Preparing for intern year by flipping though uworld for step 2 again?

[pasdedeuxandchill]

Hey y'all. I'm a 4th year and have been feeling awful twitchy about intern year approaching while it's been months since I've done any real medicine (or CK). I'd love to feel like I'm doing something to not show up day 1 of intern year dumber than I was at the start of M4. I got average scores on all the steps but never have felt confident about my knowledge. Tbh I'm pretty sure I'm very good at tricking people into thinking I'm smarter than I am and that's not what I want for my patients next year

I have electives and things like that these next few months. Here are some things I could do to feel more confident in myself come July. Could y'all maybe yay or nay any of these ideas?

• I have a coupon for Uworld for CK. Would it be worth flipping through those questions to recall basics? (I'm going into IM) I am aware that doing a Qbank will not actually make me a good intern. But I'm thinking it might make me more knowledgeable at baseline.

• Alternatively, I could purchase Uworld for Step 3 if that's any better at covering basic clinical knowledge?

• Never took an ICU rotation and that's scaring me. Resident friends say not to bother and that I'll pick things up next year just fine. I'm tempted to believe them because I really am not jazzed at the thought of doing an ICU elective late in 4th year. But I don't want to bury my head in the sand if this is something that would be good for me.

• I have a copy of Step Up to Medicine that I never really read. Also have Dubin's EKG book. I was thinking I could flip through these? Honestly I learn better from questions than just reading though so that's why I was considering the qbanks.

Are any of these plans worth pursuing? I expect some level of judgement about how I should just enjoy my 4th year holiday. (I know y'all mean well ) I think it'll just make me feel better to do a little something amidst all the chilling.

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[ThoracicGuy]

Sounds like a waste of time to do Step review...

 

[brotherman]

Nothing prepares you for intern year other than doing intern year.

 

[pasdedeuxandchill]

Thanks for the advice. I do get that nothing will prepare me for intern year. But is it really so unreasonable for med students to want to try to retain some of their basic clinical knowledge before intern year? Or to try to seek out experiences that might be a good introduction to things they might be thrown into next year? That's really all I'm trying to do.

 

[hallowmann]

Hey y'all. I'm a 4th year and have been feeling awful twitchy about intern year approaching while it's been months since I've done any real medicine (or CK). I'd love to feel like I'm doing something to not show up day 1 of intern year dumber than I was at the start of M4. I got average scores on all the steps but never have felt confident about my knowledge. Tbh I'm pretty sure I'm very good at tricking people into thinking I'm smarter than I am and that's not what I want for my patients next year

I have electives and things like that these next few months. Here are some things I could do to feel more confident in myself come July. Could y'all maybe yay or nay any of these ideas?

• I have a coupon for Uworld for CK. Would it be worth flipping through those questions to recall basics? (I'm going into IM) I am aware that doing a Qbank will not actually make me a good intern. But I'm thinking it might make me more knowledgeable at baseline.

• Alternatively, I could purchase Uworld for Step 3 if that's any better at covering basic clinical knowledge?

• Never took an ICU rotation and that's scaring me. Resident friends say not to bother and that I'll pick things up next year just fine. I'm tempted to believe them because I really am not jazzed at the thought of doing an ICU elective late in 4th year. But I don't want to bury my head in the sand if this is something that would be good for me.

• I have a copy of Step Up to Medicine that I never really read. Also have Dubin's EKG book. I was thinking I could flip through these? Honestly I learn better from questions than just reading though so that's why I was considering the qbanks.

Are any of these plans worth pursuing? I expect some level of judgement about how I should just enjoy my 4th year holiday. (I know y'all mean well ) I think it'll just make me feel better to do a little something amidst all the chilling.

Dude, are you me? This is exactly how I feel. I was going to review Uworld for Step 3 over the next few months, but its also because I plan on taking the Level 3 (COMLEX) early before it becomes a 2 day exam that will probably cost more. Hopefully that'll be sufficient in terms of base knowledge.

What I've heard from residents is that the hardest part of intern year is (1) actually being responsible for stuff, even if it is heavily supervised and (2) learning HOW to do things, like where to go for what, how to get to those places, which documents to fill out/how to fill them out, who to ask for what, what numbers to call for what, etc. They actually say the medicine is not something you really struggle with, and is more or less something you pick up as you go and while learning/reading about your patient.

Wish I had more to tell you.

