Skills/Knowledge You Wish You Had Going Into 3rd Year

[GalenAgas]

Any clinical (not social) skills or knowledge you wish you had mastered before starting 3rd year

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[tco]

Cutting the right length string after a knot has been tied -_-

 

[VisionaryTics]

Cutting the right length string after a knot has been tied -_-

Protoplasm (auto-corrected from "protip"): there is no right length. You are always wrong. Just don't cut the knot.

 

[Stellar Clouds]

Any clinical (not social) skills or knowledge you wish you had mastered before starting 3rd year

Knowing which attendings give the best evals

 

[The kitchen sink]

Cutting the right length string after a knot has been tied -_-

When in doubt, leave a long tail.

 

[Siggy]

Cutting the right length string after a knot has been tied -_-

There are only two sizes that a med student can cut at... too long and too short.

 

[Siggy]

Knowing which attendings give the best evals

...and this. There's very little more frustrating than doing 10 times the work for a pass than someone at another site or attending does for a high pass or honors.

[no... not bitter at all]

 

[duckie99]

Any clinical (not social) skills or knowledge you wish you had mastered before starting 3rd year

I think the two things that can serve you well are 1. know everything about your patient (this is not just the history, but also what was done and why; what drugs were given and their mechanisms, indications, contraindications, adverse effects; their pmhx and this involves knowing as much as possible about those disease, etc). and 2. know WHY things are being done (e.g fluid is not just given for the sake of giving fluid...). Other things you will learn and get better at with practice (e.g. calling consults, writing notes, presenting patients, etc).

For every patient you see just read as much about their diseases and treatments to learn as much as possible. 3rd year sucks because everything is always new but eventually you'll start to get it.

 

[Kaputt]

Any clinical (not social) skills or knowledge you wish you had mastered before starting 3rd year

I wish I knew that I didn't have to have anything mastered. That they expected me to know nothing on day 1.

Just show up and adapt to whatever situations you find yourself in. You pick up all this stuff along the way and preparing for it ahead of time won't be much of an advantage.

 

[fluoropHore]

I have a quick q. How many patients are you responsible for as an individual/team per week? How can you read up on *all* the patients you see in your rotation?

 

[Kaputt]

I have a quick q. How many patients are you responsible for as an individual/team per week? How can you read up on *all* the patients you see in your rotation?

Depends on what your team expects of you. Sit down with the seniors at the start and get clear expectations.

But don't worry about it now. You'll get your groove going once you dive in.

 

[duckie99]

I have a quick q. How many patients are you responsible for as an individual/team per week? How can you read up on *all* the patients you see in your rotation?

The number of patients you are responsible for presenting on rounds as a student will vary but is usually 2-3. At first it'll seem like a lot but as you build your knowledge and skills it won't be that bad. You won't have time to read up on all the patients on the team (could be up to 20 or more) but I would encourage you to look up stuff you find interesting and ask questions about stuff even if it is not directly related to one of your patients.

 

[thepoopologist]

I wish I had gone through Step up to Step 2 because the majority of my pimp questions could be answered with that book

 

[Gfliptastic]

Suturing. Suturing. More suturing.

All of you wannabe scalpel jockeys, understand the delicate nature of many operations. You will NEVER be given a scalpel if you even get close to a patient. HOWEVER, you will get many opportunities to suture or staple.

Just my 1st week of OB, I've been repeatedly offered by my preceptor the opportunity to suture up trocar defects for lap procedures, and I've declined. Unsure if my suture skills were a) impressive enough and b) this stitch job is a real live person whom will live the the after effects.

It's a lost opportunity. So practice, practice, practice. And it's not like I've never stitched, I've stitched plenty of pigs feet. However, reason b) is enough to make me balk. Needless to say I am getting more practice now, so hopefully maybe end of this week, or definitely the week after, I can suture a few patients.

 

[Stellar Clouds]

Suturing. Suturing. More suturing.

All of you wannabe scalpel jockeys, understand the delicate nature of many operations. You will NEVER be given a scalpel if you even get close to a patient. HOWEVER, you will get many opportunities to suture or staple.

