Starting first rotation in a week, need advice...

[CBG23]

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Hi all,

I am starting my internal medicine rotation in about a week and am getting pretty worried about it. I was a pretty good student first year, but barely managed to pass second year and didn't do so hot on the Step 1. I think part of my difficulties during the second year was figuring out what was and wasn't important. A lot of the lecture notes for my classes really got down into the nitty gritty details for a lot of diseases/ pharm (with the loss of big picture concepts) - stuff that in retrospect (after Studying for step I/ taking the exam) were really not important to learn for a second year student - hence a lot of wasted studying time. I would like to be as prepared as I possibly can for the Med rotation; I am mostly concerned about the studying/ shelf side of it than the ward side of it right now.

I have a couple of questions that I was hoping you guys could answer:
1.) I took a look at the stickied thread regarding what books to use, but it hasn't been updated in a couple of years. I have vaguely heard about Step up to Medicine, but don't know much about it - expect I came across a thread recently that said it had a bunch of typos 🙁. What are the books that you all recommend?

2.) I have found that watching short lectures that go over the key points on a topic before studying really helps me with studying (ex. I used some of Kaplan lecture videos, Pathoma, or Goljan before reading about certain topics). Since there are no lectures scheduled during my rotation besides the case presentations during the week, I was wondering if there were any good audio/ video resources out there for ward relevant material.

3.) Another reason I think second year didn't go so well for me is that I didn't spend enough time on review questions - I saved them toward the end and usually didn't have enough time left to make good use out of them. Is there any Qbank that people use for their IM rotation?

4.) Finally, realistically, how much time do you guys study per day? It looks like many days in the hospital will be 12+ hours. I know everyone is different, but I want to get a general idea of how much time I should be alotting.

Sorry for the long post; any advice would be greatly appreciated. Thanks in advance,

 

[DrBowtie]

Get Step Up to Medicine. I thought it was the most complete medicine book and most commonly used at my school.

Get either USMLEWorld or Kaplan QBank for the entire year. You can use them on every rotation. For Medicine specifically if you don't want to get the Qbank you can use the student MKSAP questions.

As for studying, read on uptodate about any patient you have as this will help you learn and look good on the wards. For reading time, just make a reading schedule and stick to it.

 

[Rollo]

Master The Boards or Step 2 Secrets is another good alternatives for review books.

Get Pocket Medicine for when you're on the wards and have some downtime, you can easily look something up and familiarize yourself with management.

There is a podcast called "ICU Rounds" by Dr Jeffery Guy (they're free) and he goes over lot of medicine stuff like acid-base disorders, electrolytes, acute coronary syndrome, etc. Pretty solid stuff.

 

[PTPoeny]

While the stickied thread is out of date, this thread is current and has a lot of discussion of what different people did and how it turned out for them:

http://forums.studentdoctor.net/showthread.php?t=237939&page=14

 

[myhandsarecold]

start reading Step Up to Medicine NOW! Try to do 2 passes. I realize that you're starting late and from what I read, you had trouble in the first 2 years? if this is the case, most definitely buy USMLEWorld now, for a year, so that you'll have an opportunity to do at least 2 passes for Step 2 CK. Also do the MKSAP 4 qbank for medical students, not the best, but helpful. If you have an iPhone, I really loved the PreTest qbanks which are super convenient for downtimes in the wards. For the clinical portion, pre-round really early, write good progress notes and consult up-to-date frequently for a good plan and have a copy with you during rounds, present CONCISELY, help out your intern.

 

[CBG23]

Thanks for the tips all; I am having a bit of trouble getting through Step ups bullet point format and retaining much. Is there any resource written in paragraph format that is more conducive to reading? I found Medium Robbins to be helpful during second year because the paragraph format was easier for retention than the bullet point format of a review book. Has anyone ever used "internal medicine essentials for clerkship students' - it's listed on my school's clerkship website as a recommended book.

Do people really use Step Up as their primary resource? That is, to learn it for the first time? I just think the outline format isn't very conducive to that...

 

[ZagDoc]

Thanks for the tips all; I am having a bit of trouble getting through Step ups bullet point format and retaining much. Is there any resource written in paragraph format that is more conducive to reading? I found Medium Robbins to be helpful during second year because the paragraph format was easier for retention than the bullet point format of a review book. Has anyone ever used "internal medicine essentials for clerkship students' - it's listed on my school's clerkship website as a recommended book.

Do people really use Step Up as their primary resource? That is, to learn it for the first time? I just think the outline format isn't very conducive to that...