 

[Perrotfish]

Hey y'all. I'm a 4th year and have been feeling awful twitchy about intern year approaching while it's been months since I've done any real medicine (or CK). I'd love to feel like I'm doing something to not show up day 1 of intern year dumber than I was at the start of M4. I got average scores on all the steps but never have felt confident about my knowledge. Tbh I'm pretty sure I'm very good at tricking people into thinking I'm smarter than I am and that's not what I want for my patients next year

I have electives and things like that these next few months. Here are some things I could do to feel more confident in myself come July. Could y'all maybe yay or nay any of these ideas?

• I have a coupon for Uworld for CK. Would it be worth flipping through those questions to recall basics? (I'm going into IM) I am aware that doing a Qbank will not actually make me a good intern. But I'm thinking it might make me more knowledgeable at baseline.

• Alternatively, I could purchase Uworld for Step 3 if that's any better at covering basic clinical knowledge?

• Never took an ICU rotation and that's scaring me. Resident friends say not to bother and that I'll pick things up next year just fine. I'm tempted to believe them because I really am not jazzed at the thought of doing an ICU elective late in 4th year. But I don't want to bury my head in the sand if this is something that would be good for me.

• I have a copy of Step Up to Medicine that I never really read. Also have Dubin's EKG book. I was thinking I could flip through these? Honestly I learn better from questions than just reading though so that's why I was considering the qbanks.

Are any of these plans worth pursuing? I expect some level of judgement about how I should just enjoy my 4th year holiday. (I know y'all mean well ) I think it'll just make me feel better to do a little something amidst all the chilling.

I am a believer in the late 4th year ICU or SubI elective. If you really want to get ahead of the curve you could even try to set one up at your new residency, so you walk in the door knowing the hospital layout and computer system. If you do this at all, though, only do one. One month is a good way to get your brain into gear. More than one is a good way to get burned out before you start.

Another good thing to do is to just use your electives wisely. There is a middle ground between an ICU sub-I and a 4th year radiology elective that you go to one day per week. Do a cardiology elective where you actually work 6 hours a day and by the end I think you'll be shocked to realized that you actually know Cardiology. Just do medicine subspecialties rather than random nonsense.

In terms of reading and prepping for Intern year in general, I would recommend one or two of the following:

1) Download the podcast 'ICU rounds' by Dr. Jeffrey Guy and listen to one a day. it covers pertinent topics in ICU medicine at the level of a resident

2) If you're not comfortable with EKGs read through Dubin, then go to the website wavemaven and work through 5-10 a day.

3) If you're not comfortable with plain films go to www.learningradiology.com, or alternatively buy the learning radiology textbook, and start working through cases and lectures.

4) If you still have access to uptodate read through their articles on sepsis, anaphylaxis, hyperkalemia, hypokalemia, hypernatremia, hyponatremia, hyperglycemia, and hypoglycemia and make flash cards on all of them. Try and develop a basic algorithm in you head for what to do when the nurse calls you with an abnormal routine lab value (CBC, coag, or chem10) or vital sign.

5) If you're moving to the south, seriously consider taking a course in basic medical Spanish.

I will agree with majority that step questions are not a good use of your time.

 

[armybound]

I think intern year will surprise you. It's mostly about learning how to write notes, contact social work, write orders, etc. The orders will probably be given to you for the most part, you just have to order them.

I don't think Step studying will help at all. None of that stuff really helps. You don't need to know the mechanism behind an antibiotic, you need to know the dosage, route, and duration. That's not going to come from QBank.

Just relax. There are stupider people than you who have made it through internship without killing too many people. You'll be fine.

 

[cbrons]

I am a believer in the late 4th year ICU or SubI elective. If you really want to get ahead of the curve you could even try to set one up at your new residency, so you walk in the door knowing the hospital layout and computer system. If you do this at all, though, only do one. One month is a good way to get your brain into gear. More than one is a good way to get burned out before you start.

Another good thing to do is to just use your electives wisely. There is a middle ground between an ICU sub-I and a 4th year radiology elective that you go to one day per week. Do a cardiology elective where you actually work 6 hours a day and by the end I think you'll be shocked to realized that you actually know Cardiology. Just do medicine subspecialties rather than random nonsense.

In terms of reading and prepping for Intern year in general, I would recommend one or two of the following:

1) Download the podcast 'ICU rounds' by Dr. Jeffrey Guy and listen to one a day. it covers pertinent topics in ICU medicine at the level of a resident

2) If you're not comfortable with EKGs read through Dubin, then go to the website wavemaven and work through 5-10 a day.

