MS3 AMA - ask us questions

[NickNaylor]

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Previous MS1 thread: http://forums.studentdoctor.net/threads/ms1-q-a.929521/
Previous MS2 thread: http://forums.studentdoctor.net/threads/ms2-ama-ask-us-questions.1001936/

The title says it all. MS3 is probably the most mysterious yet fascinating/terrifying year of medical school as a pre-med - at least it was for me. What questions do you have? Anything goes: from pragmatic questions to what it's like to be a student on the wards to lifestyle-related questions. I'll be as candid as I can - don't hold back!

I also encourage any other MS3s to chime in with their feedback as well. In the interests of keeping the thread on-topic and ensuring that the answers to questions are actually relevant, I'd please ask that you avoid providing input if you yourself are not a MS3.

Ask away!

I'd also encourage you to peruse the threads linked above - it serves as an interesting time capsule to see how your view of medicine might change as you go through the training. I intend to keep doing this with each year as long as I remain active on SDN.

 

[ace12345]

Thanks for doing this NickNaylor. You've been really helpful for a really long time. I wanted to ask that as an M3, what is your opinion on students changing their desired specialty with respect to research? If a student realizes they like another specialty once rotations start, for example, is there enough time to do the research in that area necessary to facilitate that switch?

 

[alt12345]

Do you have any general tips, maybe like a top 3 list, of how to do well on rotations? Is it more about being helpful or staying out of the way?

 

[NickNaylor]

Thanks for doing this NickNaylor. You've been really helpful for a really long time. I wanted to ask that as an M3, what is your opinion on students changing their desired specialty with respect to research? If a student realizes they like another specialty once rotations start, for example, is there enough time to do the research in that area necessary to facilitate that switch?

Good question. As a general rule, yes, there's enough time to still get involved in research even if you're "late" (eg, the end of MS3) to decide your specialty. But the real answer is, of course, it depends. In my own experience, I've found that departments are helpful to students that are interested in their specialty and have an interest in ensuring that they match. This means trying to find opportunities for them - research included - such that their application can be as competitive as possible. But it all depends on finding the right people and getting help from them when you do end up finding them.

Actually doing the research is another matter. If it's a clinical project that can be worked on at home and as possible, then you can definitely get some work done. I don't think spending significant time in a lab during MS3 is all that feasible though.

Hope that answers the question. Let me know if it didn't and I'll try and clarify.


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[NickNaylor]

Do you have any general tips, maybe like a top 3 list, of how to do well on rotations? Is it more about being helpful or staying out of the way?

A little of column A, a little of column B. To limit it to 3 things:

1) Try and be helpful to your team when possible, and be willing to do scut when necessary. Unfortunately, yes, this will mean you spend a good amount of time faxing stuff, getting paperwork, and a variety of things unrelated to clinical work. The person that makes it easier for your residents/attendings to get work done is the person that is well liked.

2) Don't sell yourself short when discussing plans or getting pimped. By that I mean make it a point to demonstrate that you actually know some stuff. Don't be obnoxious, but even if you don't know the answer to a question, take a stab at it and give your reasoning for answering why you did. You may not get the answer right, but if you can demonstrate to your residents/attendings that you're competent and not a total bonehead, then you'll be fine.

3) Make sure you're spending time studying for the shelves. Unfortunately what you see on the wards doesn't always correlate to what you'll be tested on for exams. In most cases I would say the correlation is very low. It'd be a huge mistake to bank on the clinical knowledge you learn on the floor to get through the shelf. You most likely won't do too well.

In short, I think the successful student is 1) not a weirdo and is fun to be around, 2) helps the team in a meaningful way, and 3) makes their knowledge known to their superiors. If you can do those things, then I think you're likely to get a good evaluation. That's a gross oversimplification, of course, so take it for what you will.


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[loofah]

What questions should we should ask an interviewer about the clinical year?

It seems a lot schools' webpages spend a bulk of their time discussing the preclinical curriculum, which makes the clinical years seem a mystery...
Thank you for putting all this time into your AMA threads!

 

[NickNaylor]

What questions should we should ask an interviewer about the clinical year?

It seems a lot schools' webpages spend a bulk of their time discussing the preclinical curriculum, which makes the clinical years seem a mystery...
Thank you for putting all this time into your AMA threads!

Try and get a sense for what the role of the medical student is on the team. Give them enough room to hang themselves. You want to go to a school that allows you to participate in patient care, develop plans, and write notes. What you don't want is anything that sounds like a glorified shadowing experience. That should really be a big red flag if that's the vibe you're getting.

I would also ask what the expectation for students is. In other words, what does a student need to do in order to earn top marks from an attending? More than anything this is getting back to the first question, because you want to make sure that the expectations are high and are preparing you well to go into residency.

I'd just focus on trying to make sure that a school is preparing it's students to go into residency as a clinician capable of functioning in a pseudo-independent way as expected of an intern. Talking to students that have been on the wards would be hugely beneficial. Pick their brains and ask them what they actually did while in the hospital. Again, IMO you want to be as "independent" and hands-on as possible. That's how you're going to learn - not by shadowing in a white coat.


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[Doudline]

Mandatory question in any AMA thread: where do you stand on the Kinsey scale atm?

 

[NickNaylor]

Mandatory question in any AMA thread: where do you stand on the Kinsey scale atm?

I've never heard of that before. Let me go ask my girlfriend who I live with.


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[sunflower18]

1) I think I read you say somewhere that you had decided on psychiatry (correct me if I'm wrong!) -- what factors did you use to decide on that as a specialty? Is it a gut feeling decision, or one based on what makes the most sense logically?

