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PLEASE, PLEASE, PLEASE, SOMEBODY ADVISE ME!

Discussion in 'Clinical Rotations' started by AMS-007, Jun 20, 2000.

  1. AMS-007

    AMS-007 Member

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    I don't mean to grovel [​IMG], but I'm going into my third year of med school and I need some advice from all of you who've done it already about how I can survive this year and the next year. Any stories of your experiences and any recommendations about what I can do to make my experience better would be appreciated.

    What handbooks or manuals do I need to buy? Which ones are essential? Which ones do I need to carry with me always? What will definitely impress an attending? Who should I get recommendation letter from? How many letters do I get? Is it OK to get one from an intern or resident (please try to be impartial [​IMG] ).

    PLEASE, PLEASE, PLEASE HELP ME!!!

    Thanks.

    Amit
     
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  3. spunkydoc

    spunkydoc Senior Member

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    amit-

    1. take a few deep breaths and chill out
    2. MUSTS:
    a.Maxwell's --a cheat sheet of just about everything from H&Ps, Procedure notes, to lab values,etc..
    b. Pharmacopeia--get the latest edition
    c. Sanford Guide to Antimicrobials
    3. Your choice, very helpful
    a. Ferris
    b. Washington manual
    c. Blueprints Board Review-OB/GYN
    i personally like ferri better but wash u is my alma matter so i have that too.
    these guides give you the scut monkey stuff--quick reference of diseases, managements..good for the on call.

    the above are what i have used consistently throughout..as far as textbooks and for the individual rotations, read what you like.

    EM: Tintanellis and Rosen are the 2 standards..most find Rosen an easier read. Tintanellis comes with a pocked companion that is pretty good

    IM: everyone buys a pocket Harrison's..i did not find it necessary..whatever text you used for pathology can suffice as a good reference and you can always zerox the verbose harrison's. i used the Path review book i had for boards--stars series. some folks like the NMS review for internal medicine..it is the guru book in the MD world.

    Peds: it can be helpful to have a harriet lane, especially if you think you will end up being a pediatrician..Nelsons is the standard--big, bulky, uneccessary--i am selling mine. Pediatric recall is helpful

    OB/GYN: Hacker and Moore is the standard but i thought that the Blueprints review series was an easier read and also better retention.

    Family Med: there is a purple family med review practice questions book that is quite helpful for boards and in general.otherwise, Gorall is the text i have seen and thought it was poor at best

    Surgery: Lawrence is the text of choice. Surgical recall was what i used in addition--who can memorize a text.. besides, surgical recall prepares you for the pimp questions

    The blueprints series and recall series are both pretty good..i would not buy a lot of textbooks, or review books for that matter..see what your classmates are using, share..

    you do not want to walk around weighted down with books..

    every nite you should go home and read for about 1 hr---you will only retain about 20 min anyway.

    i also find it helpful, and impressive, to subscribe to a journal and read it every week..set aside time, save articles..there are several family practice ones out there that have good basic review articles..you can look on the web for the one you like and subscribe.

    keep in mind that as a third year in the beginning you should focus on developing your H&P skills and presenting cases to the residents and attendings..management will come with practice and you might want to focus on that later down the line.

    as for recommendations, it is a good idea to collect them as you go along..never get letters of rec from interns--they are not much better than you in authority..always ask attenings, or at worst, the chief resident.

    make sure they can write a strong letter for you..weeny ones will do you no good.

    always carry a snack with you..

    if you don't know the answer to a question say so but go look it up so that you will know for the next day.

    never lie about what you saw or did not see..if you did not do part of an exam, then do not fudge it..

    be kind and helpful to your residents and they will treat you well..sometimes you may feel llike a complete scut monkey but that is your place in the food chain..

    if someone asks you to go get them coffee, tell them you would be happy to do that provided that they teach you "x"...you are no one's slave, there to learn--you pay to learn so make use of all the time you have in the hospital..

    last, don't worry--you know nothing..it is expected..try to read and prepare for what you can, sit back and absorb the rest.

    good luck
     
  4. I agree with all of the above, especially pharmacopeia, sanford guide to antimicrobials, and the washington manual. As an intern, they were my lifeline.



    ------------------
    Jim Henderson, MD at http://www.studentdoctor.net
     
  5. AMS-007

    AMS-007 Member

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    Spunkydoc and Jim,

    You guys are great! Thanks for all the wonderful advice. But I do have another question for you. Somewhere in the advice that Spunkydoc gave me, he spoke about going home. When is it OK to go home? I heard that most states have laws against over working interns and residents, but do those laws apply to someone like me, a third year student? My school has set some rules about keeping students overnight, but I've heard from some other third year students (who will now be fourth year students) that the hospitals often violate those rules claiming that it was "academically necessary" for the students to stay when all they were doing was scutwork. What do you guys think about this and what can I do about it? Should I take it like a man and stop whining or should I do something about it if the rumor turns out to be true? I've heard from so many docs that part of attending medical school is about "paying your dues." Is this whole thing about keeping students overnight about paying your dues or is it just plain ridiculous and I shouldn't stand for it?