3) If you're not comfortable with plain films go to www.learningradiology.com, or alternatively buy the learning radiology textbook, and start working through cases and lectures.

4) If you still have access to uptodate read through their articles on sepsis, anaphylaxis, hyperkalemia, hypokalemia, hypernatremia, hyponatremia, hyperglycemia, and hypoglycemia and make flash cards on all of them. Try and develop a basic algorithm in you head for what to do when the nurse calls you with an abnormal routine lab value (CBC, coag, or chem10) or vital sign.

5) If you're moving to the south, seriously consider taking a course in basic medical Spanish.

I will agree with majority that step questions are not a good use of your time.

There is also that Resident Readiness book which has a lot of scenarios to think about.

I did 4 general medicine sub-is this year and 1 icu sub-i. Next week is my last week of med school.

Do you think I will lose the advantage of all that "intern"-level experience if I dont see a patient until early July?

Sent from my SM-N910P using SDN mobile

 

[bashwell]

I think intern year will surprise you. It's mostly about learning how to write notes, contact social work, write orders, etc. The orders will probably be given to you for the most part, you just have to order them.

I don't think Step studying will help at all. None of that stuff really helps. You don't need to know the mechanism behind an antibiotic, you need to know the dosage, route, and duration. That's not going to come from QBank.

Just relax. There are stupider people than you who have made it through internship without killing too many people. You'll be fine.

Hah!

 

[Psai]

One thing I thought was invaluable that my school did was to have residents and attendings treat you as if you were night float and call you in the middle of the night (reasonable like 10 pm) as a nurse about your patient. They'd be like hey Dr. Psai, your patient in room 1517 is having chest pain, what do you want to do?

Podcasts are great, I also recommend ICU rounds as well as Emcrit. Practical knowledge is what you need, you already have all the theoretical stuff down.

 

[J ROD]

If I were to do anything, I would review EKGs.......that's probably it. The rest you generally pick up as you go through intern yr. Nothing can prepare you for it really except doing it.

I would suggest enjoy the time you have now because one of the worst yrs of your life is coming July 1st!!

 

[Crayola227]

you can check out my intern megaposts

https://forums.studentdoctor.net/threads/things-to-do-to-shine-in-pgy-1.1188633/#post-17640862
What interns should know day 1.
https://forums.studentdoctor.net/threads/what-interns-should-know-day-1.1130633/#post-16694615
https://forums.studentdoctor.net/threads/what-to-buy-before-residency.1241096/#post-18590956

 

[RadOncDoc21]

I would kill to get my 4th year of med school back... enjoy every moment like it's your last! After that you are "responsible" now.

 

[caffeinemia]

Wouldn't you want to study ahead and prepare for step 3 then? since that might be more relevant to intern year?

 

[HLxDrummer]

Dude... **** all that. Vacation, do your hobbies, drink beer, Netflix binge, have a baby. Seriously. The last half of fourth year is the best. Intern year sucks and nothing your going to do now will change that. Just enjoy it while it lasts!

 

[gutonc]

I absolutely agree that you should do nothing academically useful for the next 4 months.

And if you ignore this advice, please don't waste time studying irrelevant Step 2 crap.

 

[pasdedeuxandchill]

Thanks for the advice! Really appreciate y'all taking the time to help me out.

As a follow-up, is there any merit to taking step 3 prior to residency (going into IM)? I thought that the consensus was that this was not worth it for someone going into a general field like me but my attending recently mentioned that taking it before residency might be a good idea....

 

[ThoracicGuy]

Thanks for the advice! Really appreciate y'all taking the time to help me out.

As a follow-up, is there any merit to taking step 3 prior to residency (going into IM)? I thought that the consensus was that this was not worth it for someone going into a general field like me but my attending recently mentioned that taking it before residency might be a good idea....

Alot of what will be on the test will be dealt with during your intern year. There's no real benefit to you taking earlier except to be done sooner. Some residency programs will even cover your exam costs.

 

[SXMMD]

I might add that if you have the time, inclination and ability, it would save you from headache should your program require you to take it within a specific time frame. I would suggest taking a practice exam cold, without any prep, to see where you are at. If you're comfortable with that score and confident you'll pass with a little study it wont hurt to knock it out. I think you'll be ok either way

 

[Crayola227]

Thanks for the advice! Really appreciate y'all taking the time to help me out.