Just my 1st week of OB, I've been repeatedly offered by my preceptor the opportunity to suture up trocar defects for lap procedures, and I've declined. Unsure if my suture skills were a) impressive enough and b) this stitch job is a real live person whom will live the the after effects.

It's a lost opportunity. So practice, practice, practice. And it's not like I've never stitched, I've stitched plenty of pigs feet. However, reason b) is enough to make me balk. Needless to say I am getting more practice now, so hopefully maybe end of this week, or definitely the week after, I can suture a few patients.

While I do agree with the advice to practice suturing, I will have to disagree with some of the other things in this post. It is possible to be given the opportunity to use the scalpel. I made the opening incision on 15 or so patients as an MSIII, and I'm not talking trocar sites, I'm talking sternotomies. Also, if your attending/resident offers to let you suture something, do not say no. If they are asking you, it means they trust you. Saying no implies that you aren't interested or haven't been practicing your knot tying skills. If you are too afraid or are unsure what you are doing, say "hey can you show me how to do the first one?"

 

[Siggy]

While I do agree with the advice to practice suturing, I will have to disagree with some of the other things in this post. It is possible to be given the opportunity to use the scalpel. I made the opening incision on 15 or so patients as an MSIII, and I'm not talking trocar sites, I'm talking sternotomies. Also, if your attending/resident offers to let you suture something, do not say no. If they are asking you, it means they trust you. Saying no implies that you aren't interested or haven't been practicing your knot tying skills. If you are too afraid or are unsure what you are doing, say "hey can you show me how to do the first one?"

The caveat is know when it's a teaching opportunity and when it isn't. Helping to tie off arteries during an omentectomy with just a surgeon (or, in my case, gyn-onc)? Sure. Surgeon, resident, intern, student all scrubbed in? Ain't nobody got time for that.

 

[secants]

I wish I had learned to how to approach common chief complaints better and more effectively. I still have a hard time trying to work through a patient when all they say is "I've been coughing" or "my head hurts". They way they teach is at school is as if the patient already has a sign on their head with their diagnosis. Also coming up with target differentials and not just anything I can remotely remember from path.

 

[MrBeauregard]

I wish I had learned to how to approach common chief complaints better and more effectively. I still have a hard time trying to work through a patient when all they say is "I've been coughing" or "my head hurts". They way they teach is at school is as if the patient already has a sign on their head with their diagnosis. Also coming up with target differentials and not just anything I can remotely remember from path.

This.

I personally think one of the most valuable skills to begin developing in your third year is the ability to form a quality differential diagnosis list, especially for those vague chief complaints. Secants is correct in saying that in school we are taught medicine in a completely different way. Patients already have a diagnosis or we are only expected to choose from a list of 2-3 potential diagnoses. In the real world, this chief complaint could be anything, and developing a quality differential list and knowing how to work through it by taking a full history, performing a quality physical exam, and ordering appropriate confirmatory testing is paramount.

If anything, I would work on this. As with everything else (suturing, presenting, etc), it comes with practice and time. But I feel that if you want to really distinguish yourself from your fellow MS3 colleagues, showing your resident or attending that you can develop a very good differential will do more to show them your medical knowledge than anything else.

 

[NightSwim]

Spanish

 

[GalenAgas]

This.

I personally think one of the most valuable skills to begin developing in your third year is the ability to form a quality differential diagnosis list, especially for those vague chief complaints. Secants is correct in saying that in school we are taught medicine in a completely different way. Patients already have a diagnosis or we are only expected to choose from a list of 2-3 potential diagnoses. In the real world, this chief complaint could be anything, and developing a quality differential list and knowing how to work through it by taking a full history, performing a quality physical exam, and ordering appropriate confirmatory testing is paramount.

If anything, I would work on this. As with everything else (suturing, presenting, etc), it comes with practice and time. But I feel that if you want to really distinguish yourself from your fellow MS3 colleagues, showing your resident or attending that you can develop a very good differential will do more to show them your medical knowledge than anything else.

What is the best way to work on this as a MS2?