    Thanks.

    Amit

     
  6. 1918

    1918 Member

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    Spunkydoc/Jim -- I read this thread out of curiosity more than necessity since I have a couple years yet before having to tackle these questions. Just wanted to say thanks though -- it's nice to see folks taking the time to offer serious, detailed advice.
     
  7. Carbon Klein

    Carbon Klein Senior Member

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    to Amit

    Sounds like you're talking about being on call. Surgery has the most call schedules, anywhere from Q2 to Q4 (every other night to once every 4th night). You definitely have to sleep over night in the hospital. The worst is when you are at the hospital 530am on Monday morning and stay overnight Monday night and then you spend all of Tuesday in the hospital and don't go home until Tuesday night....that's very normal and in total violation of NY's laws, but nobody questions this practice. I thought it was ridiculous for students to do it, but on the first night of my call in surgery, I got a terrific case which eventually led to a publication with the chief. Calls are pretty easy after you realize that they're not killers and that you'll actually get to sleep during your call nights. I even had to stay in the hospital on Thanksgiving! At least the intern and I had a turkey sandwich while watching the Macy Day's Parade and Honey I Shrunk The Kids.

    For surgery rotations, definitely get Surgical Recall. Not only were pimp questions straight out of that book, but the oral exam and written exams were too. Instead of Lawrence (I hated that book, sorry SpunkyDoc), I had the baby Sabiston (although Baby Schwarz works too). I actually have the big Sabiston too, but I'm really into surgery, so that was $250 well spent. Definitely carry snacks with you....I was a walking vending machine (chips are too oily, try carry those pre-packaged sponge cakes, they're a quick carb and they taste better than Powerbars). And be sure to share your junk food with collegues, residents and attendings. [​IMG]

    For medicine, the pocket book to carry seems to be the Washington Manual while most people have Current Diagnosis at home for a reference. A few gung ho IM-intensive friends (who are starting their IM residency this week!!!!) had the full blown Harrisons at home IN ADDITION to the Current Diagnosis.

    In Peds, the NMS board review book is pretty good.

    On the floors, have a copy of Pocket Pharmacopoeia, Maxwell and the Surgical Intern Pocket Survival Guide (this has blank admission forms, preop/postop forms, ICU notes and tons of things that'll make life easier.). These three are tiny little books you usually see for sale at med school book store cash register counters. They are almost essential. I had Sanford's Antimicrobial guide, but I never used it. The Pocket Pharm was good enough. I also bought the Pocket Book of Eponyms and Subtle Signs of Disease. It's an interesting read....pretty cheap and small.

    If you want a letter that carries any weight, get about two from directors that KNOW YOU WELL. Letters from residents probably won't carry much weight. In some rotations, you'll get a chance to really know some attendings and directors really well, so ask them for a letter. In all, you probably won't need more than about 3-4 letters, but definitely try to get them from the big shots.

    In regards to journals, all hospitals have a library with some good journals. It's about $250-300/year for 12 issues of your average medical journal, so it might be too expensive for most folks. Having said that, I'm seriously thinking about subscribing to a journal myself, just to collect interesting articles and read them leisurely at home (I might get an attending to sponsor me for a "guest membership" in the medical professional society so that I can get a discounted $115/year subscription rate). During some conferences, well prepared residents will photocopy interesting articles for audience members. Also, hospitals have journal clubs open to students (and required of residents, so if you're attached at the hip to a resident, they'll drag you into the journal club meeting).

    I don't know about anybody else, but I absolutely LOVED my rotations and despite the scut work, the 15-18 hr days (36 hr when on call) and the lousy greasy food, being in the hospital was the best thing that happened to this business major-changed-to-MCB major! [​IMG] Just relax and enjoy your clinical experience! It's going to be a blast!
     
  8. AMS-007

    AMS-007 Member

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    Carbon Klein,

    Thanks for the great response to my question. I greatly appreciate your help. My surgery rotation is the last one on my schedule for the third year, but it is apparently the most challenging as well from what I hear from the students who were assigned there. Therefore, I'm bound to be in the situation that you described in your answer above. I know it is going to be a struggle but I'll muddle through some how.