2) If you are interested in a specialty that isn't in the core rotations -- radonc, ophthalmology, derm, etc.? I know that you can shadow in the pre-clinical years, but especially based on your earlier comments, it seems like shadowing really doesn't compare to actually being involved.

3) I've heard some people say that they felt compelled to act like every rotation corresponded to their specialty of choice. Did you feel that way? If not, how do you tactfully tell your surgery attending that you aren't interested in surgery (for example) -- or do you just avoid the topic?

Thank you so much!!

 

[Charles_Carmichael]

3) I've heard some people say that they felt compelled to act like every rotation corresponded to their specialty of choice. Did you feel that way? If not, how do you tactfully tell your surgery attending that you aren't interested in surgery (for example) -- or do you just avoid the topic?

The vast majority of people on the wards are pretty cool. They understand that not everyone will be going into their fields. If you're not interested in surgery, for example, you can be upfront about it. Don't degrade the field or go out of your way to avoid work though. Continue to work hard and you should be fine, read up on your patients, present on rounds, etc. Work hard, just like you would on the rotation in the field you're interested in. I haven't encountered any problems with this method at any of the hospitals I've rotated at and I haven't heard of classmates having this type of issue either.

YMMV.

 

[Charles_Carmichael]

Try and get a sense for what the role of the medical student is on the team. Give them enough room to hang themselves. You want to go to a school that allows you to participate in patient care, develop plans, and write notes. What you don't want is anything that sounds like a glorified shadowing experience. That should really be a big red flag if that's the vibe you're getting.

I would also ask what the expectation for students is. In other words, what does a student need to do in order to earn top marks from an attending? More than anything this is getting back to the first question, because you want to make sure that the expectations are high and are preparing you well to go into residency.

I'd just focus on trying to make sure that a school is preparing it's students to go into residency as a clinician capable of functioning in a pseudo-independent way as expected of an intern. Talking to students that have been on the wards would be hugely beneficial. Pick their brains and ask them what they actually did while in the hospital. Again, IMO you want to be as "independent" and hands-on as possible. That's how you're going to learn - not by shadowing in a white coat.

Agreed. Medicine is not a spectator sport. You gotta jump in and do as much as possible to maximize learning. That means working-up patients, coming up with assessments and plans, coming up with a good differential, presenting to residents and attendings (to fine-tune your presentation skills), writing notes (and getting feedback on those notes), etc. You want to go to a school where clinicians are willing to give you as much responsibility as you ask for (assuming that you can handle it, of course).

 

[NickNaylor]

1) I think I read you say somewhere that you had decided on psychiatry (correct me if I'm wrong!) -- what factors did you use to decide on that as a specialty? Is it a gut feeling decision, or one based on what makes the most sense logically?

2) If you are interested in a specialty that isn't in the core rotations -- radonc, ophthalmology, derm, etc.? I know that you can shadow in the pre-clinical years, but especially based on your earlier comments, it seems like shadowing really doesn't compare to actually being involved.

3) I've heard some people say that they felt compelled to act like every rotation corresponded to their specialty of choice. Did you feel that way? If not, how do you tactfully tell your surgery attending that you aren't interested in surgery (for example) -- or do you just avoid the topic?

Thank you so much!!

1) A mix of both. For me, the most important thing was whether or not I found the work interesting and enjoyed working with the patient population required of the specialty. If that wasn't true for a particular specialty, then I wouldn't even consider it. Beyond that, things like competitiveness (ie, ability to end up where I want to end up for residency), possible practice environments (academic vs. private vs. solo, insurance vs. cash-based, etc.), lifestyle (both in residency and in practice, typical hours worked per week), and salary were factors for me. For psych specifically, I enjoy the fact that talking to patients is such a critical part of the field. I also like the concept of therapy and was really drawn in by the possibility of working with patients in that way, though I'll admit I have no first-hand exposure myself. Psych also gives you the ability - more than most fields I think - to work hours you want to work in an environment that you want to work in (inpatient vs. outpatient, community vs. academic, quick med management appointments vs. longer therapy appointments vs. both, etc.). There are some definite downsides to the field, but when choosing your specialty it's all about ensuring that the positives are things that are most important to you while the negatives are things you think you can manage or otherwise deal with. For me, psych struck the best balance of the fields that I had exposure to, and I'm confident I'll enjoy the field.

2) If you're seriously considering pursuing a non-core specialty, do some shadowing during MS1/MS2. This serves two functions: getting some exposure to the field to see whether you still find it interesting or not and to begin networking with the people at your institution that will be helpful to know. Ideally you'll do an elective or away rotations in the field to get some hands on experience with being a provider in that specialty. This is more difficult in the surgical subspecialties since you obviously won't be performing surgery on patients, but for other fields you'll hopefully use those opportunities to get some more in-depth exposure and evaluate whether you could see yourself doing that for the rest of your life.

3) Once I settled on psych I was pretty upfront with that decision. I'm in a position where I don't have to grub for honors since psych is so non-competitive, so I wasn't too worried about ruffling feathers or otherwise being judged for my decision. That said, there are absolutely people that care and will **** on you for either not wanting in their specialty or for choosing something they have a low opinion of for whatever reason (psych, unfortunately, being one of the specialties which generally holds a low opinion among the public and physicians). Fortunately those people are few and far between, but they're out there. With surgery specifically I told my residents and attendings that while I thought surgery was very cool, there was zero chance I would be going into it as a career. I still worked hard, still read up on the cases and made sure I knew the basics of procedures, but they were aware if where I was leaning in terms of a specialty. I just thought it ridiculous to appease people because of childish nonsense like them being bothered about a personal decision which has nothing to do with them, but as I said, I've heard stories of people getting negative reactions when their chosen field isn't what they're rotating on.


