- Joined
- Jul 18, 2004
- Messages
- 3,293
- Reaction score
- 224
- Points
- 5,201
- Location
- Colorado
- Attending Physician


Anyone have any questions? I'll check this thread over the next week or so and answer anything that I can. I've been on SDN a long time, heard lots of good advise, and figured I could give something back during my free week between MS3 and MS4.
How does applying to residency work? Do you choose hospitals and then pick specialties? Do you rank specialties?
IE: I like radio/anes/OB. Would I rank these and then apply to hospitals or would I apply to each hospital's program individually?
What kind of class schedule did you have in MS1/2? Did you get a lot of early patient contact then or only in MS3?
Google eras. Early patient contact is useless. Almost as overrated as free clinics.
Early patient contact is useless. Almost as overrated as free clinics.
Why do you say that? Do you differentiate between MS1/2 contact vs 3/4?
Do you mean to say residency doesn't require any community service in the form of free clinics or any at all?
Could you expand?
No application 'requires' community service, never mind from free clinics. It doesn't for medical school and certainly not for residency. You risk coming off as a cold heartless bastard, but you don't need much to get rid of that...
Regarding patient contact... The problem is, the MS1/2 curriculum is about preparing you for Step 1, NOT for how to take care of patients or be a good doctor. It in no way shape or form prepares you for being in the hospital or function as an medical student/resident. Thus, most 'early' patient interactions are of limited scope and not designed to provide you with any substantive experiences beyond shadowing and seeing what happens at various clinics/wards.
Did you feel prepared to tackle your third year clerkships after 2 years of basic science?
Also, I doubt you would know enough as an MS1 to make a significant impact in a patient's medical care.
If the first two years of medical school help you with anything its on pimping questions. But to be honest the impact is minimal at best. MS1/2 do not help you in the hospital or the real world. The subset of a class that shines as an MS1/2 is different than that that shines in MS3/4. Those subsets overlap in every medical school class across the country, but the overlap can vary substantially.
agreed
I think what dirzzt was referring to (I could very easily be wrong) is that you residency placement is mainly a function of Step 1 scores, clinical rotation grades, and research. In general, free clinics and patient exposure in your first year of medical school is relatively meaningless for residency purposes. Also, I doubt you would know enough as an MS1 to make a significant impact in a patient's medical care.
No application 'requires' community service, never mind from free clinics. It doesn't for medical school and certainly not for residency. You risk coming off as a cold heartless bastard, but you don't need much to get rid of that...
Regarding patient contact... The problem is, the MS1/2 curriculum is about preparing you for Step 1, NOT for how to take care of patients or be a good doctor. It in no way shape or form prepares you for being in the hospital or function as an medical student/resident. Thus, most 'early' patient interactions are of limited scope and not designed to provide you with any substantive experiences beyond shadowing and seeing what happens at various clinics/wards.
Do attractive women look at you differently when you have your coat on?
Third year.. a different beast. I can't really think of too much I liked about it, it is what it is. You show up and do what you have to do. I can't imagine that's much different at most schools. We had long call (28 hours) which was fine. We also have a third year elective, which is great for early exposure to a field you may be interested in.What in particular did you like/dislike about how your school did third year?
What specialty are you aiming for?
If you could do it over, knowing what you know now, what factors would have been most important to you when choosing a school?
Why do you say that? Do you differentiate between MS1/2 contact vs 3/4?
Do you mean to say residency doesn't require any community service in the form of free clinics or any at all?
Is studying for the mcat.... 5 hrs days with 1 day off similar to studying in med. school?
Is med school studying better or worse?
Third year.. a different beast. I can't really think of too much I liked about it, it is what it is. You show up and do what you have to do. I can't imagine that's much different at most schools. We had long call (28 hours) which was fine. We also have a third year elective, which is great for early exposure to a field you may be interested in.
What I didn't like revolved around grading. It's very subjective and not standardized, so people could request the docs they knew always gave honors. The third year grades become almost meaningless when there's such huge variation in grading among students who really all perform roughly the same, with a few exceptions.