    As far as the journals go, I'm already getting one every two weeks from the American Academy of Family Physicians free of charge because of my student membership. It has great articles in it that tend to review the material that I learned in my first two years and also adds to my knowledge as well. As far as getting more journals, I think I'll take your advice and visit the hospital library and read articles there. There is no reason to spend so much money when I'm in enough debt already from the medical school loans.

    HERE IS A QUESTION FOR YOU (OR ANYONE ELSE): During the fourth year, medical schools provide the opportunity for students to take electives and they also say that you can also have the option to work on or finish up a Master's Degree in Public Health (MPH) or Public Administration (MPA in Health Policy and Management) to improve ones credentials. Do you think it would be a good idea to pursue a Master's Degree or should a student just stick with the elcetives. Does an MPH (in epidemiology or community health) or an MPA (in Health Policy and Management) make one look better for a residency spot or is it simply a waste of time?

    Amit

    [This message has been edited by AMS-007 (edited 06-26-2000).]
     
  9. PimplePopperMD

    PimplePopperMD Senior Member

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    Spunkydoc;

    Thanks for all the advice! Just wanted to let you know that it's most definitely appreciated.
     
  10. Carbon Klein

    Carbon Klein Senior Member

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    I joined the American College of Physicians/American College of Internal Medicine (ACP/ACIM)in my first year of med school back in the days on their internet site. Nowadays, if you want to join as a student member (free membership), you need a letter of good standing from a LCME accredited (ie. US/Canadia/Ponce, Puerto Rico) school before you can get that student membership. And I think you need to be in your clinicals before you can join. They don't offer free journals but they do send me their newletter: "IMpact" as well as their programs and applications for their annual meetings/conferences. They also have catalogs of books and stuff for IM docs, residents and students. Unfortunately, the Amer College of Surgeons have no such freebies (although they sent me some brochure/books on the surgical specialties for free).

    I have no experience with the MPH, but it sounds like it's a worthwhile endeavor because it can separate you from the rest of the applicants when you apply for programs. However, I'm using my elective times to visit potential candidate programs so that they can see what a "star" I am so that they will look favorably upon my application to their residency. As a buddy (and now surgeon) once said, "When I'm doing an elective there, I'm going to kiss everybody's ass!" [​IMG]
     
  11. AMS-007

    AMS-007 Member

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    Carbon Klein,

    Thanks for the tip but I'm already a student member of the American College of Physicians/American Society for Internal Medicine (ACP/ASIM). As a matter of fact I was so eager to join the organization that I went searching for their website the day after I received my acceptance letter to medical school. I had known of the organization because my physician had FACP after her name and I had asked her what it meant. In our conversation, she mentioned that they had a medical student membership and I had promised her that I would join when (or if) I could get into medical school. So true to my promise, I joined the day after I was accepted. I've been getting IMpact for about 2 years now. I really like doing the MKSAP questions. I couldn't do many of them at first, but now after the second year is over everything makes much more sense although they still manage to stump me every now and then.

    Like you, I also went searching for a student membership in the American College of Surgeons, but they told me the samething they told you. "Call us back when you're a surgeon, then may be we can do something for you." I didn't even a get a book out them!

    I'm currently a student member of the American Academy of Neurology. They also have a free student membership. All you need to do is fill out the form at their website, print it out, have it signed by the Dean of Students at your medical school and mail it. Apparently, they need proof that you are in medical school. They send me all sorts of magazines and published articles. They offered to send me their journal for $150 (the student rate), but I opted to read it for free at my school's library.

    The reason I asked you about the MPH and the MPA is that I'm currently pursuing a MPA (Master of Public Administration) program in Health Policy and Management at New York University. The program itself is ranked fourth in the country by U.S. News. I've about 5 more courses to take before I get the degree and I was wondering if I could get a leg up as far as internship/residency applications go. If I'm viewed more positively for making the effort, then I should go ahead and finish the degree. I got into the program before I was accepted into med school and just when I was close to the end, I had to stop taking courses because I had to attend med school. Now that I may get the opportunity to finish the degree, I was wondering whether or not I should make the effort.

    Thanks for all the great advice!

    Amit
     
  12. Carbon Klein

    Carbon Klein Senior Member

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    I wrote to the ACS at

    American College of Surgeons
    55 East Erie Street
    Chicago, IL 60611-2797

    and they sent the Surgical Career Handbook, which is a 78 page brochure that briefly describes the surgical specialties. I believe this was free.
     
  13. AMS-007

    AMS-007 Member

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    Carbon Klein,

    Thanks for giving me the ACS address. I'll be sure to get in touch with them. I'll also try sending them an e-mail to see if I can get the book from them that way.