 

[Siggy]

Spanish

It's amazing how much Spanish I'm remembering now even though my last Spanish class was in high school almost 9 years ago. I'm also much better conversation wise. I'm really tempted to go pick up something like Rosetta Stone to start filling in gaps now that I have a regular chance to practice it.

 

[tco]

What is the best way to work on this as a MS2?

Probably nearly impossible to do... Maybe just keep reminding yourself of how a patient with a given disease would present, and learn a mnemonic for the ddx (VITAMIN CDE is what I use...)

 

[neusu]

Cutting the right length string after a knot has been tied -_-

Just ask the attending if they want the tails too long or too short.

 

[Gfliptastic]

While I do agree with the advice to practice suturing, I will have to disagree with some of the other things in this post. It is possible to be given the opportunity to use the scalpel. I made the opening incision on 15 or so patients as an MSIII, and I'm not talking trocar sites, I'm talking sternotomies. Also, if your attending/resident offers to let you suture something, do not say no. If they are asking you, it means they trust you. Saying no implies that you aren't interested or haven't been practicing your knot tying skills. If you are too afraid or are unsure what you are doing, say "hey can you show me how to do the first one?"

I am probably "needle shy", but in the workshops I never felt like my sutures were good enough, tho aren't we all our own worst critics? And I am probably premature in my statement considering I'm speaking from an OB/GYN standpoint, and NOT surgery. I'll revise when I actually get to my SURG rotation.

I also agree w/ NightSwim. SPANISH!

I work w/ an Argentinian doc and a Puerto Rican doc most days. I only learned conversational Spanish (during my career before med school), and I took the medical Spanish extra-curricular class. HOWEVER, I was personally amused when I had to ask a Hispanic woman this AM, if she made "numero dos" cuz I did NOT know how to ask if she had a bowel movement. lol

 

[Siggy]

HOWEVER, I was personally amused when I had to ask a Hispanic woman this AM, if she made "numero dos" cuz I did NOT know how to ask if she had a bowel movement. lol

"Poopoo?" is what I keep hearing whenever I ask via a translator. However I always feel like I'm 5 y/o when I hear it translated that way. However, apparently "movimiento de intestino" is the literal translation for "bowel movement." That's easy enough to remember.

 

[evilbooyaa]

Suturing. Suturing. More suturing.

All of you wannabe scalpel jockeys, understand the delicate nature of many operations. You will NEVER be given a scalpel if you even get close to a patient. HOWEVER, you will get many opportunities to suture or staple.

Just my 1st week of OB, I've been repeatedly offered by my preceptor the opportunity to suture up trocar defects for lap procedures, and I've declined. Unsure if my suture skills were a) impressive enough and b) this stitch job is a real live person whom will live the the after effects.

It's a lost opportunity. So practice, practice, practice. And it's not like I've never stitched, I've stitched plenty of pigs feet. However, reason b) is enough to make me balk. Needless to say I am getting more practice now, so hopefully maybe end of this week, or definitely the week after, I can suture a few patients.

To all incoming MS3s: If the resident/attending asks if you want to do something cool (like suturing, scalpeling, etc.) SAY YES. Even if you're absolutely terrible, they'll either walk you through it, or say, F-this and take over. Saying NO makes it look like you don't know AND you have no desire to learn. If there's one thing you want to have on lockdown, is be able to tie a knot (preferably 1-handed, or possibly instrument I suppose).

Whoever got to make first incision as a MS3, wow. You had a hell of a rotation. The one downside of my hospital is that there are TONS of residents. Meaning every case has a resident covering. No opportunity for a student to make incisions. As a MS3 on surgery, I've gotten to close skin incisions. One of my friends went on neurosurgery for his surgical subspecialty, and got to do a lot more because they knew that was what he wanted to do. Most surgical services aren't like that at my hospital.

Also: very much agreed with whoever said to find out which attendings you want to get evals from. I busted my butt for 2 weeks with one attending. At mid-rotation evals, I got straight 3s and no comments besides read more. Frustrating.

 

[sevenmints]

This is a hilarious thread.

- Int Medicine = presentations are everything. God does the rest.