I hated 3rd year. Feeling totally superfluous is pretty not awesome. Luckily my school is extremely non-malignant so that was nice. All the gunners definitely showed their true colors 3rd year though, had to fight my way through to get almost all honors.
what do you mean by a malignant school?
what do you mean by a malignant school? Is it the same thing as a malignant residency? (Where everyone is yelling at you and you're getting written up for small things lol)
Nothing better than paying someone to get to pick up their dry cleaning right?Endless scut, lots of getting coffee, sending faxes, getting lunch/dinner/dry cleaning for your residents/attendings, etc
Endless scut, lots of getting coffee, sending faxes, getting lunch/dinner/dry cleaning for your residents/attendings, etc
Why do you say that? Do you differentiate between MS1/2 contact vs 3/4?
Do you mean to say residency doesn't require any community service in the form of free clinics or any at all?
Just to add some contrast...
Third year was the best time of my life. What was there not to like? I got to sample different areas of medicine, all of which were fascinating. I was given a taste of what it was like to live the life of a resident and go through the trials and tribulations that hospital teams go through every day. I have enough stories to fill several books. Being a 3rd year student is an absolute privilege. You are exposed to extremely private information, trusted to help a team, even if only doing little things. If you demonstrate a reasonable level of ability your exposure is ONLY limited by your interests. If your end perspective is "I show up, do my job and leave", you missed something along the way and maybe hospital medicine really isn't for you.
Early patient contact isn't completely useless 🙄. Well I guess it depends on what you're doing. One of the student-run clinics at my school has the medical students interviewing/examining the patients. An MS1/2 is paired with an MS3/4. The MS1/2 takes the history & the MS3/4 does the physical exam and supervises, then they present to the attending to figure out the plan. The med students also do the writeup (and get it signed by the doc). So it's an opportunity to practice your history-taking/physical exam skills.
I'd have to agree (if I was paired). As a new 4th year, if I was paired with a first year to see a patient I'd probably find it frustrating. At this point in time I think my history taking skills are able to pick up on the big things, but they're no where refined to a resident's or attending's skills. To try and rely on a first year without any clinical knowledge would be exasperating. I don't know much in the realm of things, but then to rely on a few things an MS1 was able to gleam from the patient, well I'd probably do what residents do to rotating students: go in and ask the same questions again plus more.Idk why you'd want to do free clinic as a ms3/4 esp if a m1 was taking the history.... /wrists.
I would have chosen a cheaper school. I also would have applied for the NHSC. But, alas, as an incoming MS1 you don't know where your future will be taking you.If you could do it over, knowing what you know now, what factors would have been most important to you when choosing a school?
Anyone have any questions? I'll check this thread over the next week or so and answer anything that I can. I've been on SDN a long time, heard lots of good advise, and figured I could give something back during my free week between MS3 and MS4.
congrats! i'm right there with you
it's really unfortunate that these advice threads always degenerate into drizzt complaining while patting himself on the back for having honored everything
The OP hasn't been back to respond - the thread can't degenerate if it had no substance to begin with.
I don't know much in the realm of things, but then to rely on a few things an MS1 was able to gleam from the patient, well I'd probably do what residents do to rotating students: go in and ask the same questions again plus more.
congrats! i'm right there with you
it's really unfortunate that these advice threads always degenerate into drizzt complaining while patting himself on the back for having honored everything

Or you could do what my residents tend to do: go in and talk to the patient with (or without) me, get all the critical information, then leave me to get the rest of the history. Then page me if there's something you didn't ask but need to know.
Not sure why this is a bad approach. The med student has the time to sit down and hear about all the noncritical details of the patients life. The resident is usually overtaxed and playing whack a mole -- get in, get the info, and get out fast. A lot of the time the resident already has more info about the patient than you know, from sign out, from the consult, because the patient is a frequent flyer, etc., and more importantly knows what the attending is really going to care about, which is the only golden nuggets you really are hoping to extract anyhow. Not to sound jaded, but a lot if the time as a resident the real life goal is to keep your attending happy, and good patient care is more or less usually a happy benefit of doing that primary goal. You have too much work to do to actually sit down and exchange pleasantries with the patient, but the guy in the short white coat is perfect for that role, and the patients tend to be equally happy talking to a "student doctor" as a doctor.
