Studying during third year

[justinbaily]

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I'm about to begin my clinical rotations and I'm confused about how to balance patient care with studying the subject of the rotation in general. During the first two years there is an obvious routine where the school directs you towards information, and it's expected that you will have mastered that material by the time that they assess you on it.

During third year it sounds like you are assigned a few patients with very specific problems that you are expected to read up on, but at the same time you are expected to know general information for pimping and the shelf exam at the end of the rotation. Do you do both simultaneously? Is it 'best' to read up on your patients and their conditions while at the hospital and then study Case Files and Blueprints-style books after finishing your shift? Or is there no real pattern and I should just focus on whatever is most pressing at the time?

Sorry for the basic question, but I'm just trying to get a handle on what's expected.

 

[upright]

You'll figure it out for yourself - it'll become obvious once you begin rotations. With respect to your patients, the short of it is you read what you need to read when you need to read it so you don't look like a fool should you ever get questioned. The rest of the time is spent in purgatory, and you read for the shelf when you can.

 

[MilkmanAl]

You'll figure it out for yourself - it'll become obvious once you begin rotations. With respect to your patients, the short of it is you read what you need to read when you need to read it so you don't look like a fool should you ever get questioned. The rest of the time is spent in purgatory, and you read for the shelf when you can.

More or less. I actually didn't study too much for any shelf except medicine, so it's always kind of interesting to me to hear about people going ape**** over them. I didn't destroy them, but I did pretty well above average on everything. I'm not sure why that isn't a more common experience.

 

[CanIMakeIt]

I agree. When you get a patient, read up on the condition before you present so you are ready for pimping - if it's something interesting you can bring an article to share with your team. Otherwise carry a book pertinent to your rotations (case files etc that will fit in your pocket or make cards if that's your thing and flip through them when you get a chance) - i.e. study when you can (mostly this will happen after rounds or at home) - Make sure that you go over the anatomy of the area you are supposed to scrub in for during surgery (esp arteries and nerves - surgeons love to pimp you on that and also have some general idea of what procedure can be used instead for the same condition).

Some people at our school bought UWorld for a year and did the questions for the particular subject throughout the month and then reset the UWorld when they were prepping for Step II.

Overall 3rd is not that bad - it's more about getting comfortable on the wards - you already have most of the theoretical knowledge just be ready to translate it to be used on the wards.

 

[ArcGurren]

I'm about to begin my clinical rotations and I'm confused about how to balance patient care with studying the subject of the rotation in general. During the first two years there is an obvious routine where the school directs you towards information, and it's expected that you will have mastered that material by the time that they assess you on it.

During third year it sounds like you are assigned a few patients with very specific problems that you are expected to read up on, but at the same time you are expected to know general information for pimping and the shelf exam at the end of the rotation. Do you do both simultaneously? Is it 'best' to read up on your patients and their conditions while at the hospital and then study Case Files and Blueprints-style books after finishing your shift? Or is there no real pattern and I should just focus on whatever is most pressing at the time?

Sorry for the basic question, but I'm just trying to get a handle on what's expected.

Reading up on your patients is a great way to learn a specific topic, whether it's hypertension, diabetes, sarcoidosis, sickle cell disease, etc. as well as being good in helping to make clinical decisions for your patients, but the shelf exams unfortunately do like to test the zebras that you'll never see in real life. I can't even begin to count the number of times so far (step 1, medicine shelf, just for starters) where I've had a question about central pontine myelinolysis with rapid hyponatremia correction, but it never happens anymore because nobody is crazy enough to cause it. Therefore, you do have to unfortunately do some studying outside.

For me, this is what I've learned:

1. Doing well on step 1 and learning your basic sciences well actually sets up quite a good foundation for doing well in your clinical years. My first shelf was a tough one but I was able to at times draw on knowledge gained during step 1 studying.

2. Try to read a little bit every day; sometimes clerkships will have dedicated study time (my Medicine clerkship did) near the end of it prior to the shelf exam, but not always. Therefore, reading a little on days off, when you have a break between surgeries or downtime on a rotation or something, goes a long way to helping learn the information.

3. Practice questions, practice questions, practice questions. This has become so much easier for me now that UW can be accessed on my iPhone.

It's all about budgeting your time, really.

 

[officedepot]

.