As a follow-up, is there any merit to taking step 3 prior to residency (going into IM)? I thought that the consensus was that this was not worth it for someone going into a general field like me but my attending recently mentioned that taking it before residency might be a good idea....

On one hand, you will learn a lot of what you need to know on the job.
On the other hand, you will forget more and more peds and ob/gyn stuff as you go on in the year.

So the right answer partly depends on how difficult/enabling your program is regarding Step 3, and the particulars of your own knowledge base and learning style.

Most take it in intern year, with whatever amount of "touch up" study is needed to feel like you haven't totally brain-dumped all of peds/ob/gyn from med school you're expected to still know for Step 3, happening right before.

People at risk of failing Step 3, need to schedule and take it with enough time to get scores back and reschedule and retake it, and get scores back again, for programs that do not allow you to advance to PGY-2 without it. I'm not sure what goes into some programs making this a condition of advancement, if it's a matter of rules regarding the state licensing system for trainees. Some states will not allow you to supervise other trainees without an unlimited license, if I understand correctly. Other states/programs, you don't have to pass Step 3 until graduation (although this is becoming less and less common even at programs without stipulated policies on the timing of Step 3), but it would be silly to leave it that long in any case, especially as I said, Step 3 can test a lot of information that is closer in content to what you would have graduated med school with, rather than what you have learned in your specialty at PGY3.

I believe there is a sweet spot for Step 3, that is not right after graduation, but is not PGY3. I think part of the way through intern year with time for a retake if that seems appropriate for you personally and your program's rules.

Many IMGs will take Step 3 for various reasons. One, is so they don't have to worry about any language issues or failures DURING residency to be an issue. Another, is that for various reasons they may feel it will help them prep for intern year. I think this is more reasonable if the quality of your medical education is something you have reason to be very insecure about. Another reason is that they have graduated before entering the match, so are eligible to take Step 3, and they wish to give programs another data point as well as assure that licensure re: the Steps will not be an issue.

TLDR:
Depends on you and your program.
Sweet spot is partway through intern year, where you have learned a lot on the job, and still have fairly high retention of med school specific concepts.
For IM, a quick brush up on peds/ob/gyn for Step 3 suffices.

 

[Crayola227]

OP, I can tell that you are pretty concerned about being prepared for intern year.
So was I.
Don't study, really. Relax.
This is advice coming from Chicken Little, "sky is falling," "I know I was the most ill prepared intern that ever lived" person on this board.
So believe me when I tell you, more medical knowledge base would not have made things better day 1.

-You passed the steps. You have the book knowledge needed. Step 3 may well reflect what you learn intern year, but it will not help you intern year.
-You can't really know what you need to know as a resident to do your job (application of knowledge) until you do it.
-At first you will just be learning the system and picking up bits (lots of bits) of medicine you don't know or didn't know how to apply.
-That will be your first bottleneck, efficiency in the system.
-Good news?
-More bottlenecks will make themselves known quickly as you go.
-Wow, that sounds scary! It isn't, because believe it or not each thing can be tackled, either with uptodate, your senior, or us!

-When you can, just to ease your anxiety, you can start gathering resources to help you do admissions and write orders, like the things listed by others here.
-Don't memorize them. You don't need more in your brain right now to succeed day 1.
-What *I* needed, was the right resources at my fingertips *when* I needed them, and to review the medicine most relevant to the rotation I was about to start, like an intern survival guide for wards, etc
-We've already made sure you have a good list of stuff to start gathering!

-My biggest mistake intern year was not spending enough time on SDN getting tips on being a better intern.
-Why? sad, really. I was inefficient, so I didn't have time, so I didn't have time to use SDN to be more efficient, so I would have more time to...... ugh cycle.

-You know what has been the best thing for my career from community college to residency and beyond?
-Using advice I considered carefully from SDN

 

[Psai]

Intern year is long enough. Don't prestudy for it jesus christ you're almost a resident now, act like it

 

[AdmiralChz]

-My biggest mistake intern year was not spending enough time on SDN getting tips on being a better intern.
-Why? sad, really. I was inefficient, so I didn't have time, so I didn't have time to use SDN to be more efficient, so I would have more time to...... ugh cycle.