So yeah, this sounds like appropriate use of the med student.
How about letting the med student take the history first, present the patient to you, and answer any questions you have or go get more information if there's something they missed? It helps teach the med student how to take a complete history without any information from the resident, how to present, and what kind of things they missed in the history for that particular type of patient.
Mopping up the small details doesn't really teach a med student much about gathering a relevant history. Sure it's about keeping your attending happy, but what's the point of a med student being there if they're not going to do or learn anything useful?
Simple, because when push comes to shove the attending has expectations of the residents that supersede any teaching obligations they impose on the residents. It's more important for me to know what I need to about my patients to keep the attending happy than to ensure the med student the best learning opportunity. If I don't know my patients, or if the med student misses something, I get reamed. (not all med students are superstars, and I don't want to find out who isnt during rounds.) If I dont give the med student the perfect learning experience, there's really no repercussions, so most residents err on the side of gathering all their info and pushing the med student to mop up duty when it's busy. If there's ample time to do what you describe, sure a resident will do that, but on a busy service it's much more of a "let me get what I need and don't slow me down approach". There are lots of ways a med student can add value, but being the primary history taker on a patient the resident is ultimately responsible for is very risky, and plenty of residents have been needlessly burned due to the rare bad or lazy med student, or the guy who simply doesn't give a crap because hes dead set on path or something.
I don't see the difference other than time, to be honest. You give the med student the first crack at the patient, maybe it delays you seeing that patient by 30 minutes, but if you're busy with other patients then what's the difference? You'll still have the opportunity to ask the patient all of the questions you wanted to know (since you're still going to interview the patient yourself), you just gave the student an opportunity to learn and to impress.
I understand that patient care is king, but I think good patient care and teaching can be accomplished at the same time with a little bit of patience. Obviously depends on how much time you have, though.
Our residents would usually tell us to get started in the ED and we'd present to the attending and they'd present to them separately after either they came while we were still doing our h&p or after. They quickly found out which students they trusted quickly.
Simple, because when push comes to shove the attending has expectations of the residents that supersede any teaching obligations they impose on the residents. It's more important for me to know what I need to about my patients to keep the attending happy than to ensure the med student the best learning opportunity. If I don't know my patients, or if the med student misses something, I get reamed. (not all med students are superstars, and I don't want to find out who isnt during rounds.) If I dont give the med student the perfect learning experience, there's really no repercussions, so most residents err on the side of gathering all their info and pushing the med student to mop up duty when it's busy. If there's ample time to do what you describe, sure a resident will do that, but on a busy service it's much more of a "let me get what I need and don't slow me down approach". There are lots of ways a med student can add value, but being the primary history taker on a patient the resident is ultimately responsible for is very risky, and plenty of residents have been needlessly burned due to the rare bad or lazy med student, or the guy who simply doesn't give a crap because hes dead set on path or something.
were you burned because the students saw the patient or because you didn't do your part to make sure everything was in order?I absolutely agree. Even during internship at a hospital associated with a top 10 med school, I was burned by giving too much responsibility to the students on the wards. There are specialties that are conducive to it- inpatient medicine is not one.
What in particular did you like/dislike about how your school did third year?
What specialty are you aiming for?
If you could do it over, knowing what you know now, what factors would have been most important to you when choosing a school?
How does applying to residency work? Do you choose hospitals and then pick specialties? Do you rank specialties?
IE: I like radio/anes/OB. Would I rank these and then apply to hospitals or would I apply to each hospital's program individually?
There's a complicated but simple process for applying to residencies. You fill out a standardized application and click boxes of the places that you want your application sent to. After that it's all about the interview and the rank list (you rank them and they rank you).
What kind of class schedule did you have in MS1/2? Did you get a lot of early patient contact then or only in MS3?
Did you feel prepared to tackle your third year clerkships after 2 years of basic science?
Do attractive women look at you differently when you have your coat on?
Is studying for the mcat.... 5 hrs days with 1 day off similar to studying in med. school?
Is med school studying better or worse?
How is your sex life going for you currently? (Touching girls boob for breast cancer or males for Gyno doesn't count)
The OP hasn't been back to respond - the thread can't degenerate if it had no substance to begin with.