shelf exams vs. learning on the wards

[HiddenTruth]

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So, how much of what's tested/ expected of you on the shelf is actually learnt on the floors on an everday basis. I know you have to do a lot of reading on your own even while on the floors, etc...but generally speaking, I suspect that there is a significant amount of detail/basic sci/material not learnt on the floors that one is expected to know for subject exams. It seems as if a good portion of the time is spent on scut/paper work/writing notes, etc. While, some of it is essential to know, the time could be better spent teaching/learning. What are your thoughts?

 

[Stinger86]

The most beneficial thing you can get out of third year (pertaining to shelf exams/usmle) is working with patients, whether it's writing h&p's, progress notes, going to the OR, or even just seeing them with an attending/resident in clinic. Most of the NBME's questions start out with a chief complaint and almost every time I would think "I remember a few of my patients having this complaint" and that would give me a real life reference to use for the question. If the question steers you toward pancreatitis, you've probably had a patient with pancreatitis; if it steers you toward lung cancer, you've probably had a patient who's had it. Then, once you have that reference point, it makes it easier to not only diagnose, but also to determine how it was initially diagnosed and how it was treated/corrected, two principles that are heavily tested on the third year shelf exams and the step2ck.

 

[RonaldColeman]

So, how much of what's tested/ expected of you on the shelf is actually learnt on the floors on an everday basis. I know you have to do a lot of reading on your own even while on the floors, etc...but generally speaking, I suspect that there is a significant amount of detail/basic sci/material not learnt on the floors that one is expected to know for subject exams. It seems as if a good portion of the time is spent on scut/paper work/writing notes, etc. While, some of it is essential to know, the time could be better spent teaching/learning. What are your thoughts?

This is a dilemna that I faced 3rd year. Wards ARE lots of scut/paper work/writing notes as you said. People always say "learn from your patients," however, most of what you see on the wards is all the same. When I was on surgery, all I saw were appendectomies and cholecystectomies. What makes it even worse is that ward performance at my school often counts for less than 15% of the final grade. NBME exam can be as much as 50% with the remained of the points coming from OSCEs. On surgery, we were required to turn in only one eval worth 12.5% of the final grade, and it could be from any attending we encountered over a 12 week period. Basically, there is very little incentive to work hard on the wards; if anything, it can be detrimental to your final grade. At the same time, there are things that you need to learn on wards that may not be tested on the NBME exams but will certainly come in handy when you are a resident. You also have a duty to your team. That being said, my strategy has always been to go balls to the walls for one attending, get my eval, and then tone things down. I know that sounds, well, evil, gunner-like, whatever you want to call it, but when the clinical eval counts for 15%, and you are going for a competitive specialty, you just cannot afford to spend all of your time on the wards. I might carry 5-6 pts, give presentations, etc. for the attending I plan on requesting an eval from, but after that I will carry 2-3. Now, don't get me wrong--I still know these patients and do take part in their care--it's just that I don't go the extra mile. I just can't afford to.