Purpose of 3rd year clinical rotations

[sj238]

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I'm really confused about the purpose of third year rotations.

I'm attending a DO school and interested in either internal medicine or neurology (but most likely IM)- and perhaps other areas. Regardless, I want to prepare myself the best I can and possibly attend the best residency I can obtain that is MD.

My questions are the following-

there is a good chance I won't see everything that most MD students would at large academic hospitals especially in IM, ER and surgery. In this event- how can I best prepare myself so that when I am 'pimped' at the audition rotations I am up to speed and as competitive as other medical students who may attend either prestigious MD programs or larger academic institutions?

What is expected of first year interns in IM residency at say prestigious programs ( I only use that term prestigious to indicate I guess the highest level of expectations possible- if this naive description is offensive please understand this is because of my own limited understanding of how everything works and to convey my message as succinctly as I can)? What sources can I read to obtain the best knowledge possible to prepare myself? Are there reasonable board review books I can use that would adequately prepare me? I have been looking at the Kaplan Step 2 comprehensive notes and am thinking of trying to get those- I've used them for step 1 and thought they were excellent.

Furthermore- how important is knowledge regarding procedures and practice doing them whether it is a Foley or some other procedure? If we don't have as much experience is that alright or is this expected?

If it is mostly book knowledge or understanding the clinical aspects which can be read in textbooks etc- I would think that I can do a lot of self studying and prepare myself well.

on the other hand- if its procedural I'm afraid my training may be inadequate.

Can someone please tell me what should be learned and expected from third year?

Thanks.

 

[MrBeauregard]

I would say your best bet would be to do a search. There are numerous threads on this very topic that likely adequately address your questions.

 

[sj238]

Hi,
Thanks for the reply- I spent time looking for it but was not able to find much information on this 🙁

 

[link2swim06]

If you don't have a lot of clinical experience you might benefit from a 'case files' type of a book.

MD students take a national shelf exam after each rotation. Do DO students take those?

Regardless reading up on core subjects (medicine, surgery, peds, etc.) will give you the info to answer most reasonable pimp questions.

P.S. Often being at a bigger medical center means you get to do less because there are so many residents in front of you who take the procedures or interesting cases leaving you to just 'follow' or 'watch'.

 

[pattr]

If it is mostly book knowledge or understanding the clinical aspects which can be read in textbooks etc- I would think that I can do a lot of self studying and prepare myself well.

on the other hand- if its procedural I'm afraid my training may be inadequate.

Can someone please tell me what should be learned and expected from third year?

Thanks.

From my experience having just finished third year at a DO school, the purpose of third year is to get good at being a medical student, and learning what it means to be the intern, the resident, and the attending.

You should spend your third year:
1) Getting really good at doing H&P's. Focused but thorough (with differentials in mind as you are doing the physical), well-done, and fast.
2) Learning MEDICINE. (I feel like procedures were always just an added bonus if whoever you are with is willing to teach... it's not necessarily the focus of your training right now and you can always learn those in residency.)
3) Becoming skilled at giving a long, thorough presentation of a patient you just saw (~15 min.), a more focused presentation (5 min.), and a one or two liner of the most pertinent information (30 seconds) to a resident or attending.
4) Developing a sense of "what would I do?" Develop your own assessment with a differential of the most common and most dangerous and a plan (even if it's limited) and be able to defend it to your senior. Learn to rule in or out differentials and rank them in order of likelihood based on clinical presentation, imaging, labs, etc. Question why the team is making the decisions they are and what the alternatives would be. ALWAYS try to read the EKG and imaging yourself; don't get into the habit of trusting the radiologist's read.
5) Being a student: Paying attention to lectures. Preparing for shelves. Preparing for surgical cases by reviewing anatomy, indications, complications, etc. Conversing with your residents and attendings (read, ask questions, share literature)
6) Knowing your patients inside and out Learn how to interact with patients so that they trust you and don't just consider you as "just the student." Get to know them to the point that you know everything about their medical and surgical history, their social stressors, their personalities... residents/attendings will be impressed when you know your patients better than they do.
7) Learning how to become a valued and trusted member of the team. You will have to find your niche as a medical student. Sometimes that means doing scut. But everything you do, you must do it well and with a smile on your face.

These things are what will make a difference come fourth year and aways/auditions. By the end of third year you have to evolve from just being a scut-monkey "information-getter" to someone who can actually think for themselves and converse/interact appropriately with residents and attendings.👍

 

[sj238]

Wow this was an amazing response.

It also gives me the confidence because I realize its not about knowing everything but a willingness to learn and improving as a doctor-in-training rather than attempting to act like a doctor - which is what I thought I was supposed to become by the end of the third year.

I appreciate the input.

 

[joeDO2]

MD students take a national shelf exam after each rotation. Do DO students take those?

not sure about all other DO schools but at lecom-b we must take all nbme shelf exams

 

[pattr]

There are also NBOME shelves: http://www.nbome.org/COMATMAIN.asp

 

[sj238]

Is there a way to get my school to provide the NBME shelfs?

 

[MrBeauregard]

Is there a way to get my school to provide the NBME shelfs?

Probably not.

 

[DrBowtie]

Probably not.

Ditto. They cost a lot of money.