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[No Limits]

Nick, thanks a ton for doing this. This may sound like a silly question but what does a MS3 do while they are on call? Is it just more scut work?

Are there any opportunities to explore other fields during the preclinical years outside of interest groups?

 

[Charles_Carmichael]

Nick, thanks a ton for doing this. This may sound like a silly question but what does a MS3 do while they are on call? Is it just more scut work?

Not Nick, but I can answer this one. The answer is that it really depends on the field, the site, and the team. I can give you examples of what I did on a few rotations when I was on call, but that may be different from what others experienced.

Surgery -- we had both late call and 30-hour call at my site. Either way, for me, call meant responding to all the "Code Yellows" (trauma patients), doing post-op checks and putting in my notes, responding to pages and relaying info to my intern/senior, seeing consults in the ED to decide whether someone needed immediate surgery or not, etc. For the traumas, you helped with the tear-down of the clothes, assessment of the ABCs, evaluation of gross injuries, etc. I also got to do a lot of FAST exams (basically, a quick ultrasound evaluation of the abdomen and heart to look for any hemorrhage). If anyone was taken to the OR, I scrubbed in or my classmate on-call scrubbed in. I also got to do more procedures on call (ex. putting in NG tubes). Besides that, I was responsible for doing post-op checks on the surgical service and putting in my notes for the intern/resident to co-sign. Going back to getting as much responsibility as you ask for, I also got to carry one of the service's pager a couple of times. So I was the one responding to pages and relaying info to my seniors. That was pretty cool too and gave you a real sense of responsibility.

Ob/Gyn -- mostly watching the monitors to see who's progressing on L&D and helping deliver babies when it was time. Also, seeing patients in the OB triage to see whether anyone needed to be admitted or if they can go home and follow-up at their regular appointment.

Medicine -- mostly seeing consults and going to the ED to admit patients.

Surgery and Ob/Gyn were the only rotations where I had overnight call. On the other services, I just had late call, where you stayed later than usual. Like I said though, it really depends on what rotation you're on, your team (and how much they trust you), and your hospital site. I probably did the most on surgery in terms of hands-on stuff, but I probably worked-up more patients during my medicine rotation.

Also, you have to kind of define what you mean by scut. Is it scut to call another hospital to get medical records for a patient you're taking care of? Some say yes, some say no. If it helps in taking better care of the patient, I tend to lean towards no. Besides, the residents do this too, so it's not just me making phone calls and stuff. Things like transporting patients, etc, I've generally never had to do unless it was an emergent situation and my resident and I were rushing the patient to the CT scanner or something.

 

[NickNaylor]

Nick, thanks a ton for doing this. This may sound like a silly question but what does a MS3 do while they are on call? Is it just more scut work?

Are there any opportunities to explore other fields during the preclinical years outside of interest groups?

Kaushik's post pretty accurately describes my experience as well.


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[No Limits]

@Kaushik
Wow, thanks that was pretty informative. How hard was it to do a 30 hr shift for the first time? When you do procedures such as putting in NG tubes, is that a skill acquired while on the wards or was that something you were able to practice via skills lab or something of the sort in the preclinical years?

 

[No Limits]

Kaushik's post pretty accurately describes my experience as well.


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I asked this before in my previous post but is there opportunities to explore other specialties outside of interest groups in the preclinical years?

 

[Charles_Carmichael]

Wow, thanks that was pretty informative. How hard was it to do a 30 hr shift for the first time? When you do procedures such as putting in NG tubes, is that a skill acquired while on the wards or was that something you were able to practice via skills lab or something of the sort in the preclinical years?

For me, on 30-hour call, I only had that on surgery. It tended to be fairly busy, so you were moving around doing something or the other most of the time. So I never really felt the fatigue during the time I was on call. Once call ended though, and things slowed down, that's when the fatigue really hit me. I never trusted myself to drive after those shifts, so I usually had someone come pick me up. While I was in hospital though, I didn't think it was too bad. In a weird way, I'm kind of glad I got to experience it because now I know I can handle those long shifts. At least during an 8 week elective! 🙂

For the procedural stuff, my school had a bunch of workshops practicing different stuff on mannequins before M3 year started. These procedures included things like NG tubes, ABGs, lumbar punctures, placing IVs, inserting catheters, etc. I'd imagine most schools have something like this. Plus, when you're doing it on the wards, there's someone there supervising you and guiding you.

 

[Charles_Carmichael]

I asked this before in my previous post but is there opportunities to explore other specialties outside of interest groups in the preclinical years?

Yes, there's plenty of opportunity. It's up to you make the time and seek these opportunities out, though. Most schools will have interest groups and things like that to help you get in touch with attendings in the field you're interested in. The nice thing about being a med student is that, now that you're part of the club, you have much more access to attendings and residents. It becomes a LOT easier to shadow someone or set up research in the preclinical years, for example.

 

[235009]

A little of column A, a little of column B. To limit it to 3 things:

1) Try and be helpful to your team when possible, and be willing to do scut when necessary. Unfortunately, yes, this will mean you spend a good amount of time faxing stuff, getting paperwork, and a variety of things unrelated to clinical work. The person that makes it easier for your residents/attendings to get work done is the person that is well liked.

