:


1. Learning how to stand up for yourself. There are more kunts in health-care than in basically any other field. You're gonna need to learn how to command respect.
2. Learning how to pretend to see the JVP.
3. Learning how to say no to unreasonable requests. This is probably the most important skill. If you accept too much on your plate, you'll never get it done, and you'll look foolish.
4. Learning how to network and shmooze.
5. Realizing that inpatient medicine sucks and the real money and lifestyle are in the NPC (not-patient-care) specialties, as outlined in House of God more than 30 years ago.
6. Learning how to prioritize your own needs. If you need to study, stay away from where the work is and do your thing. If they need you, they'll page you.
7. Learning that once you're finished work to turn your pager off and remove the battery so they cannot turn it on remotely.
8. Learning that people, when given even a smidgen of power, will make it known to everyone else and will be unreasonable about it. Prepare to be berated by everyone from the fat scrub nurse to the ward desk clerk(who barely has a GED) just because you're the "student" and they are "above" you. Then see point number 1 in my list.
 

ucsfstudents

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I agree that a very useful skill in 3rd year is learning how to give a well organized, succinct oral presentation. You will get better with practice, as long as you incorporate feedback from your residents and attendings.
 

NAGNAM

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Wow, sounds like you were treated very badly during your life. I feel bad for you.
I thought it sounded fairly standard. Where are you doing your rotations, Hugsville?
 

the negative 1

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The best "clinical skill" to work on would be writing SOAP format notes. If you have that down pat you will look like a rockstar on rounds and consults.
No doubt. It really makes for those rare moments during a clinical rotation when an attending tells you how impressed they are with your work. It also makes your residents and interns look good since it seems they're doing their job of educating you.

Win-win all around.
 

braluk

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Depends on how your rounds run. The best advice outside of the standard stuff is being able to present your patient thoroughly yet succinctly without reading off a card or your note (with the exception of labs and vitals, and if your attending trusts you, you could get away with "unchanged vitals, labs stable, or reporting H&H dropped to so and so from yesterday's so and so; particularly if the patient has been an inpatient after 1-2 days with a steady course). The hall mark of a good presentation is if you can see the attending paying attention to you or is just politely letting you discuss your note. The best thing my residents made me do is putting my note away when I presented to him (how well do you know your patient?)
 

smiley737

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:thumbup:

Third year is less about learning medicine and more about learning politics. Here's what's valuable:


1. Learning how to stand up for yourself. There are more kunts in health-care than in basically any other field. You're gonna need to learn how to command respect.
2. Learning how to pretend to see the JVP.
3. Learning how to say no to unreasonable requests. This is probably the most important skill. If you accept too much on your plate, you'll never get it done, and you'll look foolish.
4. Learning how to network and shmooze.
5. Realizing that inpatient medicine sucks and the real money and lifestyle are in the NPC (not-patient-care) specialties, as outlined in House of God more than 30 years ago.
6. Learning how to prioritize your own needs. If you need to study, stay away from where the work is and do your thing. If they need you, they'll page you.
7. Learning that once you're finished work to turn your pager off and remove the battery so they cannot turn it on remotely.
8. Learning that people, when given even a smidgen of power, will make it known to everyone else and will be unreasonable about it. Prepare to be berated by everyone from the fat scrub nurse to the ward desk clerk(who barely has a GED) just because you're the "student" and they are "above" you. Then see point number 1 in my list.
 

IMGUSMLEStep1

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Insightful!

Third year is less about learning medicine and more about learning politics. Here's what's valuable:


1. Learning how to stand up for yourself. There are more kunts in health-care than in basically any other field. You're gonna need to learn how to command respect.
2. Learning how to pretend to see the JVP.
3. Learning how to say no to unreasonable requests. This is probably the most important skill. If you accept too much on your plate, you'll never get it done, and you'll look foolish.
4. Learning how to network and shmooze.
5. Realizing that inpatient medicine sucks and the real money and lifestyle are in the NPC (not-patient-care) specialties, as outlined in House of God more than 30 years ago.
6. Learning how to prioritize your own needs. If you need to study, stay away from where the work is and do your thing. If they need you, they'll page you.
7. Learning that once you're finished work to turn your pager off and remove the battery so they cannot turn it on remotely.
8. Learning that people, when given even a smidgen of power, will make it known to everyone else and will be unreasonable about it. Prepare to be berated by everyone from the fat scrub nurse to the ward desk clerk(who barely has a GED) just because you're the "student" and they are "above" you. Then see point number 1 in my list.
 

Deanis

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Third year is less about learning medicine and more about learning politics. Here's what's valuable:


1. Learning how to stand up for yourself. There are more kunts in health-care than in basically any other field. You're gonna need to learn how to command respect.
2. Learning how to pretend to see the JVP.
3. Learning how to say no to unreasonable requests. This is probably the most important skill. If you accept too much on your plate, you'll never get it done, and you'll look foolish.
4. Learning how to network and shmooze.
5. Realizing that inpatient medicine sucks and the real money and lifestyle are in the NPC (not-patient-care) specialties, as outlined in House of God more than 30 years ago.
6. Learning how to prioritize your own needs. If you need to study, stay away from where the work is and do your thing. If they need you, they'll page you.
7. Learning that once you're finished work to turn your pager off and remove the battery so they cannot turn it on remotely.
8. Learning that people, when given even a smidgen of power, will make it known to everyone else and will be unreasonable about it. Prepare to be berated by everyone from the fat scrub nurse to the ward desk clerk(who barely has a GED) just because you're the "student" and they are "above" you. Then see point number 1 in my list.
Lol! Doing cardio block right now...
 