You'll learn on your clinical rotations that your time to sit down and "read something" becomes greatly compressed. Up To Date is the best for reading something in prose because it gives specific information on a narrow topic. Definitely agree with the student who said read something on UTD about one of your patients every day. Doesn't even have to be directly relatable. If you have a patient who has a creatinine bump, use it as an opportunity to review the types of acute renal failure and how to differentiate them. Etc, etc.

As for studying for shelf exams, you need the outline format because you have a lot of info to cover and sparse amount of time to cover it in (that often comes in brief bursts). You'll find things stick better when you have patients to give you context or a memory to job the information from your brain. Then a lot of it is becoming accustomed to a new style of learning. "Learning" as a MS3/MS4 (and beyond) is very different from as a MS1/MS2. It will seem awkward at first, but you'll get better at it. I used to be the type who has to sit down in a quiet room and read something to remember it, and remember early on in my third year trying to get through brief sections of a review book in the work room during downtime, and how awkward and chaotic it seemed. It felt like I wasnt retaining anything. But you get better at it. I still find time one my days off to sit down and read now as a resident, but a lot of my reading it done "on the job" now, and thats a skill you acquire and hone during your clinical years.

Good luck! Third year was when medical school became really fun for me. It's when you get to really start interacting with and participating in the care of patients. Learn from them, they have a lot to teach you.

 

[cabinbuilder]

1. Show up to morning report on time
2. Ask questions but don't be overly annoying
3. If your resident in charge of you tells you to go home - GO. They have tons of stuff to do and don't need extra bodies in the way.
4. Know your patients the best you can, pre-round and be ready to present your SOAP note when asked.
5. If your attending is busy and running short on time then don't bog down the process with incessant questions.
6. You are not there to be a slave, you are there to learn and observe. I had an attending who expected me to be there 18 hours a day on IM. I couldn't do that because I had children at home and a husband who worked the evening shift. He basically tolerated me but at the last day told me I would never graduate medical school and would never make it through residency because he "questioned my dedication to medicine" blah, blah, blah. Anyhow, he passed me barely with a 71. I filed a formal complaint with the medical education department at my school and they adjusted my grade because all my other grades were A's.

Another instance was with a psychologist. I went to his office on the first day. He put me in a room with no windows and handed me the DSMIV and a drug book and told me to memorize both and he would talk to me on friday. Really??? On the friday we went to the nursing home and he handed me a stack of patient charts and said here you go, you need to do my rounds for me. I refused as I had never done round before. He got angry of course, and drove me back to his office while berating me in the car about how I houldn't be allowed to continue in my medical career, I would never pass boards, I needed to study more. Blah, blah, blah. I got off that rotation that day. He had called the school before I even made it back. Good thing I called them first and was friends with the rotation office staff. Transferred to inpatient psych with another student of mine and did well.


When I was Chief Resident there was a medical student assigned to me. OMG that guy pissed off the attending on rounds EVERY SINGLE DAY. I had another medical student be assigned to him to keep him out of the way because I wasn't always available to shield. This medical student got yelled at every day and THOUGHT THAT WAS NORMAL. It is not. The entire hospital ended up hating him he thought he was God's gift and didn't get the hint when to shut his mouth and listen. Needless to say he was not allowed back to our program for any further rotations.

Sorry for the lenth of this post, it brought back memories.

 

[Rollo]

Can you elaborate on how that med student pissed off people every day?

 

[cabinbuilder]

Can you elaborate on how that med student pissed off people every day?

The guy essentially argued with the attending every day. Telling the attending that his way of treating the patient's was wrong and didn't follow, "evidence based medicine". Our attending was an FMG who was wicked smart and didn't take kindly to some 3rd year student telling him how to practice. Even when the attending was yelling at him to "shut his mouth" the guy thought he was more knowledgable than the attending and just kept on talking. Book medicine and the art of medicine are two different things and the student needed to realize that
1. He wasn't the one in charge,
2. He didn't know everything
3. There is a time and place for dicussion of ideas, not in front of family members, nursing staff, or during rounds with the attending when time is short.
4. You don't bad mouth the attending in front of a patient's family member who is putting their trust in that doctor. NOT COOL.

I could go on and on and on. His arrogance got the better of him. He thought he was God's gift and strutted around the hospital. Just remember that rotations are a month long interview. If you blow it, you will not get a residency slot because no one wants to deal with a non-team player for 3+ years. It's just not worth the headache.