2) Don't sell yourself short when discussing plans or getting pimped. By that I mean make it a point to demonstrate that you actually know some stuff. Don't be obnoxious, but even if you don't know the answer to a question, take a stab at it and give your reasoning for answering why you did. You may not get the answer right, but if you can demonstrate to your residents/attendings that you're competent and not a total bonehead, then you'll be fine.

1. it's really important to know what is and what isn't scut. none of the things mentioned above are scut work since they all directly affect patient care. if you think getting patients' records is unrelated to clinical work then you haven't been paying attention because in some cases it may be the most important piece of the puzzle. Scut work is doing something unrelated to patient care like getting your resident coffee, walking an attending's dog, fetching someone's pen from the workroom during rounds, etc.

2. there's no problem with taking a stab at it and getting it wrong. you're a third year, no one expects you to know everything (or much of anything for that matter). what annoys me though is when someone tries to explain to me their "reasoning" and gets all defensive about why they got it wrong. stop wasting my time, i dont care, it's my turn to talk now.

 

[alt12345]

Sorry if this has been asked before, but is there any factor you wish you had considered more when choosing where to go to med school?

 

[NickNaylor]

1. it's really important to know what is and what isn't scut. none of the things mentioned above are scut work since they all directly affect patient care. if you think getting patients' records is unrelated to clinical work then you haven't been paying attention because in some cases it may be the most important piece of the puzzle. Scut work is doing something unrelated to patient care like getting your resident coffee, walking an attending's dog, fetching someone's pen from the workroom during rounds, etc.

2. there's no problem with taking a stab at it and getting it wrong. you're a third year, no one expects you to know everything (or much of anything for that matter). what annoys me though is when someone tries to explain to me their "reasoning" and gets all defensive about why they got it wrong. stop wasting my time, i dont care, it's my turn to talk now.

With respect to #1, I agree with you and should've explained more carefully. When it becomes scut in my view is when the residents decide they want to sit down, chat, and have lunch for an hour while sending the students to go get this stuff done. I'm not dense nor do I see myself as immune from doing these things that, while boring and mindless, are critically important to the patient's care. However, what I am not is free labor so that my seniors can have some chill time at my expense. I'm there to learn, and I'm paying to learn. I'm not paying to do the NP's or PA's job while they get to sit in the workroom and do nothing. I'm more than willing to do what it takes such that we all are able to provide the best care possible. What I will not do, however, is be taken advantage of simply because I'm the low rung on the totem pole. I don't think that's unreasonable. Sending me or my colleagues to do work while you (a general you) get a coffee break is piss poor management and an irritating level of arrogance.

 

[sinombre]

How do the hours spent in the hospital vary by rotation?

 

[NickNaylor]

How do the hours spent in the hospital vary by rotation?

Very widely. Anesthesia was the best by far with a 6:45a-3:30p schedule. The worst was probably medicine or peds with 6a-6p at a minimum and 6a-8p being more common. On average though I'd say 10-12 hour days are the norm.


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[redpanda]

How do the hours spent in the hospital vary by rotation?

Medicine - 10-12 h
Peds - 10-12 h
Ambulatory - 10 h
Surgery - 14-16 h
Anesthesia - 8-10 h
Psych - 8 h, maybe
Neuro - 8 h
OB/GYN - 8-14 h

 

[deanthedream17]

I know you have said you go to a very prestigious medical school in the past. Have you worked with students from other medical schools and if so how have you compared their readiness for clinicals compared to yours and also have you noticed a great range of students who may be very good at standardized exams and academically smart, but may not be the best on the wards? This is something I have wondered.

 

[NickNaylor]

I know you have said you go to a very prestigious medical school in the past. Have you worked with students from other medical schools and if so how have you compared their readiness for clinicals compared to yours and also have you noticed a great range of students who may be very good at standardized exams and academically smart, but may not be the best on the wards? This is something I have wondered.

I've asked this of a few residents I've worked with given the multiple claims by some faculty that our school has particularly good training. Long story short, they don't really buy it.


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[Chopin26]

Very widely. Anesthesia was the best by far with a 6:45a-3:30p schedule. The worst was probably medicine or peds with 6a-6p at a minimum and 6a-8p being more common. On average though I'd say 10-12 hour days are the norm.


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On a related note, when do MS3s actually study for their shelf exams? If you're stuck in the hospital all day, how do you find the time (and have the energy) to study for shelves?

Also, how exactly does teaching work during MS3? I remember one of my interviewers at one school told me that the attendings don't really teach you anything and that the residents are supposed to be the ones teaching us (Is this true?), so she told me to make sure to go to a school with strong residency programs.

Last, how hard is it to adapt to rotations once you're done with pre-clinicals? It scares me that you suddenly go from the classroom to the hospital with very little transition in between.

 

[tantacles]

On a related note, when do MS3s actually study for their shelf exams? If you're stuck in the hospital all day, how do you find the time (and have the energy) to study for shelves?

Also, how exactly does teaching work during MS3? I remember one of my interviewers at one school told me that the attendings don't really teach you anything and that the residents are supposed to be the ones teaching us (Is this true?), so she told me to make sure to go to a school with strong residency programs.

Last, how hard is it to adapt to rotations once you're done with pre-clinicals? It scares me that you suddenly go from the classroom to the hospital with very little transition in between.

Like most things, it's dependent on site and rotation. At least at my school, the rotations that have attendings teaching are at sites without residency programs, mainly because the attendings essentially rely on medical students to scrub in for every case. In some rotations without residents, however, the midlevel practitioners do much of the teaching.