    As for the handbooks and manuals that you, spunkydoc and Jim have recommended, they are currently on order and I'll be getting them in a few days. I've ordered:

    1. Tarascon Pocket Pharmacopoeia, 2000 (shirt pocket edition)
    2. Maxwell Quick Medical Reference
    3. Washington Manual of Medical Therapeutics
    4. Surgical Recall
    5. Surgical Intern Pocket Survival Guide
    6. The Harriet Lane Handbook

    I got a great deal on these books from Yahoo! Books. The best price for the Harriet Lane was at Borders (online). In addition (with the exception of Borders) there were no shipping and handling charges (if you ordered from e-campus). E-campus had the lowest prices for all of the books too (except Harriet Lane).

    I've held off on buying any books for Emergency Medicine, OB/GYN, and Family Medicine until the time of the rotations. As for the Medicine I already own the "big mama" version of Harrison's. In addition, I've ordered the Washington Manual. This should be sufficient to meet my needs for now (if not forever).

    I've written the above not only for you to read, but also for anyone who is going to buy these books for their rotations. They'll definitely get the lowest price at the locations (Yahoo! Books and Borders) that I mentioned above.

    If you have any more advice that I've not asked for on a particular subject, please, please, please, tell me right now. I don't want to find out the hard way later.

    Thanks.

    Amit

    [This message has been edited by AMS-007 (edited 06-29-2000).]
     
  14. Detroit Rock City

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    Do not go out and buy and books for ER. You simply do not need them unless that is the residency that you want, and in that case you will get them from the program after you start. All the EM info that you will be tested on for Step 2 you can get from any surgery review book. As for OB/GYN, I agree that blueprints was very good, but I personally thought that Hacker & Moore was a great textbook. For Peds, no dot buy it, but just go look at a copy of Oski's essentials of peds about 1-2 weeks before step 2. There is a picture glossary in the back of various facial features and associated deformities and the causes ( FAS, Edwards, pataus etc) Just look at a couple of the big ones, you will see it on step 2.
    Good luck!
    DRC
     
  15. AMS-007

    AMS-007 Member

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    DRC,

    Thanks for the advice. I was wondering why you thought the Hacker and Moore was a great book? Was it better than the Blue Prints?

    As for the Peds, I've only bought the Harriet Lane. Now that you've mentioned the other book (Oski), I'll go look in the library for it as well. Thanks.
     
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  17. Detroit Rock City

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    Don't get me wrong, blueprints for OB/Gyn and Peds were right on the money, but grades are not everything. You can do well using only blueprints, but they are not textbooks. Ob is a big part of step II, at least for me it was. Hacker and Moore is fairly easy reading, and common sense will dictate which chapters you need to read and which ones you can skim, same goes for peds (Oski). You dont really need to study for psych, it's the same as step I but with more epi ( so brush up on the epi) and medicine( you should know enough of the basics by now!), so you will have plenty of time to read. As far as step II is concerned, I looked at the compass/ark venture notes and thought they were good, but not worth the time and money for the course. NMS question book ( Big book w/ 5 tests, blue and white cover) is A MUST!!!! Don't just do the test, but read the explanations and you will do just fine!
     
  18. Matt

    Matt New Member

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    Question from a senior undergrad. I have had a hard time finding hard info on how much residents, and med students during rotations actually work, and want to get some hard information from those who actually know.

    I have heard horror stories of surgery residents working 120 hour weeks. As was discussed in earlier replies, you indicated 16 hour days.

    Question - Is this for real?!?

    I consider myself a hard worker, and have worked 16.5 hour shifts in a hospital every week of the past two summers. They are horrible, life draining, soul killing shifts.

    -Do you really routinely work this long?
    -Are you always moving during this period, or is it on and off?

    I can't imagine two 16 hours shifts in a row, let alone 5 or 6.

    -When do you sleep.
    -I have heard that a new law limits residents to 80 hour weeks, is it true? Do hospitals care?

    The reason I ask is to separate the hype from reality. I have always worked hard, and don't mind working harder, but 100 hour weeks are ludicrous. Do you really think people function well enough to make life and death decisions after nights of no sleep, and days with no rest? Pilots and train operators have stong guidelines against overwork, for safety, why not doctors?

    PLEASE, provide any personal experience or advice.

     
  19. surg

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    100+ hr weeks take a toll on your mental and physical state. However, the residents who typically work these hours tend to be junior level i.e 1st and 2nd yrs. Your main responsibility is to gather info and pass it up the chain of command (which is difficult but do-able on minimal sleep). The more senior residents and staff (more well rested) interpret the data and make the crucial decisions.

    This system helps to minimize mistakes with overworked residents.

     
  20. Future DOc

    Future DOc Senior Member

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    INTERN RULES:

    EAT when you can,
    SLEEP when you can, &
    LEAVE when you can. [​IMG]

    Rob
    MS III
     

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