- Surgery =
1) don't be timid, say yes to everything and anything
2) know all the anatomy of the abdomen (at least).
3) Learn about suturing: instrument-tie, instrument assist tie (that's a plastics thing, but at my school, you get to do 1 specialty month), one hand tie, two hand tie. Understand why certain stitches and certain suture is used the way it is.
4) Learn about dressings: how to remove dressings, put on dressings, read/strip/empty/remove drains. 5) most important of all don't touch the f-ing mayo tray - EVER - even if the attending is flipping out about getting the metz or something. Only exception is if the scrub nurse says okay.

 

[Stellar Clouds]

This is a hilarious thread.

- Int Medicine = presentations are everything. God does the rest.

- Surgery =
1) don't be timid, say yes to everything and anything
2) know all the anatomy of the abdomen (at least).
3) Learn about suturing: instrument-tie, instrument assist tie (that's a plastics thing, but at my school, you get to do 1 specialty month), one hand tie, two hand tie. Understand why certain stitches and certain suture is used the way it is.
4) Learn about dressings: how to remove dressings, put on dressings, read/strip/empty/remove drains. 5) most important of all don't touch the f-ing mayo tray - EVER - even if the attending is flipping out about getting the metz or something. Only exception is if the scrub nurse says okay.

Best advice, ever.

 

[ijn]

Also remember that experiences people post about of the forum may have absolutely no relation to what your surgery rotation will be like.

You can say no, have no clue how to suture anything besides the most basic knot, and know nothing about dressing changes yet still comfortably honor the clerkship if you just know your anatomy and know your medicine. Oh, and I touched the mayo.

 

[MrBeauregard]

Always the outlier, ijn.

 

[JJMrK]

Suturing. Suturing. More suturing.

All of you wannabe scalpel jockeys, understand the delicate nature of many operations. You will NEVER be given a scalpel if you even get close to a patient. HOWEVER, you will get many opportunities to suture or staple.

Just my 1st week of OB, I've been repeatedly offered by my preceptor the opportunity to suture up trocar defects for lap procedures, and I've declined. Unsure if my suture skills were a) impressive enough and b) this stitch job is a real live person whom will live the the after effects.

It's a lost opportunity. So practice, practice, practice. And it's not like I've never stitched, I've stitched plenty of pigs feet. However, reason b) is enough to make me balk. Needless to say I am getting more practice now, so hopefully maybe end of this week, or definitely the week after, I can suture a few patients.

Just say yes. They are asking to see if you are interested, and then are going to teach you how to do it. They can always cut out the stitch.

You get to do more and more as you get comfortable in the OR with basic things, and as the attending gets comfortable with you.

 

[Gfliptastic]

To update my previous post, YES I suture now.

What others have posted is true. My attending said, "If they aren't good we will cut them out and you will redo them." Which they haven't done. NOW they want me to be quicker tho lol.

Just ask the attending if they want the tails too long or too short.

3 weeks into OB, that is ironic/funny. What you see as a centimeter is rarely a centimeter.

Also, to add to the list, make sure you know a proper SOAP note for your rotation. I had a classmate tell me she got read the riot act for one. An OB SOAP is not the same as an IM SOAP. To state the obvious.

As far as everything else concerning scrubbing in and assisting in procedures, it's a huge game of Simon Says. Don't touch anything unless someone tells you to. If someone wants scissors or a hemostat, the nurse usually hears the doctor before you even reach up, and she will put it in your hand. Gauze, anything. Don't reach, don't touch, unless you're told.

Good luck!

 

[mimelim]

To all incoming MS3s: If the resident/attending asks if you want to do something cool (like suturing, scalpeling, etc.) SAY YES. Even if you're absolutely terrible, they'll either walk you through it, or say, F-this and take over. Saying NO makes it look like you don't know AND you have no desire to learn. If there's one thing you want to have on lockdown, is be able to tie a knot (preferably 1-handed, or possibly instrument I suppose).

Whoever got to make first incision as a MS3, wow. You had a hell of a rotation. The one downside of my hospital is that there are TONS of residents. Meaning every case has a resident covering. No opportunity for a student to make incisions. As a MS3 on surgery, I've gotten to close skin incisions. One of my friends went on neurosurgery for his surgical subspecialty, and got to do a lot more because they knew that was what he wanted to do. Most surgical services aren't like that at my hospital.