In programs with strong residency programs I would say you are far more likely to be taught by residents as opposed to attendings, but that can absolutely be a positive or a negative depending on the site. And, of course, at some sites, the attendings love to teach medical students and, while you get a good chunk of teaching time with your resident, the attending does help out with teaching occasionally (or more than occasionally). There's no real answer for this that isn't program-, site-, and rotation-specific.

 

[Mt Kilimanjaro]

Did you stay involved in any EC during third year? Is this common or even possible?

Have you done any rotations at community/rural locations? How did those compare to Big Name Academic Center in terms of hours, teaching, friendliness, etc?

Maybe this is an MS2 thread question, but if you could craft a strategy for Step 1 starting from day 1 of med school, what would that look like?

 

[tantacles]

Maybe this is an MS2 thread question, but if you could craft a strategy for Step 1 starting from day 1 of med school, what would that look like?

Well, MS2 questions are questions I can handle.

Learn things well in your first two years. Don't go absolutely crazy; just try to learn. If your grades don't thrill you don't worry. Everyone knows that many PhDs teach details that are not always of the utmost importance, especially for Step 1. Don't stress yourself out by studying for 12 hours every day. Try to relax and enjoy yourself.

When February of M2 comes (or 3 months before your exam), you should be ready to buckle down and review what you've learned. Shift your study focus to Step 1, and make sure that even if your curriculum kills you during this time that you start reviewing First Aid (10 pages per day maximum), doing UWorld Questions (1 block per day), and rewatching Pathoma (2-3 lectures per week).

Once you get into dedicated study time, or whatever your school has that approximates this, start ramping up your Step 1 studying. Minimum of 2 Uworld sets per day, at least 1 chapter of Pathoma every day, and 20-30 pages of Step 1 per day (this number will increase as you keep going). Test yourself with at least 1 NBME every week so that you can understand your progress (and get exposure to actual test questions.) In the last week of studying, you should be reviewing your weak points for around 4-6 hours each day. In the two days leading up to the exam, study for only 2-3 hours each day at maximum, and stop doing questions. Let yourself relax during these few days.

Go into the exam rested and ready to answer questions for 8 hours. If you prepare this way, it should be no problem.

Take note: I did 2 specific things that are very important.

1. I did not start studying for Step 1 until 3 months before the exam.

2. I did not wait until dedicated study period to start answering UWorld questions.

If your academic adviser tells you to wait to start a question bank, do not listen. You don't need to go crazy early, but you need to get used to answering board style questions before your dedicated study period.

Final note: My study strategy is one of many, and substitute or add materials as you need them. I used only a few study materials:

1. First Aid
2. Pathoma
3. UWorld
4. DIT (for the first pass through First Aid. Absolutely optional)
5. Kaplan Qbank (Did only 700 questions before I felt it wasn't worth my time.)

 

[Mt Kilimanjaro]

Thanks for the post, @tantacles . So you're saying DO get acquainted with the board question format early, but DON'T actually start studying the material until that last 3 months? In other words, do the questions without accompanying review in First Aid or some other source?

I've heard people say don't look at anything, even FA, until 3 months ahead of time and people who say you should start looking at UWorld questions along with MS1 classwork, so it's hard to know who's crazier.

 

[tantacles]

Thanks for the post, @tantacles . So you're saying DO get acquainted with the board question format early, but DON'T actually start studying the material until that last 3 months? In other words, do the questions without accompanying review in First Aid or some other source?

I've heard people say don't look at anything, even FA, until 3 months ahead of time and people who say you should start looking at UWorld questions along with MS1 classwork, so it's hard to know who's crazier.

It really depends on your style. Many people (not me) started using questions from USMLERx during second year to help them get more familiar with pharmacology and pathology.

I started doing questions (UWorld) in late February, and my exam is on Thursday. You should absolutely start doing Uworld questions before you've finished reviewing First Aid, again, around 3 months before your exam. That's when board studying starts. When I say don't start studying until 3 months before Step 1, I really mean don't start studying, meaning don't do any UWorld questions or start going through First Aid in earnest until that point. I tried to mark up First Aid with some details about pharmacology during the year, but I largely ended up crossing out or ignoring almost all of what I wrote in simply because it just wasn't something I wanted to commit to memory, either because the PhD's teaching it are not clinicians or because the information was so miniscule that I considered it a waste of space.

 

[EMDO2018]

Previous MS1 thread: http://forums.studentdoctor.net/threads/ms1-q-a.929521/
Previous MS2 thread: http://forums.studentdoctor.net/threads/ms2-ama-ask-us-questions.1001936/

The title says it all. MS3 is probably the most mysterious yet fascinating/terrifying year of medical school as a pre-med - at least it was for me. What questions do you have? Anything goes: from pragmatic questions to what it's like to be a student on the wards to lifestyle-related questions. I'll be as candid as I can - don't hold back!

I also encourage any other MS3s to chime in with their feedback as well. In the interests of keeping the thread on-topic and ensuring that the answers to questions are actually relevant, I'd please ask that you avoid providing input if you yourself are not a MS3.

Ask away!

I'd also encourage you to peruse the threads linked above - it serves as an interesting time capsule to see how your view of medicine might change as you go through the training. I intend to keep doing this with each year as long as I remain active on SDN.

How do remember all of you classmates names during med school if you have a big class 150-200? How do you NOT burn any bridges with classmates or faculty? If you want to do research during the first 2 years, how important is chemistry with the PI and lab?