 

[2012mdc]

More or less. I actually didn't study too much for any shelf except medicine, so it's always kind of interesting to me to hear about people going ape**** over them. I didn't destroy them, but I did pretty well above average on everything. I'm not sure why that isn't a more common experience.

It may be more common than you realize. SDN self selects for the type who would go ape**** over shelf exams. Also you have the schools that have high cutoffs for honors like 85 or 90 raw. Those can be done without studying like crazy but it's no guarantee

I studied hard for medicine (so much info and minimum score needed for honors) and surgery (1st shelf, didn't know what to expect, and minimum score needed for honors) but the effort I put in for the other four was minimal. I think it's possible to get a raw score in the 80s on every shelf except Medicine with minimal studying. The shelf exams seemed pretty damn high yield.

 

[45408]

I did pretty well above average on everything. I'm not sure why that isn't a more common experience.

Because it's not possible for more than a minority to do "pretty well above average"?


For the OP - if your patient has any kind of common problem (asthma, diabetes, COPD, hypertension, heart disease [any kind], cancer, blah blah blah), then read as much about that as you can. When you can tie a specific patient to a specific management plan, it'll stick a lot better than if you just read about it in an abstract sense.

 

[MossPoh]

I go crazy studying for shelf exams, but it is because we need 70th percentile to honor, which isn't awful, but not easy. I have also never looked back and regretted working harder than I should have (at least with any real weight). I do have regrets with the time I slacked and fell just short.

 

[olemissbabydoc]

The only rotation I've found it hard to have enough study time on is surgery, and that's just because I'm in hell (ie: the operating room or the operating holding area) most of the time or just too darn tired when I get home. It was quite easy to figure out on all the other rotations.

Good luck, and welcome to the second part of medical school!

 

[justaregularmed]

I go crazy studying for shelf exams, but it is because we need 70th percentile to honor, which isn't awful, but not easy. I have also never looked back and regretted working harder than I should have (at least with any real weight). I do have regrets with the time I slacked and fell just short.

Holy grade inflation. Minimum of 80+ here.

 

[45408]

Holy grade inflation. Minimum of 80+ here.

Oh yeah? We had to have a 95. You guys are handing out the honors like candy.

(see how that sounds?)

 

[KnuxNole]

Damn, a 95 raw score???

Intense dude...

 

[justaregularmed]

.

 

[ArcGurren]

Oh yeah? We had to have a 95. You guys are handing out the honors like candy.

(see how that sounds?)

That's insane. Most of my clerkships have required a 90+ to honor with a 90+ on the shelf.

 

[2012mdc]

That's insane. Most of my clerkships have required a 90+ to honor with a 90+ on the shelf.

90 raw is pretty tough, 95 is crazy. First time I heard of a cut off that high. What percent ended up getting honors Prowler?

80 is pretty reasonable and obtainable with minimal studying (except for internal)

 

[VenusinFurs]

90 raw is pretty tough, 95 is crazy. First time I heard of a cut off that high. What percent ended up getting honors Prowler?

80 is pretty reasonable and obtainable with minimal studying (except for internal)

Really? Cuz I have studied at least a moderate amount for all of my shelves and have never broken a 73.

 

[ArcGurren]

90 raw is pretty tough, 95 is crazy. First time I heard of a cut off that high. What percent ended up getting honors Prowler?

80 is pretty reasonable and obtainable with minimal studying (except for internal)

Not 90 raw; usually 80 + 10 point curve. So technically just 80. 95 raw is ridiculous. I actually managed > 90 on most of my shelf exams so far.

 

[ArcGurren]

Really? Cuz I have studied at least a moderate amount for all of my shelves and have never broken a 73.

Everyone has a different amount they need to study; I know people who need to study WAY more than me to get the same grade, and I know people who cram the night before and get the same grade as me. So it's not really the same across the board for everyone.

 

[2012mdc]

Not 90 raw; usually 80 + 10 point curve. So technically just 80. 95 raw is ridiculous. I actually managed > 90 on most of my shelf exams so far.

Oh ok. That makes a lot more sense

 

[officedepot]

.

 

[SlickNickMD]

Oh ok. That makes a lot more sense

lol @ you believing it was actually that high, I wouldn't even bother studying if the cutoffs were that high

I think over 80 raw (not the the adjusted shelf grade) is a reasonable cutoff for Honors

 

[2012mdc]

lol @ you believing it was actually that high, I wouldn't even bother studying if the cutoffs were that high

I think over 80 raw (not the the adjusted shelf grade) is a reasonable cutoff for Honors

I've heard 90 raw as the cutoff at several different schools.