Also: very much agreed with whoever said to find out which attendings you want to get evals from. I busted my butt for 2 weeks with one attending. At mid-rotation evals, I got straight 3s and no comments besides read more. Frustrating.

I opened an abdomen as an MS1 and then maybe 6-7 as an MS3 and a dozen or so as an MS4. The MS1 was kinda funny in retrospect. I was 'shadowing'/doing research between MS1 and MS2 and all the MS3/MS4 were on break in June. I was scrubbed with the attending and chief resident who thought it would be funny if they had the MS1 who had no idea what was going on open the belly full of liquid ****. So, I cut down, open the fascia and a wave of essentially diarrhea comes flying out. In goes the sucker, but not before I get hit all over with poo water.

Now as a resident I routinely walk medical or PA students through suturing/closures. Unless there is a vessel/graft directly below where we are suturing, I'll let them do 90%+ of it. Most of our attendings scrub out after the critical part of the case is over, so they can usually take their time getting it right. I don't really care if you are going into surgery. If you are interested in what is going on and you are at least somewhat helpful on the floor, I'll let you do as much as possible when its just in the OR. (as long as my anastamosis or graft isn't in jeopardy). I also have a rule that students can't do anything wrong the first time. You aren't supposed to know how to do anything coming in. But, if I show you how to do something and tell you to practice and the second time it is obvious that you didn't practice, I'm going to take it away from you. We have a large inanimate skills lab with tons of suture/instruments, there is no excuse to not be practicing. If I can get into the lab working 100+ hours a week to practice my skills, you can get in there as a student.

 

[LRAccord624]

Mimelim, you sound like an awesome resident. I met maybe one other resident like you on my 2 months of surgery. I have no interest in surgery and still have no clue how to tie most knots etc, but if someone had just shown me one time without slapping my hand or belittling me in front of the attending and scrub techs, I would have practiced and tried my best to be useful/at least get something out of being in the OR. I really like reading how you deal with students; sounds like you're a great teacher.

 

[Stellar Clouds]

If you were interested in surgery, I'd invite you accross the street to Methodist to hang out with us . As it so happens, I'm actually on the UT Trauma service for another week, and am twiddling my thumbs on SDN until sign out in one of your call rooms XD.

I just don't see the point in the behavior you described. We aren't going to attract good students to surgery, we aren't going to teach anyone skills by being negative and abusive. It is just pointless and it is very unfortunate =/.

I couldn't agree with you more. It takes a special person to want to go into a field after being abused in it from the get-go (or they can see the bigger picture).

 

[evilbooyaa]

Mimelim, you sound like an awesome resident. I met maybe one other resident like you on my 2 months of surgery. I have no interest in surgery and still have no clue how to tie most knots etc, but if someone had just shown me one time without slapping my hand or belittling me in front of the attending and scrub techs, I would have practiced and tried my best to be useful/at least get something out of being in the OR. I really like reading how you deal with students; sounds like you're a great teacher.

Agree with this. Keep on keepin on mime. I just started on my vascular service and am trying to use some of your general advice that is beneficial even after 9 weeks on service.

 

[wholeheartedly]

I find myself wishing I could create a clerkship series composed of some of the residents and attendings on here that really seem to have a strong desire to teach.

 

[siliso]

The branch points of the vessels in the fundus of the eye point like arrows to the disc.

Fishing line type sutures get cut with a tail. Braided do not. Cut on the knot: slide the blade down until you feel the stop, quarter turn up, cut. Get the suction in there but don't get in the way: a delicate dance.

It's good to know how to poke a vein. And do a rectal with two gloves on the bum hand and one glove on the other. Then you can toss the poop glove and still have gloves on for dealing with the hemoccult and all.

You can get by with a lot of **** you don't know by being cheerfully clueless and also politely enthusiastic to learn. Hi scrub tech sir/maam, it's my first day and I am stupid, could you please remind me exactly how to hold this towel, or tie this gown, or whatever?

Ask people: any suggestions for me?