 

[dbeast]

 

[dbeast]

Some advice for MS1 and MS2- if you want to do derm, ophtho or radonc or probably even ortho or uro, start doing research on day one. Sorry it has to be this way, but that's how it works. Some people decide later on, but they often take a year off to do research. Maybe my school is full of overachievers, but I've heard this is the case at other schools too. Other MS3's, feel free to correct me if this isn't the case.

Step 1 works like this: It's better to know First Aid and Uworld (and maybe pathoma) like the back of your hand rather than spreading yourself thin over 8 different sources.

Rotations are such a different animal that you shouldn't even worry about them until med school starts. Just look for a school that can provide the experience you're looking for (county hospital vs research hospital vs community, etc.). Early "clinical experience" in pre-clinical years is a selling point from schools that, while I think is cool, doesn't really add much to your education in the scheme of things. It's just fun, but not necessarily useful.

Most importantly, have fun. It doesn't suck that bad.

 

[CherryRedDracul]

How do remember all of you classmates names during med school if you have a big class 150-200?

The same way I memorize all the drugs I need to know about: flash cards.

 

[EMDO2018]

The same way I memorize all the drugs I need to know about: flash cards.

Seriously?

 

[NickNaylor]

On a related note, when do MS3s actually study for their shelf exams? If you're stuck in the hospital all day, how do you find the time (and have the energy) to study for shelves?

Also, how exactly does teaching work during MS3? I remember one of my interviewers at one school told me that the attendings don't really teach you anything and that the residents are supposed to be the ones teaching us (Is this true?), so she told me to make sure to go to a school with strong residency programs.

Last, how hard is it to adapt to rotations once you're done with pre-clinicals? It scares me that you suddenly go from the classroom to the hospital with very little transition in between.

Ah, yes - welcome to the plight of third year. You study when you can. Sometimes you won't actually be that busy in the hospital, so being prepared and having something to work on (be it a question book, a review text, etc.) is key. Really, though, you just have to fit it in after you get home. I was in my max gunner mode on medicine since I did it first and didn't want to suck, and my goal was basically to get 2-3 hours of studying done per day. I tried to be efficient when I was at the hospital so that I didn't have to worry about it at home. You're right about being tired and not having energy, though. This was a chronic problem for me that I never got over, and my performance on the shelf exams reflected that.

Regarding teaching: yes and no. For our rotations, we have lectures provided on a variable schedule. Sometimes there are lectures every day, other times there's one day per week dedicated totally to lecture (more common). When it comes to teaching on the wards, though, that's definitely a role done more by residents than attendings in my experience. The good attendings recognize that they should, you know, teach, and so they'll sometimes to a quick 15-30 min talk on a topic. As an example, I'm currently on the CTICU service, so our attending gives us talks related to that: etiology, diagnosis, and management of shock, ditto with renal failure, etc.. The problem with the experience on the wards is that it is heavily dependent upon the people you work with. This will be true no matter where you go. If your team sucks, you probably won't have such a good time and you probably won't learn that much. If you have a team that isn't a bunch of boneheads, then you'll probably have a great time and learn some stuff. The best teams for me have been the ones where medical students are welcomed to the team and given responsibility, residents manage your time effectively, and make a point to do some kind of teaching with you. As you might imagine, the residents themselves are generally pretty busy and stressed, so this doesn't always happen. It's very team-dependent.

It's a rough transition, but you'll manage. During the first block of my first rotation (cardiology), I had absolutely no ****ing idea what was going on. The adage "fake it until you make it" is absolutely the way to approach MS3. You will feel clueless. You will feel like an imposter... because you are. But you stick with it, keep doing the best you can, and eventually things will start to make sense. I'm currently on surgery, but during my last rotation (family medicine) something clicked in my brain and things suddenly seemed much more... intuitive. By that I don't mean to say that I'm some kind of clinical all-star savings lives left and right, but coming up with differentials, knowing the things I should do when seeing specific problems, etc. suddenly became much more second-nature. At some point your brain reaches a critical mass of information and you have a greater understanding of general medical principles. It's not a transition you can really prepare for. You'll adapt when you yourself go through it.

 

[snowflakes]

Hey Nick, thanks for doing this! I've been reading SDN for a couple years, and it seems that your views towards med school/medicine in general have changed quite a bit in that time period. Can you talk a bit about how your perspective has changed and what caused that change? How have you noticed your classmates changing since first year?

 

[NickNaylor]

Did you stay involved in any EC during third year? Is this common or even possible?

Have you done any rotations at community/rural locations? How did those compare to Big Name Academic Center in terms of hours, teaching, friendliness, etc?

Maybe this is an MS2 thread question, but if you could craft a strategy for Step 1 starting from day 1 of med school, what would that look like?

I didn't do any ECs, really - or at least not any in the traditional "go to meetings, do X, etc." type sense. It's definitely possible depending upon the rotation that you're on and your hours. As a general rule, though, I'd say it's not all that possible.

My institution happens to be affiliated with a large community hospital in the suburbs, so we have the chance to rotate there. I've enjoyed my experience there significant more than I have at Big Name Academic Center. I found the attendings to be more kind and interested in teaching, the staff much more helpful and friendly, and the learning easier because patients were significantly less complex. It's difficult to learn on patients with 10 medical problems because oftentimes you're simply trying to stay above water with making sure you know what's going on with them, much less trying to understand all of the particulars about their diseases.

Since doing my first rotation at the community hospital, I've requested to be there at every rotation afterward. I find it's a much more enjoyable experience. Plus, we get put up in a relatively nice hotel nearby, which is also fun since it becomes a bit like college where you "live" with a lot of your classmates. The suburb itself is fun, too, since there are a lot of restaurants to eat at.