I cracked 90 on a couple shelf exams and I'm confident I could have done it on the others except for probably Surgery (first shelf so I studied reasonably hard yet still was only in the mid 80s)

 

[MilkmanAl]

Yeah...you're also an exceptionally awesome student. It doesn't seem reasonable to hold people to that sort of standard.

 

[2012mdc]

Yeah...you're also an exceptionally awesome student. It doesn't seem reasonable to hold people to that sort of standard.

I know you were being sarcastic but I don't consider my performance on the shelf exams to be that special. I've talked to people who scored 90+ on every shelf and there seems to be a lot of posters on SDN who score in the 90s regularly. Enough where a cutoff of 90 would still allow 10-20% of students to get honors at the more competitive schools. A 90 would be unreasonable at my school (quality and number of students) but a top school with 150 - 200 students per class could have 20+ people crack 90.

I'm obviously just speculating though.

 

[SlickNickMD]

I've heard 90 raw as the cutoff at several different schools.

I cracked 90 on a couple shelf exams and I'm confident I could have done it on the others except for probably Surgery (first shelf so I studied reasonably hard yet still was only in the mid 80s)

That humble brag

90 is still a bit excessive as a cutoff, I got 93rd percentile on the fam med shelf and it was still "only" an 86 raw score-If all schools were held to those standards some schools would have no honors based on this exam, others would have about 7 percent or more with honors

Like you said, I suspect it depends on the school and "quality of students"--Each school adjusts its cutoff to maintain a certain percentage of honors

 

[MilkmanAl]

I know you were being sarcastic

Believe it or not, I wasn't. I've seen your scores, man. I know you kick ass. Even at the elite schools, I still think a raw 90 is a pretty big reach. That's, what, 97-98th percentile nationally for everything other than psych?

 

[FeatherDeOro]

I am new to this site, and new to pre-med as well, I was just wondering what does the term "pimping" mean in medical terms?

 

[Oxer45]

I am new to this site, and new to pre-med as well, I was just wondering what does the term "pimping" mean in medical terms?

It involves a guy in a long jacket (the streets have velvet overcoat, medicine has starch white) whoring you out to the nurses.

 

[2012mdc]

Believe it or not, I wasn't. I've seen your scores, man. I know you kick ass. Even at the elite schools, I still think a raw 90 is a pretty big reach. That's, what, 97-98th percentile nationally for everything other than psych?

Yeah I'm not sure. The way they calculate percentiles has never really been clear. The SDN sample bias probably has me overestimating how many folks get those scores. 90 is a high cut off but I was thinking maybe if a school wanted to be stingy with honors it might work in a big competitive class.

 

[Kaustikos]

Kind of a necro bump, but I'm curious given my situation. I unfortunately had my summer vacation block first... so I spent that focusing on reading step up to medicine and some first aid. I'm not trying to gun at all; I'm trying to retain this information for rotations. My first two months are FM and Peds. I don't know my schedule atm, but I'll definitely be focusing on keeping up on medicine. I'm just kind of worried because a part of me feels like FM will be different from IM and the info I learn from this book won't correlate with FM shelf.

Are there any helpful/recommended books for FM and Peds? I love Step-Up Medicine. They've really helped in Clin Med during second year and the way they have the diagrams setup for helping diagnosing things (GI pain, for instance) really helps/helped.

I just got this book through a recommendation from friends/classmates. It's being shipped, so I'm waiting.

Again - this isn't about gunning. I just want to keep this info fresh and know my **** for residency. It's not about grades (minus step 1), but not feeling clueless/like an idiot when I'm in a hospital.

Thanks


edit - d'oh. Nvm. I just realized the sticky. Sorry. I'm an idiot. 😆

 

[ijn]

FM and IM felt like the same test, except that the FM exam has more preventative medicine and behavioral sciences as well as basic geriatrics/peds/vag problems. In the hospital setting the two specialties are even more identical.

Test subject breakdown, per the NBME:
http://www.nbme.org/Schools/Subject-Exams/Subjects/clinicalsci_family.html
http://www.nbme.org/Schools/Subject-Exams/Subjects/clinicalsci_med.html