Presenting would have been good for more practice.writing a h&p is one thing, spitting it concisely and in order without making everyone bored out of their mind is another and a very good skill to have.

 

[JShephard]

If you guys could pick one book that is the most important to learn during M3 what would it be?

Step up to medicine? Step up to medicine step 2? First Aid for step 2? First Aid for the wards?

Basically is there an equivalent to first aid for step 1?

 

[duckie99]

If you guys could pick one book that is the most important to learn during M3 what would it be?

Step up to medicine? Step up to medicine step 2? First Aid for step 2? First Aid for the wards?

Basically is there an equivalent to first aid for step 1?

I used different books like "case files" for each separate rotation. It's good to the learn the details. Step up to medicine is a good choice for IM (I didn't personally use it though). I'd recommend first aid for step 2 CK when you are studying for CK mainly because it's not really detailed enough for rotations and also because it's quick and easy to review in a few days while doing questions for step 2 preparation.

 

[Kaputt]

If you guys could pick one book that is the most important to learn during M3 what would it be?

Step up to medicine? Step up to medicine step 2? First Aid for step 2? First Aid for the wards?

Basically is there an equivalent to first aid for step 1?

There's generally a good book or combo for every rotation.

Surgery=pestana + nms casebook
Psych=first aid for psych
Neuro=blueprints neuro
Peds=brs peds (in my opinion, though it's long)
Ob/gyn=blueprints ob/gyn
IM=step up to medicine

Then do UWorld for each before the shelf. presto. done.

 

[JShephard]

There's generally a good book or combo for every rotation.

Surgery=pestana + nms casebook
Psych=first aid for psych
Neuro=blueprints neuro
Peds=brs peds (in my opinion, though it's long)
Ob/gyn=blueprints ob/gyn
IM=step up to medicine

Then do UWorld for each before the shelf. presto. done.

Thanks for the feedback.

 

[Stellar Clouds]

there's generally a good book or combo for every rotation.

Surgery=pestana + nms casebook
psych=first aid for psych
neuro=blueprints neuro
peds=brs peds (in my opinion, though it's long)
ob/gyn=blueprints ob/gyn
im=step up to medicine

then do uworld for each before the shelf. Presto. Done.

+1

 

[evilbooyaa]

There's generally a good book or combo for every rotation.

Surgery=pestana + nms casebook
Psych=first aid for psych
Neuro=blueprints neuro
Peds=brs peds (in my opinion, though it's long)
Ob/gyn=blueprints ob/gyn
IM=step up to medicine

Then do UWorld for each before the shelf. presto. done.

Very good synopsis of books.

I've also heard Casefiles for ob/gyn is good, and I personally used casefiles for IM as well.

Used casefiles for peds too, but I did turrible on the shelf.

 

[Stellar Clouds]

Very good synopsis of books.

I've also heard Casefiles for ob/gyn is good, and I personally used casefiles for IM as well.

Used casefiles for peds too, but I did turrible on the shelf.

Casefiles for obgyn is pretty good. The main author is an attending at my school, and he has a real knack for knowing exactly what kinds of questions will show up on the shelf.

 

[JJMrK]

If you guys could pick one book that is the most important to learn during M3 what would it be?

Step up to medicine? Step up to medicine step 2? First Aid for step 2? First Aid for the wards?

Basically is there an equivalent to first aid for step 1?

There's generally a good book or combo for every rotation.

Surgery=pestana + nms casebook
Psych=first aid for psych
Neuro=blueprints neuro
Peds=brs peds (in my opinion, though it's long)
Ob/gyn=blueprints ob/gyn
IM=step up to medicine

Then do UWorld for each before the shelf. presto. done.

Adding to this other books people traditionally use and things that were popular at my school:

Surgery=pestana + nms casebook
Psych=first aid for psych + casefiles + Lange Q&A
Neuro=casefiles
Peds=blueprints + pretest
Ob/gyn=blueprints + casefiles
IM=step up to medicine + casefiles
Family= AAFP practice questions + casefiles
Ambulatory= SUTM + medicine casefiles

UW is good for everything, especially surgery, IM, ambulatory. A little too easy for psych and OB, IMO.