If you have the ability to rotate at Big Name Academic Center as well as a smaller community setting, I'd highly recommend it. I think it's important to remember that more than likely you will not be working at Big Name Academic Center for the rest of your life. I think it's important to get some exposure outside of that if at all possible.

 

[NickNaylor]

Some advice for MS1 and MS2- if you want to do derm, ophtho or radonc or probably even ortho or uro, start doing research on day one. Sorry it has to be this way, but that's how it works. Some people decide later on, but they often take a year off to do research. Maybe my school is full of overachievers, but I've heard this is the case at other schools too. Other MS3's, feel free to correct me if this isn't the case.

Step 1 works like this: It's better to know First Aid and Uworld (and maybe pathoma) like the back of your hand rather than spreading yourself thin over 8 different sources.

Rotations are such a different animal that you shouldn't even worry about them until med school starts. Just look for a school that can provide the experience you're looking for (county hospital vs research hospital vs community, etc.). Early "clinical experience" in pre-clinical years is a selling point from schools that, while I think is cool, doesn't really add much to your education in the scheme of things. It's just fun, but not necessarily useful.

Most importantly, have fun. It doesn't suck that bad.

Completely agree.

 

[NickNaylor]

Hey Nick, thanks for doing this! I've been reading SDN for a couple years, and it seems that your views towards med school/medicine in general have changed quite a bit in that time period. Can you talk a bit about how your perspective has changed and what caused that change? How have you noticed your classmates changing since first year?

I think everyone gets a little more cynical to variable degrees, but I'm not so sure. My perspective changed simply because the glamor and mystique faded away. "Medicine" as it is in reality wasn't really what I expected to be despite my clinical experience beforehand. It's not that it's necessarily worse than I was expecting, it just wasn't what I expected.

It's hard as a layman to really think about healthcare and how it's delivered in an intelligent way because you don't really have the experience or judgment necessary to do so. This is why I read threads like the "how I'm going to be a better doctor" or whatever it is and just laugh. It's not that being optimistic and having goals isn't laudable - it is. But those goals are so disconnected from reality in a lot of ways that it's hard to even discuss them in a meaningful way. By no means am I some kind of guru or expert, but once you've gotten your hands dirty I think you develop a perspective that allows you to begin having that conversation with yourself or others.

I think also that it's becoming more and more clear to be how much of a corporate production the delivery of healthcare is. Of course, I recognized at some level as I'm sure most do that it's ultimately all about the Benjamins. But I think I sorely underestimated how deep and fundamental that rot goes. I naively though that people delivering healthcare would actually, you know, give a damn about patients, and sometimes that's so far from the case that it's deeply, deeply saddening if not disturbing. That's not limited just to residents and attendings - it's applicable to all levels of the staff, from LPNs to RNs to midlevels and on up. The processes in place that you see the politicians jerking themselves off about when it comes to Medicare/Medicaid fall so ridiculously short of providing anything close to competent care that you wonder what ***** came up with this system in the first place and how they could possibly be feel good about it.

As I said, everyone knows and appreciates that money is ultimately the driver of all things, healthcare included. I suppose I just didn't expect how strong that driver was. I'll admit that being in a position to avoid that nonsense as much as possible is a huge factor in determining my career goals. I really, truly believe that third-party payers are the physician's worst enemy, and avoiding them at all costs if possible is a wise thing to do. When you talk to physicians about the worst parts of the job, it's not really the hours or the hard work. I think most physicians have no problem doing those things if they feel like they're actually helping the patient. Instead, things like shrinking reimbursement, limited time available to work with patients, and having to deal with more and more bureacratic nonsense are what they complain about and lead to deep dissatisfaction, among other things. All those things are related to third-party payers and their ability to manipulate how you practice medicine.

 

[ace12345]

Some advice for MS1 and MS2- if you want to do derm, ophtho or radonc or probably even ortho or uro, start doing research on day one. Sorry it has to be this way, but that's how it works. Some people decide later on, but they often take a year off to do research. Maybe my school is full of overachievers, but I've heard this is the case at other schools too. Other MS3's, feel free to correct me if this isn't the case.

Step 1 works like this: It's better to know First Aid and Uworld (and maybe pathoma) like the back of your hand rather than spreading yourself thin over 8 different sources.

Rotations are such a different animal that you shouldn't even worry about them until med school starts. Just look for a school that can provide the experience you're looking for (county hospital vs research hospital vs community, etc.). Early "clinical experience" in pre-clinical years is a selling point from schools that, while I think is cool, doesn't really add much to your education in the scheme of things. It's just fun, but not necessarily useful.

Most importantly, have fun. It doesn't suck that bad.

Thanks for the response. During M1/M2 years, would you recommend basic science or clinical research? I've heard it's easier to make time for clinical, but are there any other advantages to pursuing one over the other as a med student?

 

[Chopin26]

So then, if attendings generally don't teach you (if they have a residency program), how do you find faculty who can write LORs for you?

 

[CherryRedDracul]

Seriously?

Lol no. I have a large class size within the 150-200 range, but I didn't make it an absolute priority to learn everyone's names. As I gradually made friends, I learned names. That's about it. By the time you're finished with MS1, if you've been social with everyone, you'll know almost everyone except for those weirdos who never come out from their studying hole except for mandatory events.