-You know what has been the best thing for my career from community college to residency and beyond?
-Using advice I considered carefully from SDN

I hope there is some hyperbole here? While SDN can be helpful, it can also be frustrating and pandering quite often. Particularly in subspecialty forums there are a lot of jaded, burnt out physicians who spend most of their time complaining about the state of medicine, the work schedule, the future of the profession, their failing marriage, etc... For those of us with a more positive disposition, it can bring you down for sure. Don't become too attached, and take all advice with a grain of salt (particularly career advice). There is a lot of helpful information out there, but sometimes you have to sort through some real scut to get there.

Remember to have a real life outside of the hospital - go out to dinner, have some drinks (or sodas, or water if you prefer) with co-residents and decompress from time to time. It is OK and you will be a better doctor for it.

And for all that is right in the world, PLEASE do not review minimally-useful Step 2 information prior to intern year. You will be a glorified reporter and will have to run everything by senior residents anyway, learn from them.

 

[Crayola227]

I hope there is some hyperbole here? While SDN can be helpful, it can also be frustrating and pandering quite often. Particularly in subspecialty forums there are a lot of jaded, burnt out physicians who spend most of their time complaining about the state of medicine, the work schedule, the future of the profession, their failing marriage, etc... For those of us with a more positive disposition, it can bring you down for sure. Don't become too attached, and take all advice with a grain of salt (particularly career advice). There is a lot of helpful information out there, but sometimes you have to sort through some real scut to get there.

Remember to have a real life outside of the hospital - go out to dinner, have some drinks (or sodas, or water if you prefer) with co-residents and decompress from time to time. It is OK and you will be a better doctor for it.

And for all that is right in the world, PLEASE do not review minimally-useful Step 2 information prior to intern year. You will be a glorified reporter and will have to run everything by senior residents anyway, learn from them.

1) I'm being a little sweeping. Notice I said carefully considered, and I should have said I meant it as caveat emptor - SDN has provided me excellent advice, however I had to weigh it for myself as with any advice.

2) Besides jaded venting, the career advice is actually quite good. Everyday I see or post in threads that handle licensing questions to how to pick IM vs Med/Peds to how to resign from residency and not get totally boned. People have had their careers saved/salvaged as a result of info they've gotten on SDN.

3) In my intern year, I was not a glorified reporter, had to do tons on my own, and seniors were hit or miss. I think it can depend on team structure as well. One intern one resident can be hell if your senior sucks. I was alone half the day once a week cuz clinic, and I had 10 patients to my lonesome one day a week. I handled floor to ICU transfers (people in mid-crump) myself with the senior and attending just coming over to look after I did everything - that's hardly glorified reporting. That's big shoes your second month. Nightfloat I was alone in the hospital, the senior in a different building, available by phone, and fond of sleep. I had to practically beg them to come over with a patient about to code blue & other stuff. I could do 2 or 3 admissions back to back before getting to staff them, and I wouldn't get to run my plan by the senior before staffing with the attending. Some other occasions I had to override attending and senior orders - which I got away with because it was clearly right for the patient. I don't know, I was doing a lot on my own and not getting much more than a glance over my shoulder a lot of times. I'm not acting like omigosh I had the hardest intern year ever and zero supervision - just that some programs you will have to put in a lot of orders and have already carried out a lot of decisions before running things by anyone.

OP - you don't need to freak out about the responsibilities I just said. I was the worst dumbest slowest intern that ever lived. Just learn your system, have resources to help guide your decisions, and it will be fine. Being more than a glorified reporter will not mean that you won't have enough supervision to get things done right.

TLDR:
SDN rocks besides caveat emptor, and stepping over jaded bodies strewn about
Don't approach intern year like you're going to be an overglorified reporter, you will be doing a lot of admission and putting in a lot of orders, don't expect them to be spoonfed to you. You have a license of your own and you are still responsible for everything you sign, even if the buck doesn't stop with you

 

[Beezlebub]

-My biggest mistake intern year was not spending enough time on SDN getting tips on being a better intern.
-Why? sad, really. I was inefficient, so I didn't have time, so I didn't have time to use SDN to be more efficient, so I would have more time to...... ugh cycle.

Thanks. Now we all feel less guilty procrastinating on here. You should be the poster child of SDN.

 

[Crayola227]

Thanks. Now we all feel less guilty procrastinating on here. You should be the poster child of SDN.

That's what I'm going for. That or one of those gift cards or something.

 

[Beezlebub]

That's what I'm going for. That or one of those gift cards or something.

pineapple pizza courtesy of not the iceland king

 

[Dr.Acula99]

What is this Uworld coupon and how did you get it?