MCYan

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learn to suture and tie different knots
 

juiceman311

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Do nothing. You will acquire all that you need as you progress third year. Your first rotation will know it is your first rotation and will subsequently expect less from you for an A performance. Your last rotation will know that you have had a full year of the scut business and will expect a little more for an A. These posts are getting repetitive, 3rd and 4th year are so much more enjoyable than the first two years, no need to get stressed.

My one piece of advice for 3rd year is definitely enjoy any free time you have after M1 and after Step1. Nothing you read for M3 before M3 will help you at all, trust that.
 

bola

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Do nothing. You will acquire all that you need as you progress third year. Your first rotation will know it is your first rotation and will subsequently expect less from you for an A performance. Your last rotation will know that you have had a full year of the scut business and will expect a little more for an A. These posts are getting repetitive, 3rd and 4th year are so much more enjoyable than the first two years, no need to get stressed.

My one piece of advice for 3rd year is definitely enjoy any free time you have after M1 and after Step1. Nothing you read for M3 before M3 will help you at all, trust that.
I agree with the above. Not much you can do to prepare- apart from building your knowledge base by doing what is expected of you in both 1st and 2nd yr.

The hallmark of 3rd yr is FLEXIBILITY- for example with presentations, you can try to practice as much as you want but what is succinct for medicine is way too detailed for surgery, and what is too detailed for one attending is succinct for another. You just have to be ready to take feedback the first time you do something and come back the next time doing it the "right" way.

One interesting thing I learnt is also that doing more doesn't always mean you're doing better: taking on 5 pts and thinking that makes you look hardworking even though you barely have time to understand each one's condition is worse than having 2-3 pts and knowing them cold (of course this depends on expectations - if you're expected to carry >4 pts then that's a diff story), very few attendings remember how many pts the med student presented on rounds but rather how well they knew the pts they presented.
 

spicedmanna

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Agree that good H&P and presentation skills are essential. If you focus on these things alone, you'll be a rock star. Presentation skills are difficult and takes a lot of stumbling through and feedback to get it right. Furthermore, it can be context-specific, meaning how you present to a medicine team will differ than how you present to a surgical one. Learn how to write good, succinct progress notes and consults; this is also critical.

Beyond that, I found that since we have little to no real responsibility, now is a good time to practice physical exam skills (context appropriate, of course). What I usually do is to pick a certain thing, like otoscopic exam, abdominal exam, pulm, cardio, or whatever and do it for every patient that walks in, whether it is specifically indicated or not, to get the numbers in and to see a lot of variation in normal and in various pathological states. This way, I get to really practice and refine my skill set. It is further enhanced if you can get direct feedback, which is probably easier to obtain in an outpatient setting.

Being helpful and trying to anticipate what is needed next has been useful to me this year. If we are working up a patient, I try to figure out what is needed at the next step, and if it is appropriate and I have permission (which can be presumptive at times) to do so, I try to facilitate or suggest that, whether it is getting a pulse-ox, doing an EKG, ordering labs, pulling old records, listening in on consults, repleting 'lytes, running down to radiology to get an interpretation that is pending, noticing important physical exam changes, keeping an eye on critical trends, and trying to know everything about your patients, etc. Obviously, you are going to need to work with the team on this very closely (can't emphasize this enough). Keep everyone in the loop, checking in frequently. Naturally, a modicum of common sense is needed; you don't want to do anything that is not appropriate for your level, or you don't have the permission to do. Keep everyone on your team as informed as possible. It amounts to being proactive to the extent that is reasonable without compromising on your learning, which is what you are there for (don't forget that).

I received some good advice from a lot of residents that it helps your own learning a lot (with the side-effect of impressing those around you) if you try to function a little above your level. That is to say, if you are a medical student, try to function like an intern. Do this only if you have a decent grasp and familiarity with your own level, of course, but stretching to the next certainly improves learning. Use your common sense, of course, and don't do anything foolish or too far beyond, and certainly work closely with your ward team.

Finally, try to really talk to your patients. We have much more time than interns and residents. Because of that, it is possible for us to notice things that others may not have the time to find out. Sometimes, we are the first person to see the patient and others on the team will depend more heavily on your take. For example, one time, we had a patient that was DMII, but because the patient was a somewhat poor historian and admitted to our service during the night, nobody figured out that he was on basal and sliding-scale insulin, in addition to oral meds. Because I had the luxury of spending more time with the patient, I found that out, informed my team, and proactively wrote the necessary orders for my resident to sign.
 
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njbmd

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At the beginning of third year, I expect a medical student to be able to:
  • Perform an efficient complete physical exam correctly.
  • Relate the patient's history and physical exam efficiently and appropriately for the clinical situation.
  • Use correct form in writing admission and progress notes.
  • Be able to correct basic electrolytes properly.
Learning to perform and present patient history and physical exam findings that are appropriate for the clinical situation is a very difficult task. The medical students who generally earn honors are the ones that are able to do this efficiently. The clincical situations where one would alter history and exam findings are:
  • Emergency Department
  • New Ward Admission
  • Clinic
  • Morning rounds
  • Afternoon rounds
  • Formal Case Presentation
If you can master these skills along with a clear and concise documentation style, you are on your way. I find that many medical students when new to the wards will try to copy the interns findings or will be reluctant to suggest treatment plans. There is no penalty for offering a treatment plan that I don't agree with but there are penalties for not have any plan at all because this shows lack of critical clinical thinking skills. Trust your instints and see where they take you.