 

[NickNaylor]

Thanks for the response. During M1/M2 years, would you recommend basic science or clinical research? I've heard it's easier to make time for clinical, but are there any other advantages to pursuing one over the other as a med student?

Depends on what you're interested in. Objectively, I'd say that clinical research is superior in that 1) they typically take less time and require less work than a lab-based project, making it easier to get a pub or at least a poster; 2) they are typically amenable to working on them as you're able (read: work from home whenever you want); and 3) they typically do not require as much training as a lab-based project (e.g., it might take weeks to learn how to do a lab technique with any degree of proficiency while clinical projects are typically more "intellectual," where the training is learning).

I'm painting with broad strokes here but that's how I'd frame the discussion. I should also say that I'm not a huge fan of lab-based work at all, so read my comments with an appropriate grain of salt.

 

[NickNaylor]

So then, if attendings generally don't teach you (if they have a residency program), how do you find faculty who can write LORs for you?

By interacting with them on the wards. You still see them, and they still pimp you and will see your presentations. Depending upon the service and the attending, though, that may be all they have to go on when it comes to your evaluation. This is why rounds and ensuring that you don't look like a bonehead is so important.

 

[mimelim]

Do you have any general tips, maybe like a top 3 list, of how to do well on rotations? Is it more about being helpful or staying out of the way?

I just did evals for our medical students from February. Supposedly the clerkship director will edit/review them, but I kinda doubt it since what I wrote will be more detailed than he could ever write based on his interaction with them which was minimal.

I will only talk about surgery clerkships since that is what I know. A lot of this will apply to other clerkships that others can adapt. I can give specific examples for every single number below based on last month alone. These are very common issues.

To avoid being a bad student:
1) Show up on time
2) Look professional
3) Be available. You should never disappear and unreachable.
4) If asked to do something, either say, "Yes, I'll do it" or, "I don't feel comfortable with that, do you mind teaching me how to do it so I can do it next time?"
5) Do not ask "Anything that I can do right now?", ask, "How can I help?" or simply offer to do things, I hate scutting stuff to students, but if you offer to drop my notes off for me, or you feel comfortable finishing a dressing change on your own, if you say, "I can handle this" or just "I got this".

To be a good student:
1) Know your patients inside out and backwards. You are carrying less patients than your residents/attendings, you should know the details about your patient, even if they don't. You may not know what it means, but you should have the info available.
2) Always make an assessment, attempt to develop a plan. Start with a wide differential and focus in on the most likely diagnoses.
3) Read. Every night, even if it is for 15 minutes. Read about your patient or the procedure they are about to have or have had.
4) Be helpful. Getting labs, dropping notes in charts etc. Scut sucks, we all have to do it.
5) Tie and suture. I will walk anyone through how to do something, but I expect you to know the basics before showing up in the OR. If I show you how to do something, you should practice it at home and if you don't get it, ask me to show you again when we have down time.

To be a rock star:
1) Know your patients inside and out, but pay attention to what residents and attendings find important. Nobody will fault an MS3 for giving a laundry list of normal physical exam findings/labs, but eventually you have to learn to focus in on the important things so you can effectively communicate with colleagues down the road.
2) Develop skills. You are as useful as the skills that you posses. Things that an MS3 could potentially know how to do solo or with only resident observation:
a) Wet to dry dressings
b) Wound vac exchanges
c) Chest tube placements
d) Chest tube removals
e) Suturing - Simple, horizontal mattress, vertical mattress, sub Q, deep dermal, running
f) Central line placement
g) Central line removal
h) Fever workup
i) Getting outside hospital records
3) Learn to solve the common problems. Every rotation, go to the charge nurse on your main floor and ask them what the 10 most common intern calls are for. They should sound like this: Pain, fever, nausea, tachycardia, hypertension, electrolyte abnormalities etc. And then the specifics, Vascular: loss of previously dopplerable pulse, Gen Surg: change in abdominal exam findings etc. Then learn how to work up or manage those issues. As an MS4 on sub-I a good student will function like an intern. Those skills don't show up overnight, you have to develop them over time starting as an MS3.
4) Do not stop suturing or knot tieing. If you are interested in surgery, innate ability counts for something, but more important is practice. You should be able to do one handed ties left and right handed with ease. You should be efficient and accurate. When in conference, tie to your scrub bottoms or the chair next to you. If you have down time, have someone check your technique.
5) Think before cutting suture. What kind of suture are you cutting? Where are you cutting it? What is the purpose of this stitch? How many knots were tied? There is a logic behind suture tail length. While you will always have people that do things a particular way "just because", the vast majority will have a method behind their madness.

http://forums.studentdoctor.net/thr...etent-fool-on-rotations.988111/#post-13752337

So then, if attendings generally don't teach you (if they have a residency program), how do you find faculty who can write LORs for you?

This depends entirely on the hospital/faculty and I would be careful not to generalize this. For instance, at UT-Hermann, Red Duke (http://en.wikipedia.org/wiki/James_"Red"_Duke) teaches all of the didactics for 3rd year medical students that rotated through the trauma service (which is about half the students since it is so busy). He got really sick this last year (open heart surgery) and was holding sessions on post op day 4 in his hospital room. When he sits down at the end of the MS3 rotations and asks the residents for their feedback on students, you can tell that he knows who every single one of them is. He may not know every single person's name, but he knows what everyone is interested in, he knows who likes fishing or football, who speaks French, who has good hands etc.

On the other hand, there are a lot of attendings that don't know that we have medical students on service. It is hit or miss.

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Always a pleasure to read NN's threads. Always a treasure trove of solid information. Saves me on typing time 😉